Suicide and Self-Harm

Definitions 

Suicide is an intentional act of terminating one’s individual life (Turecki & Brent, 2016). Self-harm implies self-inflicted injury in which an individual has to intention to die. Attempted suicide has been defined by as an involvement in a potentially harmful activity to oneself in which the intention is to take one’s own life (Nock et al., 2013).

Overview global suicide

Suicide is a global issue. Because of that, the World Health Organization (WHO) has been addressing it as early as 1950, two years after its establishment (Fleischmann, 2016).  The statistical data on suicide as presented by WHO of its member states are reliable and unbiased. Suicides are ranked second leading causes of early deaths in young people of 15 to 29 years, whereas the suicide rates of those aged 15 to 44 years being ranked at number three. The highest mortality rate is caused by accidents related to transportation (Bertolote & Fleischmann, 2015). Fleischmann (2016) reports that 78% of suicides in 2015 took place in low- and average income countries based on the WHO 2014 data.

The world suicide mortality rate in 2016 was 1.8%, with Africa countries being represented by 0.5%, and the South-East nations having 1.9% of the world mortality rate as shown in Figure 2.1 (WHO, 2016). According to WHO (2016), most of the African countries alongside other developing countries reported the lowest mortality rates of 0 and 49, while some countries such as Mexico, Panama, Turkey, Congo among others had suicide rates between 5.0 and 9.9. The highest suicide rates of 15 and above were reported in countries such as Poland, Switzerland, Finland, and Thailand among others.

Young adults and adolescents aged between 15 and 29 years have the highest suicide rates worldwide. Suicide is the third leading cause of death in the age bracket of 10 to 14 years, while in the age group of 10 to 34 years, suicide is the second most common cause of death (NCIPC, 2016). Generally, it is an observable trend that the majority of the young die of suicide compared to the old folk. However, the comparative numbers per age bracket are eight times more than in the old people (Bertolote & Fleischmann, 2015). Likewise, WHO reports the lowest worldwide suicide rates amongst adolescent and children aged 15 years and below, but increases after that at a steady pace up to the age of 70 and beyond (Fleischmann, 2016).

Figure 1: Global Male: Female suicide ratios per 100,000 people in 2016.

Overview of Australia suicide

Suicide rates in Australia have been on the rise to alarming levels which have attracted the attention of world humanitarian organizations and researchers. According to the Australian Bureau of Statistics (2016), the Australian suicide rate as at 2016 was 11.7% per 100,000 population, which represented an increase by 1.1 per 100,000 population in 2007. The statistics further report a mortality rate of 2,866 people due to suicide. The statistics provided by the World Health Organization is relatively equal to that of the Australian Bureau of Statistics. The WHO (2018) placed Australian suicide rate at 10.4% per 100,000 population annually using age-adjusted data. On the other hand, the standardized age rate of suicide as reported by the Australian Department of Health was 10.3 per 100,000 people in 2005, representing a decrease of 4.4 up from 1997. The mortality rate due to suicide in Australia is thrice higher in men than in women. The Australian Bureau of Statistics indicates that there were 17.8 deaths per 100,000 population in men and 5.8 deaths per 100,000 for the females. More astonishing is the prevalence of suicide rate among the young Australian population. The death of the majority of young people in Australia aged between 15 and 24 years is caused by suicide (WHO, 2014).

