International Journal of Environmental Research and Public Health

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14 pages, 354 KiB

Open AccessArticle

Factors Associated with Thoughts of Self-Harm or Suicide among Aboriginal and Torres Strait Islander People Presenting to Urban Primary Care: An Analysis of De-Identified Clinical Data

by Neha A. Pandeya, Philip J. Schluter, Geoffrey K. Spurling, Claudette Tyson, Noel E. Hayman and Deborah A. Askew

Int. J. Environ. Res. Public Health 2022, 19(1), 153; https://doi.org/10.3390/ijerph19010153 - 23 Dec 2021

Cited by 2 | Viewed by 4024

Abstract

Suicide amongst Aboriginal and Torres Strait Islander people is a major cause of premature mortality and a significant contributor to the health and life expectancy gap. This study aimed to estimate the prevalence of thoughts of self-harm or suicide in Aboriginal and Torres [...] Read more.

Suicide amongst Aboriginal and Torres Strait Islander people is a major cause of premature mortality and a significant contributor to the health and life expectancy gap. This study aimed to estimate the prevalence of thoughts of self-harm or suicide in Aboriginal and Torres Strait Islander people attending an urban primary health care service and identify factors associated with these thoughts. Multilevel mixed-effects modified Poisson regression models were employed to analyse three years of data gathered during the annual Aboriginal and Torres Strait Islander health assessments. At their first health assessment, 11.5% (191/1664) of people reported thoughts of suicide or self-harm in the prior two weeks. Having children, participating in sport or community activities or being employed full-time decreased the risk of such thoughts. Conversely, factors relating to social exclusion including homelessness, drug use, unemployment and job insecurity increased the risk of thoughts of self-harm or suicide. Individual clinicians, health services, and policy-makers all have a role in suicide prevention. Clinicians need appropriate training to be able to respond to people expressing these thoughts. Aboriginal and Torres Strait Islander community organisations need sovereignty and self-determination over resources to provide programs that promote cultural connectivity and address social exclusion, thereby saving lives. Full article

(This article belongs to the Special Issue Understanding and Prevention of Suicide)

18 pages, 5052 KiB

Open AccessArticle

Relationships between Expenditure of Regional Governments and Suicide Mortalities Caused by Six Major Motives in Japan

by Toshiki Hasegawa, Kouji Fukuyama and Motohiro Okada

Int. J. Environ. Res. Public Health 2022, 19(1), 84; https://doi.org/10.3390/ijerph19010084 - 22 Dec 2021

Cited by 6 | Viewed by 3002

Abstract

Suicide mortality in Japan reduced in the period of 2009–2018. A number of studies identified the impact of financial governmental support for social welfare systems on suicide mortality; however, the detailed effects of specific regional policies, designed according to regional cultural, economic, education [...] Read more.

Suicide mortality in Japan reduced in the period of 2009–2018. A number of studies identified the impact of financial governmental support for social welfare systems on suicide mortality; however, the detailed effects of specific regional policies, designed according to regional cultural, economic, education and welfare situations, on suicide mortality remain to be clarified. Therefore, the present study analyses the associations between the regional governmental expenditure of six major divisions, “public health”, “public works”, “police”, “ambulance/fire services”, “welfare” and “education”, and suicide mortalities caused by six major suicidal motives, related to “family”, “health”, “economy”, “employment”, “romance” and “school”, across the 47 prefectures in Japan during the period of 2009–2018, using fixed-effect analysis of hierarchal linear regression with robust standard error. The expenditure of “public works” displayed a positive relationship with suicide mortality of females caused by family-related motives but was not related to other suicide mortalities, whereas the expenditures in “public health”, “police”, “ambulance/fire services”, “welfare” and “education” contributed to a reduction in suicide mortality, at least in some statistical indicators. The expenditures of both “ambulance/fire” and “education” were predominantly effective among the six major divisions of regional governmental expenditure in reducing suicide mortalities. In the education subdivisions, the expenditure of “kindergarten” was related to a reduction in suicide mortalities caused by a wide spectrum of motives. The amount of expenditure of welfare indicated the limited possibility of facilitating a reduction in suicide mortalities caused by only motives associated with economy or employment. However, in the welfare subdivisions, the expenditure of “child welfare” and “social welfare” was effective in reducing suicide mortalities, but the expenditure of “elderly welfare” was unexpectedly related to an increase in suicide mortalities. These results suggest that most Japanese people are struggling to bring up children even in the situation of an increasing elderly population with a decreasing birth rate. Therefore, it is important to enhance the investment welfare policy for the future to improve the childcare environment. Although the issue of an increasing elderly population and a decreasing birth rate in Japan has not yet improved, the obtained results suggest that evidence-based welfare expenditure redistributions of prefectures and municipalities could improve Japanese society and welfare systems. Full article

