Conference Agenda

Introduction

Members of the Traveller community in Ireland represent 1% of the population yet account for 10% of national suicide deaths, making surveillance of suicide in this ethnic group a key public health priority. This study aimed to investigate the surveillance of probable suicide among Irish Travellers using mixed methods.

Methods

Phase 1 involved analysis of probable suicide data among Travellers collected in 2024 compared to national rates in 2021 from the Central Statistics Office, alongside Traveller population data from the 2022 Census. Phase 2 involved one-to-one interviews with nine professionals involved in Traveller suicide surveillance who gather and submit probable suicide data, such as community-workers and Traveller Mental Health Coordinators. Data was thematically analysed. Two female lived experience representatives from the Traveller community shaped Phase 2 design and analysis.

Results

Phase 1 identified 32 probable suicide deaths among Travellers resident in Ireland in 2024 (21 male). The suicide rate was 97 per 100,000—ten times higher than the general population. Traveller men's rate (130 per 100,000) was eight times higher, while Traveller women's rate (66 per 100,000) was fifteen times higher than national counterparts. Phase 2 shows that recording is more organised in recent times, with allied organisations and services collaborating to gather information. However, surveillance is fragmented and variable across counties, which can lead to recording inconsistencies. Facilitators included positive local relationships, media communication, formal agreements around confidentiality, sharing of information and collaborative community response plans. Barriers included difficulties linking related deaths across counties, confidentiality concerns, verification challenges during clusters and stigma.

Conclusions

Findings highlight the need for a formal, centralized, real-time co-owned surveillance system with two-way information flow. Recommendations include establishing governance structures, harnessing existing community relationships, co-producing surveillance capacity with Travellers, eliminating parallel processes through coordination, enabling standardized yet contextual data collection, and addressing resource gaps.

Intro: The underreporting of suicide is a well-recognised problem. Suicide rates may be underestimated by 10-30%. A recent study estimated that instead of 727,000 deaths due to suicide per year, the actual number may be closer to one million.

Death by suicide may not be reported due to stigma, illegality of suicide attempt, or financial and other disincentives. Even if a death is reported, it may be reported as death due to other causes such as accidents. Nigeria has higher than regional age standardized suicide rate. Suicide attempt is criminalised with evidence of stigma and underreporting.

Methods: Process mapping is a technique in health care quality improvement to understand how patient pathways work. We employ the process mapping framework to understand pathways of underreporting and misreporting of suicide in Nigeria as part of a larger study conducted by the Ministry of Environment and funded by the University of Edinburgh.

Process mapping will comprise of interviews with 30-50 key informants such as local leaders and administrators, religious leaders, local health practitioners, police, coroners, mortuary and funeral staff and others. A series of open-ended questionnaires were developed for each type of key informants. The interviews will take place in the spring of 2026 in Kano state in Nigeria. Two trained researchers will conduct interviews in several districts selected following random sampling.

Results:

The outcome will include a process map with clearly defined reporting pathways between death, the notification of death, attendance by medical certifier, completion of the death certificate, submission of the information contained in the death certificate to authorities in charge of civil registration. It will identify points in this process where misreporting or non-reporting can and do occur.

Conclusions: The results will help improve suicide surveillance in Nigeria, reduce stigma and increase numbers of correctly reported incidences.

Background: Delayed discovery following suicide death substantially limits opportunities for early intervention that could prevent fatal outcomes. The timing of discovery may reflect pre-existing social isolation and disconnection prior to death and provide insight into blind spots within current suicide prevention frameworks.

Objective: To examine sociodemographic and suicide-related characteristics by time of discovery and identify factors associated with delayed discovery.

Methods: : We analyzed 96,337 suicide decedents aged 10 years or older, using data from the Korean National Investigations of Suicide Victims Through Police Records (2013–2020). Discovery timing was categorized as: alive at discovery (reference), within 24 hours, and after 24 hours. Group differences were compared across sociodemographic, situational, and suicide-related characteristics. Multinomial logistic regression was used to examine factors independently associated with delayed discovery.

Results: Among all suicide decedents, those discovered more than 24 hours after death were predominantly middle-aged 40–59 years (50.3%), living alone (64.0%), and had a high proportion of gas poisoning (34.7%). In multivariable analyses, living alone (aOR=9.17, 95% CI: 8.62–9.75) and deaths occurring outdoors (aOR=27.53, 95% CI: 21.69–34.93) were strongly associated with delayed discovery. Mental illness was more frequently reported as the primary cause among cases discovered alive (41.0%), whereas economic problems were more common among cases with delayed discovery (33.7%).