Study	Method/ Sector	Aims	Key findings
Authors & Date	The method used in the study	Method, Purpose or research question author posed	Major finding of the study Main idea or themes distilled from the finding. How does the finding confirm thoe of studies or information not found in other sources?
Székely et al. (2013)	European Alliance Against Depression (EAAD) programme, Hungary	The objective of the study was to assess the effectiveness of the EAAD programme as a community intervention programme in decreasing suicide rates in both men and women. The EAAD programme was actualised in Szolnok town in Hungary with a population of 76,311 with highest suicide rate. The effectiveness of the intervention was examined by comparing the rates of suicide in the experimental area after the intervention with the differences in the nationwide suicide rates and those in the waitlist group.	Decreased suicide rate during the intervention programme compared to the former three years and after one year of follow-up. Suicide rates and trends: The rate of suicide decreased by 56% between 2004 and 2005 and by 60.1% between 2006 and 2007. No significant difference of the decrease in suicide rate based on gender. Secondary outcome measures: There was an increase in the number of emergency hotline service calls, more so those related with suicide
Khasakhala, Ndetei & Mathai, (2013)	Interviews, Kenya	The study assessed the association between suicidal behaviour and existing substance or psychiatric disorders among young adults and depressive and consumption of alcohol among their parents. A sample of 678 participants consisting of 226 biological fathers and 202 biological mothers, and 250 youths.	There was a significant statistical relationship between depressive, consumption of alcohol, and drug abuse disorders and suicidal conduct among youths. Suicidal behavior among the young adults in association with their background features: Youth background characteristics such as depression, drug, and substance abuse disorders have a substantive statistical association with suicidal behavior in youths. Suicidal behavior among the young adults in association with the features of their parents: The findings showed a substantial association between depressive disorder in the mother and supposed rejection behavior by the mother with youth suicidal behavior. The outcomes of the study indicate that youths diagnosed with disorders related to substance abuse and psychiatric have their mothers diagnosed with depressive disorder.
Wanyoike, (2015). Kenya	Qualitative and quantitative methods	The study was aimed at assessing the existence of suicide among university students. The target population consisted of 50 university students distributed across six university and 40 mental health care provider. A sample size of 35 students and 30 healthcare practitioners were included in the analysis. the author used structured interview schedules and a questionnaire to gather data from the respondents	The author found out that the society has a critical role in the control, prevention and intervention of suicide among the youths. However, no existing data regarding the suicide rate among the youths in Kenya was ascertained. Cause of suicide: the study found out that the main causes of suicide among the Kenyan university students include loneliness (10%), depression (39%), anger (15%), hopelessness (30%), and conflict (6%), with depression being reported as the most common cause. Impact of suicide: 70% of the respondents reported that suicide led to trauma, shame, anger, sense of guilt and betrayal. Stigma was identified as the most significant effect of suicide and suicidal behaviour Intervention: the study findings indicated that 73% of the participants believed that it was possible to prevent suicide, with 42% believing the same on condition that support is made available
Freuchen, Kjelsberg, & Grøholt (2012).	Comparison of quantitative data	The study adopted data form a countrywide psychological autopsy of adolescents aged 15 years and below who had succumbed to suicide or accidents in Norway (n=84). A distinction between the two death causes were determined as well	The study found out that victims of young suicide cases had less risk factors and less attempted suicide compared with the older youths. Risk factor for suicide: mental health issues, self-harm, attempted suicide among others Mental health: most parents attributed suicide behaviour in their children to mental health problem
Asarnow,  Hughes, Babeva, & Sugar (2017).	Randomised control trial	A randomised control trial was carried out on youths of 12-18 years who had experienced attempted suicide or any other self-harm in the past 3 months. The adolescents were randomized to SAFETY or normal intervention as advocated by parental education. The findings were assessed at baseline, 3 months before and after the intervention period, with a follow-up of six to twelve months.	The authors found out that there were high chances of survival in the absence of suicide attempt during the follow-up after administering the SAFETY programme to youths compared to the Education and support accessing community treatment (E-TAU). Thus SAFETY is the most appropriate approach in the prevention of suicide attempts
