Suicide Literacy and Attitudes Toward Seeking Professional Psychological Help: A Cross-Sectional Study Among Emergency Nurses

Suicide Literacy and Attitudes Toward Seeking Professional Psychological Help: A Cross-Sectional Study Among Emergency Nurses | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Suicide Literacy and Attitudes Toward Seeking Professional Psychological Help: A Cross-Sectional Study Among Emergency Nurses Ali Ghanbari Rafatie, Salam Vatandost, Vahid Ghanbari, Tayeb Mohammadi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8041607/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Suicide is a major public health concern, particularly among healthcare professionals, with nurses at increased risk due to occupational stress, long shifts, and close patient contact. Mental health literacy, including suicide literacy, plays a crucial role in recognizing risk factors, identifying warning signs, and encouraging timely help-seeking. Despite international evidence on the importance of suicide literacy and attitudes toward professional psychological support, limited research exists among emergency nurses, particularly in Iran. This study aimed to examine the association between suicide literacy and attitudes toward seeking professional psychological help in this high-risk group. Method A convenience sample of emergency nurses was recruited. Participants completed a demographic questionnaire, the Short Literacy of Suicide Scale, and the Attitudes Toward Seeking Professional Psychological Help questionnaire. Statistical analyses included independent-samples t tests, one-way analysis of variance (ANOVA), Mann–Whitney U tests, Pearson’s correlation, and multivariable linear regression to identify predictors of suicide literacy and attitudes toward seeking professional psychological help. All analyses were performed using SPSS version 19, with statistical significance set at P < 0.05. Results A total of 280 nurses participated. The mean suicide literacy and attitudes toward seeking professional psychological help were at a moderate level. The lowest awareness was observed in the domain of “causes and nature of suicide.” Age and clinical work experience were negatively associated with suicide literacy, whereas being female, higher education, and contractual or temporary employment were positively associated. Women and participants with higher income demonstrated more positive attitudes toward seeking professional psychological help, while a family history of suicide was associated with lower attitudes. Suicide literacy, particularly the domains of “signs and symptoms” and “prevention and treatment strategies,” showed a significant positive correlation with attitudes toward seeking professional psychological help. Conclusion This study highlights the significant role of suicide literacy in shaping emergency nurses’ attitudes toward seeking professional psychological help. Nurses with greater knowledge of suicide warning signs and prevention strategies demonstrated more positive attitudes toward help-seeking. Enhancing suicide literacy through targeted education and ongoing psychological support can improve both nurses’ well-being and patient care. Incorporating suicide literacy into training programs and considering demographic factors such as age, gender, and work experience can further strengthen intervention effectiveness. attitude emergency nursing literacy professional help-seeking behavior suicide 1. Background Every year, approximately 727,000 people lose their lives due to suicide, and many more attempt suicide. Each suicide represents a tragedy that profoundly affects families, communities, and nations, resulting in long-lasting consequences for survivors. In 2021, suicide was the third leading cause of death among individuals aged 15–29 worldwide, underscoring its status as a serious public health problem that requires an urgent and comprehensive response (1). Psychiatric disorders, a history of suicide attempts, sex , and marital status can all contribute to the development of suicidal thoughts. However, on a global scale, the majority of suicides occur among the working-age population, and many individuals who die by suicide are employed at the time of their death (2). A study by Jain and colleagues demonstrated that healthcare workers face serious mental health challenges, including burnout, psychological distress, and an elevated risk of suicide. These issues have been observed across various specialties and professional groups, with nurses being particularly affected by their close contact with patients, long working shifts, limited autonomy, and additional household responsibilities (3). Between 2017 and 2018, 729 nurses in the United States died by suicide, which was the highest number ever recorded. However, this alarming figure may represent only the beginning of a deeper mental health crisis, as the ongoing stressors and psychological trauma associated with the COVID-19 pandemic have further increased the risk of mental health problems among nurses compared with other healthcare professionals (4). Emergency nurses who have easy access to lethal means, work under highly stressful conditions, and tend to delay seeking help when experiencing mental health problems are at an even greater risk. When these factors coincide with other stressful life events or individual vulnerabilities, the likelihood of suicide increases significantly (5) . The good news is that suicide is preventable. Identifying the factors that influence suicidal thoughts from a prevention perspective is crucial for effective suicide prevention. One key factor is mental health literacy, as awareness that help is available and knowledge of how to access it significantly influence individuals’ willingness to seek support (6). Like mental health literacy, suicide literacy focuses on functional knowledge and increased awareness of risk factors to encourage individuals to seek appropriate treatment (7). Such literacy is essential among healthcare professionals for the early identification of high-risk groups, the establishment of effective therapeutic communication, and the development of comprehensive care plans for patients (8). Scientific evidence indicates that individuals who hold misconceptions about risk factors, treatments, and signs of suicidal behavior may themselves be at increased risk of experiencing suicidal thoughts or engaging in suicidal behaviors (9). Approximately 80% of individuals who die by suicide exhibit warning signs or symptoms prior to their suicide attempt. These findings highlight the need for greater suicide awareness within communities and suggest that enhancing public awareness of suicide may contribute to the prevention of such behavior (10). If the ultimate goal of suicide prevention is to reduce premature deaths, a critical step is to increase the likelihood that individuals receive appropriate treatment. This includes encouraging people to seek timely and adequate help to reduce the risk of suicidal thoughts and behaviors (11) because, naturally, access to psychological services can reduce suicide rates (12). Help-seeking in mental health serves as a bridge between individuals experiencing psychological difficulties and available support services. Help-seeking refers to the actions taken by an individual to obtain professional support when facing mental health problems (13). It can include behaviors such as discussing problems, expressing emotions, and crying (14). Seeking help for mental health is a gradual process that begins with the recognition of one’s own symptoms. Identifying these symptoms as indicators of a mental health problem leads to the formation of an intention, which ultimately results in active engagement in help-seeking behavior (15). Studies have also indicated that insufficient suicide literacy can serve as a barrier to help-seeking (16, 17). Suicide literacy refers to awareness of the causes, risk factors, signs or symptoms, and treatments associated with suicidal behaviors (18). It also encompasses attitudes toward seeking professional psychological services, defined as the beliefs, perspectives, and inclinations of an individual who influence their willingness to pursue professional psychological support and treatment (13). To date, few studies have specifically examined these two variables and their relationships among emergency nurses, whereas these variables have been investigated in other groups, such as medical students and residents (19, 20), and of course, suicide literacy alone has been examined in nurses (21). In the study by Karakaya and colleagues, which examined suicide literacy among nurses, nurses’ knowledge of suicide was low. The authors recommended that training programs on caring for patients at risk of suicide be provided for all nurses working in general clinics (21). Furthermore, a study by Xuntao He and colleagues demonstrated that increased suicide literacy and social support can help improve emergency nurses’ attitudes toward seeking professional psychological help (22). Additionally, the study by Shamspour and colleagues indicated that certain factors, such as gender and age, may influence suicide literacy and attitudes toward help-seeking, whereas a history of mental illness, medication use, and educational level do not have a significant effect. The study also confirmed a positive relationship between suicide literacy and attitudes toward help-seeking (19). Despite international evidence (20, 21), research in Iran examining the relationship between suicide literacy and attitudes toward seeking professional psychological help among nurses, particularly emergency nurses, is limited. Considering the points mentioned above and the existing gaps in this field, the present study was conducted to determine the associations between suicide literacy and attitudes toward seeking professional psychological services among emergency nurses. 2. Methods Design The current study is a descriptive-analytical investigation conducted between June and August 2025. The research was carried out at Kermanshah University of Medical Sciences, the governing body responsible for healthcare services in Kermanshah province. This university comprises seven teaching hospitals that served as the setting for this research. Study setting and sampling The study population consisted of nurses working in the emergency departments of seven teaching hospitals affiliated with Kermanshah University of Medical Sciences. Sampling was conducted via a convenience sampling method. In the study by Zielinskas and Lesinskiene (20), the following formula was used to calculate the sample size: \(\:n={\left(\frac{{Z}_{1-\frac{\alpha\:}{2}}+{Z}_{1-\beta\:}}{\omega\:}\right)}^{2}+3\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\) sample size estimation formula $$\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:\:n={\left(\frac{1.96+0.84}{\omega\:}\right)}^{2}+3=225$$ Considering a 10% dropout rate, the final sample size was determined to be 280 participants. $$\:n\:=\:\frac{n}{\left(1\:-\:attritio{n}_{rate}\right)}=\frac{225}{1-0.2}=280\:$$ Inclusion and exclusion criteria The inclusion criteria for participants were a minimum of six months of employment in the emergency department, having at least a bachelor’s degree in nursing, and being willing to participate in the study. The exclusion criteria included failing to answer more than 10% of the questionnaire items or not returning the questionnaire. Instrument The data collection instruments for the study consisted of three sections demographic information, a suicide literacy questionnaire, and a questionnaire assessing attitudes toward seeking professional psychological services. Demographic information form This form consists of 16 items, including age, gender, education, marital status, household income, clinical work experience, emergency department work experience, employment status, psychiatric ward work experience, history of psychiatric disorders, history of psychiatric medication use, history of utilizing psychiatric or psychological services, experience caring for patients with suicidal thoughts or attempts, history of a family member’s suicide attempt, history of a family member’s death by suicide, and participation in workshops related to suicide. Suicide literacy questionnaire This instrument was first developed by Calear and Batterham in 2012. The original version consisted of 26 items, and the shortened version, known as the suicide literacy scale, was created by Batterham and colleagues in 2013(23). This version of the questionnaire, consisting of 12 items, assesses suicide literacy across four domains causes or nature of suicide (items 1, 7, 10, and 12), risk factors (items 3, 4, and 11), signs and symptoms (items 5, 6, and 8), and treatment and prevention strategies (items 2 and 9). The respondents answer these items with “true,” “false,” or “i don’t know. ” Correct answers receive a score of 1, whereas incorrect or “i don’t know” responses receive a score of 0, resulting in a total score ranging from 0–12 (23). Its reliability and validity were confirmed by Saeed and colleagues in a population of online social media users in Iran, with a Cronbach’s alpha of 0.76 (24). Additionally, a study conducted in a province in Iran by tabari and colleagues (2023) among nurses and physicians reported a Cronbach’s alpha of 0.86 for internal consistency reliability (25). Questionnaire on attitudes toward seeking professional psychological services This instrument, developed by Fischer and Farina in 1995, consists of 10 items scored on a 4-point Likert scale (0 = strongly disagree to 3 = strongly agree ). The reverse-scored items (2, 4, 8, 9, and 10) are scored as “strongly disagree” = 3 and “strongly agree” = 0. Higher total scores indicate more positive attitudes toward seeking psychological help (26). Its reliability and validity in the Persian version were reported, with a Cronbach’s alpha of 0.84 (27). Additionally, Nazari and colleagues reported a Cronbach’s alpha of 0.78, confirming the reliability and validity of the scale (28). Data collection First, the necessary administrative approvals and coordination were obtained. The researcher then visited the emergency department and, in coordination with the head nurses, obtained a list of nurses with at least six months of work experience in this department. Next, the researcher referred to the emergency department during different shifts, introduced himself, explained the study objectives, and invited nurses to participate in the study. Those who agreed received an informed consent form and data collection questionnaires. After reviewing and signing the consent form, participants were asked, if possible, to complete the questionnaires immediately. The questionnaires were self-administered onsite in the presence of the researcher so that any questions or ambiguities could be clarified. If nurses were unable to complete the questionnaires at that time, the researcher returned to the emergency department on a date agreed upon by the participants to collect the completed questionnaires. If a questionnaire was incomplete or not returned, the researcher followed up once more to ensure completion. Ultimately, if a questionnaire remained incomplete or unreturned, the participant was excluded from the study. Data analysis Continuous variables are expressed as the means ± standard deviations (SDs), and categorical variables are expressed as frequencies (percentages). In this cross-sectional study, the normality of the data distribution was assessed via the Kolmogorov–Smirnov and Shapiro–Wilk tests. Depending on the number of groups and distributional assumptions, comparisons of mean values were performed via the independent-samples t test, one-way analysis of variance (ANOVA), or the Mann–Whitney U test. Pearson’s correlation coefficient was used to evaluate associations between continuous variables. Multivariate linear regression analysis was further conducted to identify predictors of suicide literacy scores and attitudes toward seeking professional psychological help. All the statistical analyses were carried out via SPSS software, version 19, with a significance threshold set at p < 0.05. 