(This article belongs to the Special Issue Understanding and Prevention of Suicide)

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11 pages, 326 KiB

Open AccessArticle

Metacognitive Beliefs and Suicidal Ideation: An Experience Sampling Study

by Vikki Aadahl, Adrian Wells, Robert Hallard and Daniel Pratt

Int. J. Environ. Res. Public Health 2021, 18(23), 12336; https://doi.org/10.3390/ijerph182312336 - 24 Nov 2021

Cited by 8 | Viewed by 3103

Abstract

The current study aimed to examine the relationship between metacognitive beliefs about suicidal ideation and the content and process of suicidal ideation. This was to examine the potential contribution of the Self-Regulatory Executive Function (S-REF) model (Wells and Matthew, 2015) to suicidal ideation. [...] Read more.

The current study aimed to examine the relationship between metacognitive beliefs about suicidal ideation and the content and process of suicidal ideation. This was to examine the potential contribution of the Self-Regulatory Executive Function (S-REF) model (Wells and Matthew, 2015) to suicidal ideation. Twenty-seven participants completed both trait and state-level measures of suicidal ideation, negative affect, defeat, hopelessness, entrapment and metacognitive beliefs. Experience Sampling Methodology (ESM) was adopted to measure state-level measurements with participants invited to complete an online diary up to seven times a day for six days. Multi-level modelling enabled a detailed examination of the relationships between metacognitive beliefs and suicidal ideation. Positive (β = 0.241, p < 0.001) and negative (β = 0.167, p < 0.001) metacognitive beliefs about suicidal ideation were positively associated with concurrent suicidal ideation even when known cognitive correlates of suicide were controlled for. The results have important clinical implications for the assessment, formulation and treatment of suicidal ideation. Novel meta-cognitive treatments targeting beliefs about suicidal ideation are now indicated. A limited range of characteristics reported by participants affects the generalizability of findings. Future research is recommended to advance understanding of metacognition and suicide but results demonstrate an important contribution of the S-REF model. Full article

(This article belongs to the Special Issue Understanding and Prevention of Suicide)

49 pages, 1091 KiB

Open AccessArticle

Looking for Razors and Needles in a Haystack: Multifaceted Analysis of Suicidal Declarations on Social Media—A Pragmalinguistic Approach

by Michal Ptaszynski, Monika Zasko-Zielinska, Michal Marcinczuk, Gniewosz Leliwa, Marcin Fortuna, Kamil Soliwoda, Ida Dziublewska, Olimpia Hubert, Pawel Skrzek, Jan Piesiewicz, Paula Karbowska, Maria Dowgiallo, Juuso Eronen, Patrycja Tempska, Maciej Brochocki, Marek Godny and Michal Wroczynski

Int. J. Environ. Res. Public Health 2021, 18(22), 11759; https://doi.org/10.3390/ijerph182211759 - 9 Nov 2021

Cited by 8 | Viewed by 6366

Abstract

In this paper, we study language used by suicidal users on Reddit social media platform. To do that, we firstly collect a large-scale dataset of Reddit posts and annotate it with highly trained and expert annotators under a rigorous annotation scheme. Next, we [...] Read more.