Czyz, Horwitz,  Eisenberg,Kramer,  & King (2013	Web-based questionnaire	The study aimed at exploring self-recorded barriers to expert aid seeking among college students at increased risk of suicide and ascertain whether the hindrances are different based on the clinical features and demographic information. 165 respondents not seeking treatment were recruited for inclusion and assessment.  The Web-based questionnaire was used to collect data	The study found out that the leading barrier to seeking for professional aid was the notion that treatment is unnecessary (66%) with stigma (12%) being reported as the least barrier. Self-reported barriers to seeking the advice of professionals: The students considered the suicide behaviours as inconsequential hence no need for professional help. 18% preferred self-managing their issues using self-help methods
Dvorak, Lamis,. & Malone (2013).	Cross-sectional study	The study assessed the relationship between the elements of the impulsivity model and alcohol intake as pointers of the prevalence of suicide among college students. A sample of 1100 students successfully undertook the online evaluation prompts in demographics, prevalence of suicide, impulsivity and depressive symptoms.	The research ascertained a positive relationship between all the predictors with high frequency of suicide. Depressive symptoms x alcohol use x urgency: at increased intake of alcohol/high-urgency, the relationship between depressive signs and suicide frequency was potentiated. At decreased alcohol consumption or low-urgency, the relationship was slightly weakened. Depressive symptoms x alcohol use x sensation seeking: at increases alcohol or sensation seeking point, the association between suicide frequency and depressive symptoms was a little bit higher and vice versa.
Inder et al. (2014)	Parallel cross-sectional analyses	The objective of the study was to ascertain the determinants of suicidal ideation and attempted suicide using two data sets of rural and urban residents of Australia. The National Survey of Mental Health and Wellbeing data set of 2007 (n=8,463) under-represented the residents from the rural community. While the Australian Rural Mental Health Study (n=634) over-represented the rural community. The attempted suicide and suicidal ideation and mental disorder were ascertained using the World Mental Health Composite International Diagnostic Interview, and different logistical regressions undertaken.	The study reported similarity in the predictors and rates of suicidal ideation and attempted suicide in all the geographical locations. 12-month suicidal ideation: Psychiatric disorder was reported to be the primary determinant of the one year and lifetime attempted suicide and suicidal ideation in all the locations. Lifetime suicidal ideation: Other factors like marital status, apparent fiscal hardship, employment status, and mental health service were critical determinants for lifetime suicidal ideation and attempted suicide In the sub-analysis of the ARMHS, enhanced apparent infrastructure, higher optimism and accessibility to service are linked with lower possibility of lifetime suicidal ideation when factors such as sex, age, mental health service were considered.
Handley et al. (2012)	Composite International Diagnostic Interview	The study aimed at determining the role of depression in rural suicidality and the effect of co-existing psychiatric disorders to attempted suicide and suicide ideation using a sample of Australian rural community. A sample size of 618 participants were enlisted in the Composite International Diagnostic Interview which investigated suicide attempts, affective disorders, suicidal ideation, depressive disorders, and disorders due to drug abuse in the lifetime. Logistic regression analyses were carried out to determine the role of depression and supplementary diagnoses to suicidality.	The outcomes of the analyses showed that 41% of the respondents with suicidal ideation in their lifetime and 34% of those with attempted suicide reported no background cases of depression. Suicidal ideation: this were forecast by the youths, presently unmarried, and post-traumatic disorder or anxiety when there was control for lifetime depression. Suicide attempts: these were forecast by disorders related to substance abuse, lifetime anxiety, in addition to youths that are presently married and working.
Sharma, Nam, Kim, & Kim, (2015).	Cross-sectional survey	The study is aimed at assessing the occurrence of suicidal ideation and attempted suicide, and related factors among adolescents enrolled in urban schools in Peru. The authors carried out a cross-sectional survey using 916 adolescents in secondary schools in 2014. Data collection was carried out using a structured questionnaire of the Global School-based Student Health Survey. Logistic regression models were used to analyse data at 5% significance level.	The findings indicate a relatively high prevalence of suicidal ideation and attempted suicide in the area of study. Female sex were highly susceptible to cases of attempted suicide and suicidal ideation. Risk factors of suicidal ideation: female adolescents that engaged in fights, slighted, attacked, smoked and were initiated into sexual intercourse were noticeably linked with high rate of suicidal ideation. Risk factors of suicide attempt: the female adolescents who were involved in drug and substance abuse, fight, attacked and insulted were reported to experience suicide attempt