3. Results Characteristics of the participants In this study, 314 questionnaires were distributed among emergency nurses. Of these, 24 questionnaires were not returned due to the high workload and stressful conditions in the emergency department, and 10 questionnaires were incomplete. Therefore, 34 questionnaires were excluded from the final analysis, resulting in a final sample of 280 participants. The mean age of the participants was 31.20 years (range: 21–58), the mean clinical work experience was 6.90 years (range: 1–32), and the mean emergency department work experience was 4.22 years (range: 1–30). More than half of the participants (55.4%) were female, 90% held a bachelor’s degree, and 56.4% were single. Additionally, 42.5% reported an income below household expenses, and 46.8% were employed under temporary contracts. Most nurses had no prior experience working in psychiatric wards (83.6%), no history of psychiatric disorders (90.4%), no history of psychiatric medication use (83.2%), and no history of utilizing psychological or psychiatric services (71.4%). Furthermore, 60.7% had no experience caring for patients with suicidal thoughts or attempts, 96.1% had no family history of suicide attempts, 98.6% had no family history of death by suicide, and 80.4% had not participated in suicide-related workshops (Table 1 ). Statistical analysis revealed a significant negative correlation between age and total suicide literacy score (p < 0.001). Similarly, clinical work experience was negatively and significantly correlated with the total suicide literacy score (p < 0.001), and emergency department work experience was weakly but significantly negatively correlated with the total suicide literacy score (p < 0.001). Additionally, the difference in total suicide literacy scores between male and female participants was significant (p = 0.03). Moreover, the mean suicide literacy score differed significantly between educational levels (p = 0.02) and between employment status groups (p = 0.03) ( Table 1 ). Table 1 Descriptive statistics and correlations of demographic variables with suicide literacy scores Variable Mean ± SD Median (IQR) Range (Min–Max) R (with suicide literacy) Age (years) 31.20 ± 6.79 29 (26–35) 21–58 –0.204 Clinical work experience (years) 6.90 ± 6.63 4 (2–9) 1–32 –0.194 Emergency work experience (years) 4.22 ± 4.52 3 (1–6) 1–30 –0.146 IQR = Interquartile range Table 2 Relationship of Demographic Variables with Suicide Literacy of Emergency Nurses Variables Category N (%) Mean ) SD( of Suicide Literacy Test Statistic P Gender Male 12544.6)) 5.64(2.00) Z = -2.16 03/0 Female (55.4) 155 6.07 ( 1.87) Education Bachelor’s Degree (90)252 5.79 ( 1.89) T = -2.31 0.02 Master’s Degree and Above (10)28 6.68 ( 2.17) Marital Status Married (41.4)116 5.93 ( 1.85) F = 0.09 0.90 Single (56.4)158 5.85 ( 2.00) Divorced (2.1)6 5.67 (2.33) Income Level Less Than Household Expenses (42.5)119 5.90 (1.86) F = 2.24 0.10 Equal To Household Expenses (42.9)120 5.68 (2.00) More Than Household Expenses (14.6)41 6.41 (1.97) Employment Status Official (36.1)101 5.57 (1.88) F = 2.95 0.03 Fixed-Term (6.1)17 6.88 (1.45) Contract (10.4)29 5.55 (2.11) Project-Based (46.8)121 6.04 (1.96) Work Experience in Psychiatric Department Yes (16.4)46 6.04 (2.12) T = -0.62 0.53 No (83.6)234 5.85 (1.90) History of Psychiatric Disorder Yes (9.6)27 6.22 ( 2.30) T = -0.96 0.33 No (90.4)253 5.84 ( 1.90) History of Psychiatric Medication Use Yes (16.8)47 5.96 (2.08) T = -0.30 0.71 No (83.2)233 5.86 (1.91) History of Using Psychological or Psychiatric Services Yes (28.6)80 6.05 (2.03) T = -0.93 0.35 No (71.4)200 5.81 (1.90) History of Caring for Patients with Suicidal Thoughts or Attempts Yes (39.3)110 6.11 (1.80) T = -1.60 0.11 No (60.7)170 5.73 (2.01) Family History of Suicide Attempt Yes (3.9)11 5.18 (1.88) T = 1.21 0.22 No (96.1)269 5.91 (1.94) Family History of Suicide Death Yes (1.4)4 5.25 (1.25) T = 0.65 0.51 No (98.6)276 5.89 (1.95) History of Attending Suicide-Related Workshops Yes (19.6)55 6.07 (1.74) T = -0.82 0.40 No (80.4)225 5.83 (1.98) R = Pearson correlation coefficient, t = independent t-test statistic, F = analysis of variance (ANOVA) statistic, Z = Mann–Whitney statistic. Significance level = p < 0.05. As shown in Table 3 , the means and standard deviations of the suicide literacy subscales, total suicide literacy score, and attitudes toward seeking professional psychological services among emergency nurses in teaching hospitals Kermanshah are presented. The mean total suicide literacy score was approximately six, and the mean attitude score toward seeking psychological care was approximately 18.5. Among the suicide literacy domains, awareness of the causes or nature of suicide had the lowest mean score ( Table 3 ). Table 3 Means of Suicide Literacy and Attitudes toward Seeking Professional Psychological Services Domains Minimum Score Maximum Score Mean (SD) Total Suicide Literacy Score 1 12 5.88(1.94) Causes Nature of Suicide 0 4 1.25(1.12) Risk Factors 0 3 1.50(0.74) Signs And Symptoms 0 3 1.64(0.87) Treatment and Prevention Strategies 0 2 1.49(0.62) Total Score of Attitude toward Seeking Professional Psychological Services 2 30 18.40(5.30) The results indicated that female nurses had more positive attitudes toward suicide than did male nurses, and this difference was statistically significant (p < 0.001). Additionally, the mean attitude score differed significantly among income groups (p = 0.02). The results from an independent t test also revealed that the mean attitude scores of nurses who had not utilized psychological or psychiatric services compared with those who had utilized these services were significantly different (p < 0.001). Furthermore, a family history of death by suicide was significantly associated with attitude scores (p = 0.00) ( Table 4 ) . Table 4 Comparison of Participants' Attitude toward Seeking Professional Psychological Services by Gender, Household Income, History of Using Psychological or Psychiatric Services, and History of Suicide a Family Member Variable Category N Mean ( SD) Test Statistic P Attitude toward Seeking Professional Psychological Services Gender Male 125 17.08(5.28) T = -3.84 < 0.001 Female 155 19.47(5.09) Income Level Less Than Household Expenses 119 17.67(5.31) F = 3.68 0.02 Equal To Household Expenses 120 (5.31) More Than Household Expenses 41 20.24(4.88) History Of Psychiatric Medication Use No 200 17.85(5.23) T = -2.79 0.00 Yes 80 19.79(2.25) Family History of Suicide Death No 276 18.50(5.26) T = 2.65 0.00 Yes 4 11.50(3.10) Furthermore, the total attitude score toward seeking professional psychological services was positively and significantly correlated with the total suicide literacy score (p < 0.001), signs and symptoms (p < 0.001), and treatment and prevention strategies (p < 0.001), indicating that better attitudes were associated with greater awareness in these domains. In contrast, attitudes were weakly and non significantly correlated with awareness of the causes or nature of suicide (p = 0.22) and risk factors (p = 0.23), suggesting that these two dimensions of suicide literacy do not have a significant effect on the total attitude score toward seeking professional psychological services ( Table 5 ). Table 5 Relationships between Suicide Literacy (and Its Dimensions) and Attitudes Toward Seeking Professional Psychological Services Independent Variable Dependent Variable R P 95% CI (lower–upper) Suicide Literacy Attitude Toward Seeking Professional Psychological Services 0.16 < 0.001 0.05 0.28 Causes or Nature of Suicide 0.07- 0.22 -0.18 0.04 Risk Factors 0.07 0.23 -0.04 0.18 Signs And Symptoms 0.16 < 0.001 0.04 0.27 Treatment And Prevention Strategies 0.16 < 0.001 0.23 0.43 In this study, multivariable linear regression was used to develop two models. In the first model, the dependent variable was considered “suicide literacy. ” Multiple regression analysis indicated that the overall model of predictors explained 13% of the variance in the suicide literacy score. The results showed that age, sex , and educational level significantly predicted the dependent variable. Age had a negative and significant effect; as age increased, the suicide literacy score decreased. Gender also had a positive and significant effect, with mean scores being higher in females than in males. Educational level (master’s degree or higher than a bachelor’s degree) was a positive and significant predictor; thus, participants with higher education obtained higher scores ( Table 6 ). Table 6 Prediction of Suicide Literacy Components Based on Demographic Variables among Study Participants Dependent Variable Independent Variable B β P 95% CI (lower–upper) Model Summary Suicide Literacy Constant 7.41 - < 0.001 5.53 9.30 R = 0.36 R² = 0.13 Adjusted R² = 0.10 Std. Error = 1.84 F = 4.11 P < 0.00 Age -0.09 -0.32 < 0.001 -0.13 -0.05 Gender 0.63 0.16 < 0.001 0.18 1.09 Education 1.34 0.20 < 0.001 0.57 2.11 Income (Equal Vs. Lower) -0.26 -0.06 0.28 -0.75 0.21 Income Level (Higher Vs. Lower) 0.23 0. 40 0.49 -0.44 0.92 Employment Status (Permanent Vs. Temporary) -0.33 -0.08 0.20 -0.87 0.18 History Of Psychiatric Problems (Yes/No) 0.07 .010 0.86 -0.73 0.88 Receiving Psychiatric Services (Yes/No) 0.11 02.0 0.68 -0.42 0.65 Caring For a Person Who Attempted Suicide (Yes/No) 0.33 .080 0.14 -0.11 0.78 Family History of Suicide Death (Yes/No) -0.75 -0.04 0.42 -2.60 1.09 The results of identifying factors associated with the dependent variable also indicated that gender, income level, and family history of suicide were significant predictors, with approximately 13% of the variance in attitudes toward seeking professional psychological services explained by the model variables. Specifically, females scored higher than males did, and participants with higher incomes had higher mean scores than did those with lower incomes. In contrast, a family history of suicide was associated with a significant decrease in the dependent variable score. Furthermore, suicide literacy, although at a marginally significant level (p = 0.05), showed a positive trend in predicting the dependent variable. Other variables, including age, education, employment status, history of psychiatric disorders, use of psychiatric medications, and utilization of psychological services, did not significantly affect the model ( Table 7 ) . Table 7 Prediction of the component “Attitude Toward Seeking Professional Psychological Services” on the basis of suicide literacy and demographic variables among the study participants. Dependent Variable Independent Variable B β P 95% CI (lower–upper) Model Summary Attitude Toward Seeking Professional Psychological Services Constant 12.84 - < 0.001 7.17 1 R = 0.37 R² = 0.13 Adjusted R² =0.10 Std. Error = 5.02 F = 3.87 P < 0.00 Suicide Literacy Score 0.32 0.11 0.05 -0.00 0.65 Age 0.01 0.02 0.76 -0.09 0.13 Gender 2.01 0.18 < 0.001 0.77 3.26 Education 1.38 0.07 0.20 -0.75 3.52 Income = Equal (Reference: Lower) 0.94 0.08 0.16 -0.37 2.27 Income = Higher (Reference: Lower) 2.16 0.14 0.02 0.26 4.06 Employment Status = Permanent (Reference: Temporary) -0.32 -0.03 0.66 -1.78 1.13 History Of Psychiatric Disorder (Yes/No) -0.24 -0.01 0.83 -2.61 2.11 Use Of Psychiatric Medication (Yes/No) 0.53 0.03 0.59 -1.44 2.52 Receiving Psychiatric/Psychological Services (Yes/No) 0.97 0.08 0.22 -0.61 2.56 Family History Of Suicide Death (Yes/No) -7.15 -0.16 < 0.001 -12.18 -2.12 Note. Dependent variable: attitude score. B = Unstandardized coefficients; β = Standardized coefficients; SE B = standard error of B; CI = confidence interval. Predictors: Suicide literacy = total suicide literacy score; Age = age (years); Gender = Female (ref: Male); Education = 1 (Master’s or higher, ref: Bachelor); Income = Equal/Higher (ref: Lower); Employment Status = Permanent (ref: Temporary); Psychiatric Disorder History = yes/no; Psychiatric Medication Use = yes/no; Psychiatric/Psychological Service Use = yes/no; Family Suicide History = yes/no. 4. Discussion This study aimed to investigate suicide literacy and attitudes toward professional psychological help-seeking among emergency nurses working in hospitals affiliated with Kermanshah University of Medical Sciences. To the best of our knowledge, this is the first study to specifically examine this relationship among emergency nurses. The mean score of suicide literacy in this group was 5.88 ± 1.94, indicating a moderate level of suicide literacy among nurses. This finding is consistent with those of previous studies (21, 25), highlighting the necessity of implementing targeted and evidence-based training programs to increase suicide literacy. The analysis of different dimensions of suicide literacy revealed that the highest mean score pertained to the recognition of suicide signs and symptoms, whereas the lowest mean score was related to the understanding of its causes and nature. These findings suggest that nurses, particularly in the area of understanding the causes and nature of suicide, require further training. Suicide literacy plays a crucial role in designing educational programs and improving health communication and can serve as a key factor in policymaking and suicide prevention initiatives (29). Moreover, the findings of the study by Ozturk et al. indicated that a lack of knowledge leads to ambiguity, which in turn causes anxiety among nurses (7). In the study conducted by Kara Kaya et al.