In this paper, we study language used by suicidal users on Reddit social media platform. To do that, we firstly collect a large-scale dataset of Reddit posts and annotate it with highly trained and expert annotators under a rigorous annotation scheme. Next, we perform a multifaceted analysis of the dataset, including: (1) the analysis of user activity before and after posting a suicidal message, and (2) a pragmalinguistic study on the vocabulary used by suicidal users. In the second part of the analysis, we apply LIWC, a dictionary-based toolset widely used in psychology and linguistic research, which provides a wide range of linguistic category annotations on text. However, since raw LIWC scores are not sufficiently reliable, or informative, we propose a procedure to decrease the possibility of unreliable and misleading LIWC scores leading to misleading conclusions by analyzing not each category separately, but in pairs with other categories. The analysis of the results supported the validity of the proposed approach by revealing a number of valuable information on the vocabulary used by suicidal users and helped to pin-point false predictors. For example, we were able to specify that death-related words, typically associated with suicidal posts in the majority of the literature, become false predictors, when they co-occur with apostrophes, even in high-risk subreddits. On the other hand, the category-pair based disambiguation helped to specify that death becomes a predictor only when co-occurring with future-focused language, informal language, discrepancy, or 1st person pronouns. The promising applicability of the approach was additionally analyzed for its limitations, where we found out that although LIWC is a useful and easily applicable tool, the lack of any contextual processing makes it unsuitable for application in psychological and linguistic studies. We conclude that disadvantages of LIWC can be easily overcome by creating a number of high-performance AI-based classifiers trained for annotation of similar categories as LIWC, which we plan to pursue in future work. Full article

(This article belongs to the Special Issue Understanding and Prevention of Suicide)

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24 pages, 442 KiB

Open AccessArticle

Very Young Child Survivors’ Perceptions of Their Father’s Suicide: Exploring Bibliotherapy as Postvention Support

by Cortland Watson, Elizabeth A. Cutrer-Párraga, Melissa Heath, Erica E. Miller, Terrell A. Young and Suzanne Wilson

Int. J. Environ. Res. Public Health 2021, 18(21), 11384; https://doi.org/10.3390/ijerph182111384 - 29 Oct 2021

Cited by 4 | Viewed by 3623

Abstract

Each year in the United States, 7000 to 30,000 children experience their parent’s suicide. Due to the stigma associated with suicide, feelings of guilt, and intense grief, surviving family members avoid talking about suicide. Over time, children struggle with confusion and intense emotions [...] Read more.

Each year in the United States, 7000 to 30,000 children experience their parent’s suicide. Due to the stigma associated with suicide, feelings of guilt, and intense grief, surviving family members avoid talking about suicide. Over time, children struggle with confusion and intense emotions associated with their parent’s suicide. In this study, seven adults, who reported being younger than six years old at the time of their father’s suicide, participated in individual semi-structured interviews. Participants’ responses highlight the challenges that young children face due to limited memories of their deceased parent. Interviews concluded with an opportunity for participants to review and express their impressions of 10 children’s picture books. Participants offered impressions about how these books may or may not be helpful in supporting young child survivors. Implications for applied practice include considering how children’s literature may open communication and assist children in navigating Worden’s tasks of grief: (a) accepting the reality of their parent’s death; (b) facing the grief and pain; (c) adapting to life changes due to their father’s suicide, in particular adapting to altered family relationships; and (d) building memories of the deceased loved one, when possible, to ensure healthy attachment to the deceased parent. Participants’ insights provide considerations for selecting children’s literature for bibliotherapy. Due to young child survivors’ increased risk for attempting and completing suicide, supporting child survivors of parent suicide not only addresses postvention needs but aligns with suicide prevention. Full article