Milner et al. (2014)	Case control study	The research aimed at examining the impact of involuntary job loss on suicide attempt and suicide in youths. The authors conducted a case control study of youths aged 18 and 34 years in New South Wales Australia. The sample size for the suicide attempts was 101 and for suicides was 84. Regarding the suicide cases, a structured interview was carried out on the next kin and with cases of attempted suicide admitted to the hospital. the controls obtained from the overall population were compared to cases on the basis of gender and age. The analysis was adjusted to accommodate other factors.	After the adjustment for other factors, the outcomes showed that involuntary job was linked to both attempted and suicide odds ratio of 1.82. Low socio-economic status also influenced suicide and attempted suicide at an odds ratio of 3.80. Mental disorders also influenced attempted suicide and suicide with an odds ratio of 7.87 to 12.01
Strandheim et al.(2014)	Prospective Cohort study that is population based	The objective of the study was to assess the relationships between health and lifestyle influences reported in the adolescents and development of suicidal thoughts after 4 years of follow-up. An invitation was made to all students in the two year classes in Nord-Trondelag school and a response of 80% was attained. The sample size included in the analysis was 2399 high school students aged 13 to 15 years enrolled in the Young-HUNT 1 study and later followed up after 4 years when they are 17 to 19 years.	The authors found out that the 17 to 19 years teenagers’ experienced suicidal thoughts during the follow-up that is 158 boys and 250 girls. Factors such as depressive signs, baseline anxiety, behavioural issues, tension, and muscular pain were all linked to suicidal thoughts after the follow-up study. the Female sex predominated in one to six ration of youths that underwent suicidal thoughts
Park & Lee (2016).	Web-based survey	The study assessed the factors that influence attempted suicide in young adults from multicultural families in South Korea. The study was based on the Korean Youth Risk Behaviour Web-Based Survey (KYRBS) conducted in 2105. The sample size was 727 adolescents whose parents were not born in South Korea. The females were 351 whereas the males were 376. Out of these 41 had experiences suicide attempts within one year	The findings show that increased odds of attempted suicide was significantly associated with  high residence rate in large cities by the female sex, residing with a relative, alone or with friends, socio-economic status, perceived depression and disagreement with. The outcomes are an indication that suicidal behaviour is much prevalent in adolescents from multicultural families with particular risk factor such as foreign parents, teacher- student conflict and living independent of the parents
Randall, Doku, Wilson,& Peltzer, (2014).	Cross-sectional study	The authors explored the risk factors associated with suicidal behaviour among junior and senior high adolescents in Benin. The study was based on the Global School-based Health Survey carried out in 2009 in Benin. A sample of 2690 young adults were included in the analysis. a multinomial logistic regression was used to test risk factors  such as socio-environmental, demographic, and psychosocial factors for their relationship with attempted suicide and suicidal ideation	The outcomes of the study show that 23.2% of the participants had contemplated on suicide, and 28.3% had attempted suicide within the last 12 months. Loneliness, disquiet, drug and substance abuse, and the absence of support from adults were independently associated with results of ideation.
Asante, Kugbey, Osafo, Quarshie, & Sarfo (2017).	Cross-sectional survey design	The objective of the study was to assess the prevalence and risk and preventive influences related with suicide in Ghana. The authors used an International School-based Student Health Survey data obtained from senior school going youths	The findings indicated that students in senior high school experienced high rates of suicidal behaviour. The suicidal ideation reported a suicidal behaviour prevalence of 18.2%, suicidal attempt had 22.5% and suicidal plan reported 22.2%. Further, analysis showed that the odds of suicidal behaviour are further increased by anxiety even after other variables are regulated. Other risk factors that lead to suicidal behaviour such as attempted suicide, suicide planning and contemplation include physical assault, food insecurity, and being bullied.