(21), the highest score was observed in the dimension related to the causes of suicide, whereas the lowest score pertained to the recognition of suicide signs. This finding can be explained by the short form of the Literacy of Suicide Scale used in the present study. The mean score of attitudes toward seeking professional psychological help was 18.4 ± 5.30, indicating a moderately positive attitude. This finding is consistent with those of previous studies (30). However, it is still possible that this attitude can be improved through professional support and targeted interventions, as it may be influenced by the effects of external social stigma and internal shame experienced by nurses when seeking psychiatric care. Individuals who hold negative attitudes toward mental health problems may engage in negative self-talk, leading to feelings of internal shame and perceptions of personal weakness or inadequacy. They may also experience external shame, as concerns about their mental health status could make them fear being judged negatively by others or believing that they might bring shame to their family or community (30). In addition, a study showed that nurses who have been exposed to their patients’ suicide attempts or who have completed suicide become secondary victims of these events (31). These individuals experience negative emotions toward completed or attempted suicide, which may manifest as intense emotional distress, stress, and feelings of incapacity (32). This underscores the necessity of psychological interventions, particularly in light of the prevalence of mental health issues such as depression and anxiety and the high rate of suicide among healthcare professionals (11). In examining the relationships between demographic variables and suicide literacy, six variables, namely, age, clinical work experience, emergency department work experience, education, gender, and employment status, demonstrated significant associations. Age was negatively correlated with suicide literacy, which is consistent with the findings of the study by Letho et al.(33), whereas Kara Kaya et al. (21) did not observe such a relationship and suggested that this relationship be further investigated. In the present study, suicide literacy decreased with increasing age, which may be due to the limited access of older individuals to up-to-date training and the better access of younger individuals to educational resources and the internet. Gender was also significantly associated with suicide literacy, with female nurses reporting higher literacy levels. Overall, findings in this area (21) are inconsistent and appear to depend on various factors. To better understand this issue, further research using comprehensive approaches that consider cultural, social, and gender-related factors is needed. Clinical work experience and emergency department work experience were negatively and significantly associated with suicide literacy and were also identified as significant predictors in the regression model. In the study by Kara Kaya et al.(21), emergency department work experience was similarly significantly associated with suicide literacy, whereas overall work experience showed no such relationship. Considering that age was also negatively associated with suicide literacy in the present study, it can be inferred that with increasing work experience, nurses may have less access to up-to-date training, which could lead to a decrease in their suicide literacy. Employment status was also significantly associated with suicide literacy, with nurses employed under temporary or contract positions demonstrating higher literacy levels. These individuals were generally younger and newly employed, further supporting previous findings. Similarly, education level was significantly associated with suicide literacy; individuals with a master’s degree or higher reported higher levels of suicide literacy. This finding is consistent with the studies by Letho et al. and Kara Kaya et al., confirming the results of the present study that access to up-to-date scientific resources contributes to increased suicide literacy(21, 33). Gender was significantly associated with attitudes toward seeking professional psychological help and emerged as a significant predictor in the regression analysis, with female nurses scoring higher. This finding aligns with a previous meta-analysis showing that women are more likely than men to seek help from informal sources, such as family members and friends. This may reflect social and cultural roles that encourage women to be more attentive to their mental health and more comfortable seeking both social and professional support (34). Furthermore, the results indicated that individuals with higher income levels exhibited more positive attitudes toward seeking psychological services, and this variable was also identified as a significant predictor in the regression model. Few studies have examined this issue to date, and future research is recommended to explore it further. In the present study, the first author observed during data collection that some participants reported economic difficulties as a reason for not seeking psychological services, suggesting that financial barriers may be a key factor preventing individuals from accessing these services. Additionally, the use of psychological services is associated with more positive attitudes toward these services in subsequent encounters. As shown in the study by Xuntao He et al., trust in mental health professionals plays a central role in shaping nurses’ attitudes toward seeking psychological help and has been identified as a key determinant in the utilization of these services (22). Furthermore, individuals with a history of losing a family member due to suicide presented more negative attitudes toward psychological services, a relationship that was statistically significant and identified as a significant predictor in the regression model. Consistent with this finding, the study by Wlliye et al. demonstrated that witnessing or experiencing suicide within the family is associated with increased feelings of shame, guilt, and social isolation, which may reduce the likelihood of seeking psychological help (35). An examination of the relationship between suicide literacy and attitudes toward seeking professional psychological help revealed a significant positive correlation between these two variables. Moreover, in the regression model, suicide literacy was identified as a predictor of attitudes. Further analysis of the different dimensions of suicide literacy indicated that two dimensions, “recognition of signs and symptoms” and “prevention and treatment strategies,” were positively and significantly associated with attitudes. These findings suggest that although the total suicide literacy score was only marginally significant in relation to attitude, a closer examination of its dimensions demonstrated that these two aspects play crucial roles in shaping positive attitudes. Therefore, enhancing suicide literacy, particularly by focusing on “recognition of signs and symptoms” and “prevention and treatment strategies,” is essential for fostering positive attitudes among nurses. A similar finding was reported by Jahanbakhsh et al., who reported a positive relationship between these two variables (19). Overall, the findings of this study emphasize the importance of enhancing suicide literacy among emergency nurses and its impact on attitudes toward seeking professional psychological help. Nurses with higher levels of suicide literacy, particularly in recognizing signs and symptoms and in prevention and treatment strategies, are more likely to seek professional psychological support when facing stressors and crises. Targeted training and intervention programs that strengthen these skills can not only improve nurses’ suicide literacy but also foster more positive attitudes toward help-seeking. Furthermore, considering the individual and demographic characteristics of nurses, such as gender, age, education, and work experience, can enhance the effectiveness of training programs. It is recommended that suicide-related education be regularly integrated into academic curricula and in-service training and that accessible, reliable informational resources be provided to nurses. This approach can not only improve knowledge but also enhance the ability to manage patients at risk of suicide. Combining the enhancement of suicide literacy with ongoing psychological support may contribute to improving the quality of care and reducing negative psychological outcomes for both nurses and patients. Limitations The cross-sectional design of this study implies that the data were collected at a single point in time, which does not allow for causal inferences. Therefore, researchers recommend the use of longitudinal or correlational approaches in future studies to better identify relationships. Additionally, reliance on self-reported data to assess knowledge and attitudes may introduce response bias. One limitation of this study was the conditions under which the responses were provided in the emergency department. Nurses were required to respond quickly, and some may not have fully read certain items or may have provided rapid and less focused answers. To mitigate this limitation, the researchers employed the short form of the LOSS questionnaire, which simplified the response process. Recommendations for Further Research On the basis of these findings, a detailed investigation of the mechanisms through which demographic factors, including age, work experience, and income level, influence suicide literacy and attitudes among emergency nurses is recommended. Additionally, identifying the root causes of negative attitudes and designing targeted educational interventions to modify these attitudes should be prioritized. Implications for policy and practice These findings indicate that enhancing suicide literacy, particularly in the areas of warning sign recognition and prevention and treatment strategies, can strengthen nurses' positive attitudes toward seeking professional psychological help. Educational and training programs for nurses should consistently include content related to suicide literacy, and up-to-date, accessible educational resources should be made available to them. Furthermore, attention to the individual and demographic characteristics of nurses, such as age, gender, work experience, and education level, can enhance the effectiveness of educational interventions. For example, designing different educational modules on the basis of gender and years of work experience can significantly increase the effectiveness of training programs. This personalized approach ensures that the educational content directly aligns with the needs and conditions of each group of nurses. 5. Conclusion This study demonstrated that suicide literacy and attitudes toward seeking professional psychological help among emergency nurses are moderate and that factors such as age, work experience, education, gender, and personal experience are associated with these variables. The findings also indicate that enhancing suicide literacy, particularly in understanding the causes and nature of suicide and in prevention and treatment skills, can strengthen positive attitudes toward seeking professional help. Therefore, targeted and continuous training programs, alongside psychological support, can improve both suicide literacy and the acceptance of psychological help among nurses. Declarations Ethics approval and consent to participate: The study protocol was approved by the Ethics Committee of Kurdistan University of Medical Sciences (Ethics Approval Code: [ IR.MUK.REC.1404.132 ]). The committee supervised all stages of the study, and all procedures were conducted in accordance with the Declaration of Helsinki and the university’s ethical guidelines. All participants provided written informed consent prior to completing the questionnaires. Confidentiality was maintained by anonymizing the responses and storing them securely. Participants were informed that they could withdraw from the study at any time without any consequences. Consent for publication: Not applicable. This research does not contain any individual person’s data in any form (including individual details, images, or videos). Availability of data and materials: The datasets generated and/or analysed during the current study are not publicly available due to privacy and confidentiality agreements with participants but are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors' contributions: 1.Ali Ghanbari Rafatie Conceptualization, writing – original draft, Data collection, writing – review and editing 2.Salam Vatandost Writing – original draft, writing – review and editing 3.Vahid Ghanbari Conceptualization, writing – original draft, writing – review and editing 4.Tayeb Mohammadi Data curation, Formal analysis 5.Nazila Oliaee Conceptualization, writing – original draft, writing – review and editing, Project administration Acknowledgements: The authors would like to express their sincere gratitude to Kurdistan University of Medical Sciences for their support, and to the Research Deputy of Kermanshah University of Medical Sciences for their valuable collaboration and assistance. Authors' information (optional): Not applicable References WHO. suicide: World Health Oraganization; 2025 [cited{ 2025 25}]. Available from: https://www.google.com/url?client=internal-element-cse&cx=40555c832b6924a9d&q=https://www.who.int/news-room/fact-sheets/detail/suicide&sa=U&ved=2ahUKEwiqu52FtNuPAxUsVKQEHQ8nKwkQFnoECAIQAg&usg=AOvVaw0Qf5d6lFV41Ym0hj2zbLvu. Andela M. Work-related stressors and suicidal ideation: the mediating role of burnout. Journal of Workplace Behavioral Health. 2021;36(2):125-45.(Journal of Workplace Behavioral Health).(http://dx.doi.org/10.1080/15555240.2021.1897605) Jain L, Sarfraz Z, Karlapati S, Kazmi S, Nasir MJ, Atiq N, et al. Suicide in healthcare workers: an umbrella review of prevalence, causes, and preventive strategies. Journal of Primary Care & Community Health. 2024;15:21501319241273242.(Journal of Primary Care & Community Health).(https://doi.org/10.1177/21501319241273242) Kunz M, Strasser M, Hasan A. Impact of the coronavirus disease 2019 pandemic on healthcare workers: systematic comparison between nurses and medical doctors. Current opinion in psychiatry. 2021;34(4):413-9.(Current opinion in psychiatry).(https://doi.org/10.1097/YCO.0000000000000721) Braquehais MD, González-Irizar O, Nieva G, Mozo X, Llavayol E, Pujol T, et al. Assessing high risk of suicide amongst physicians and nurses in treatment. Psychiatry research. 2020;291:113237.(Psychiatry research).