(This article belongs to the Special Issue Understanding and Prevention of Suicide)

16 pages, 345 KiB

Open AccessArticle

Mapping Institutional Interventions to Mitigate Suicides: A Study of Causes and Prevention

by Zia Ullah, Nighat Akbar Shah, Sonia Shamroz Khan, Naveed Ahmad and Miklas Scholz

Int. J. Environ. Res. Public Health 2021, 18(20), 10880; https://doi.org/10.3390/ijerph182010880 - 16 Oct 2021

Cited by 28 | Viewed by 3722

Abstract

Suicide is an extreme, tragic act and an important subject for social inquiry. It is the rising public health issue prevalent in the Himalayan range of Pakistan. The young and educated population is more prone to suicide instead of using this prime phase [...] Read more.

Suicide is an extreme, tragic act and an important subject for social inquiry. It is the rising public health issue prevalent in the Himalayan range of Pakistan. The young and educated population is more prone to suicide instead of using this prime phase of age productively. Unfortunately, the suicide problem remains unaddressed, the causes remain undefined, solutions are not in the works, and in situations when others play a part in driving someone to commit suicide, no one is being held accountable. This study is aimed at uncovering the root causes of suicide and proposing some preventive measures to mitigate the problem. Our team studied three years’ worth of data (2017–2019) on suicides from the office of Human Rights Commission of Pakistan, Chitral. In addition, we conducted semi-structured interviews of different stakeholders, including family members, neighbors, lawyers, and police personnel. The findings revealed that extended family pressures, the power dynamic between sustainers and dependents, family conflicts, and inheritance cases were the major causes of the domestic violence that preceded suicide attempts. Mental health issues, forced marriages, academic competitions, and flawed litigation processes were also among the leading causes of suicide. Awareness through education and religious sermons, strengthening healthcare organizations, restructuring family systems, establishing police complaint centers, effective prosecution processes, and imparting lifesaving skills have been identified as measures to prevent suicide. This study has theoretical and practical implications, as it adds certain novel variables regarding the causes and solutions of suicide to the existing body of literature and guides public authorities to strengthen institutions to intervene effectively. Full article

(This article belongs to the Special Issue Understanding and Prevention of Suicide)

18 pages, 2030 KiB

Open AccessArticle

The Relationship between the Therapeutic Alliance and Suicidal Experiences in People with Psychosis Receiving Therapy

by Charlotte Huggett, Patricia Gooding, Gillian Haddock and Daniel Pratt

Int. J. Environ. Res. Public Health 2021, 18(20), 10706; https://doi.org/10.3390/ijerph182010706 - 12 Oct 2021

Cited by 3 | Viewed by 3592

Abstract

Few studies have examined the relationship between the therapeutic alliance in therapy and suicidal experiences. No studies have examined this relationship with people with non-affective psychosis. The present study sought to redress this gap in the literature. Sixty-four participants with non-affective psychosis and [...] Read more.

Few studies have examined the relationship between the therapeutic alliance in therapy and suicidal experiences. No studies have examined this relationship with people with non-affective psychosis. The present study sought to redress this gap in the literature. Sixty-four participants with non-affective psychosis and suicidal experiences who were receiving a suicide-focused cognitive therapy were recruited. Self-reported suicidal ideation, suicide plans, suicide attempts, depression, and hopelessness were collected from participants prior to starting therapy. Suicidal experience measures were collected again post-therapy at 6 months. Therapeutic alliance ratings were completed by clients and therapists at session 4 of therapy. Dose of therapy was documented in number of minutes of therapy. Data were analyzed using correlation coefficients, independent samples t-tests, a multiple hierarchical regression, and a moderated linear regression. There was no significant relationship found between suicidal ideation prior to therapy and the therapeutic alliance at session 4, rated by both client and therapist. However, there was a significant negative relationship between the client-rated therapeutic alliance at session 4 and suicidal ideation at 6 months, after controlling for pre-therapy suicidal ideation, depression, and hopelessness. Furthermore, the negative relationship between the client-rated alliance and suicidal ideation was the strongest when number of minutes of therapy was 15 h or below. A stronger therapeutic alliance developed in the first few sessions of therapy is important in ameliorating suicidal thoughts in people with psychosis. Nevertheless, it is not necessarily the case that more hours in therapy equates to a cumulative decrease in suicidal ideation of which therapists could be mindful. A limitation of the current study was that the alliance was analyzed only at session 4 of therapy, which future studies could seek to redress. Full article