Global Suicide Statistics

Different and relevant articles, websites, and books were critically examined under the literature review. The researcher used search engines such as PubMed and Google Scholar to conduct systematic research to ascertain the articles and government websites that reported on the factors associated with suicide and attempted suicide across the world. The researcher used the following key terms during the research: suicide, attempted suicide, adolescents, prevalence, incidence, risk factors, mental disorders, impact, strategies, prevention, suicidal behaviors, suicide methods, and mortality. The search was limited to publications published within five years.

A total of 70 abstracts and articles were retrieved and after screening, filtering, and quality check, 57 studies were selected for analysis.  Furthermore, ten articles were excluded due to replication and fifteen for not being primary articles. The remaining 32 studies assessed for suitability and 12 of them that did not meet the inclusion criteria were excluded further. Five more papers did not have full access and were thus eliminated leaving a sample of 15 articles which were included in the analysis. The researcher then came up with several themes relevant to the study topic as demonstrated in the literature review section of this study.

By Age

In 2017, the highest mortality rate among 15 to 44-year-old people in Australia was attributed to suicide, which is also the second leading cause of death among the people aged 45 to 54 years old.  The median suicide age at death was 44.5 years which is half that of all other deaths. The males’ median age of death was 44.0, whereas that of the females was 45.7 years. The leading proportion of suicide deaths was reported among the age group of 45 to 49 years in males and females. The highest age-specific suicide rate in 2017 was reported among the males of 85 years and above, representing 32.8 deaths per 100,000 population. About the females, the age-specific suicide rate was reported in the age group of 45 to 49 years, with the lowest rate being recorded in the age group of 85 years and above (Australian Bureau of Statistics, 2017).

By Region

In 2017, all Australian states had recorded an increase in the deaths caused by wilful harm except for South Australia, Victoria, and Tasmania. The leading increase in suicide rates of 804 deaths in 2017 was found in Queensland, while the Australian Capital Territory reporting the greatest percentage increase in deaths due to self-harm compared to the survey in 2016. Increase in mortality rates as a result of suicide was also reported in Western Australia and New South Wales. Concerning time series of ten years, The Northern Territory state recorded the leading suicide rate per capita in 2017, followed by Queensland with 130 deaths representing 49.6% of all the rise in suicide mortality. The most significant increase in mortality rate due to wilful self-harm was reported in the Australian Capital Territory with 14.1 from 7.2 deaths per 100,000 people (Australian Bureau of Statistics, 2017).

By Indigenous and non-indigenous

The suicide rate among the Aboriginal and Torres Strait Islanders Australians is startling as it is twice that reported among non-indigenous Australians with some remote locations being much higher. For every three deaths, one is attributed to suicide (29%) in the Indigenous people of the 15 to 34 age bracket.   Additionally, between 2008 and 2012, the primary cause of death in this age group was suicide.  The suicide mortality rate in 2014 among the non-indigenous people was 1.8%, while in all indigenous people it accounted for 5.2%.  It is likely that the indigenous people are twice more prone to succumb to suicide than non-indigenous people (The Department of Health, 2013).

Suicide by Age Group and Risk Factors

In far rural regions, most of the suicide cases are carried out by hanging which is witness more often by most of the members of the community. As a result increased cases of trauma, sorrow, depression, drug and substance abuse which influences suicidal behavior have been witnessed among the Aboriginal and Torres Islander peoples. Suicide cases have been on the rise among the indigenous people for the last three decades, with the male youths being at greater risk. The indigenous males aged 15 to 19 years are 4.4 times likely to end their lives through suicide compared to those of Australian male youths. On the other hand, the females from the Aboriginal community are 5.9 times at risk of death due to suicide than those of Australia (The Department of Health, 2013).

