Dr. Rahel Eynan is a researcher with Lawson Health Research Institute who has dedicated her life to studying the nature of suicide and those affected. 

She is the lead author on a study recently published in Suicide and Life-Threatening Behavior by The American Association of Suicidology. A first of its kind in the world, this study retrospectively compared the psychosocial and clinical characteristics of people who have died by suicide and left an E-note with those who left a paper note, or no note at all. 

“Suicide notes are intimate last communications left by suicide decedents to their loved ones, friends or foes,” explains Dr. Eynan. Only a minority of suicide decedents leave a suicide note, which is defined as a message expressed by a person who intends to end their life. 

Typically, the notes are handwritten on paper, walls, body parts or mirrors. However, electronic suicide notes have been reported with increasing frequency including communication through email, text messages, tweets, blogs, video sharing websites, chat rooms and posts on social media networks. 

This emerging phenomenon remains generally under-researched. 

“The notes play an important role in forensic investigations and have evidentiary value in the courtroom. They are also considered integral to understanding suicidal behaviour as they provide a unique opportunity to examine an unsolicited account of the person’s thoughts and emotions prior to the self-destructive act,” says Dr. Eynan. 

This study was embedded in the Southwestern Ontario Suicide Study (SOSS) and was conducted  in collaboration with the Office of the Chief Coroner and Ontario Forensic Pathology Services and the London regional coroner office. The researchers collected data for 476 deaths by suicide that occurred between January 2012 and December 2014. Socio-demographic, psychosocial and clinical characteristics were collected with a modified version of the Manchester questionnaire used in the UK. 

“Note leaving does not appear to be a random phenomenon among suicide decedents. There are common characteristics between those that do offer a final communication and in what form,” states Dr. Eynan.

They found that final communication was left by 45.8 per cent of the individuals and of those almost 75 per cent left notes that were handwritten or typed. Electronic notes were left by 17.9 per cent, usually in the form of text messages, and 7.8 per cent left a combination of paper and electronic notes, as some people left more than one. Some notes contain a just a single word while others were several pages in length. 

The average age of suicide decedents is 47.2 years old and the majority are men. Death by suicide often happens after a major life transition, including those involving finances, business and employment or the dissolution of a marriage or relationship. In some cases, it is associated with a mental illness. 

Those who did not leave a note were more likely to have had a diagnosed mental disorder; histories of self-harm; other physical illnesses; previous admissions to hospital or mental health services; and, been assessed for suicide behavior 3 months prior to their death.

People who left a note were significantly younger in age; more likely to be divorced or separated; less likely to be living with a partner; and, less likely to have been retired. 

“Suicide decedents with fewer than two admissions to a mental health unit, including those with no history at all, were three times more likely to have left a suicide note,” explains Dr. Eynan. “Two-thirds of these people however did have contact with a primary health care provider in the month prior to their deaths. Interestingly, most were for routine and non-urgent reasons.”

Suicide notes are written for several purposes. It can be an opportunity to put affairs in order, justify or explain their suicidal action, or reduce the emotional burden of those left behind. 

It can be theorized that people without a diagnosis of mental illness and fewer health care admissions may be more compelled to complete their suicide narrative and explain their motives. On the other hand, those who did not leave notes may have felt that their long-standing struggles with mental illness were well known to family and friends. 

The findings point to a subgroup of younger suicide people who have less contact with mental health services, have no mental illness and yet are at risk of suicide. 

“This tells us that we can be more proactive in assessing for suicidal behaviours at each interaction of help-seeking and health care.” For example, routinely giving screening questions at every appointment which assess mood and other indicators. “It could be something like a paper form or tablet in the waiting room, reducing the stigma and more easily opening up the conversation,” adds Dr. Eynan. 

The general public should also be educated to take any communication by any means of suicide risk or intent as serious.

The shifting methods of communicating final good-byes that make use of newer forms of technologies could provide a window of opportunity for intervention. Social media sites and app developers could partner with researchers to develop innovative protocols and mechanisms that identify users at risk and intervene by sending the user links to crisis services or directly connecting them to an appropriate service.

Dr. Eynan is often reminded of the quote ‘whoever saves a life, saves an entire world.’ She takes the utmost care to treat each person’s story with dignity and respect. 

“There was a lot of suffering shared in the notes, but the most prevalent messages were expressions of love.”  

While this kind of research can be difficult, it gives her a lot of hope. 

If you need help:

Canadian Mental Health Association’s Reach Out program is a 24-7 telephone hotline and internet service for individuals experiencing mental health concerns, addictions or crisis.

Reach Out can be contacted at 519-433-2023, toll free at 1-866-933-2023 or online at www.reachout247.ca. 
 

September is World Alzheimer’s Month and Saturday, September 21 was World Alzheimer’s Day. 

In recognition, the Journal of Alzheimer’s Disease has published an open access, special issue that will be available to everyone for the first two weeks of publication. 

Dr. Manuel Montero-Odasso, Scientist at Lawson Health Research Institute, has edited and led the special issue focusing on gait disorders and dementia. 