(This article belongs to the Special Issue Understanding and Prevention of Suicide)

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10 pages, 313 KiB

Open AccessArticle

by Denise Erbuto, Isabella Berardelli, Salvatore Sarubbi, Elena Rogante, Alice Sparagna, Gaia Nigrelli, David Lester, Marco Innamorati and Maurizio Pompili

Int. J. Environ. Res. Public Health 2021, 18(16), 8296; https://doi.org/10.3390/ijerph18168296 - 5 Aug 2021

Cited by 11 | Viewed by 3215

Abstract

Inadequate knowledge of the potential signs and risk factors of suicide negatively affects the ability of healthcare professionals to recognize patients at risk of suicide. The principal aim of the present study is to assess the attitudes and knowledge about suicide in a [...] Read more.

Inadequate knowledge of the potential signs and risk factors of suicide negatively affects the ability of healthcare professionals to recognize patients at risk of suicide. The principal aim of the present study is to assess the attitudes and knowledge about suicide in a large sample of mental health professionals. We examined the relationship between Suicide Knowledge and Skills Questionnaire items and the experience of a patient dying by suicide. We also examined whether various healthcare professionals respond differently to the items of the Impact of a Patient’s Suicide on Professional and Personal Lives Scale. Results demonstrated that healthcare professionals who had experienced a patient suicide reported greater skills than professionals who had not experienced a patient suicide. However, 44% of professionals who had experienced a patient suicide felt that they did not have adequate training on this particular issue. Among those who had experienced a patient suicide, there was an increased tendency to hospitalize patients with suicide risk and an increased use of collegial consultation. Concerning personal emotions, healthcare professionals reported troubled relationships with family members and friends and the loss of self-esteem. In conclusion, better knowledge and attitudes about suicide are necessary for suicide-prevention strategies. Full article

(This article belongs to the Special Issue Understanding and Prevention of Suicide)

16 pages, 2208 KiB

Open AccessArticle

Impacts of Dual-Income Household Rate on Suicide Mortalities in Japan

by Misaki Nakamoto, Takatoshi Nakagawa, Masahiko Murata and Motohiro Okada

Int. J. Environ. Res. Public Health 2021, 18(11), 5670; https://doi.org/10.3390/ijerph18115670 - 25 May 2021

Cited by 18 | Viewed by 3446

Abstract

To explore impact of enhancing social advancement of females in Japan, this study determined the effects of the dual-income household rate on suicide mortalities disaggregated by attributes of gender, age, and motives between 2009 and 2017 in Japan. This study analysed impact of [...] Read more.