Mental Disorder

Increased mortality risks in most of the cases of mental disorders have been deteriorating over time (Walker, McGee, & Druss, 2015). Chesney, Goodwin, and Fazel (2014) conducted a meta-review on the mental disorders and associated mortality risk and found out that mental disorders were the leading general cause of mortality risks. Different mental diseases had posed different mortality risks with schizophrenia and bipolar disorders having an SMR score of 2.5 and adjusted risk ratio of 2.3 respectively. Hoertel et al. (2015) found out that 75.3% males and 66.9% females that had attempted suicide had past medical conditions of DSM-IV Axis I.PAFs mental disorders accounted for 12.8% suicide cases of while smoking dependence had 30% suicide cases

Trauma    

Existing literature has associated increased mortality rates due to suicide to be caused by psychiatric disorders. For instance, a critical review of psychological studies by Hawton, Comabella, Haw, and Saunders (2013) showed that over 90% of those who succumb to suicide had initially been diagnosed of a psychiatric disorder. Furthermore, the prevalence of suicidal thoughts and suicidal attempts have been attributed to those who have been diagnosed with trauma (Franklin et al., 2017). Edmondson, Brennan, and House (2016) have demonstrated that increased cases of suicidal conducts and successful suicides have been found among people with bad life experiences. Zhang, Jia, Zhang, Wang, and Liu (2015) conducted a study among patients admitted to a psychiatric ward after incidences of suicide attempts and found out that the initial suicide attempts were noticeably determined the negative life experiences they had undergone previously.

Family history

Studies have explored the significance of the family factor as a determinant of suicidal conduct among the youths. These family factors include parental psychopathology, suicidal conducts, disagreement in the family, divorce, death of parents, discordance between parents and children, and maltreatment (Turecki and Brent, 2016). There exists substantial evidence that suicidal conduct is familial, and in some cases, genetic, and that the obligation to suicidal conduct is passed on in families despite psychiatric disorder (Rajalin, Hirvikoski, & Jokinen, 2013). The authors found out that families with cases of attempted suicide showed increased suicide risk in other family members. This is proving to the assertion that phenotype transmission for the inclination of suicidal behavior was present.   There is also an increased rate of 2 to 6 fold of suicidal conduct among relatives of youth suicide victims and attempters of suicide (Page et al., 2014). Studies have also compared the children of parents who are mood disordered against the offsprings of those who are not and found out that the children of the former group are five times more likely to engage in suicidal behavior (Brent et al., 2015).   Suicide attempts were more prevalent in offsprings whose parents had depicted suicidal behavior, hence showing that suicidal behavior can be familial. The transmission of suicidal tendencies from the parent to the offspring were controlled by the inheritance of impulsive aggression (Brent et al., 2015).   

Suicide in Australia

Alcohol and Drugs

Disorders associated with drug abuse can significantly contribute to the risk of suicide, more so in young adults when they coincide with upsetting disorders (Nock et al., 2013). Darvishi, Farhadi, Haghtalab, and Poorolajal (2015) assessed the association between binge drinking and suicide attempts in young adults. The authors found out the adolescents aged 13 years and below who engaged in heavy drinking were 2.6 times much more likely to engage in suicide attempts when equated to those that didn’t. Wong, Zhou, Goebert, and Hishinuma (2013) indicated that drug abuse when under depression increased the threefold the risk of entertaining suicidal thoughts

Social Media

Some studies have indicated that there is a positive correlation between the prevalence of internet usage with the suicide rates in the general population. Daine et al. (2013) undertook a systematic review and assessed the relationship between the frequency of internet usage and suicide rate and found that those who frequently used the internet were at significant risk of entertaining suicidal thoughts. Biddle et al. (2016) carried out a systematic web search of keywords associated with suicide and found out that over 50% of the websites were prosuicide and provided real-time information on suicide. These studies indicate that detailed information on suicide method can readily be accessed on the internet.

Generally, studies have shown with convincing evidence of the effectiveness of the use of psychological interventions in the treatment of suicidal cases. This approach is focused on minimizing or discouraging the youths from entertaining suicidal thoughts and behaviors, and fostering behavior change and improving interpersonal relationships.  

