Conference Agenda

Simulation and iterative model assessment are widely used in the natural sciences but remain underutilized in medicine and the social sciences. In suicidology, recent work has highlighted simulation as a promising avenue for advancing suicide prevention (Gariepy et al., 2024), aligning with earlier calls for attention to individual-level processes (Michaud et al., 2021), suicide dynamics (Rudd, 2006), and the nonlinear nature of time-domain processes (Bryan et al., 2020). This approach was applied in a suicide dynamics study using Ecological Momentary Assessment to evaluate suicide risk in patients with recent suicide attempts.

The aim was to use pre‑emptive model specification and individualized simulation of suicide risk to improve methodological design and theoretical understanding before data collection. A Bayesian generative model was constructed to clarify how modelling choices affect suicide‑dynamic properties, study design, and analytical strategies. Informed by prior empirical findings, the model incorporated individualized risk factors and their distributional properties, transfer functions linking each univariate factor to increases in suicide risk, and the multivariate aggregation of overall risk accounting for all factors.

Results showed that this approach yielded valuable insights into how modelling decisions influenced theoretical interpretation and design. Benefits were especially evident for individualized processes, an area with limited research. Simulating individual behaviour improved understanding of distributional characteristics, hyperparameter selection, and aggregation effects. This improved study quality by, aligning theoretical description of idealized behaviour with univariate and multivariate effects, defining different model parametrisation explaining similar outcomes and identify limitations in what can and cannot be evaluated.

Overall, although pre‑emptive modelling requires extra time during preparation, it streamlines later stages of method development and data collection and provides clear gains in methodological, analytical, and theoretical robustness.

Background

Suicide registers have been developed in many countries and many now provide near-real time information on the incidence of suspected suicides. While the data is available in real-time, tools to understand and interpret the data have yet to be developed. This poses challenges when determining if suicides have increased.

Methods

The aim of this study is to evaluate the usefulness of statistical control chart methodology for monitoring monthly suicides.

Results

Using data from the Victorian Suicide Register, I show how two sources of variation – shocks and gradual changes – can be detected using u-charts and exponentially weighted moving average charts. I discuss how to identify a calibration period to tune the upper and limits, how to calculate appropriate limits in the monitoring period and how to interpret the charts.

Conclusion

The availability of near real-time data presents new challenges for decision making. Statistical control methodology is widely used in other areas of health care, and the use of that approach here could provide decision-makers with better information on when suicides are increasing, for whom, and what the possible causes of that increase might be.

Research ethics is about how research must be conducted in a specific correct way.

During WW2, research was dehumanized and experiments with humans were done without limitations (Mengele, for example). Afterwards, in the attempt to give ethical guidance for research, one looked back to the Age of Enlightenment, and three principles became fundamental: Neutrality, utility, and the categorical imperative (Kant), meaning that these principles should be universal. These principles provide the basis for the formal ethics that researchers meet in institutional ethics reviews. Much effort seems put into the evaluations to protect vulnerable participants, who is exactly what suicide research targets.

In qualitive suicide research, the researcher must deal with two kinds of ethics: The formalized ethics described above, and practical ethics that involves the ethical choices made during the research process. Practical ethics is prominent in qualitative research since this is a flexible approach, which must adjust to the participants, the context, as well as to unforeseen incidents. Formal ethics, however, is tailored to quantitative biomedical research, which does not allow necessary flexibility during the research process. Pre-emptive formal regulations thus frequently both hinder practical ethical adjustments during the research process and are an impediment for good quality qualitative research. The formalized concept of vulnerability refers either to an assumed incapacity of the participants to provide informed consent, or to a higher susceptibility to harm. However, precautions to protect participants must be taken during the research process in the particular context through sensible practical ethical adjustments. The researcher’s possibility to make necessary adjustments is threatened by pre-emptive formal regulations, which can do harm to both participants and research.

This paper discusses these problems for suicide research and reflects on possibilities to overcome these obstacles.

Lived experience involvement is increasingly called for in suicide research, yet it remains unclear what this inclusion means in practice. Our meta-ethnography critically explored how lived/living experiences of suicide are defined, conceptualised and engaged with in qualitative research, and how this is experienced by advisors/co-researchers involved in it.