(http://dx.doi.org/10.1016/j.psychres.2020.113237) Thomás M, Ciara M, Laura M, Richéal B. Promoting early-intervention for suicide prevention: The role of mental health literacy and attitudes towards suicide: A quantitative study in Ireland. Health Policy. 2024;149:105150.(Health Policy).(http://dx.doi.org/10.1016/j.healthpol.2024.105150) Öztürk S, Hicdurmaz D. A qualitative study on the perspectives and needs of oncology nurses about recognition and management of suicide risk in cancer patients. Journal of clinical nursing. 2023;32(5-6):749-63.(Journal of clinical nursing).(https://doi.org/10.1111/jocn.16304) Ramberg I-L, Di Lucca MA, Hadlaczky G. The impact of knowledge of suicide prevention and work experience among clinical staff on attitudes towards working with suicidal patients and suicide prevention. International journal of environmental research and public health. 2016;13(2):195.(International journal of environmental research and public health).(https://doi.org/10.3390/ijerph13020195) Sharaf AY, Ossman LH, Lachine OA. A cross-sectional study of the relationships between illness insight, internalized stigma, and suicide risk in individuals with schizophrenia. International journal of nursing studies. 2012;49(12):1512-20.(International journal of nursing studies).(https://doi.org/10.1016/j.ijnurstu.2012.08.006) Jafari A, Moshki M, Mokhtari AM, Ghaffari A, Nejatian M. Title page: psychometric properties of literacy of suicide scale (LOSS) in Iranian population: long form. BMC public health. 2023;23(1):608.(BMC public health).(http://dx.doi.org/10.1186/s12889-023-15528-8) Revata BK, Djaja N. The Role of Suicide Literacy and Suicide Stigma in Shaping Attitudes toward Seeking Professional Psychological Help among Indonesian Emerging Adults. Journal of Educational, Health & Community Psychology (JEHCP). 2025;14(1).(Journal of Educational, Health & Community Psychology (JEHCP)).(https://doi.org/10.12928/jehcp.vi.30367) Maryam M, Siroos A. Macro Socioeconomic Determinants of Suicide in Iran: A Time Series Study during 1991-2023. Iranian Journal of Public Health. 2025;54(8).(Iranian Journal of Public Health).(https://doi.org/10.18502/ijph.v54i8.19587) Fischer EH, Turner JI. Orientations to seeking professional help: development and research utility of an attitude scale. Journal of consulting and clinical psychology. 1970;35(1p1):79.(Journal of consulting and clinical psychology).(https://doi.org/10.1037/h0020198) Kantar A, Yalçın İ. Masculine Gender Role Stress and Attitudes Towards Seeking Psychological Help: Serial Mediation by Self-Stigma and Self-Compassion. Current Psychology. 2023;43:1-11.(Current Psychology).(https://doi.org/10.1007/s12144-023-04702-1) Alqhtani SS, Aldhafeeri NA, Alotaibi L, Alanzi H, Alshamrani W, Alqhtani N, et al. Nursing students’ attitudes and intentions towards seeking professional psychological help: the mediating role of emotional intelligence. BMC psychology. 2025;13(1):144.(BMC psychology).(http://dx.doi.org/10.1186/s40359-025-02474-w) Han J, Batterham PJ, Calear AL, Ma J. Seeking professional help for suicidal ideation: A comparison between Chinese and Australian university students. Psychiatry Res. 2018;270:807-14.(Psychiatry Res).(https://doi.org/10.1016/j.psychres.2018.10.080) Hom MA, Stanley IH, Joiner TE, Jr. Evaluating factors and interventions that influence help-seeking and mental health service utilization among suicidal individuals: A review of the literature. Clin Psychol Rev. 2015;40:28-39.(Clin Psychol Rev).(http://dx.doi.org/10.1016/j.cpr.2015.05.006) Boukouvalas E, El-Den S, Murphy AL, Salvador-Carulla L, O'Reilly CL. Exploring Health Care Professionals' Knowledge of, Attitudes Towards, and Confidence in Caring for People at Risk of Suicide: a Systematic Review. Arch Suicide Res. 2020;24(sup2):S1-s31.(Arch Suicide Res).(https://doi.org/10.1080/13811118.2019.1586608) Jahanbakhsh F, Raaii F, Mohammadi A, Aminaie M, Shamspour M. Suicide literacy and attitudes toward seeking psychological help among medical residents. Archives of Iranian medicine. 2024;27(7):385.(Archives of Iranian medicine).(http://dx.doi.org/10.34172/aim.28839) Žilinskas E, Lesinskienė S. Suicide literacy and attitudes toward psychological help-seeking: a cross-sectional study of students. Journal of international medical research. 2023;51(5):03000605231172452.(Journal of international medical research).(http://dx.doi.org/10.1177/03000605231172452) Karakaya D, Özparlak A, Önder M. Suicide literacy in nurses: A cross-sectional study. J Clin Nurs. 2023;32(1-2):115-25.(J Clin Nurs).(https://doi.org/10.1111/jocn.16205) He X, Chen S, Zhang Q, He S, Yang L, Ma J. Mental Health Literacy and Professional Psychological Help-Seeking Attitudes Among Primary Healthcare Workers: The Mediating Role of Social Support and Mental Illness Stigma. Risk Management and Healthcare Policy. 2025:703-18.(Risk Management and Healthcare Policy).(http://dx.doi.org/10.2147/RMHP.S512458) Calear AL, Batterham PJ, Trias A, Christensen H. The literacy of suicide scale. Crisis. 2021.(Crisis).(https://doi.org/10.1027/0227-5910/a000798) Saeed F, Zangenehnia N, Zabihi Poursaadati M, Noroozi M, Kazemi Khaledi E, Mousavi SB. Psychometric properties of Persian Short forms of the literacy and stigma of suicide scales on the Iranian Population. Iran J Psychiatry Behav Sci. 2024;18(1):e143381.(Iran J Psychiatry Behav Sci).(https://doi.org/10.5812/ijpbs-143381) Tabari HO, Marznaki ZH, Moudi S, Kashi MA, Fendereski A, Kalal N, et al. Suicide Literacy and Stigmatising Attitude Among Poisoning Wards Nurses and Physicians Towards Patients With Suicide Attempts: A Cross‐Sectional Study. Nursing Open. 2025;12(5):e70182.(Nursing Open).(http://dx.doi.org/10.1002/nop2.70182) Fischer EH, Farina A. Attitudes toward seeking professional psychologial help: A shortened form and considerations for research. Journal of college student development. 1995.(Journal of college student development).( Khoie K. Predictors of attitudes of Iranian males toward seeking psychological help: Alliant International University, Los Angeles; 2002. Nazari A, Garmaroudi G, Foroushani AR, Askari A. Psychometric assessment of the Persian adaptation of the attitudes toward seeking professional psychological help scale-short form. BMC psychiatry. 2024;24(1):75.(BMC psychiatry).(https://doi.org/10.1186/s12888-023-05388-2) Fitzpatrick SJ. Epistemic justice and the struggle for critical suicide literacy. Social Epistemology. 2020;34(6):555-65.(Social Epistemology).(https://doi.org/10.1080/02691728.2020.1725921) Qutishat MG. Psychological distress and attitudes toward seeking professional psychological help among Omani nurses: Strategies for nursing practice. Journal of Education and Health Promotion. 2024;13(1):325.(Journal of Education and Health Promotion).(https://doi.org/10.4103/jehp.jehp_209_24) Amit Aharon A, Fariba M, Shoshana F, Melnikov S. Nurses as ‘second victims’ to their patients’ suicidal attempts: A mixed‐method study. Journal of clinical nursing. 2021;30(21-22):3290-300.(Journal of clinical nursing).(https://doi.org/10.1111/jocn.15839) Clua‐García R, Casanova‐Garrigós G, Moreno‐Poyato AR. Suicide care from the nursing perspective: A meta‐synthesis of qualitative studies. Journal of advanced nursing. 2021;77(7):2995-3007.(Journal of advanced nursing).( https://doi.org/10.1111/jan.14789) LETHO Z. KNOWLEDGE AND ATTITUDE TOWARDS SUICIDE AMONG NURSES IN NATIONAL REFERRAL HOSPITAL, BHUTAN: BURAPHA UNIVERSITY; 2017. Nagai S, Kimura M, Honda M, Iida T, Mizuno H. Gender Differences in Help‐Seeking: A Meta‐analysis of Japanese Studies, Including Unreported Data 1. Japanese Psychological Research. 2023.(Japanese Psychological Research).(https://doi.org/10.1111/jpr.12467) Wyllie JM, Robb KA, Sandford D, Etherson ME, Belkadi N, O’Connor RC. Suicide-related stigma and its relationship with help-seeking, mental health, suicidality and grief: scoping review. BJPsych Open. 2025;11(2):e60.(BJPsych Open).(https://doi.org/10.1192/bjo.2024.857) Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 06 Dec, 2025 Reviews received at journal 05 Dec, 2025 Reviewers agreed at journal 04 Dec, 2025 Reviewers agreed at journal 04 Dec, 2025 Reviews received at journal 01 Dec, 2025 Reviewers agreed at journal 27 Nov, 2025 Reviewers invited by journal 27 Nov, 2025 Editor invited by journal 07 Nov, 2025 Editor assigned by journal 07 Nov, 2025 Submission checks completed at journal 07 Nov, 2025 First submitted to journal 05 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Background","content":"\u003cp\u003eEvery year, approximately 727,000 people lose their lives due to suicide, and many more attempt suicide. Each suicide represents a tragedy that profoundly affects families, communities, and nations, resulting in long-lasting consequences for survivors. In 2021, suicide was the third leading cause of death among individuals aged 15\u0026ndash;29 worldwide, underscoring its status as a serious public health problem that requires an urgent and comprehensive response (1). Psychiatric disorders, a history of suicide attempts, \u003cb\u003esex\u003c/b\u003e, and marital status can all contribute to the development of suicidal thoughts. However, on a global scale, the majority of suicides occur among the working-age population, and many individuals who die by suicide are employed at the time of their death (2).\u003c/p\u003e\u003cp\u003eA study by Jain and colleagues demonstrated that healthcare workers face serious mental health challenges, including burnout, psychological distress, and an elevated risk of suicide. These issues have been observed across various specialties and professional groups, with nurses being particularly affected by their close contact with patients, long working shifts, limited autonomy, and additional household responsibilities (3). Between 2017 and 2018, 729 nurses in the United States died by suicide, which was the highest number ever recorded. However, this alarming figure may represent only the beginning of a deeper mental health crisis, as the ongoing stressors and psychological trauma associated with the COVID-19 pandemic have further increased the risk of mental health problems among nurses compared with other healthcare professionals (4). Emergency nurses who have easy access to lethal means, work under highly stressful conditions, and tend to delay seeking help when experiencing mental health problems are at an even greater risk. When these factors coincide with other stressful life events or individual vulnerabilities, the likelihood of suicide increases significantly (5) .\u003c/p\u003e\u003cp\u003eThe good news is that suicide is preventable. Identifying the factors that influence suicidal thoughts from a prevention perspective is crucial for effective suicide prevention. One key factor is mental health literacy, as awareness that help is available and knowledge of how to access it significantly influence individuals\u0026rsquo; willingness to seek support (6). Like mental health literacy, suicide literacy focuses on functional knowledge and increased awareness of risk factors to encourage individuals to seek appropriate treatment (7). Such literacy is essential among healthcare professionals for the early identification of high-risk groups, the establishment of effective therapeutic communication, and the development of comprehensive care plans for patients (8). Scientific evidence indicates that individuals who hold misconceptions about risk factors, treatments, and signs of suicidal behavior may themselves be at increased risk of experiencing suicidal thoughts or engaging in suicidal behaviors (9). Approximately 80% of individuals who die by suicide exhibit warning signs or symptoms prior to their \u003cb\u003esuicide\u003c/b\u003e attempt. These findings highlight the need for greater suicide awareness within communities and suggest that enhancing public awareness of suicide may contribute to the prevention of such behavior (10).\u003c/p\u003e\u003cp\u003eIf the ultimate goal of suicide prevention is to reduce premature deaths, a critical step is to increase the likelihood that individuals receive appropriate treatment. This includes encouraging people to seek timely and adequate help to reduce the risk of suicidal thoughts and behaviors (11) because, naturally, access to psychological services can reduce suicide rates (12). Help-seeking in mental health serves as a bridge between individuals experiencing psychological difficulties and available support services. Help-seeking refers to the actions taken by an individual to obtain professional support when facing mental health problems (13). It can include behaviors such as discussing problems, expressing emotions, and crying (14). Seeking help for mental health is a gradual process that begins with the recognition of one\u0026rsquo;s own symptoms. Identifying these symptoms as indicators of a mental health problem leads to the formation of an intention, which ultimately results in active engagement in help-seeking behavior (15). Studies have also indicated that insufficient suicide literacy can serve as a barrier to help-seeking (16, 17).\u003c/p\u003e\u003cp\u003eSuicide literacy refers to awareness of the causes, risk factors, signs or symptoms, and treatments associated with suicidal behaviors (18). It also encompasses attitudes toward seeking professional psychological services, defined as the beliefs, perspectives, and inclinations of an individual who influence their willingness to pursue professional psychological support and treatment (13). To date, few studies have specifically examined these two variables and their relationships among emergency nurses, whereas these variables have been investigated in other groups, such as medical students and residents (19, 20), and of course, suicide literacy alone has been examined in nurses (21).\u003c/p\u003e\u003cp\u003eIn the study by Karakaya and colleagues, which examined suicide literacy among nurses, nurses\u0026rsquo; knowledge \u003cb\u003eof\u003c/b\u003e suicide was low. The authors recommended that training programs on caring for patients at risk of suicide be provided for all nurses working in general clinics (21). Furthermore, \u003cb\u003ea\u003c/b\u003e study by Xuntao He and colleagues demonstrated that increased suicide literacy and social support can help improve emergency nurses\u0026rsquo; attitudes toward seeking professional psychological help (22). Additionally, the study by Shamspour and colleagues indicated that certain factors, such as gender and age, may influence suicide literacy and attitudes toward help-seeking, whereas a history of mental illness, medication use, and educational level do not have a significant effect. The study also confirmed a positive relationship between suicide literacy and attitudes toward help-seeking (19).