Individual and Family Therapy

Nock et al. (2013) found out that the integration of individual and family therapy was successful in youths that were contemplating suicide. The authors applauded the use of Integrated Cognitive Behavioural Therapy (I-CBT) because it allows the combination of three major elements namely parent training, individual and family CBT.  Diamond, Russon, and Levy (2016) pointed out that Attachment-based Family Therapy (ABFT) was significant in improving the quality of family relationships through the use of the individual approach. The young adults that were enrolled under I–CBT reported minimal suicide attempts during the entire period of study (Asarnow, Berk, Hughes, & Anderson, 2015).

Transitory Interventions during High-risk Periods

Empirical evidence suggests that treatments carried out during post-discharge have been more effective in reducing suicide and attempted suicide. The examples of brief interventions deal with aspects of emergency control such as safety planning, provision of psychoeducation to parent and adolescents (Asarnow, Hughes, Babeva, & Sugar, 2017). Kennard et al. (2015) showed that safety planning as an independent intervention beneficial to patients in ascertaining the most appropriate managing strategies for cases of suicide. Asarnow et al. (2017) have also pointed out a small RCT shows that such brief interventions can be worthwhile for dropping the number of suicide attempts.

Technology and the Internet

Suicidal behaviors have lately been attributed to the increased influx of suicidal information on the internet that is readily accessible. Furthermore, Franklin, Puzia, Lee, and Prinstein (2014) indicated that individuals who express suicidal or self-harm behaviors had prior thoughts of the same. The use of a smartphone application that discourages any thinking of suicide or self-harm was found to reduce any involvement in suicide or attempted suicide among online recruited participants who received the treatment. However, the outcomes of these interventions are in their initial stages and did not continue post-intervention. There is, therefore, the need to further research to test and determine their effectiveness since they best fit the technological savvy youths.

Key Studies

Universal and Selective Prevention

Most of the suicide prevention strategies focus on offering school-based education to create awareness of suicide signs and symptoms and ascertain the populations at risk. A randomized control trial on European nations was conducted and involved the creation of awareness on youth mental health. The study reported a decline in cases of self-reported suicidal cases and attempts compared to the use of independent use of posters for awareness (Wasserman et al., 2015).

The objective of screening interventions is to find out the young adults population that is at risk of suicide by carrying out formal mental health evaluations in the average daily life. Based on the findings various screening interventions in school settings, several referrals have been made to mental health services thus leading to more unsuccessful attempted suicides and suicide aversion among the adolescents (Moyer, 2013). Wasserman et al. (2015) propose the use of gatekeeper programs which aims at offering skills to individuals who can be able to effectively respond to people who are at risk of committing suicide.

Selective prevention programs have also been recommended to help in the management of common suicidal risk factors by equipping people with skills on problem-solving and self-control (Calear et al., 2016). Many interventions aimed at addressing family conflict or tension have also been recommended. Furthermore, these programs have been effective in preventing drug abuse and the management of various disorders that contribute to suicide or attempted suicide (Connell, McKillop, & Dishion, 2016).

The search for primary articles relevant to suicide and attempted suicide in the youth of modern Australia identified 70 articles which after critical review and assessment for quality 15 were included in the analysis. Thematic analysis was used to analyze the findings which were presented in different themes and sub-themes. The search for articles on the prevalence of suicide and attempted suicide identified six articles. A common finding across the articles is that suicidal rates varied widely based on many factors such as culture, gender, age, location, family among others. However, the highest prevalence of suicidal behavior was reported on adolescents. For instance, Asante et al. (2017) were highest in school-going teenagers, while Nock et al. (2013) found out that lifetime prevalence of suicide ideation, attempts, and organization was highest in adolescents. According to Handley et al. (2012), the prevalence of suicide is highest in the rural communities that in urban centers and yet the degree of depression is much higher in towns than in remote areas. The authors found out that while suicide is mostly caused by depression, other factors such as demographic influences also have a significant impact on suicidal behaviors.