Methods

Following meta-ethnography guidance and predefined protocol (CRD42024610503), systematic searching was employed to identify relevant peer reviewed articles. From 8849 retrieved records, 241 articles were included. Definitions of lived experience and modes of engagement were identified by charting study characteristics and using research questions as a priori headings. Translational analysis was only possible with 11/241 articles that contained primary data reflecting the views of people with lived/living experience (LLE) about their involvement in research.

Results

Findings highlight involvement of people with LLE was often limited to the role of research participant, with a recent growth in studies adopting co-production approaches. However, few studies critically engage with, define lived experience, or report how involvement with research was supported or experienced by people with LLE. Experiences of involvement were more frequently reported when lead authors/researchers reported having LLE therefore holding autonomy over disclosure. In contrast the experiences of advisory groups/peer researchers were typically unreported or framed by academics. Preliminary translational analysis further reinforces the complex but pertinent power dynamics evident in how lived experience involvement in suicide research is experienced and reported.

Conclusions

The term 'lived experience of suicide' remains conceptually ambiguous. Furthermore, insufficient attention to the purpose, process and impact of lived experience involvement undermines its complexity and need for a considered approach. Overall, improved reporting of lived experience involvement in suicide research beyond the role of participant is needed, both to honour this experience and exemplify the value of this involvement, not only to the research process and outcomes, but the individuals involved.

Introduction. This study uses the Delphi expert consensus method to work with lived-experience experts and establish research priorities to advance our understanding of male suicide risk and recovery.

Methods. Items for the Delphi were generated via findings from two recent quantitative and qualitative systematic reviews on male suicide, a comprehensive grey literature search, responses to a global survey on male suicide, and feedback from a panel of 10 international academic/clinical male suicide experts. A 2-round Delphi study was conducted to gain consensus among 242 lived-experience experts representing 34 countries on 135 potential male suicide research questions. Panellists were asked to rate each item on a 5-point Likert scale from ‘should not be included’ to ‘essential’. Consensus was defined as 80% of respondents scoring an item as “Essential” or “Important”.

Results. After 2 Delphi rounds, consensus was reached on 87 items. The final questions were then grouped by the author team and expert academic/clinical panel into thematic clusters to create a 22-point agenda of research priorities.

Conclusion. A final agenda of 22 research priorities was developed. Questions related to ten thematic domains: 1. Relationships with others, 2. Relationship with self, 3. Relationship with emotions, 4. Mental Health, 5. Suicidal behaviours, 6. Early life experiences, 7. Structural challenges, 8. Cultural challenges, 9. At-risk groups, and 10. Support and recovery. The three highest endorsed items related to loneliness and isolation (98%), feelings of failure (97%), and sources of stress and emotional pain (96%) for men who are suicidal.

Introduction:
Self-harm risk, defined as deliberate self-inflicted injury regardless of intent, is dynamic yet typically research relies on retrospective methods that are insufficient to capture this variability. Sleep disturbances are increasingly recognised as a key risk factor for self-harm, particularly in young people. Ecological Momentary Assessment (EMA), repeated data collection in natural environments, offers a valuable method for examining these short-term processes in real time. However, EMA protocols are rarely co-designed with young people, despite growing recognition that participatory approaches can enhance acceptability and relevance. This project aimed to develop an accessible, feasible and acceptable EMA protocol with young people for a future assessment of the relationship between sleep and self-harm.

Methods:
Seventeen young people aged 18-24 with lived experience of self-harm contributed to six iterative co-design workshops, alongside individual discussions and a two-day pilot of the proposed EMA protocol. Through discussions, activities and feedback, participants collaboratively shaped the EMA protocol with the research team. Acceptability of the co-design process was assessed using post-workshop surveys and qualitative feedback.

Results:
The co-design process informed key methodological decisions, including personalised scheduling aligned with sleep and daily routines, accessible youth-friendly recruitment materials (e.g. participant information sheet) and safety and distress management procedures. This resulted in a 14-day EMA protocol with three surveys per day assessing sleep, mood, context and self-harm. All completed post-workshops surveys indicated that participation was not distressing. Open-text survey responses and informal feedback reflected positive experiences of involvement, including feeling valued and heard in a safe environment.

Conclusions:
This study demonstrates the feasibility and value of co-designing EMA research with young people who have lived experience of self-harm. Refining EMA design through participatory methods can strengthen ethical practice, improve feasibility and produce protocols that better reflect young people’s lived realities. Insights from this work informed subsequent sleep and self-harm research.