He is world renowned for his findings on the relationship between cognition and mobility in the elderly, and gait as a predictor of frailty and dementia. He leads the Mobility, Exercise and Cognition (MEC) Team in London, comprised of top researchers in the areas of mobility, exercise and brain health.

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Dr. Montero-Odasso is also a professor at Western University’s Schulich Medicine & Dentistry, geriatrician at St. Joseph’s Health Care London and London Health Sciences Centre, and Director of the Gait and Brain Lab, a part of Lawson’s Parkwood Institute Research group. 

“This Journal of Alzheimer’s Disease supplemental issue showcases studies presenting the epidemiology of gait disturbances and cognitive impairment, dissecting specific associations between cognitive domains and quantitative gait parameters, and addressing with advanced neuroimaging techniques the potential mechanisms underlying the gait-cognitive interaction seen before dementia,” explains Dr. Montero-Odasso. “Also, this issue highlights how to manage mobility impairment in the cognitive impaired by using assistive devices.”

Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills. It is the most common cause of dementia among older adults. There are over half a million Canadians living with dementia - plus about 25,000 new cases diagnosed every year. By 2031, that number is expected to rise to 937,000, an increase of 66 per cent.

Read the Gait Disorders Special Issue with editorial from Drs. Montero-Odasso and George Perry entitled “Gait Disorders in Alzheimer’s Disease and Other Dementias: There is Something in the Way You Walk.” 
 

In a new study, researchers at Lawson Health Research Institute and Western University are demonstrating that gait, or motion testing, while simultaneously performing a cognitively demanding task can be an effective predictor of progression to dementia and eventually help with earlier diagnosis. To date, there is no definitive way for health care professionals to forecast the onset of dementia in a patient with memory complaints.

Dr. Manuel Montero-Odasso, a Lawson scientist, geriatrician at St. Joseph’s Health Care London, and associate professor in the Division of Geriatric Medicine at Western University’s Schulich School of Medicine & Dentistry, is leading the “Gait and Brain Study.” His team is assessing up to 150 seniors with mild cognitive impairment (MCI), a slight decline of memory and other mental functions which is considered a pre-dementia syndrome, in order to detect an early predictor of cognitive and mobility decline and progression to dementia.

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Dr. Montero-Odasso with study participant, Roy Bratty

“Finding methods to detect dementia early is vital to our ability to slow or halt the progression of the disease,” says Dr. Montero-Odasso. The study, funded by the Canadian Institutes of Health Research, followed participants for six years and included bi-annual visits. Researchers asked participants to walk while simultaneously performing a cognitively demanding task, such as counting backwards or naming animals. Those individuals with MCI that slow down more than 20 per cent while performing a cognitively demanding task are at a higher risk of progressing to dementia.

“While walking has long been considered an automatic motor task, emerging evidence suggests cognitive function plays a key role in the control of walking, avoidance of obstacles and maintenance of navigation,” says Dr. Montero-Odasso. “We believe that gait, as a complex brain-motor task, provides a golden window of opportunity to see brain function.”

The “gait cost,” or speed at which participants completed a single task (walking) versus a dual-task, was higher in those MCI individuals with worse episodic memory and who struggle with executive functions such as attention keeping and time management.

“Our results reveal a ‘motor signature’ of cognitive impairment that can be used to predict dementia,” adds Dr. Montero-Odasso. “It is conceivable that we will be able to diagnose Alzheimer’s disease and other dementias before people even have significant memory loss. Our hope is to combine these methods with promising new medications to slow or halt the progression of MCI to dementia.”

The study, “Association of Dual-Task Gait with Incident Dementia in Mild Cognitive Impairment”, was published in the journal, JAMA NEUROLOGY.

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Members of the study’s research team, from left to right: Korbin Blue, Research Assistant (Co-op Student); Yanina Sarquis-Adamson, Lab Research Assistant; Frederico Faria, Post-Doctoral Fellow; Dr. Montero Odasso, Director, Gait and Brain Lab; research participant; Alanna Black, Lab Research Coordinator; Stephanie Cullen, Research Assistant (Undergraduate Student); and, Navena Lingum, Research Assistant (Master Student). 

Canada’s 150th anniversary of Confederation is an opportunity to celebrate the impact of health research over the last 150 years. In recognition, Lawson has launched a Canada 150 website (www.lawsonresearch.ca/canada150) to celebrate our past, our present and to look forward to how Lawson research can shape the future of health care.

Lawson’s Canada 150 website will be updated through the rest of the year with new content, including your feedback and ideas about the future of health research. We’re asking “What does the next 150 years hold for health research and innovation in Canada?” You can provide your input here or send us your ideas by tweeting us. We’ll be sharing your feedback on the Canada 150 website and social media throughout the year.

On July 1, Lawson will also be appearing alongside our hospital and foundation partners in a special insert of the London Free Press. Additionally, if you are celebrating Canada 150 at London’s Sesquifest you can view Lawson’s Canada 150 banner in the Explore Tent on Talbot Street.