Bakgrund: Mer än 700 000 liv globalt avslutas årligen till följd av suicid och omkring 45 procent av de som dör till följd av suicid har uppsökt primärvård månaden innan. Få studier har dock belyst vårdpersonalens perspektiv på suicidprevention i primärvård. Syfte: Att belysa hälso- och sjukvårdspersonals erfarenheter av att arbeta med suicidprevention i primärvården. Metod: Litteraturstudie baserad på tio kvalitativa studier. Databassökning genomfördes i Cinahl, PubMed och Scopus. Analysen genomfördes med inspiration av Fribergs analysmodell. Resultat: Av analysen framkom att hälso- och sjukvårdpersonal upplevde både hindrande och underlättande faktorer i arbetet med suicidprevention i primärvård. Låg kunskapsnivå, brist på utbildning, resursbrist, tidsbrist och avsaknad av riktlinjer utgjorde de huvudsakliga utmaningarna. Emellertid upplevdes fungerande teamarbete, tydlig ansvarsfördelning, lättillgänglig specialistvård, intuition och lång arbetslivserfarenhet som underlättande faktorer. Konklusion: För att förebygga suicid krävs ett systematiskt arbete samt förbättrad samverkan mellan instanser för att öka patientsäkerheten. Genom att uppmärksamma erfarenheter av brister i verksamheten och åtgärda dessa kan antalet suicid reduceras. / Background: Globally, more than 700 000 lives end annually due to suicide, and about 45 percent of those who died by suicide had visited primary care the previous month. Nonetheless, few studies have shed light on health care professionals’ experiences working with suicide prevention in primary care.  Aim: To illuminate health care professionals’ experiences of suicide prevention within primary care. Method: A literature study consisting of ten qualitative studies. Articles were found using Cinahl, PubMed and Scopus. Analysis was then performed with inspiration from Friberg's analytical model. Results: Findings suggest that health care professionals experienced both barriers and facilitators working with suicide prevention in primary care. Insufficient knowledge and education, lack of resources, time pressure and lack of guidelines were perceived as the main challenges. However, teamwork, clear division of responsibilities, easy access to specialist care, intuition and extensive clinical experience were seen as facilitators. Conclusion: To prevent suicide, a systematic approach and improved collaboration between primary and specialist care are needed. By adopting measures to correct perceived flaws in primary care, the number of suicides could be reduced.

Psykisk ohälsa är ett växande problem i samhället där ambulansteam möter patienterna i prehospital miljö. World Health Organization belyser att psykisk ohälsa ökar och suicid är den näst vanligaste dödsorsaken bland 15–29 åringar. I Sverige år 2020 vårdades 6 666 personer hospitalt efter suicidförsök och samma år omkom 1 168 person till följd av suicid. Studiens syfte var att belysa ambulanssjuksköterskors upplevelser av att möta och vårda suicidala patienter. En intervjustudie genomfördes med sex informanter som alla var ambulanssjuksköterskor. Intervjuerna analyserades med kvalitativ metod med induktiv ansats. Resultatet visar att ambulanssjuksköterskorna upplever det vårdande mötet som komplex och en svår utmaning. De upplever att de är beroende av ett välfungerande kollegialt samspel inför mötet med patienten. Svårigheterna i vårdmötet handlade om att vårda utan frivillighet, känna osäkerhet kring den vårdande kompetensen och att möta hot och våld. Att vara öppen och ärlig, lyssna och ge patienten tid upplevs vara en nödvändig grund i det vårdande mötet. Deltagarna belyser även att mötet berör på ett personligt plan. Ambulanssjuksköterskors upplevelser av det vårdande mötet och vårda suicidala patienter är ett relativt outforskat ämne. Ökad kunskap om hur ambulanssjuksköterskor bör förhålla sig till, möta och vårda suicidala patienter kan förhoppningsvis bidra till ett bättre och ett mer patientsäkert omhändertagande. / Mental illness is a growing problem in society where ambulance teams meet patients in prehospital environments. The World Health Organization highlights that mental illness is increasing and suicide is the second most common cause of death among 15–29-year-olds. In Sweden in 2020, 6,666 people were treated in hospital after suicide attempts and in the same year 1,168 people died because of suicide. The purpose of the study was to shed light on ambulance nurses' experiences of meeting and caring for suicidal patients. An interview study was conducted with six informants, all of whom were ambulance nurses. The interviews were analyzed using a qualitative method with an inductive approach. The results show that the ambulance nurses experience the caring meeting as complex and a difficult challenge. They feel that they are dependent on a well-functioning collegial interaction before the meeting with the patient. The difficulties in the care meeting were about caring without volunteering, feeling insecure about the caring competence, and facing threats and violence. Being open and honest, listening and giving the patient time is perceived as a necessary foundation in the caring meeting. The participants also highlight that the meeting touches on a personal level. Ambulance nurses' experiences of meeting and caring for suicidal patients is a relatively unexplored topic. Increased knowledge of how ambulance nurses should relate to, meet, and care for suicidal patients can hopefully contribute to better and more patient-safe care.