Eight of the articles reviewed were on factors that influence suicidal behavior.  The findings of the review indicated that a range of factors affected suicidal behavior among the youth. Some of this factor include drug and substance abuse, depression, anxiety, a poor child-parent relationship among others. Dvorak et al. (2013) suicide proneness among college students was influenced by risk factors such as depressive signs, alcohol use among others. Handley et al. (2012) demonstrated that it is not depression alone that significantly affects suicidal behavior but other factors such as environmental, familial, psychiatric conditions and demographic characteristics. Similar conclusions were generally arrived at by Sharma et al. (2015); Strandheim et al. (2015); Park & Lee, (2016) among others.

Conclusion

A review of the articles on suicide prevention and intervention resulted in the analysis of five articles. The findings across the review showed that suicide and suicide attempt can be prevented as long as the appropriate mechanisms for the same are put in place. However, a behavioral approach was emphasized across the review based on its effectiveness in previous studies and because suicide and attempted suicide is a behavioral issue.  Asarnow et al. (2017) recommended a cognitive behavioral intervention with a particular focus on the family members.  Czyz et al. (2013) found out that barriers towards a professional treatment of suicide and attempted suicide were behavioral. The EAAD intervention program was a community-based intervention that focuses on behavioral therapy (Székely et al., 2013).

The systematic review of the 15 articles alongside others indicated that suicide and attempted suicide among the youth was very high worldwide. Additionally, modern Australia was leading in mortality rates due to suicide according to both the Australian Bureau of Statistics and the World Health Organization among other surveys. The factors that have been found to contribute to the high incidences of suicidal behavior include depression, drug and substance abuse, internet and social media, family factors and mental disorders. However, the most common factors that influence youth suicidal behavior among these factors include drug and substance abuse and depression. Zhang, Jia, Zhang, Wang, and Liu (2015)  Observes that negative life experiences that the youth undergo are the primary cause of depression and drug abuse.

Similarly, other studies have attributed the increased suicidal behavior among the youths to unemployment and involuntary job loss, which further aggravates depression and mental disorders.  This, therefore, calls intervention approaches to suicide and attempted suicide. The study findings have ascertained that a cognitive behavioral approach is the most effective method to be used both in prevention and intervention. Other interventions and preventive programmes include regulation of the information that is accessed by the youths on the internet in addition to establishing emergency response mechanisms.   

This review had limitations despite the rigour with which it was conducted.  The rampant omissions in the articles included the absence of testing for publication bias and the lack of more than one data extractor. This limited the validity and reliability of the reviews and thus by extension this one. Moreover, most of the suicide statistics in some countries were underreported, a phenomenon common across nations (Yang, Jia, & Qin, 2015). Even though this study has used only primary articles, the data sets upon which the studies are based have their weaknesses. Ioannidis (2013) shows that such datasets are often overpowered to such an extent that the results obtained maybe statistical substantial even when there are small variations in mortality.

The analysis of data from a range of reviews and comparing the findings with other studies conducted in a different setting but with more or less the same objective ensured that triangulation was accomplished. As a result, the credibility of the findings was strengthened.  The review of different studies under different settings and the deduction of a common finding across the studies ensured the transferability of the study (Leung, 2015). This implies that the findings of this study can be used in other contexts with varying or the same phenomena. All the reviewed articles were based on primary data, an aspect that strengthens the confirmability of the findings.  Primary data discourages any potential bias that may be due to the researchers’ different motivations. Therefore, the outcome of this study is reliable as there is neutrality regarding the influence of the researcher on the findings. Furthermore, this increases the dependability of the findings in addition to the extensive information provided in each review (Elo et al., 2014).

Conclusion

Prevalence of suicide and attempted suicide has become a public health problem worldwide. Most strikingly are the increasing prevalence of suicidal behavior among the youth. More specifically cases of attempted suicide and completed suicide in Australia are much higher than any other country in the world. A critical review of fifteen original articles relevant to suicide and attempted suicide across the world have indicated the magnitude of the matter by addressing the risk factors of suicide, prevalence, and the most effective intervention and prevention approaches. The most common factors that influence suicidal behavior among the youth include mental disorders, social media and internet, and family history. Lastly, the findings of this review showed that suicide and attempted suicide can be controlled as long as appropriate support mechanisms are put in place.

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