To explore impact of enhancing social advancement of females in Japan, this study determined the effects of the dual-income household rate on suicide mortalities disaggregated by attributes of gender, age, and motives between 2009 and 2017 in Japan. This study analysed impact of dual-income household rate, other household-related factors (savings, liabilities and yearly incomes per household, minors and elderly rate per household), and social/employment factors (complete unemployment rate, employment rate, temporary male and female employment rates and certification rate of long-term care insurance) on suicide mortalities disaggregated by attributes of gender, age, and motives using hierarchical linear-regression model. Dual-income household rate was significantly/negatively related to suicide mortality of the working-age female population, but significantly/positively related to that of the elderly female population. Suicide mortalities of the working-age male population and the elderly male population were significantly/positively related to dual-income household rate. Male suicide mortalities caused by family-, health-, economy- and employment-related motives were significantly/positively related to dual-income household rate; however, the dual-income household rate was significantly/positively related to female suicide mortalities caused by family-, health-, economy- and school-related motives, but significantly/negatively related to suicide mortalities caused by romance-related motives. Dual-income households suppress social-isolation and develop economical/psychological independence of females, leading to reduced suicide mortality in working-age females. However, elderly and school-age populations, who are supported by the working-age female, suffer from isolation. Working-age males also suffer from inability to adapt from the traditional concept of work–life and work–family balances to the novel work–family balance concept adapted to dual-income households. These results suggest occurrence of new social/family problems in the 21st century due to vulnerability of traditional Japanese culture and life–working–family balance concepts as well as novel sociofamilial disturbances induced by declining birth rate and ageing population in Japan. Full article

(This article belongs to the Special Issue Understanding and Prevention of Suicide)

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18 pages, 931 KiB

Open AccessArticle

Attachment Security and Suicide Ideation and Behaviour: The Mediating Role of Reflective Functioning

by Jessica Green, Katherine Berry, Adam Danquah and Daniel Pratt

Int. J. Environ. Res. Public Health 2021, 18(6), 3090; https://doi.org/10.3390/ijerph18063090 - 17 Mar 2021

Cited by 14 | Viewed by 3900

Abstract

Background: To understand why attachment difficulties predispose individuals to suicidal thinking (suicide ideation) and behaviour, a leading cause of death, we need to explore the role of pertinent psychological mechanisms. Attachment processes are closely linked to the development of mentalisation capabilities, or reflective [...] Read more.

Background: To understand why attachment difficulties predispose individuals to suicidal thinking (suicide ideation) and behaviour, a leading cause of death, we need to explore the role of pertinent psychological mechanisms. Attachment processes are closely linked to the development of mentalisation capabilities, or reflective functioning; the ability to understand and interpret self and other behaviour as an expression of mental states. Interventions designed to improve mentalisation have been associated with a reduction in suicidal behaviour, yet reflective functioning has not been directly investigated in relation to suicidal ideation and behaviour. Aim: We aim to further verify the link between adult attachment security and suicidal ideation and examine whether deficits in reflective functioning mediate this relationship. Methods: Sixty-seven participants who experienced suicidal ideation within the past 12 months completed self-report measures of adult attachment, current suicidal ideation, reflective functioning, depressive symptomology and hopelessness. Partial correlations, mediation analyses and group comparisons were conducted to explore relationships between these factors. Results: Findings did not support a mediational role for reflective functioning in the relationship between attachment security and suicidal ideation. A direct relationship was established between attachment avoidance and suicidal ideation, after controlling for age, gender and depressive symptoms. However, participants with a history of attempted suicide were higher in anxious attachment compared to participants with no such history. Conclusions: This study shows that the attachment dimensions of attachment anxiety and avoidance may play differential roles in increasing risk for suicidal attempts versus ideation. This has important implications for tailoring interventions. Those aimed at reducing suicide attempts should focus on reducing attachment anxiety by helping people develop skills in emotional regulation. Interventions aimed at reducing suicidal ideation should focus on reducing attachment avoidance by helping people develop closer relationships with significant others. However, longitudinal and experimental designs are required to verify causality. Full article

(This article belongs to the Special Issue Understanding and Prevention of Suicide)

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Review

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15 pages, 389 KiB

Open AccessReview

Psychological Resilience to Suicidal Experiences in People with Non-Affective Psychosis: A Position Paper

by Patricia A. Gooding, Kamelia Harris and Gillian Haddock

Int. J. Environ. Res. Public Health 2022, 19(7), 3813; https://doi.org/10.3390/ijerph19073813 - 23 Mar 2022

Cited by 6 | Viewed by 3010

Abstract

It is important to understand the psychological factors which underpin pathways to suicidal experiences. It is equally as important to understand how people develop and maintain resilience to such psychological factors implicated in suicidal experiences. Exploring optimal routes to gaining this understanding of [...] Read more.