Bakgrund: Suicid är ett globalt förekommande fenomen. Orsakerna till suicid är ofta flera och komplexa, men den största riskfaktorn är tidigare genomfört suicidförsök. På akutmottagningen vårdar sjuksköterskor suicidbenägna människor som vanligtvis intoxikerat eller medvetet skärskadat sig. Sjuksköterskor spelar en huvudroll i det suicidpreventiva arbetet, då de jobbar patientnära. De har i uppgift att lindra lidande i form av exempelvis psykisk smärta. Syfte: Att beskriva sjuksköterskors upplevelser av att vårda suicidbenägna patienter inom akutsjukvården. Metod: Uppsatsen genomfördes i form av en litteraturbaserad studie. Tio kvalitativa artiklar valdes ut och analyserades enligt Fribergs (2022) fem steg. Resultat: Resultatet mynnade ut i tre teman med tillhörande subteman. Teman var: Bristande kunskaper, Skiftande attityder och värderingar och Arbetsmiljö och organisatorisk inverkan på vården. Det framkom att akutsjukvårdens stressiga arbetsmiljö, bristande suicidkompetens och personliga värderingar är faktorer som påverkar eller försvårar sjuksköterskors arbete. Sjuksköterskor önskar att få ytterligare utbildning i suicid och suicidhjälp. Konklusion: Att vårda suicidbenägna patienter är komplext för sjuksköterskor. Det är viktigt att sjuksköterskor besitter kompetens om suicid oavsett arbetsplats. Detta för att kunna göra adekvata suicidriskbedömningar samt förhindra suicid i tid. / Background: Suicide is a global phenomenon. The reasons behind suicide are often many and complex, but the biggest risk is an earlier attempt. Nurses at the emergency department meet suicidal individuals that usually are intoxicated or have slice-wounds. Nurses play a leading role in suicide prevention work, as they work close to patients. They are tasked with alleviating suffering, as for example psychical pain. Aim: To describe nurses’ experiences of caring for suicidal patients within emergency healthcare. Method: A literature-based study was made. Ten qualitative articles were selected and analyzed according to Friberg’s (2022) five steps. Findings: The result became three themes with belonging subthemes. The themes were: Lack of knowledge, Various attitudes and values, Work environment and organizational impact on the care. It appeared that the stressful work environment of emergency healthcare, lack of suicide competence and personal values affects or complicates nurses’ work. Nurses want further education about suicide and suicide help. Conclusion: Caring for suicidal patients is complex for nurses. It is important that nurses have competence in suicide, regardless of workplace. This because they must be able to do adequate suicide risk assessments and prevent suicide in time.

Suicide is the 10th leading cause of death in the U.S. and has increased in prevalence during the past 15 years. Patients who attempt suicide are more likely to have contact with their primary care provider than a mental health provider in the month before attempting suicide, highlighting the need for competency in suicide ideation (SI) assessment. The Communications Skills for Health Professionals is an interprofessional course involving first-year medical, nursing, and pharmacy students. Specific instruction regarding assessment of SI was delivered through an online module and later practiced by students with standardized patients (SP). A final Objective Structured Clinical Examination featured an SP with depression, but without SI, though an assessment of SI was indicated. Three hundred fifty six interviews were reviewed and 55.1% (196/356) of students assessed for SI. Across professions, 65.5% (93/142) of medical students, 52.5% (32/61) of nursing students, and 46.4% (71/153) of pharmacy students performed an assessment. Medical students’ SI assessment was highest across the groups (p = 0.001), while pharmacy students’ SI assessment was lowest (p = 0.004). Results suggest that additional educational strategies should be developed and implemented to increase SI assessment performance in all professions, but especially in pharmacy students.

