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Item The associations of childhood adversities and mental disorders with suicidal thoughts and behaviors - Results from the World Mental Health International College Student Initiative(Elsevier B V, 2025-08-01) Mortier P; Yang X; Altwaijri YA; Holdcraft JA; Lee S; Sampson NA; Albor Y; Alhadi AN; Alonso J; Al-Saud NK; Andersson C; Atwoli L; Auerbach RP; Muaka CA; Báez-Mansur PM; Ballester L; Bantjes J; Baumeister H; Bendtsen M; Benjet C; Berman AH; Bruffaerts R; Carrasco P; Chan SCN; Cohut I; Covarrubias Díaz Couder MA; Crockett MA; Cuijpers P; David OA; Dong D; Ebert DD; Gaete J; Felez-Nobrega M; García Forero C; Gili M; Gutiérrez-García RA; Haro JM; Hasking P; Hunt X; Husky MM; Jaguga F; Jansen L; Langer ÁI; Liu Y; Mac-Ginty S; Martínez V; Mason A; Mathai M; McLafferty M; Miranda-Mendizabal A; Murray EK; Musyoka CM; O'Neill SM; Papasteri CC; Piqueras JA; Popescu CA; Rapsey C; Robinson K; Rodriguez-Jimenez T; Scarf D; Siu O-L; Stein DJ; Struijs SY; Tomoiaga CT; Valdés-García KP; Vereecke S; Vigo DV; Wang AY; Wong SYS; Kessler RC; World Mental Health International College Student collaboratorsObjective: To investigate the associations of demographic variables, childhood adversities (CAs), and mental disorders (MDx) with onset, transition, and persistence of suicidal thoughts and behaviors (STB) among first-year university students. Method: Poisson regression models within a discrete-time survival framework were constructed using web-based self-report survey data from 72,288 incoming university students across 18 countries (response rate=20.9%; median age=19 years, 57.9% female, 1.4% transgender, 21.0% non-heterosexual). These models examined the associations of four demographic variables, five CAs, and eight MDx with STB outcomes. Results: Lifetime prevalence of suicidal ideation, plans, and attempts was 47.0%, 26.0%, and 9.6%, respectively; 12-month estimates were 30.6%, 14.0%, and 2.3%. In unadjusted analyses, associations were strongest between lifetime onset of suicidal ideation and CAs (RR range 4.4–7.0), particularly parental psychopathology (relative risk [RR]=7.0 [95% CI 6.5–7.7]), followed by MDx (RR range 1.3–3.0). Of the demographic subgroups, transgender students had highest risk of STB (lifetime ideation onset RR=2.4 [2.3–2.6]; ideation-to-attempt transition RR=1.5 [1.3–1.8]). In fully adjusted models, strongest predictors of lifetime ideation onset were emotional abuse (RR=2.1 [1.9–2.2]), major depressive disorder (RR=2.0 [1.9–2.1]), and bipolar disorder (RR=1.8 [1.6–2.0]). Ideation-to-attempt transition remained most strongly associated with panic disorder (RR=1.5 [1.3–1.7]), bipolar disorder (RR=1.4 [1.2–1.7]), and sexual abuse (RR=1.4 [1.2–1.7]). Most predictors were significantly but weakly associated with persistence of ideation and plan, while only physical abuse remained associated with repeated suicide attempts (RR=1.3 [1.0–1.8]). Conclusion: CAs and MDx are strong predictors of both onset of and transition within the STB spectrum, underscoring the importance of implementing early-life prevention interventions.Item A temporal network analysis of risk factors for suicide : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Manawatū, New Zealand(Massey University, 2024-03-19) Holman, MikaylaSuicide is a major public health concern in New Zealand, with the number of lives lost due to suicide increasing almost every year. The factors influencing a person’s decision to take their own life are numerous and often complex. Some of these factors are dynamic, fluctuating over short periods of time and ultimately altering a person’s risk for suicide. Network analysis is a novel statistical technique that can be used to explore complex causal associations in systems of variables, such as risk factors for suicide. The present study used temporal network analysis to explore the associations between dynamic risk factors for suicide over time. Data collection involved ecological momentary assessment, where a general community sample of 39 adult participants completed a brief survey five times per day for ten days, resulting in 1420 completed surveys. Each survey assessed participants’ momentary experience of suicidal ideation, depressed mood, hopelessness, social support, self-esteem, thwarted belongingness, perceived burdensomeness, anhedonia, worthlessness, alcohol intoxication, and fatigue. All variables fluctuated from measurement to measurement at least some of the time, highlighting the dynamic nature of suicide risk. Temporal, contemporaneous, and between-persons networks of the 11 measured variables were estimated using temporal network analysis. In the temporal network, hopelessness was the only variable that predicted an increase in suicidal ideation at the subsequent measurement. Multiple nodes were estimated to be positively associated with suicidal ideation in the contemporaneous network, including depressed mood, thwarted belongingness, perceived burdensomeness, and worthlessness, while self-esteem was negatively associated with suicidal ideation in this network. In the between-persons network, hopelessness was the only variable with a significant association with suicidal ideation. The results of this study highlight the importance of continuously assessing changes in