It is important to understand the psychological factors which underpin pathways to suicidal experiences. It is equally as important to understand how people develop and maintain resilience to such psychological factors implicated in suicidal experiences. Exploring optimal routes to gaining this understanding of resilience to suicidal thoughts and acts in people with severe mental health problems, specifically non-affective psychosis, was the overarching aim of this position paper. There are five central suggestions: 1. investigating resilience to suicidal experiences has been somewhat over-looked, especially in those with severe mental health problems such as schizophrenia; 2. it appears maximally enlightening to use convergent qualitative, quantitative and mixed research methods to develop a comprehensive understanding of resilience to suicide; 3. relatedly, involving experts-by-experience (consumers) in suicide research in general is vital, and this includes research endeavours with a focus on resilience to suicide; 4. evidence-based models of resilience which hold the most promise appear to be buffering, recovery and maintenance approaches; and 5. there is vast potential for contemporary psychological therapies to develop and scaffold work with clients centred on building and maintaining resilience to suicidal thoughts and acts based on different methodological and analytical approaches which involve both talking and non-talking approaches. Full article

(This article belongs to the Special Issue Understanding and Prevention of Suicide)

21 pages, 2165 KiB

Open AccessReview

Suicide and Associations with Air Pollution and Ambient Temperature: A Systematic Review and Meta-Analysis

by Seulkee Heo, Whanhee Lee and Michelle L. Bell

Int. J. Environ. Res. Public Health 2021, 18(14), 7699; https://doi.org/10.3390/ijerph18147699 - 20 Jul 2021

Cited by 46 | Viewed by 7892

Abstract

Given health threats of climate change, a comprehensive review of the impacts of ambient temperature and ar pollution on suicide is needed. We performed systematic literature review and meta-analysis of suicide risks associated with short-term exposure to ambient temperature and air pollution. Pubmed, [...] Read more.

Given health threats of climate change, a comprehensive review of the impacts of ambient temperature and ar pollution on suicide is needed. We performed systematic literature review and meta-analysis of suicide risks associated with short-term exposure to ambient temperature and air pollution. Pubmed, Scopus, and Web of Science were searched for English-language publications using relevant keywords. Observational studies assessing risks of daily suicide and suicide attempts associated with temperature, particulate matter with aerodynamic diameter ≤10 μm (PM₁₀) and ≤2.5 mm (PM_2.5), ozone (O₃), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), and carbon monoxide (CO) were included. Data extraction was independently performed in duplicate. Random-effect meta-analysis was applied to pool risk ratios (RRs) for increases in daily suicide per interquartile range (IQR) increase in exposure. Meta-regression analysis was applied to examine effect modification by income level based on gross national income (GNI) per capita, national suicide rates, and average level of exposure factors. In total 2274 articles were screened, with 18 studies meeting inclusion criteria for air pollution and 32 studies for temperature. RRs of suicide per 7.1 °C temperature was 1.09 (95% CI: 1.06, 1.13). RRs of suicide per IQR increase in PM_2.5, PM₁₀, and NO₂ were 1.02 (95% CI: 1.00, 1.05), 1.01 (95% CI: 1.00, 1.03), and 1.03 (95% CI: 1.00, 1.07). O₃, SO₂, and CO were not associated with suicide. RR of suicide was significantly higher in higher-income than lower-income countries (1.09, 95% CI: 1.07, 1.11 and 1.20, 95% CI: 1.14, 1.26 per 7.1 °C increased temperature, respectively). Suicide risks associated with air pollution did not significantly differ by income level, national suicide rates, or average exposure levels. Research gaps were found for interactions between air pollution and temperature on suicide risks. Full article

(This article belongs to the Special Issue Understanding and Prevention of Suicide)

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