Suicide is the third leading cause of death among youth and young adults ages 10--24. In 2001 the U.S. Surgeon General laid out a national strategic plan to more effectively address suicide prevention (United States Public Health Service, 2001). In 2008, Gene Cash, then president of The National Association of School Psychologists, made a "call to action" to prevent suicide. Although suicide prevention has been repeatedly identified as a priority in mental health care, the vast majority of interventions with suicidal youth are not evidence based due to a lack of research utilizing controlled studies (Daniel & Goldston, 2009). Unfortunately this leaves mental health professionals (MHPs) to routinely implement interventions that are not research based and not proven effective in deterring suicidal thoughts and actions. No-suicide contracts (NSCs), commonly used in clinical and medical settings, solicit a commitment from a suicidal individual, a promise not to complete suicide. The prevalence of school-based MHPs' use of NSCs with suicidal youth (SY) is unknown. Additionally, minimal feedback is available regarding MHPs' perceptions of and current practice regarding implementation of NSCs. Likewise, school policy directing MHPs' intervention when working with SY is neither well described nor understood. A brief survey was created to access these perceptions and practices. Of 326 MHPs attending a Utah Youth Suicide Prevention Conference, 243 completed a survey (74.5% participation rate). Half of participants intervening with SY reported using NSCs. Only 27 of the 243 participants indicated that their school's policy encouraged or required a NSC. Only 8 participants reported knowledge of a formal written school policy that specifically guided their intervention with SY. Reasoning underlying decisions to use or not to use NSCs were explored. Common explanations included attending to individual student needs, following perceived guidelines, building trust with SY and adapting contracts to fit student needs, and opening discussion about suicide. Several participants expressed a need for additional training with no-suicide contracting. A few participants called for either renaming NSCs or implementing a similar, but more positive, "commitment to treatment" strategy. Participants did not mention a need for additional research to explore the efficacy of NSCs. In fact, research was not mentioned. This reflects the gap between research and practice and the dependency on personal experience and going along with the status quo versus depending on research findings to dictate improvement and change in practice.

For youth between the ages of 10 and 24, suicide is the third leading cause of death. School-aged youth that struggle with suicidal thoughts often express their feelings to peers and some trusted adults. Generally, these trusted adults work in school settings. Potentially, teachers and staff can serve as vital gatekeepers to identify and support students who struggle with suicide ideation. In particular, paraeducators, who are often seen as less of an authority figure, become easier to approach due to the personal relationships created in small groups and one-on-one interactions with students. If trained in suicide prevention, paraeducators, who work closely with students and are part of the local community, could become an important gatekeeper. The current study sought to investigate paraeducators' perceptions of the following questions: (a) Are paraeducators approached by students with suicide ideation? and (b) How are paraeducators currently responding to suicidal students? The final purpose of this survey was to collect information that informed and supported the implementation of training for paraeducators in the area of school-based suicide prevention and intervention. This study's survey was distributed in an urban Utah school district to 854 paraeducators. Of the 854 surveys, 77 surveys were completed by paraeducators (9% participation rate). Of the participating paraeducators, 32% reported being approached by a student who expressed suicidal thoughts. Paraeducators indicated that their most frequent response to suicidal students was to provide counsel (39%), whereas to tell supervising teachers or administrators was listed as their third or fourth response option. Most paraeducators (97%) perceived that their role included reporting a student at-risk for suicide, however most (67%) reported having no suicide training or being unsure of what training was available. This lack of training is problematic due to the number of paraeducators being approached by students expressing thoughts of suicide. Additionally this research supports the need to train school support staff.