\u003c/p\u003e\u003cp\u003eDespite international evidence (20, 21), research in Iran examining the relationship between suicide literacy and attitudes toward seeking professional psychological help among nurses, particularly emergency nurses, is limited. Considering the points mentioned above and the existing gaps in this field, the present study was conducted to determine the associations between suicide literacy and attitudes toward seeking professional psychological services among emergency nurses.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e\u003cb\u003eDesign\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe current study is a descriptive-analytical investigation conducted between June and August 2025. The research was carried out at Kermanshah University of Medical Sciences, the governing body responsible for healthcare services in Kermanshah province. This university comprises seven teaching hospitals that served as the setting for this research.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy setting and sampling\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study population consisted of nurses working in the emergency departments of seven teaching hospitals affiliated with Kermanshah University of Medical Sciences. Sampling was conducted via a convenience sampling method.\u003c/p\u003e\u003cp\u003eIn the study by Zielinskas and Lesinskiene (20), the following formula was used to calculate the sample size:\u003c/p\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:n={\\left(\\frac{{Z}_{1-\\frac{\\alpha\\:}{2}}+{Z}_{1-\\beta\\:}}{\\omega\\:}\\right)}^{2}+3\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\)\u003c/span\u003e\u003c/span\u003e sample size estimation formula\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:n={\\left(\\frac{1.96+0.84}{\\omega\\:}\\right)}^{2}+3=225$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eConsidering a 10% dropout rate, the final sample size was determined to be 280 participants.\u003cdiv id=\"Equb\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equb\" name=\"EquationSource\"\u003e\n$$\\:n\\:=\\:\\frac{n}{\\left(1\\:-\\:attritio{n}_{rate}\\right)}=\\frac{225}{1-0.2}=280\\:$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eInclusion and exclusion criteria\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe inclusion criteria for participants were a minimum of six months of employment in the emergency department, having at least a bachelor\u0026rsquo;s degree in nursing, and being willing to participate in the study. The exclusion criteria included failing to answer more than 10% of the questionnaire items or not returning the questionnaire.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInstrument\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eThe data collection instruments for the study consisted of three sections\u003c/strong\u003e\u003cp\u003edemographic information, a suicide literacy questionnaire, and a questionnaire assessing attitudes toward seeking professional psychological services.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eDemographic information form\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis form \u003cb\u003econsists\u003c/b\u003e of 16 items, including age, gender, education, marital status, household income, clinical work experience, emergency department work experience, employment status, psychiatric ward work experience, history of psychiatric disorders, history of psychiatric medication use, history of utilizing psychiatric or psychological services, experience caring for patients with suicidal thoughts or attempts, history of a family member\u0026rsquo;s suicide attempt, history of a family member\u0026rsquo;s death by suicide, and participation in workshops related to suicide.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSuicide literacy questionnaire\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis instrument was first developed by Calear and Batterham in 2012. The original version consisted of 26 items, and the shortened version, known as the suicide literacy scale, was created by Batterham and colleagues in 2013(23).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eThis version of the questionnaire, consisting of 12 items, assesses suicide literacy across four domains\u003c/strong\u003e\u003cp\u003ecauses or nature of suicide (items 1, 7, 10, and 12), risk factors (items 3, 4, and 11), signs and symptoms (items 5, 6, and 8), and treatment and prevention strategies (items 2 and 9). The respondents answer these items with \u0026ldquo;true,\u0026rdquo; \u0026ldquo;false,\u0026rdquo; or \u0026ldquo;i don\u0026rsquo;t know.\u003cb\u003e\u0026rdquo;\u003c/b\u003e Correct answers receive a score of 1, whereas incorrect or \u0026ldquo;i don\u0026rsquo;t know\u0026rdquo; responses receive a score of 0, resulting in a total score ranging from 0\u0026ndash;12 (23). Its reliability and validity were confirmed by Saeed and colleagues in a population of online social media users in Iran, with a Cronbach\u0026rsquo;s alpha of 0.76 (24). Additionally, a study conducted in a province in Iran by tabari and colleagues (2023) among nurses and physicians reported a Cronbach\u0026rsquo;s alpha of 0.86 for internal consistency reliability (25).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eQuestionnaire on attitudes toward seeking professional psychological services\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis instrument, developed by Fischer and Farina in 1995, consists of 10 items scored on a 4-point Likert scale (0\u0026thinsp;=\u0026thinsp;strongly disagree to 3\u0026thinsp;=\u0026thinsp;strongly agree\u003cb\u003e).\u003c/b\u003e The reverse-scored items (2, 4, 8, 9, and 10) are scored as \u0026ldquo;strongly disagree\u0026rdquo; = 3 and \u0026ldquo;strongly agree\u0026rdquo; = 0. Higher total scores indicate more positive attitudes toward seeking psychological help (26). Its reliability and validity in the Persian version were reported, with a Cronbach\u0026rsquo;s alpha of 0.84 (27). Additionally, Nazari and colleagues reported a Cronbach\u0026rsquo;s alpha of 0.78, confirming the reliability and validity of the scale (28).\u003c/p\u003e\u003cp\u003e\u003cb\u003eData collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFirst, the necessary administrative approvals and coordination were obtained. The researcher then visited the emergency department and, in coordination with the head nurses, obtained a list of nurses with at least six months of work experience in this department. Next, the researcher referred to the emergency department during different shifts, introduced himself, explained the study objectives, and invited nurses to participate in the study. Those who agreed received an informed consent form and data collection questionnaires. After reviewing and signing the consent form, participants were asked, if possible, to complete the questionnaires immediately. The questionnaires were self-administered \u003cb\u003eonsite\u003c/b\u003e in the presence of the researcher so that any questions or ambiguities could be clarified. If nurses were unable to complete the questionnaires at that time, the researcher returned to the emergency department on a date agreed upon by the participants to collect the completed questionnaires. If a questionnaire was incomplete or not returned, the researcher followed up once more to ensure completion. Ultimately, if a questionnaire remained incomplete or unreturned, the participant was excluded from the study.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eContinuous variables are expressed as the means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations (SDs), and categorical variables are expressed as frequencies (percentages). In this cross-sectional study, the normality of the data distribution was assessed via the Kolmogorov\u0026ndash;Smirnov and Shapiro\u0026ndash;Wilk tests. Depending on the number of groups and distributional assumptions, comparisons of mean values were performed via the independent-samples \u003cem\u003et\u003c/em\u003e test, one-way analysis of variance (ANOVA), or the Mann\u0026ndash;Whitney U test. Pearson\u0026rsquo;s correlation coefficient was used to evaluate associations between continuous variables. Multivariate linear regression analysis was further conducted to identify predictors of suicide literacy scores and attitudes toward seeking professional psychological help. All the statistical analyses were carried out via SPSS software, version 19, with a significance threshold set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003eCharacteristics of the participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, 314 questionnaires were distributed among emergency nurses. Of these, 24 questionnaires were not returned due to the high workload and stressful conditions in the emergency department, and 10 questionnaires were incomplete. Therefore, 34 questionnaires were excluded from the final analysis, resulting in a final sample of 280 participants. The mean age of the participants was 31.20 years (range: 21\u0026ndash;58), the mean clinical work experience was 6.90 years (range: 1\u0026ndash;32), and the mean emergency department work experience was 4.22 years (range: 1\u0026ndash;30). More than half of the participants (55.4%) were female, 90% held a bachelor\u0026rsquo;s degree, and 56.4% were single. Additionally, 42.5% reported an income below household expenses, and 46.8% were employed under temporary contracts. Most nurses had no prior experience working in psychiatric wards (83.6%), no history of psychiatric disorders (90.4%), no history of psychiatric medication use (83.2%), and no history of utilizing psychological or psychiatric services (71.4%). Furthermore, 60.7% had no experience caring for patients with suicidal thoughts or attempts, 96.1% had no family history of suicide attempts, 98.6% had no family history of death by suicide, and 80.4% had not participated in suicide-related workshops (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eStatistical analysis revealed a significant negative correlation between age and total suicide literacy score (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, clinical work experience was negatively and significantly correlated with the total suicide literacy score (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and emergency department work experience was weakly but significantly negatively correlated with the total suicide literacy score (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, the difference in total suicide literacy scores between male and female participants was significant (p\u0026thinsp;=\u0026thinsp;0.03). Moreover, the mean suicide literacy score differed significantly between educational levels (p\u0026thinsp;=\u0026thinsp;0.02) and between employment status groups (p\u0026thinsp;=\u0026thinsp;0.03) \u003cstrong\u003e(\u003c/strong\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cstrong\u003e).\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDescriptive statistics and correlations of demographic variables with suicide literacy scores\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003cth style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eMedian (IQR)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eRange (Min\u0026ndash;Max)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eR (with suicide literacy)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eAge (years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e31.20\u0026thinsp;\u0026plusmn;\u0026thinsp;6.79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e29 (26\u0026ndash;35)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e21\u0026ndash;58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026ndash;0.204\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eClinical work experience (years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e6.90\u0026thinsp;\u0026plusmn;\u0026thinsp;6.63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e4 (2\u0026ndash;9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e1\u0026ndash;32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026ndash;0.194\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eEmergency work experience (years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e4.22\u0026thinsp;\u0026plusmn;\u0026thinsp;4.52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e3 (1\u0026ndash;6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e1\u0026ndash;30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026ndash;0.146\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr style=\"height: 13px;\"\u003e\n\u003ctd style=\"height: 13px;\" colspan=\"5\"\u003e\u003cstrong\u003eIQR\u0026thinsp;=\u0026thinsp;Interquartile range\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eRelationship of Demographic Variables with Suicide Literacy of Emergency Nurses\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCategory\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eN (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMean ) SD( of Suicide Literacy\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTest Statistic\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12544.6))\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.64(2.00)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eZ = -2.16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e03/0\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(55.4) 155\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.07\u003cstrong\u003e(\u003c/strong\u003e1.87)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eEducation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBachelor\u0026rsquo;s Degree\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(90)252\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.79\u003cstrong\u003e(\u003c/strong\u003e1.89)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eT = -2.31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMaster\u0026rsquo;s Degree and Above\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(10)28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.68\u003cstrong\u003e(\u003c/strong\u003e2.17)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eMarital Status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(41.4)116\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.93\u003cstrong\u003e(\u003c/strong\u003e1.85)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.90\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSingle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(56.4)158\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.85\u003cstrong\u003e(\u003c/strong\u003e2.00)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDivorced\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(2.1)6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.67\u003cstrong\u003e(2.33)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eIncome