Corinne Isaak

A systematic review of school-based suicide prevention programs

Suicide is one of the leading causes of death among youth today. Schools are a cost‐effective way to reach youth, yet there is no conclusive evidence regarding the most effective prevention strategy. We conducted a systematic review of the empirical literature on school‐based suicide prevention programs.

GATEKEEPER TRAINING FOR SUICIDE PREVENTION IN FIRST NATIONS COMMUNITY MEMBERS: A RANDOMIZED CONTROLLED TRIAL

Gatekeeper training aims to train people to recognize and identify those who are at risk for suicide and assist them in getting care. Applied Suicide Intervention Skills Training (ASIST), a form of gatekeeper training, has been implemented around the world without a controlled evaluation. We hypothesized that participants in 2 days of ASIST gatekeeper training would have increased knowledge and preparedness to help people with suicidal ideation in comparison to participants who received a 2‐day Resilience Retreat that did not focus on suicide awareness and intervention skills (control condition).

Meaning of Health: The Perspectives of Aboriginal Adults and Youth in a Northern Manitoba First Nations Community

OBJECTIVE To explore perspectives on the meaning of health to Aboriginal adults and youth living in a northern Manitoba First Nations community. METHODS Six focus groups with 29 youth and individual interviews with 10 adults were audio-recorded, transcribed verbatim and thematically analyzed. RESULTS Adults and older youth used aspects of health depicted in the Medicine Wheel to describe being healthy, but younger youth were not as specific. Both generations spoke about the importance of positive adult role models (emotional health), incorporation of traditional First Nations practices into everyday life (spiritual health), changes in diet and activity (physical health) and the significance of making good choices (mental health). CONCLUSIONS Participants incorporated aspects of current and traditional lifestyles into their discussion of health. Use of the Medicine Wheel to conceptualize health holistically on the part of both adults and older youth suggest that it may be an effective way to frame health promotion strategies for younger youth. Because it is in harmony with cultural values, such an approach may influence other members of this community to adopt healthful lifestyle practices.

Promising Strategies for Advancement in Knowledge of Suicide Risk Factors and Prevention

Suicide is an important public health problem. Although there have been advances in our knowledge of suicide, gaps remain in knowledge about suicide risk factors and prevention. Here, we discuss research pathways that have the potential to rapidly advance knowledge in suicide risk assessment and reduction of suicide deaths over the next decade. We provide a concise overview of the methodologic approaches that have the capacity to rapidly increase knowledge and change practice, which have been successful in past work in psychiatry and other areas of medicine. We suggest three specific pathways to advance knowledge of suicide risk factors and prevention. First, analysis of large-scale epidemiologic surveys and administrative data sets can advance the understanding of suicide. Second, given the low base rate of suicide, there is a need for networks/consortia of investigators in the field of suicide prevention. Such consortia have the capacity to analyze existing epidemiologic data sets, create multi-site cohort studies of high-risk groups to increase knowledge of biological and other risk factors, and create a platform for multi-site clinical trials. Third, partnerships with policymakers and researchers would facilitate careful scientific evaluation of policies and programs aimed at reducing suicide. Suicide intervention policies are often multifaceted, expensive, and rarely evaluated. Using quasi-experimental methods or sophisticated analytic strategies such as propensity score-matching techniques, the impact of large-scale interventions on suicide can be evaluated. Furthermore, such partnerships between policymakers and researchers can lead to the design and support of prospective RCTs (e.g., cluster randomized trials, stepped wedge designs, waiting list designs) in high-risk groups (e.g., people with a history of suicide attempts, multi-axial comorbidity, and offspring of people who have died by suicide). These research pathways could lead to rapid knowledge uptake between communities and have the strong potential to reduce suicide.

Life Changes Among Homeless Persons With Mental Illness: A Longitudinal Study of Housing First and Usual Treatment

OBJECTIVE This study compared the life changes of homeless people with mental illness participating in Housing First or treatment as usual and examined factors related to various changes. METHODS Semistructured narrative interviews were conducted with 219 participants in five Canadian cities at baseline; 197 were interviewed again at 18 months after random assignment to Housing First (N=119) or treatment as usual (N=78). Interviews were coded across 13 life domains, and each participant was categorized as reporting positive, mixed-neutral, or negative changes. Housing First and treatment as usual participants were compared with respect to change patterns. Thematic analysis was used to examine factors related to various changes. RESULTS The percentage of participants in Housing First reporting positive changes was more than double that for participants in treatment as usual, and treatment as usual participants were four times more likely than Housing First participants to report negative changes. Factors related to positive changes included having stable good-quality housing, increased control over substance use, positive relationships and social support, and valued social roles. Factors related to negative changes included precarious housing, negative social contacts, isolation, heavy substance use, and hopelessness. Factors related to mixed-neutral changes were similar to those for participants reporting negative changes but were less intense. CONCLUSIONS Housing First with intensive support was related to more positive changes among homeless adults with mental illness across five Canadian cities. Those with poor housing or support, more common in treatment as usual, continued to struggle. These findings are relevant for services and social change to benefit this population.