Conclusions: Suicide prevention strategies have primarily focused on individuals classified as high risk, particularly those with mental illness or advanced age. Suicides among middle-aged adults associated with economic difficulties are associated with delayed discovery and social factors, including living alone and deaths occurring outside the home. These patterns appear to be less readily captured by conventional risk classification frameworks. These findings underscore the need for preventive approaches that extend beyond high-risk groups to include socially isolated middle-aged adults experiencing economic instability.

Introduction: The incidence of people being reported missing has increased globally over the last decade. Complex mental health and psychological distress, including suicidal thoughts and behaviours, are risk factors associated with being reported missing. Yet, the evidence connecting being reported missing and dying by suicide is scant.

Methods: To explore this link, we undertook a case record analysis of data sourced from the Australian National Coronial Information System. We searched for cases of suicide deaths that occurred between 01 January 2017 and 31 December 2024 in one Australian state (New South Wales) in which there was a reference to ‘missing person’. Data was extracted from police and coronial reports, along with demographics, mental health history, previous suicide attempts, engagement with mental health services, and interventions offered while missing. This data was used to examine the relationship between going missing and suicide.

Results: A total of 186 eligible records were identified. Fifty-one (27.9%) records identified a history of prior suicide attempt before being reported as a missing person. Time missing ranged from less than 1 day to 165 days, with people missing for an average of five days prior to being located deceased by suicide. Thirty-seven (20.0%) individuals shared or left a note highlighting an intention to die by suicide, and just under half (42.0%) of records demonstrated the individual was connected via their mobile device while missing. Regression analysis identified links between demographic information and missing event details (e.g., distance from home, length of time missing, and phone use).

Conclusion: The findings offer insight to better understand the trajectory between going missing and dying by suicide. The analysis suggests there may be a window between disappearance and death in which to deliver a suicide intervention by SMS, but that it's imperative that any such intervention is trauma-informed to minimise harm.

Background

Individuals living with chronic neurological diseases face a substantially elevated risk of suicide compared with the general population. Despite this, little is known about how these patients interact with the healthcare system in the weeks and months preceding suicidal behavior, and whether identifiable high‑risk periods exist. A detailed understanding of healthcare utilization around suicidal events may enable more precise, well‑timed preventive strategies rather than broad, non‑targeted interventions.

Aim

To identify critical healthcare contact points that may signal acutely elevated risk of suicidal behavior among individuals with chronic neurological diseases, and to determine whether risk varies with disease progression and across healthcare sectors.

Methods

We conduct a nationwide observational cohort study of using Danish registry data (2010–2021), including adults newly diagnosed at a neurological department. We map healthcare utilization in 30‑day windows before and after suicidal behavior (suicide, suicide attempt, self‑harm). Incidence rates of suicidal behavior are also estimated. Relative risks will be estimated using Poisson regression, and absolute risks will be calculated using competing‑risk methods. Supplementary analyses examine sex, age groups, and psychiatric history.

Results (hypothesized)

We hypothesize that distinct patterns of healthcare contact may emerge in the period leading up to suicidal behavior among individuals with chronic neurological diseases. Healthcare contact peaks may be observable shortly before suicidal events, potentially varying across sectors. Acute high‑risk periods may occur in the weeks following neurological outpatient consultations or neurological hospitalizations, reflecting fluctuations in disease progression, functional impairment, or treatment transitions. Markers of disease progression - including repeated neurological consultations, frequent healthcare engagement, or multiple neurological hospitalizations - may be associated with increased incidence rates of suicidal behavior.

Conclusions

By identifying concrete moments in the healthcare pathway where suicide risk escalates, our findings aim to support the development of targeted, timely prevention strategies within both neurological and primary care settings.

Background

Despite considerable interest in detecting, understanding, and preventing suicide clusters since the 1980s, suicide cluster surveillance is only now becoming a possibility. This is due to the development of several “real-time” suicide monitoring systems that manage current and precise suicide information. Here, we report our approach to real-time suicide cluster monitoring.

Method

Using monthly data updates from a real-time register in the Australian state of Victoria, we routinely search for clusters using the scan statistic. We then output a timely report to the Coroner’s Court of Victoria (the data custodians), who can initiate various responses.

Results

We search for clusters with a high precision cluster detection method (space-time permutation elliptical scan statistic) and are able to detect clusters in precise geographical areas (circular or ellipse shape) in units of days.

Discussion

Real-time suicide monitoring systems open the door to suicide cluster surveillance that, through rapid cluster identification, might be able to limit the growth and/or community impact of suicide clusters. Here, we discuss our application of the best practice cluster detection algorithm for real-time cluster surveillance.