Level\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLess Than Household Expenses\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(42.5)119\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.90\u003cstrong\u003e(1.86)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eF\u0026thinsp;=\u0026thinsp;2.24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.10\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEqual To Household Expenses\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(42.9)120\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.68\u003cstrong\u003e(2.00)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMore Than Household Expenses\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(14.6)41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.41\u003cstrong\u003e(1.97)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eEmployment Status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOfficial\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(36.1)101\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.57\u003cstrong\u003e(1.88)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eF\u0026thinsp;=\u0026thinsp;2.95\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFixed-Term\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(6.1)17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.88\u003cstrong\u003e(1.45)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eContract\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(10.4)29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.55\u003cstrong\u003e(2.11)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProject-Based\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(46.8)121\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.04\u003cstrong\u003e(1.96)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eWork Experience in Psychiatric Department\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(16.4)46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.04\u003cstrong\u003e(2.12)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eT = -0.62\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.53\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(83.6)234\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.85\u003cstrong\u003e(1.90)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eHistory of Psychiatric Disorder\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(9.6)27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.22\u003cstrong\u003e(\u003c/strong\u003e2.30)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eT = -0.96\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.33\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(90.4)253\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.84\u003cstrong\u003e(\u003c/strong\u003e1.90)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eHistory of Psychiatric Medication Use\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(16.8)47\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.96\u003cstrong\u003e(2.08)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eT = -0.30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.71\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(83.2)233\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.86\u003cstrong\u003e(1.91)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eHistory of Using Psychological or Psychiatric Services\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(28.6)80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.05\u003cstrong\u003e(2.03)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eT = -0.93\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.35\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(71.4)200\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.81\u003cstrong\u003e(1.90)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eHistory of Caring for Patients with Suicidal Thoughts or Attempts\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(39.3)110\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.11\u003cstrong\u003e(1.80)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eT = -1.60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(60.7)170\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.73\u003cstrong\u003e(2.01)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eFamily History of Suicide Attempt\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(3.9)11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.18\u003cstrong\u003e(1.88)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eT\u0026thinsp;=\u0026thinsp;1.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.22\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(96.1)269\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.91\u003cstrong\u003e(1.94)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eFamily History of Suicide Death\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(1.4)4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.25\u003cstrong\u003e(1.25)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eT\u0026thinsp;=\u0026thinsp;0.65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.51\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(98.6)276\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.89\u003cstrong\u003e(1.95)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eHistory of Attending Suicide-Related Workshops\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(19.6)55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.07\u003cstrong\u003e(1.74)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eT = -0.82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.40\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(80.4)225\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.83\u003cstrong\u003e(1.98)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\" align=\"left\"\u003e\n\u003cp\u003eR\u0026thinsp;=\u0026thinsp;Pearson correlation coefficient, t\u0026thinsp;=\u0026thinsp;independent t-test statistic, F\u0026thinsp;=\u0026thinsp;analysis of variance (ANOVA) statistic, Z\u0026thinsp;=\u0026thinsp;Mann\u0026ndash;Whitney statistic. Significance level\u0026thinsp;=\u0026thinsp;p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, the means and standard deviations of the suicide literacy subscales, total suicide literacy score, and attitudes toward seeking professional psychological services among emergency nurses in teaching hospitals Kermanshah are presented. The mean total suicide literacy score was approximately six, and the mean attitude score toward seeking psychological care was approximately 18.5. Among the suicide literacy domains, awareness of the causes or nature of suicide had the lowest mean score \u003cstrong\u003e(\u003c/strong\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cstrong\u003e).\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMeans of Suicide Literacy and Attitudes toward Seeking Professional Psychological Services\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDomains\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMinimum Score\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMaximum Score\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMean (SD)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal Suicide Literacy Score\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5.88(1.94)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCauses Nature of Suicide\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.25(1.12)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRisk Factors\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.50(0.74)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSigns And Symptoms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.64(0.87)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTreatment and Prevention Strategies\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.49(0.62)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTotal Score of Attitude toward Seeking Professional Psychological Services\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18.40(5.30)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe results indicated that female nurses had more positive attitudes toward suicide than did male nurses, and this difference was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, the mean attitude score differed significantly among income groups (p\u0026thinsp;=\u0026thinsp;0.02). The results from an independent t test also revealed that the mean attitude scores of nurses who had not utilized psychological or psychiatric services compared with those who had utilized these services were significantly different (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Furthermore, a family history of death by suicide was significantly associated with attitude scores (p\u0026thinsp;=\u0026thinsp;0.00) \u003cstrong\u003e(\u003c/strong\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cstrong\u003e)\u003c/strong\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eComparison of Participants' Attitude toward Seeking Professional Psychological Services by Gender, Household Income, History of Using Psychological or Psychiatric Services, and History of Suicide a Family Member\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCategory\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMean ( SD)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTest Statistic\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"9\" align=\"left\"\u003e\n\u003cp\u003eAttitude toward Seeking Professional Psychological Services\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e125\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17.08(5.28)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eT = -3.84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e155\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.47(5.09)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eIncome Level\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLess Than Household Expenses\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e119\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17.67(5.31)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eF\u0026thinsp;=\u0026thinsp;3.68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEqual To Household Expenses\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e120\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e(5.31)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMore Than Household Expenses\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20.24(4.88)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eHistory Of Psychiatric Medication Use\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e200\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17.85(5.23)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eT = -2.79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.00\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.79(2.25)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eFamily History of Suicide Death\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e276\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18.50(5.26)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eT\u0026thinsp;=\u0026thinsp;2.65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.00\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.50(3.10)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eFurthermore, the total attitude score toward seeking professional psychological services was positively and significantly correlated with the total suicide literacy score (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), signs and symptoms (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and treatment and prevention strategies (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating that better attitudes were associated with greater awareness in these domains. In contrast, attitudes were weakly and non significantly correlated with awareness of the causes or nature of suicide (p\u0026thinsp;=\u0026thinsp;0.22) and risk factors (p\u0026thinsp;=\u0026thinsp;0.23), suggesting that these two dimensions of suicide literacy do not have a significant effect on the total attitude score toward seeking professional psychological services \u003cstrong\u003e(\u003c/strong\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cstrong\u003e).\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eRelationships between Suicide Literacy (and Its Dimensions) and Attitudes Toward Seeking Professional Psychological Services\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eIndependent Variable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDependent Variable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eR\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e95% CI (lower\u0026ndash;upper)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSuicide Literacy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eAttitude Toward Seeking Professional Psychological Services\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.05 0.28\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCauses or Nature of Suicide\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.07-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.18 0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRisk Factors\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.04 0.18\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSigns And Symptoms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.04 0.27\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTreatment And Prevention Strategies\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.23 0.43\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eIn this study, multivariable linear regression was used to develop two models. In the first model, the dependent variable was considered \u0026ldquo;suicide literacy.\u003cstrong\u003e\u0026rdquo;\u003c/strong\u003e Multiple regression analysis indicated that the overall model of predictors explained 13% of the variance in the suicide literacy score. The results showed that age, \u003cstrong\u003esex\u003c/strong\u003e, and educational level significantly predicted the dependent variable. Age had a negative and significant effect; as age increased, the suicide literacy score decreased. Gender also had a positive and significant effect, with mean scores being higher in females than in males. Educational level (master\u0026rsquo;s degree or higher than a bachelor\u0026rsquo;s degree) was a positive and significant predictor; thus, participants with higher education obtained higher scores \u003cstrong\u003e(\u003c/strong\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e\u003cstrong\u003e).