suicide risk factors given their dynamic nature. Hopelessness may be an especially important risk factor to assess given its temporal association with increased suicidal ideation. Regarding future research opportunities, experimental N=1 network studies about the effectiveness of personalised interventions based on node centrality are an important next step in determining whether individualised networks have a place in personalised treatment for suicidality.Item Service user experiences and provider attitudes towards a caring contacts suicide prevention intervention : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand(Massey University, 2022) High, OliviaSuicide prevention is a global public health priority. Caring contacts (CC) is a suicide prevention intervention that has shown promise and increasing research interest. However, there has been a lack of clarity as to ideal intervention protocols, with service users having limited opportunities to meaningfully contribute to the design and development of the intervention. This study aimed to identify factors that could lead to improved implementation of CC delivered via text messaging in a New Zealand crisis mental health context. The primary study recruited 20 people who presented to the Wellington Emergency Department (ED) due to suicidal ideation or behaviour and agreed to receive 12 supportive one-way text messages over a period of 6 months. Of those recruited, 11 people completed follow-up interviews. Thematic analysis abstracted four themes related to participants’ experiences of receiving the messages: Caring Connection, Safety and Security, Reflections on Recovery, and Limitations. The secondary study explored service provider attitudes towards features of the intervention, suicide prevention and workplace culture towards research utilisation and implementation. Interviews with seven crisis mental health team members were conducted. Content analysis of interviews identified staff concerns about how service users may experience CC via text messaging, concerns about responsibility and possible flow-on effects. These concerns were underpinned by significant time constraints and resourcing pressures that also formed barriers to research engagement and service improvement efforts. This study has implications for understanding the mechanisms driving CC interventions and specific implementation considerations at the level of the innovation, provider, and organisation.Item Non-suicidal self-injury and suicide risk among young adults : an examination of the role of perceived burdensomeness : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand(Massey University, 2019) Edwards, LouiseBackground: Non-suicidal self-injury (NSSI) is defined as direct, self-inflicted damage of body tissue in the absence of the intent to die, and outside of that which is socially sanctioned (Nock, 2009). The Interpersonal-Psychological Theory of Suicide (IPTS; Joiner, 2005; Van Orden et al., 2010) posits that serious suicide attempts occur when an individual experiences both thwarted belongingness and perceived burdensomeness (leading to the desire to die) and the capability to act upon that desire (acquired capability). Current Study: The current research suggests the possibility that in addition to the role played in suicidal behaviours, perceived burdensomeness (PB) also plays a role in NSSI and conceivably in the transition between NSSI and a suicide attempts. The aims of the current study were to gain further insight into the role of PB and its relationship with NSSI and to explore themes, narratives and meaning making of PB amongst those who have engaged in NSSI. The study hypothesised that higher levels of PB will be present amongst individuals who have engaged in NSSI compared with those who have not. Methods: A mixed methods approach was utilised, consisting of an anonymous online survey completed by 159 young New Zealanders (18 – 24 years of age). Results: A total of 36.9% of participants endorsed perceiving some degree of burdensomeness towards significant others in their lives, while over half of participants (51.6%) endorsed having engaged in NSSI. Question responses were combined to produce an overall PB score to be used for comparison between groups. An interpretative phenomenological analysis (IPA) was conducted consisting of six in-depth semi-structured interviews with individuals who had engaged in NSSI and made at least one suicide attempt. Study findings include the following, in a sample of individuals who engaged in self- injurious behaviours, scores on a measure of PB increased as self-injurious behaviour moved from NSSI to suicidal behaviour. Findings: Findings suggested that emotional regulation or reducing internal distress was a major driver for engaging in NSSI. Regression analysis suggested that scores on a screening measure for Major Depressive Disorder, scores on a screening measure for Borderline Personality Disorder, frequency of NSSI and number of NSSI methods used were independently predictive of PB score, accounting for 39.8% of the variation in PB scores. However Major Depression scores were most significantly predictive, accounting for 34.2% of the variation in PB scores. A model of the interaction of PB, guilt and shame has been proposed from the IPA findings. Major