Best practices in adolescent suicide prevention include teachers as major participants, because teachers are in a unique and frontline position to support students. Unfortunately, many teachers are unaware of their role in suicide prevention efforts. In addition to confusion about their roles, teachers may feel uncomfortable and/or lack confidence in their abilities to identify warning signs and intervene with suicidal students. This study assessed secondary teachers' (N = 74) perceptions of their role in suicide prevention as well as how they perceive their comfort and confidence levels in identifying and intervening with suicidal students. In addition, this study explored possible reasons teachers might feel uncomfortable assisting in suicide prevention. While teachers overwhelmingly agreed that they should have a role in adolescent suicide prevention, teachers also reported having limited confidence in their ability to identify or help potentially suicidal youth. Teachers also acknowledged limited training, fear of making the situation worse, and fear of legal repercussions as potential barriers to participating in suicide prevention efforts. Consequently, teachers will benefit from more direct training which clearly identifies their roles and allows opportunities for teachers to role play.

Suicide ranks as the second leading cause of death for youth aged 10-24. To address this public health problem, novel and effective risk mitigation interventions are needed. Evidence-based research has found that collaborative safety planning is a promising approach to reducing suicide risk. Traditionally, safety plans have been administered in a paper-based format. Emerging research has attempted to translate suicide prevention safety plans to mobile Health (mHealth) smart technologies (i.e., mobile apps); yet, this work is still in preliminary stages and lacks systematic assessment, especially mHealth apps for youth. Our research aims to highlight the needs of technological solution for suicide safety planning and call attention to the shortcomings of baseline safety planning apps so that mHealth researchers can build a better solution for youth to manage their mental health. To do this, we developed a mobile application for suicide safety planning called “SafeLINC.” We had young adult participants assess and compare this newly developed app with an open-source suicide safety planning app currently available for use (i.e., “Suicide Safety Plan") to identify whether either app would be useful for youth to manage their mental health through safety planning. SafeLINC is an Android and iOS app that incorporates the six dimensions of Stanley and Brown’s framework for suicide safety planning as well as sharing safety planning data with parents and clinicians, and visualizing safety planning data over time. We conducted a user study with ten college students (ages 18-21). We first aimed to understand how they currently managed their mental health and their perceptions. Then we asked them to complete a core set of tasks across both suicide safety planning applications to conduct a comparative analysis of the strengths and weaknesses of the two apps. We also asked participants to suggest new features to incorporate into the apps that would better support their mental health and coping strategies. We found that most participants use a variety of emotional outlets to cope with their mental health; sometimes using online tools to support these outlets. When using the apps, participants overall preferred SafeLINC to the baseline app because it allowed them to connect with their support network, provided better guidance in the creation of their safety plans, and enabled them to keep track of changes to their mental health. However, participants identified barriers that could inhibit their use of safety planning applications. For example, the downsides of including parents or guardians in the support network, unclear terminologies, and reminding negative feelings were prominent perceptions while using the SafeLINC app. Participants offered suggestions relating to the weaknesses they observed in both apps. Our study highlights how suicide safety planning apps may be beneficial to manage mental health, but contextual factors may still affect usage. We provide recommendations for overcoming these challenges based on the insights gained from our study.

This qualitative study reviews the document “Insatser inom området psykisk hälsa och suicidprevention 2023" published on the government´s website. This is done with the purpose of identifying and problematizing how risk groups are presented in the government and SALAR's document regarding mental illness and suicide. Furthermore, the document also examines and problematized whether sociological factors emerge as the underlying reasons why certain groups are identified as riskgroups. By using critical discourse analysis as a method of analysis, risk groups can be demonstrated, sociological factors identified, and the document critiqued. In Sweden, the state has overall responsibility for mental health and together with Sweden's municipalities and regions, the government has entered into an agreement, which is presented in the analysed document. The result we found is that the risk groups identified are not presented specifically as risk groups in the document. What the document focuses on is that certain interventions should be put in place for these individuals without any direct interventions being specified. During the work on the critical discourse analysis, it has become clear that the document lacks important information that makes credibility disappear. The document feels like a compilation of previous information as they talk about the shortcomings that exist for mental illness and suicide prevention, although this is not a single reference in the document. / I denna kvalitativa studie granskas dokumentet ”Insatser inom området psykisk hälsa och suicidprevention 2023” publicerat på regeringens webbsida. Detta görs med syftet att påvisa och problematisera vilka riskgrupper som presenteras i regeringens och SKR:s dokument gällande psykisk ohälsa och suicid. Vidare undersöks och problematiseras om det i dokumentet framträder sociologiska faktorer som ligger till grund varför vissa grupper pekas ut som riskgrupper. Genom att använda kritisk diskursanalys som analysmetod kan riskgrupper påvisas, sociologiska faktorer identifieras och dokumentet kritiseras. I Sverige har staten det övergripande ansvaret för den psykiska hälsan och tillsammans med Sveriges kommuner och regioner har regeringen ingått en överenskommelse, vilket presenteras i det analyserade dokumentet. Det resultat vi funnit är att de riskgrupper som identifieras, inte presenteras specifikt som riskgrupper i dokumentet. Det som dokumentet fokuserar på är att vissa insatser bör sättas in för dessa individer utan att inga direkta insatser specificeras. Under arbetets gång med den kritiska diskursanalysen har det tydliggjorts att dokumentet saknar viktig information som gör att trovärdigheten försvinner. Dokumentet känns som en sammanställning av tidigare information då de talar om vilka brister som finns för psykisk ohälsa och suicidprevention, trotts detta finns inte en enda referens i dokumentet.