\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab6\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003ePrediction of Suicide Literacy Components Based on Demographic Variables among Study Participants\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003cth style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eDependent Variable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eIndependent Variable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026beta;\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e95% CI (lower\u0026ndash;upper)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eModel Summary\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 385px;\" rowspan=\"11\" align=\"left\"\u003e\n\u003cp\u003eSuicide Literacy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eConstant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e7.41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e5.53 9.30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 385px;\" rowspan=\"11\" align=\"left\"\u003e\n\u003cp\u003eR\u0026thinsp;=\u0026thinsp;0.36\u003c/p\u003e\n\u003cp\u003eR\u0026sup2; = 0.13\u003c/p\u003e\n\u003cp\u003eAdjusted R\u0026sup2; = 0.10\u003c/p\u003e\n\u003cp\u003eStd. Error\u0026thinsp;=\u0026thinsp;1.84\u003c/p\u003e\n\u003cp\u003eF\u0026thinsp;=\u0026thinsp;4.11\u003c/p\u003e\n\u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e-0.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e-0.32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e-0.13 -0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.18 1.09\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eEducation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e1.34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.57 2.11\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eIncome (Equal Vs. Lower)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e-0.26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e-0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e-0.75 0.21\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eIncome Level (Higher Vs. Lower)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0. 40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e-0.44 0.92\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eEmployment Status (Permanent Vs. Temporary)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e-0.33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e-0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e-0.87 0.18\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eHistory Of Psychiatric Problems (Yes/No)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e.010\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.86\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e-0.73 0.88\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eReceiving Psychiatric Services (Yes/No)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e02.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e-0.42 0.65\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eCaring For a Person Who Attempted Suicide (Yes/No)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e.080\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e-0.11 0.78\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eFamily History of Suicide Death (Yes/No)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e-0.75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e-0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.42\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e-2.60 1.09\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe results of identifying factors associated with the dependent variable also indicated that gender, income level, and family history of suicide were significant predictors, with approximately 13% of the variance in attitudes toward seeking professional psychological services explained by the model variables. Specifically, females scored higher than males did, and participants with higher incomes had higher mean scores than did those with lower incomes. In contrast, a family history of suicide was associated with a significant decrease in the dependent variable score. Furthermore, suicide literacy, although at a marginally significant level (p\u0026thinsp;=\u0026thinsp;0.05), showed a positive trend in predicting the dependent variable. Other variables, including age, education, employment status, history of psychiatric disorders, use of psychiatric medications, and utilization of psychological services, did not significantly affect the model \u003cstrong\u003e(\u003c/strong\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e\u003cstrong\u003e)\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab7\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003ePrediction of the component \u0026ldquo;Attitude Toward Seeking Professional Psychological Services\u0026rdquo; on the basis of suicide literacy and demographic variables among the study participants.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDependent Variable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eIndependent Variable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026beta;\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e95% CI (lower\u0026ndash;upper)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eModel Summary\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"12\" align=\"left\"\u003e\n\u003cp\u003eAttitude Toward Seeking Professional Psychological Services\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eConstant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12.84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7.17 1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"12\" align=\"left\"\u003e\n\u003cp\u003eR\u0026thinsp;=\u0026thinsp;0.37\u003c/p\u003e\n\u003cp\u003eR\u0026sup2; = 0.13\u003c/p\u003e\n\u003cp\u003eAdjusted R\u0026sup2; =0.10\u003c/p\u003e\n\u003cp\u003eStd. Error\u0026thinsp;=\u0026thinsp;5.02\u003c/p\u003e\n\u003cp\u003eF\u0026thinsp;=\u0026thinsp;3.87\u003c/p\u003e\n\u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSuicide Literacy Score\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.05\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.00 0.65\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.76\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.09 0.13\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.77 3.26\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEducation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.75 3.52\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIncome\u0026thinsp;=\u0026thinsp;Equal (Reference: Lower)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.94\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.37 2.27\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIncome\u0026thinsp;=\u0026thinsp;Higher (Reference: Lower)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2.16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.26 4.06\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEmployment Status\u0026thinsp;=\u0026thinsp;Permanent (Reference: Temporary)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-1.78 1.13\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHistory Of Psychiatric Disorder (Yes/No)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-2.61 2.11\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUse Of Psychiatric Medication (Yes/No)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-1.44 2.52\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReceiving Psychiatric/Psychological Services (Yes/No)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.97\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-0.61 2.56\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFamily History Of Suicide Death (Yes/No)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-7.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e-12.18 -2.12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eNote.\u003c/strong\u003e Dependent variable: attitude score. B\u0026thinsp;=\u0026thinsp;Unstandardized coefficients; \u0026beta;\u0026thinsp;=\u0026thinsp;Standardized coefficients; SE B\u0026thinsp;=\u0026thinsp;standard error of B; CI\u0026thinsp;=\u0026thinsp;confidence interval. Predictors: Suicide literacy\u0026thinsp;=\u0026thinsp;total suicide literacy score; Age\u0026thinsp;=\u0026thinsp;age (years); Gender\u0026thinsp;=\u0026thinsp;Female (ref: Male); Education\u0026thinsp;=\u0026thinsp;1 (Master\u0026rsquo;s or higher, ref: Bachelor); Income\u0026thinsp;=\u0026thinsp;Equal/Higher (ref: Lower); Employment Status\u0026thinsp;=\u0026thinsp;Permanent (ref: Temporary); Psychiatric Disorder History\u0026thinsp;=\u0026thinsp;yes/no; Psychiatric Medication Use\u0026thinsp;=\u0026thinsp;yes/no; Psychiatric/Psychological Service Use\u0026thinsp;=\u0026thinsp;yes/no; Family Suicide History\u0026thinsp;=\u0026thinsp;yes/no.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study aimed to investigate suicide literacy and attitudes toward professional psychological help-seeking among emergency nurses working in hospitals affiliated with Kermanshah University of Medical Sciences. To the best of our knowledge, this is the first study to specifically examine this relationship among emergency nurses. The mean score of suicide literacy in this group was 5.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.94, indicating a moderate level of suicide literacy among nurses. This finding is consistent with those of previous studies (21, 25), highlighting the necessity of implementing targeted and evidence-based training programs to increase suicide literacy.\u003c/p\u003e\u003cp\u003eThe analysis of different dimensions of suicide literacy revealed that the highest mean score pertained to the recognition of suicide signs and symptoms, whereas the lowest mean score was related to the understanding of its causes and nature. These findings suggest that nurses, particularly in the area of understanding the causes and nature of suicide, require further training. Suicide literacy plays a crucial role in designing educational programs and improving health communication and can serve as a key factor in policymaking and suicide prevention initiatives (29). Moreover, the findings of the study by Ozturk et al. indicated that a lack of knowledge leads to ambiguity, which in turn causes anxiety among nurses (7). In the study conducted by Kara Kaya et al.(21), the highest score was observed in the dimension related to the causes of suicide, whereas the lowest score pertained to the recognition of suicide signs. This finding can be explained by the short form of the Literacy of Suicide Scale used in the present study.\u003c/p\u003e\u003cp\u003eThe mean score of attitudes toward seeking professional psychological help was 18.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.30, indicating a moderately positive attitude. This finding is consistent with those of previous studies (30). However, it is still possible that this attitude can be improved through professional support and targeted interventions, as it may be influenced by the effects of external social stigma and internal shame experienced by nurses when seeking psychiatric care. Individuals who hold negative attitudes toward mental health problems may engage in negative self-talk, leading to feelings of internal shame and perceptions of personal weakness or inadequacy. They may also experience external shame, as concerns about their mental health status could make them fear being judged negatively by others or believing that they might bring shame to their family or community (30). In addition, a study showed that nurses who have been exposed to their patients\u0026rsquo; suicide attempts or who have completed suicide become secondary victims of these events (31). These individuals experience negative emotions toward completed or attempted suicide, which may manifest as intense emotional distress, stress, and feelings of incapacity (32). This underscores the necessity of psychological interventions, particularly in light of the prevalence of mental health issues such as depression and anxiety and the high rate of suicide among healthcare professionals (11).\u003c/p\u003e\u003cp\u003eIn examining the relationships between demographic variables and suicide literacy, six variables, namely, age, clinical work experience, emergency department work experience, education, gender, and employment status, demonstrated significant associations. Age was negatively correlated with suicide literacy, which is consistent with the findings of the study by Letho et al.(33), whereas Kara Kaya et al. (21) did not observe such a relationship and suggested that this relationship be further investigated. In the present study, suicide literacy decreased with increasing age, which may be due to the limited access of older individuals to up-to-date training and the better access of younger individuals to educational resources and the internet. Gender was also significantly associated with suicide literacy, with female nurses reporting higher literacy levels. Overall, findings in this area (21) are inconsistent and appear to depend on various factors. To better understand this issue, further research using comprehensive approaches that consider cultural, social, and gender-related factors is needed.\u003c/p\u003e\u003cp\u003eClinical work experience and emergency department work experience were negatively and significantly associated with suicide literacy and were also identified as significant predictors in the regression model. In the study by Kara Kaya et al.(21), emergency department work experience was similarly significantly associated with suicide literacy, whereas overall work experience showed no such relationship. Considering that age was also negatively associated with suicide literacy in the present study, it can be inferred that with increasing work experience, nurses may have less access to up-to-date training, which could lead to a decrease in their suicide literacy. Employment status was also significantly associated with suicide literacy, with nurses employed under temporary or contract positions demonstrating higher literacy levels. These individuals were generally younger and newly employed, further supporting previous findings. Similarly, education level was significantly associated with suicide literacy; individuals with a master\u0026rsquo;s degree or higher reported higher levels of suicide literacy. This finding is consistent with the studies by Letho et al. and Kara Kaya et al., confirming the results of the present study that access to up-to-date scientific resources contributes to increased suicide literacy(21, 33).