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Mapping workplace interventions to prevent suicide involves analyzing their effects, mechanisms, implementation, and costs, as well as evaluating how they are assessed. As suicide disproportionately affects working-age adults and has significant repercussions for individuals and families, employers are obligated to ensure a safe work environment, which includes promoting mental health and addressing suicide prevention.
Annually, over 700,000 people die by suicide, with many more attempting it, particularly among those of working age. In England, suicide ranks among the top causes of death for people aged 20–64. It’s a devastating event that impacts individuals and families deeply, increasing the risk for others in the family. Suicide is complex, with genetic, psychosocial, and cultural factors playing a role, making prevention strategies challenging.
While employment is generally a protective factor, certain job pressures and high stress can elevate suicide risks, especially in specific occupational groups. For instance, between 2011 and 2015, men in low-skilled occupations, particularly construction, had high suicide risks in the UK. Female artists and nurses also faced increased risks. Similar patterns were seen in Sweden, where men in male-dominated professions and women in female-dominated professions showed elevated risks.
Barriers to help-seeking behavior among the working population include fears about career impacts, stigma, and confidentiality concerns. Most individuals who die by suicide never engage with mental health services, emphasizing the role of organizations in prevention.
Employers have a legal and ethical obligation to ensure a safe working environment, including addressing suicide prevention and promoting mental well-being. Suicide among employees can significantly impact morale and productivity. Hence, suicide prevention is crucial for organizations to support their employees’ well-being, meet their obligations, and maintain productivity.
However, the evidence supporting workplace suicide prevention is limited. While psychosocial interventions like cognitive-behavioral therapy have shown effectiveness in reducing anxiety and depression symptoms, more comprehensive approaches are likely needed, given the wide-ranging risk factors for suicide.
This review aims to map out organizational interventions for workplace suicide prevention. It seeks to identify the effects, mechanisms, moderators, implementation, and costs of such interventions, evaluate how they’re assessed, and make recommendations for practice and further research.
Workplace suicide prevention interventions are complex, requiring evaluation from a realist perspective to determine effectiveness for different contexts and individuals, rather than traditional scientific methods focused on effect size. Realism aims to understand how interventions work through the interaction of context, mechanisms (causal forces), and outcomes (intended and unintended).
This scoping review explored global workplace suicide prevention interventions across industries, outlining their mechanisms by socio-ecological level and summarizing their effectiveness, moderators, implementation barriers and facilitators, and economic costs. Most interventions focused on immediate environment factors, including assessment, treatment, referral, and crisis support.
Over the past two decades, most relevant studies were published within the last ten years, with nearly half conducted in North America and others globally, including three in low- and middle-income countries. These interventions span various sectors, with a notable presence in construction and military industries.
However, no randomized controlled trials have been conducted to determine the efficacy of workplace suicide prevention interventions, making causal relationships difficult to establish. Nonetheless, studies consistently showed reduced suicide rates or risks post-intervention.
Interventions were successful in altering beliefs and attitudes, which are linked to suicidal behavior. Modified attitudes were observed, though studies didn’t directly link these to reduced suicide behaviors. Industries with higher suicide rates have seen more intervention initiatives.
Understanding which elements of these programs are most effective is crucial. Currently, it’s unclear which mechanisms are most impactful, and whether cultural or procedural factors influence their effectiveness.
Certain sectors have higher suicide rates, like construction and military, while nursing also sees elevated risks among women. However, despite higher rates of suicide attempts among women, deaths by suicide are more common among men. Gender differences in help-seeking behaviors and suicidal methods contribute to this paradox.
The review suggests a need to explore gender-specific organizational suicide prevention strategies, especially in high-risk professions like nursing. Intersectionality should also be considered in future research to address other characteristics like ethnicity, sexuality, and disability in suicide prevention strategies.
The review indicates difficulty in making definitive conclusions due to the diversity of studies. However, it suggests that organizational suicide prevention programs can positively impact attitudes toward suicide and reduce suicide risk. Although it’s unclear which elements are most effective, education to recognize signs of stress and mental health issues seems promising. Interventions should be adapted to specific contexts, as demonstrated by successful adaptations like MATES from construction to energy sectors and HEAR from medical students to nurses. Trust is crucial, especially in sectors where health disclosures could affect careers, like the military.
Source:
Hallett, N., Rees, H., Hannah, F., Hollowood, L., & Bradbury-Jones, C. (2024). Workplace interventions to prevent suicide: A scoping review. PloS one, 19(5), e0301453. https://doi.org/10.1371/journal.pone.0301453