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1/23/23, 9:14 PM JMIR Research Protocols – Family Members’ Perspectives on Family and Social Support Available to Suicidal Patients, and Health Systems’ Int…

https://www.researchprotocols.org/2020/11/e19112 1/9

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Published on 24.11.2020 in Vol 9 , No 11 (2020) :November

 Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/19112, �rst published April 04, 2020.

Family Members’ Perspectives on Family and Social Support Available to Suicidal Patients, and Health Systems’ Interactions and Responses to Suicide Cases in Alberta: Protocol for a Quantitative Research Study Rabab M Abou El-Magd 1 ;  Liana Urichuk 2 ;  Shireen Surood 2 ;  Daniel Li 2 ;   Andrew Greenshaw 1 ;  Mara Grunau 3 ;  Laureen MacNeil 4 ;  Ione Challborn 5 ;   David Grauwiler 5 ;  Robert Olson 3 ;  Vincent Israel Opoku Agyapong 1, 2

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Abstract

Introduction

Methods

Results

Discussion

References

Abbreviations

Copyright

Abstract

Background: Suicide is a major cause of preventable death globally and a leading cause of death by injury in Canada. To support people who experience suicidal thoughts and behaviors and to ultimately prevent people from dying by suicide, it is important to understand individual and familial experiences with the health care system.

Objective: We present the protocol for a study, the objective of which is to explore how people who died by suicide, and their family members, interacted with the health care system.

Methods: This is a quantitative research study. Data will be collected through a self-administered paper-based or online survey of the family member of patients who died by suicide. The sample size was calculated to be 385 (margin of error ±3%).

Results: Data collection will start in October 2020 and results will be available by March 2021. We expect the results to shed light on the experiences of individuals who died by suicide and their family members with the health care system. The study has received ethical clearance from the Health Ethics Research Board of the University of Alberta (Pro00096342).

Conclusions: 

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1/23/23, 9:14 PM JMIR Research Protocols – Family Members’ Perspectives on Family and Social Support Available to Suicidal Patients, and Health Systems’ Int…

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Our study may inform practice, policy, and future research. The �ndings may shape how members of the health care system respond to people who are at risk of suicide and their families.

International Registered Report Identi�er (IRRID): PRR1-10.2196/19112

JMIR Res Protoc 2020;9(11):e19112

doi:10.2196/19112

Keywords

suicide in Alberta (1); suicide (30); family members’ perspectives; social support (49); health systems interactions (1) 

Introduction

Background

Suicide is a serious global public health problem, with an estimated 800,000 people reported to die by suicide every year [ ]. In Canada, suicide remains the 9th leading cause of death and the second leading cause of death among children, youth, and young adults [ ]. Suicide impacts people of all ages and backgrounds in Canada. Every day, an average of more than 10 Canadians die by suicide. There are close to 6000 emergency department visits and 2000 hospitalizations every year for self-in�icted injuries [ ]. For every person lost to suicide, many more experience thoughts of suicide or suicide attempts. For every death by suicide, a large circle of survivors are signi�cantly affected by the loss. Each suicide results in 135 people exposed (ie, who knew the person), who may need clinician services or support following exposure [ ].

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1/23/23, 9:14 PM JMIR Research Protocols – Family Members’ Perspectives on Family and Social Support Available to Suicidal Patients, and Health Systems’ Int…

https://www.researchprotocols.org/2020/11/e19112 3/9

There were 4000 suicides in Canada in 2018 [ ], with more than 500 of these deaths occurring in Alberta. Suicide is consistently a leading cause of death among Albertans. Suicide claims more lives annually than other causes such as motor vehicle collisions and homicides. Over 75% of those deaths occur among men, most between the ages of 30-69 years [ ]. Health care systems play a vital role in suicide prevention. One study in Alberta, for instance, found that the majority of people who died by suicide used a health service in the year prior to their death. They were also more likely to use the emergency department, in-patient services, or community mental health services than those who died from other causes; they typically used health services for mental disorders as well [ ].

In Alberta, which is the site of this study, suicide prevention initiatives, including Living Hope, are underway to enhance aspects of the health care system, as evidenced by the Implementation Plan for the Edmonton Suicide Prevention Strategy [ ]. Living Hope promotes a comprehensive preventative approach that seeks to enhance access to the protective factors that decrease the risk of suicide. The implementation plan upholds the inherent value of every person and recognizes that residents of Alberta, both as service providers and as community members, can offer the compassion, respect, and hope needed to increase resilience and nurture hope for those contemplating suicide [ ].

The Mental Health Commission of Canada, in collaboration with the Canadian Association for Suicide Prevention, the Centre for Suicide Prevention, the Public Health Agency of Canada, alongside an Advisory Committee comprising people with lived experience related to suicide, have developed toolkits to support individuals who have been impacted by suicide. One toolkit is tailored for people who have attempted suicide, and the other is focused on resources for people who have lost someone to suicide [ ].

Beyond stakeholder engagement [ ] and an understanding of the dimensions of service quality [ ], little is known locally about the personal, family, and social circumstances of people who died by suicide in Alberta. Similarly, little is known about how individuals who died by suicide and those close to them experienced the health care system. The current mechanism by which Alberta Health Services (AHS) investigates suicide is through the Quality Assurance Review (QAR). A QAR of an adverse event utilizes the Systems Analysis Methodology, which aims to determine what happened, how it happened, and what can be done to improve care for future patients. This type of review generally involves engaging a multidisciplinary team to examine all of the health care system components (eg, environment, task, policy, etc) as they relate to an event (or group of similar events). This process often results in recommendations aimed at improving the quality and safety of health care delivery. The focus is on improving structures, processes, and/or practices within AHS [ ]. QARs are done following a suicide on a case-by-case basis, and the results are not shared beyond those directly involved. The privacy of the QAR limits case comparison and knowledge translation. Additionally, an understanding of the context of death by suicide is needed, as it is thought to differ from the context of a suicide attempt. QARs usually focus on the health systems’ contributions to the suicide and do not place much emphasis on examining the personal, familial, and societal factors that also contribute to deaths by suicide. One study found that while individuals who attempt suicide generally exhibited similar levels of depression, those who died by suicide were signi�cantly more likely to have experienced signi�cant job stress and �nancial problems, left a suicide note, and used alcohol and drugs prior to the act [ ]. AHS is committed to patient- and family-centered care [ ], which highlights the importance of talking to families about both their own and their relatives’ experiences with the health care system. Ultimately, insight into the experiences of people who died by suicide, and their family members, has the potential to inform policy and practice, and shape how members of the health care system, and AHS speci�cally, respond to individuals who are at risk of suicide.

Objectives

The purpose of this study is to understand better the family and social circumstances of individuals who died by suicide, and how those who died by suicide and their family members interacted with the health care system. This study extends the knowledge to be gained from a recently completed qualitative study that examined family members’ perspectives on health system interactions with those who died by suicide [ ].

Our speci�c quantitative research questions are:

1. What factors related to family, society, and health systems contribute to death by suicide in Alberta?

2. How do individuals impacted by the suicide of a family member perceive their own interactions with the health care system?

To the best of our knowledge, no previous province-wide study has examined the personal, familial, societal, and health systems factors that contribute to suicide deaths in Canada. One study was conducted by Schaffer et al [ ] to investigate the population- based analysis of health care contacts among suicide decedents prior to death by suicide. It was a systematic extraction of data from records at the O�ce of the Chief Coroner of Ontario of each person who died by suicide in the city of Toronto from 1998 to

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