How does Housing First catalyze recovery?: Qualitative findings from a Canadian multi-site randomized controlled trial

ABSTRACT Qualitative narrative interviews were conducted with 195 participants with histories of homelessness and mental illness at baseline and at an 18-month follow-up. Participants were randomly assigned at baseline to Housing First (HF; n = 119) or treatment as usual (TAU; n = 76) in five Canadian cities. Changes in consumers’ narratives over time were examined for 13 life domains (e.g., housing stability, typical day, social relationships). HF participants showed superior housing stability that led to three important transitions in their recovery journeys: (1) the transition from street to home (e.g., greater control over one’s environment, becoming unstuck), (2) the transition from home to community (e.g., pursuing relationships, participating in the community), and (3) the transition from the present to the future (e.g., developing autonomy and hope). In spite of the gains experienced by many HF participants and some TAU participants, there was a subgroup of HF participants and many more TAU participants who experienced considerable difficulty making positive transitions. This research affirms the importance of housing and support for people with mental illness who are homeless but extends previous research by elucidating how HF enables participants to navigate important transitions in their recovery journeys. Once housing stability is achieved, other services (e.g., supported employment, education, and socialization) are needed to accelerate the transitions that participants strive to make in their lives.

Community-based Suicide Prevention Research in Remote On-Reserve First Nations Communities

Suicide is a complex problem linked to genetic, environmental, psychological and community factors. For the Aboriginal population more specifically, loss of culture, history of traumatic events, individual, family and community factors may also play a role in suicidal behaviour. Of particular concern is the high rate of suicide among Canadian Aboriginal youth. While the need to develop interventions to reduce suicidal behaviour for First Nations on-reserve populations is evident, there may be an element of distrust of researchers by Aboriginal communities. Furthermore, research in mental health and specifically suicide is much more sensitive than studying medical illnesses like diabetes. Clearly, this issue requires a unique and insightful approach. While numerous suicide prevention/intervention plans and guidelines have been published specifically for work involving Aboriginal people, the literature lacks a comprehensive discussion of the methodological and logistical issues faced by research teams and Aboriginal communities attempting to develop culturally-grounded and community-specific suicide prevention and intervention strategies. This paper outlines the research process, key challenges and lessons learned in a collaborative University-First Nations suicide prevention project conducted with eight north-western Manitoba First Nations communities (Canada).

A history in-care predicts unique characteristics in a homeless population with mental illness.

Multiple studies of homeless persons report an increased prevalence of a history in-care, but there is a dearth of information on associated outcomes or relevant demographic profiles. This information is critical to understanding if certain individuals are at elevated risk or might benefit from specific intervention. Here, we investigate how a history in-care relates to demographics and multiple outcome measures in a homeless population with mental illness. Using the Mini International Neuropsychiatric Interview (MINI), the Short-Form 12, and a trauma questionnaire, we investigated baseline differences in demographics and length of homelessness in the At Home/Chez Soi Trial (N=504) Winnipeg homeless population with and without a history in-care. Approximately 50% of the homeless sample reported a history in-care. This group was significantly more likely to be young, female, married or cohabitating, of Aboriginal heritage, have less education, and have longer lifetime homelessness. Individuals of Aboriginal heritage with a history in-care were significantly more likely to report a familial history of residential school. Individuals with a history in-care experienced different prevalence rates of Axis 1 mental disorders. Those with a history in-care also reported significantly more traumatic events (particularly interpersonal). A distinctive high-risk profile emerged for individuals with a history in-care. Sociocultural factors of colonization and intergenerational transmission of trauma appear to be particularly relevant in the trajectories for individuals of Aboriginal heritage. Given the high prevalence of a history in-care, interventions and policy should reflect the specific vulnerability of this population, particularly in regards to trauma-informed services.

Complementary Food Consumption of Canadian Infants

In July, 2003, a cross-sectional survey was conducted by Heinz Canada, on a nationally representative sample of mothers with infants aged three to 12 months. The surveys mailed to new mothers consisted of 1) a questionnaire to as- sess demographic information and 2) a four day food diary, providing dietary data for nearly 2,951 infants. The initiation rate of breastfeeding was 73% for study infants. At three months, 81% of the infants received complementary foods (mostly cereal, fruits, and vegetables, but some had also been introduced to meats, dairy products, and mixed dishes). These data suggest a current pattern for the early introduction of complementary foods, some by three months and the ma- jority by six months of age. The World Health Organization (WHO) and Health Canada now recommend exclusive breastfeeding until six months of age. The impact this recommendation may have on the feeding pattern of Canadian in- fants remains to be seen.

Pathways into homelessness: Understanding how both individual and structural factors contribute to and sustain homelessness in Canada:

This qualitative study examined how homeless individuals with mental illness experience pathways into homelessness. Study participants were enrolled in the At Home/Chez Soi project, a Pan-Canadian Randomized Controlled Trial comparing the Housing First approach with Treatment as Usual for homeless individuals. This inquiry is grounded in social ecological perspective, which considers interactions between individual and structural factors. Findings from consumer narrative interviews (n = 219) revealed that individual factors, such as substance abuse, relationship conflicts and mental health issues significantly contributed to homelessness, in addition to structural transitions from foster care and institutional settings into the community. Additional structural factors entrenched participants in unsafe communities, created obstacles to exiting homelessness and amplified individual risk factors. The study findings confirm the role of individual risk factors in pathways into homelessness, but underscore the need for policies and interventions to address structural factors that worsen individual risks and create barriers to exiting homelessness.