ABSTRACT Background: Suicide is one of the leading causes of death worldwide and a serious public health issue. A prior suicide attempt is therefor a significant risk factor for future suicide, which could be preventable with evidence-based interventions. Stigmatization surrounding mental health and suicide has led to many people that are thinking of suicide, or those who have attempted it, to not seek help. This increases the risk for future suicide attempts, and therefore the amount of deaths.    Aim: The aim of this study was to describe patients experiences of support and care after a suicide attempt.    Method: A qualitative literature study where 14 articles were included from the databases PubMed and PsycInfo. The articles were quality reviewed using the SBU’s quality assessment template and were analyzed using the meta-synthesis method.    Result: Experiences of inadequate care were mostly based on insufficient knowledge, deficiencies in how patients were treated, stigmatization and fear, and bad quality of care. Experiences of good care were mostly based on patient centered care, a strong patient-personal relationship, good care meeting, and patient involvement. The patients emphasized the need to be heard and support from others in the same situation.    Conclusion:  Three main categories were identified that described how patients experienced support and care after a suicide attempt: experiences of inadequate care, experiences of good care, and favorable factors for good care. The results highlighted the need for more knowledge among nurses to ensure the best possible care for people who have gone through a suicide attempt.   Keywords: Nursing Care, Patient Experience, Suicide Attempt, Suicide Prevention. / SAMMANFATTNING Bakgrund: Suicid är en av de ledande dödsorsakerna i världen, och ett allvarligt folkhälsoproblem. Ett tidigare suicidförsök är en stor riskfaktor för senare suicid, vilket anses kunna förebyggas med evidensbaserade insatser. Stigmatisering kring psykisk ohälsa och suicid har lett till att många människor som tidigare begått suicidförsök eller har tankar om det, väljer att inte söka vård vilket ökar risken för fler suicidförsök och därmed dödsfall.  Syfte: Syftet var att beskriva patienters upplevelse av stöd och vård efter suicidförsök.   Metod:  En kvalitativ litteraturöversikt där 14 artiklar inkluderades från databaserna PubMed och PsycInfo. Artiklarna kvalitetsgranskades med SBU:s kvalitetsgranskningsmall, och innehållet analyserades med hjälp av metasyntesen.    Resultat: Upplevelser av bristande vård grundade sig främst i otillräcklig kunskap och kompetens, brister i bemötande, stigmatisering och rädsla, samt brister avseende vårdkvalitet. Upplevelser av god vård grundade sig mycket i personcentrerad vård, god relation mellan patient och vårdpersonal, vårdpersonalens goda bemötande, samt delaktighet. Patienterna framhävde även behovet av att bli hörd och få stöd av andra i samma situation.    Slutsats:  Tre kategorier identifierades som beskrev hur patienter upplevde stöd och vård efter suicidförsök; upplevelser av bristande vård, upplevelser av god vård, och gynnsamma faktorer för god vård. Resultatet visade på att det krävs mer kunskap och kompetens hos sjuksköterskor för att bemötandet av patienter som genomgått ett suicidförsök ska bli så bra som möjligt.    Nyckelord: Bemötande, Patienters upplevelse, Suicidförsök, Suicidprevention, Omvårdnad.