conclusions were that higher levels of PB are present in individuals who have engaged in NSSI compared to those who have not engaged in any self-injurious behaviours; that there is evidence to suggest that a continuum of PB may exist moving from NSSI behaviours to suicidal behaviours and finally that PB is an important construct both clinically and for research into NSSI and suicide prevention. Study limitations are discussed and suggestions for future research made.Item Suicide risk and protective factors : a network approach : a thesis presented in fulfilment of the requirements for the degree of Master of Science (by thesis) in Psychology at Massey University, Albany, New Zealand(Massey University, 2019) Holman, MikaylaSuicide is a complex phenomenon, with numerous factors contributing to an individual’s risk of suicide. To visualise and quantify complex interactions between variables, a novel approach called network analysis can be used. The aim of the present study was to explore how risk and protective factors for suicide interact with one another, and to determine which factors were most central to a network of these factors. Using an online survey, cross- sectional data was collected from a sample of 515 individuals who lived in New Zealand, Australia, the United Kingdom, and the United States of America, who were recruited through either social media or Prolific Academic. A network of 18 risk and protective factors for suicide was estimated using network analysis. In the network, suicidal ideation was strongly related to the suicide risk factors of feeling depressed, anxious, and hopeless, as well as substance use and perceived burdensomeness. In contrast, self-esteem, resilience, access to mental health services and a positive attitude towards these services were each protective against suicidal ideation. Factors which had the highest strength centrality were feeling depressed, feeling hopeless, perceived burdensomeness, self-esteem, and social support. The results of this research emphasise the importance of examining protective factors as well as risk factors when determining an individual’s suicide risk.Item How do lay people interpret and respond to suicide warning signs? : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology, School of Psychology, Massey University, New Zealand(Massey University, 2017) McAllister, AmberSuicide is a worldwide problem with over 800,000 people dying by suicide every year, and many more attempting suicide or thinking of suicide. Despite prevention efforts, suicide rates are increasing. One promising area of prevention is educating the public to recognise and respond to suicidal signs. Yet knowledge of this area is currently lacking in the literature, especially in New Zealand. The aim of this study was to understand and explore how lay people in New Zealand currently interpret and respond to suicidal signs. A second aim was to assess whether there were gender or age group differences. A mixed methods approach was used that included a validated questionnaire and a semi-structured vignette interview developed specifically for the study. Participants were 24 adults from one location in New Zealand, grouped equally by gender and age (20-30 years or 40-50 years). The results reveal a number of psychological, cognitive, and communicative barriers to interpretation and intervention, and a lack of intervention knowledge. Small gender and age group differences are also revealed. These findings have implications and recommendations for suicide prevention strategies in New Zealand.Item Making sense of youth suicide : exploring young New Zealanders' views : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Wellington, New Zealand(Massey University, 2016) Williams, CaseyDue to its sensitive nature, the suicide of young people can be a complex and difficult issue to address; yet it needs to be better understood in order to reduce the rate of young New Zealanders who die from suicide. While there has been a significant amount of research conducted on youth suicide, the aim of this research was to gain a deeper understanding of youth suicide within New Zealand by exploring why young people think their peers attempt, or die from, suicide. Six focus groups were held with 19 participants aged 16 to 24 years old. Discussions were transcribed and thematic analysis of the transcripts identified five themes and ten subthemes. These were: relationship factors (bullying and intimate relationships), internal factors (depressive disorders and coping skills), gender (kiwi masculinity and rates), external factors (alcohol and other drugs and circumstances), and support services (access and reluctance/barriers). The participants identified that youth suicide can be the result of a variety of factors, particularly noting the relationship between bullying (face to face or cyber-bullying) and suicide. It is recommended that a component which addresses youth suicide and provides young people with positive coping strategies is implemented into the New Zealand educational curriculum. It is anticipated that changes to the education curriculum, and by society challenging and changing common gender stereotypes, will help reduce youth suicide within New Zealand. Given that this research utilised a small sample size, where the majority