A scoping review of research about suicidality in rural and remote Canadian communities, published between 2009 and July 2020 was conducted by searching Embase, Medline, CINAHL, PsychInfo, SocIndex, Geobase, and PsycArticles databases. Included articles were reviewed and charted using data extraction. Thirty-nine Canadian, non-Indigenous articles met inclusion. Most publications were based on quantitative research (23). Apart from one intervention study, articles were prevention focused, with suicidality risk and protective factors noted to be of particular interests. The most frequently referenced suicidality risk factor was rural residence. It is anticipated that results of this review will inform future research, particularly the need to include qualitative and mixed methodologies, protocol, and evaluations of interventions as well as postvention research, with further consideration of different Canadian settings and populations.

Although trauma informed (TI) care has been well researched and is used in many disciplines, TI practices for research are less developed. In this article, we explore the use of TI practices when discussing the sensitive topic of suicide within an online focus group. Qualitative studies on rural suicide are sparse, even though the incidence of suicide is higher rurally than in urban areas. Rural communities are often close knit and stigma can be greater toward non-normative experiences such as mental illness and suicide. Due to the nature of rural communities, the trauma of suicide can affect many people. We conducted focus groups with rural community participants who had an interest in suicide prevention to explore the gaps in rural suicide research and the best methods for knowledge dissemination of existing research. Steps were taken to mitigate re-traumatization and/or severe distress in the participants through a TI research approach. An online video conferencing platform became necessary due to the COVID-19 pandemic. The online features promoted safety and transparency by: enabling participants to turn off camera and microphone if they became distressed, allowing them time to self-regulate until feeling sufficiently safe to return to the focus group discussion; leaving the discussion at any time with little disruption; and being able to choose a comfortable place to join the discussion. Other TI activities included ensuring ongoing consent throughout the process, recruiting through a third party to enhance safety, having support resource lists tailored to the region, and encouraging participants to share and debrief final thoughts. A number of participants commented on feeling safe within the environment of the focus group. Limitations included challenges identifying distress online and technological difficulties associated with rural internet services. To our knowledge, this is the first article using a TI approach for discussing suicide through an online method.

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Rural residence has been identified as a risk factor for suicide, especially for men. Little qualitative research exists on rural suicide, which might help deepen understandings of prevention strategies within rural places. Therefore, virtual focus groups were held across six Canadian provinces to give voice to rural community members and service workers about suicide prevention. Barriers to accessing services and the need to strengthen rural support networks were discussed. Enhancing peer support was highlighted as a strategy to better address the needs of rural Canadians.