of participants were female of European or Pakeha descent, future research with a larger more diverse sample would be beneficial.Item Suicide contagion : is the media placing the public at risk? An analysis of suicide reporting in New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Palmerston North, New Zealand(Massey University, 2016) Colhoun, CraigThe media’s reporting of suicide has been shown to increase subsequent community suicide rates through a process called suicide contagion. It is not necessarily the reporting of suicide that causes suicide contagion, but rather it is the manner in which it is reported. As a result, within New Zealand a number of legislative (the Coroners Act, 2006) and industry guidelines (Reporting Suicide: A resource for the media, 2011) have been introduced to decrease any risk of suicide contagion. The aim of the present study was to investigate how suicide is portrayed in newspapers, examine whether suicide reporting has changed between two timeframes, and explore journalists’ beliefs and behaviour about suicide reporting. The present thesis is divided into two parts. Study One uses quantitative and qualitative methods to compare and contrast all suicide newspaper articles from leading New Zealand newspapers from 12 month periods in 1997 (pre-suicide guidelines) and 2009 (post-suicide guidelines). The results revealed that reporting quality had improved where there was a decrease in the occurrence of elements known to contribute to suicide contagion. However, despite reporting quality improving the study identified that articles continued to include a number of areas where suicide reporting could be improved upon. Study Two complemented Study One by interviewing journalists about their knowledge of contagion, reporting practices and barriers and difficulties in suicide reporting. The rhetorical analysis demonstrated that participants argued that evidence for suicide contagion was inconclusive and problematic. This had important implications as the media argued their reporting was to a high standard and consequently did not view reporting guidelines or the Coroners Act as necessary. As a result, participants largely avoided these restrictions and viewed them as a threat to media freedom. Together these studies demonstrated that suicide reporting quality can still be improved, however, in order to improve writing styles, implementing suicide guidelines does not appear enough. Instead, this study demonstrates that it is necessary to increase media awareness of suicide contagion, so the media understand the importance of applying reporting guidelines.Item A qualitative study of the coping strategies and needs of adults bereaved by suicide : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University,(Massey University, 2006) Kelly, Linda GraceThe aftermath of suicide can have devastating effects on family and friends. Research has shown that the complexities of suicide bereavement can lead to physical and mental health problems, increased risk of suicide, pathological grief, and non-specific stress disorders. How the bereaved cope with the loss of a loved one by suicidc was the focus of this study. It explored factors that were helpful or unhelpful, as well as the specific needs of this group. Fifteen volunteers over the age of 18, bereaved for more than two, and less than five years, told their stories in 45-60 minute semi-structured interviews. Using interpretative phenomenological analysis, results revealed a variety of coping strategies, and highlighted a number of factors that helped or hindered the individual's ability to cope. Results also highlighted a need for training for personnel dealing with the bereaved, suggested improvements in procedures following a suicidal death, and indicated a need for professional help and support immediately following the death. The findings of this study could be beneficial to policymakers at many levels, and to medical and associated professionals. Understanding the factors that can help or hinder the bereaved's ability to cope will help in the assessment of risk, and consequently be useful in the development of early intervention strategies to minimize the risk of physical and psychological problems that can result from such a traumatic event.Item The experiences of New Zealanders bereaved by suicide : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University(Massey University, 1998) Berrett, Maria JoanneBereavement by suicide is a relatively untapped facet of suicidology in New Zealand. The current study used a qualitative approach to investigate the experiences of New Zealanders bereaved by suicide. It was intended that such an approach would provide rich and detailed information. Audiotaped interviews were conducted with eight New Zealand suicide survivors. Grounded theory was used to analyse the transcribed data and to construct a theory of the experiences of New Zealanders bereaved by suicide. Grief responses which parallel those documented in suicide bereavement literature were identified and a host of Intensifying and Alleviating Factors were involved in compounding or lessening participants' grief. These findings are discussed in terms of the aims of the study. Limitations of the study are acknowledged and suggestions for further research are presented.