\u003c/p\u003e\u003cp\u003eGender was significantly associated with attitudes toward seeking professional psychological help and emerged as a significant predictor in the regression analysis, with female nurses scoring higher. This finding aligns with a previous meta-analysis showing that women are more likely than men to seek help from informal sources, such as family members and friends. This may reflect social and cultural roles that encourage women to be more attentive to their mental health and more comfortable seeking both social and professional support (34). Furthermore, the results indicated that individuals with higher income levels exhibited more positive attitudes toward seeking psychological services, and this variable was also identified as a significant predictor in the regression model. Few studies have examined this issue to date, and future research is recommended to explore it further. In the present study, the first author observed during data collection that some participants reported economic difficulties as a reason for not seeking psychological services, suggesting that financial barriers may be a key factor preventing individuals from accessing these services. Additionally, the use of psychological services is associated with more positive attitudes toward these services in subsequent encounters. As shown in the study by Xuntao He et al., trust in mental health professionals plays a central role in shaping nurses\u0026rsquo; attitudes toward seeking psychological help and has been identified as a key determinant in the utilization of these services (22).\u003c/p\u003e\u003cp\u003eFurthermore, individuals with a history of losing a family member due to suicide presented more negative attitudes toward psychological services, a relationship that was statistically significant and identified as a significant predictor in the regression model. Consistent with this finding, the study by Wlliye et al. demonstrated that witnessing or experiencing suicide within the family is associated with increased feelings of shame, guilt, and social isolation, which may reduce the likelihood of seeking psychological help (35).\u003c/p\u003e\u003cp\u003eAn examination of the relationship between suicide literacy and attitudes toward seeking professional psychological help revealed a significant positive correlation between these two variables. Moreover, in the regression model, suicide literacy was identified as a predictor of attitudes. Further analysis of the different dimensions of suicide literacy indicated that two dimensions, \u0026ldquo;recognition of signs and symptoms\u0026rdquo; and \u0026ldquo;prevention and treatment strategies,\u0026rdquo; were positively and significantly associated with attitudes. These findings suggest that although the total suicide literacy score was only marginally significant in relation to attitude, a closer examination of its dimensions demonstrated that these two aspects play crucial roles in shaping positive attitudes. Therefore, enhancing suicide literacy, particularly by focusing on \u0026ldquo;recognition of signs and symptoms\u0026rdquo; and \u0026ldquo;prevention and treatment strategies,\u0026rdquo; is essential for fostering positive attitudes among nurses. A similar finding was reported by Jahanbakhsh et al., who reported a positive relationship between these two variables (19).\u003c/p\u003e\u003cp\u003eOverall, the findings of this study emphasize the importance of enhancing suicide literacy among emergency nurses and its impact on attitudes toward seeking professional psychological help. Nurses with higher levels of suicide literacy, particularly in recognizing signs and symptoms and in prevention and treatment strategies, are more likely to seek professional psychological support when facing stressors and crises. Targeted training and intervention programs that strengthen these skills can not only improve nurses\u0026rsquo; suicide literacy but also foster more positive attitudes toward help-seeking.\u003c/p\u003e\u003cp\u003eFurthermore, considering the individual and demographic characteristics of nurses, such as gender, age, education, and work experience, can enhance the effectiveness of training programs. It is recommended that suicide-related education be regularly integrated into academic curricula and in-service training and that accessible, reliable informational resources be provided to nurses. This approach can not only improve knowledge but also enhance the ability to manage patients at risk of suicide. Combining the enhancement of suicide literacy with ongoing psychological support may contribute to improving the quality of care and reducing negative psychological outcomes for both nurses and patients.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe cross-sectional design of this study implies that the data were collected at a single point in time, which does not allow for causal inferences. Therefore, researchers recommend the use of longitudinal or correlational approaches in future studies to better identify relationships. Additionally, reliance on self-reported data to assess knowledge and attitudes may introduce response bias. One limitation of this study was the conditions under which the responses were provided in the emergency department. Nurses were required to respond quickly, and some may not have fully read certain items or may have provided rapid and less focused answers. To mitigate this limitation, the researchers employed the short form of the LOSS questionnaire, which simplified the response process.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRecommendations for Further Research\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOn the basis of these findings, a detailed investigation of the mechanisms through which demographic factors, including age, work experience, and income level, influence suicide literacy and attitudes among emergency nurses is recommended. Additionally, identifying the root causes of negative attitudes and designing targeted educational interventions to modify these attitudes should be prioritized.\u003c/p\u003e\u003cp\u003e\u003cb\u003eImplications for policy and practice\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThese findings indicate that enhancing suicide literacy, particularly in the areas of warning sign recognition and prevention and treatment strategies, can strengthen nurses' positive attitudes toward seeking professional psychological help. Educational and training programs for nurses should consistently include content related to suicide literacy, and up-to-date, accessible educational resources should be made available to them.\u003c/p\u003e\u003cp\u003eFurthermore, attention to the individual and demographic characteristics of nurses, such as age, gender, work experience, and education level, can enhance the effectiveness of educational interventions. For example, designing different educational modules on the basis of gender and years of work experience can significantly increase the effectiveness of training programs. This personalized approach ensures that the educational content directly aligns with the needs and conditions of each group of nurses.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study demonstrated that suicide literacy and attitudes toward seeking professional psychological help among emergency nurses are moderate and that factors such as age, work experience, education, gender, and personal experience are associated with these variables. The findings also indicate that enhancing suicide literacy, particularly in understanding the causes and nature of suicide and in prevention and treatment skills, can strengthen positive attitudes toward seeking professional help. Therefore, targeted and continuous training programs, alongside psychological support, can improve both suicide literacy and the acceptance of psychological help among nurses.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Ethics Committee of Kurdistan University of Medical Sciences (Ethics Approval Code: [\u003cstrong\u003eIR.MUK.REC.1404.132\u003c/strong\u003e]). The committee supervised all stages of the study, and all procedures were conducted in accordance with the Declaration of Helsinki and the university’s ethical guidelines.\u003c/p\u003e\n\u003cp\u003eAll participants provided written informed consent prior to completing the questionnaires. Confidentiality was maintained by anonymizing the responses and storing them securely. Participants were informed that they could withdraw from the study at any time without any consequences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This research does not contain any individual person’s data in any form (including individual details, images, or videos).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due to privacy and confidentiality agreements with participants but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1.Ali Ghanbari Rafatie\u003c/p\u003e\n\u003cp\u003eConceptualization, writing – original draft, Data collection, writing – review and editing\u003c/p\u003e\n\u003cp\u003e2.Salam Vatandost\u003c/p\u003e\n\u003cp\u003eWriting – original draft, writing – review and editing\u003c/p\u003e\n\u003cp\u003e3.Vahid Ghanbari\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConceptualization, writing – original draft, writing – review and editing\u003c/p\u003e\n\u003cp\u003e4.Tayeb Mohammadi\u003c/p\u003e\n\u003cp\u003eData curation, Formal analysis\u003c/p\u003e\n\u003cp\u003e5.Nazila Oliaee\u003c/p\u003e\n\u003cp\u003eConceptualization, writing – original draft, writing – review and editing, Project\u0026nbsp;administration\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their sincere gratitude to Kurdistan University of Medical Sciences for their support, and to the Research Deputy of Kermanshah University of Medical Sciences for their valuable collaboration and assistance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' information (optional):\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWHO. suicide: World Health Oraganization; 2025 [cited{ 2025 25}]. Available from: https://www.google.com/url?client=internal-element-cse\u0026amp;cx=40555c832b6924a9d\u0026amp;q=https://www.who.int/news-room/fact-sheets/detail/suicide\u0026amp;sa=U\u0026amp;ved=2ahUKEwiqu52FtNuPAxUsVKQEHQ8nKwkQFnoECAIQAg\u0026amp;usg=AOvVaw0Qf5d6lFV41Ym0hj2zbLvu.\u003c/li\u003e\n\u003cli\u003eAndela M. Work-related stressors and suicidal ideation: the mediating role of burnout. Journal of Workplace Behavioral Health. 2021;36(2):125-45.(Journal of Workplace Behavioral Health).(http://dx.doi.org/10.1080/15555240.2021.1897605)\u003c/li\u003e\n\u003cli\u003eJain L, Sarfraz Z, Karlapati S, Kazmi S, Nasir MJ, Atiq N, et al. Suicide in healthcare workers: an umbrella review of prevalence, causes, and preventive strategies. Journal of Primary Care \u0026amp; Community Health. 2024;15:21501319241273242.(Journal of Primary Care \u0026amp; Community Health).(https://doi.org/10.1177/21501319241273242)\u003c/li\u003e\n\u003cli\u003eKunz M, Strasser M, Hasan A. Impact of the coronavirus disease 2019 pandemic on healthcare workers: systematic comparison between nurses and medical doctors. Current opinion in psychiatry. 2021;34(4):413-9.(Current opinion in psychiatry).(https://doi.org/10.1097/YCO.0000000000000721)\u003c/li\u003e\n\u003cli\u003eBraquehais MD, Gonz\u0026aacute;lez-Irizar O, Nieva G, Mozo X, Llavayol E, Pujol T, et al. Assessing high risk of suicide amongst physicians and nurses in treatment. Psychiatry research. 2020;291:113237.(Psychiatry research).(http://dx.doi.org/10.1016/j.psychres.2020.113237)\u003c/li\u003e\n\u003cli\u003eThom\u0026aacute;s M, Ciara M, Laura M, Rich\u0026eacute;al B. Promoting early-intervention for suicide prevention: The role of mental health literacy and attitudes towards suicide: A quantitative study in Ireland. Health Policy. 2024;149:105150.(Health Policy).(http://dx.doi.org/10.1016/j.healthpol.2024.105150)\u003c/li\u003e\n\u003cli\u003e\u0026Ouml;zt\u0026uuml;rk S, Hicdurmaz D. A qualitative study on the perspectives and needs of oncology nurses about recognition and management of suicide risk in cancer patients. Journal of clinical nursing. 2023;32(5-6):749-63.(Journal of clinical nursing).(https://doi.org/10.1111/jocn.16304)\u003c/li\u003e\n\u003cli\u003eRamberg I-L, Di Lucca MA, Hadlaczky G. The impact of knowledge of suicide prevention and work experience among clinical staff on attitudes towards working with suicidal patients and suicide prevention. International journal of environmental research and public health. 2016;13(2):195.(International journal of environmental research and public health).(https://doi.org/10.3390/ijerph13020195)\u003c/li\u003e\n\u003cli\u003eSharaf AY, Ossman LH, Lachine OA. A cross-sectional study of the relationships between illness insight, internalized stigma, and suicide risk in individuals with schizophrenia. International journal of nursing studies. 2012;49(12):1512-20.(International journal of nursing studies).(https://doi.org/10.1016/j.ijnurstu.2012.08.006)\u003c/li\u003e\n\u003cli\u003eJafari A, Moshki M, Mokhtari AM, Ghaffari A, Nejatian M. Title page: psychometric properties of literacy of suicide scale (LOSS) in Iranian population: long form. BMC public health. 2023;23(1):608.(BMC public health).(http://dx.doi.org/10.1186/s12889-023-15528-8)\u003c/li\u003e\n\u003cli\u003eRevata BK, Djaja N. The Role of Suicide Literacy and Suicide Stigma in Shaping Attitudes toward Seeking Professional Psychological Help among Indonesian Emerging Adults. Journal of Educational, Health \u0026amp; Community Psychology (JEHCP). 2025;14(1).(Journal of Educational, Health \u0026amp; Community Psychology (JEHCP)).(https://doi.org/10.12928/jehcp.vi.30367)\u003c/li\u003e\n\u003cli\u003eMaryam M, Siroos A. Macro Socioeconomic Determinants of Suicide in Iran: A Time Series Study during 1991-2023. Iranian Journal of Public Health. 2025;54(8).(Iranian Journal of Public Health).(https://doi.org/10.18502/ijph.v54i8.19587)\u003c/li\u003e\n\u003cli\u003eFischer EH, Turner JI. Orientations to seeking professional help: development and research utility of an attitude scale. Journal of consulting and clinical psychology. 1970;35(1p1):79.(Journal of consulting and clinical psychology).(https://doi.org/10.1037/h0020198)\u003c/li\u003e\n\u003cli\u003eKantar A, Yal\u0026ccedil;ın İ. Masculine Gender Role Stress and Attitudes Towards Seeking Psychological Help: Serial Mediation by Self-Stigma and Self-Compassion. Current Psychology. 2023;43:1-11.(Current Psychology).(https://doi.org/10.1007/s12144-023-04702-1)\u003c/li\u003e\n\u003cli\u003eAlqhtani SS, Aldhafeeri NA, Alotaibi L, Alanzi H, Alshamrani W, Alqhtani N, et al. Nursing students\u0026rsquo; attitudes and intentions towards seeking professional psychological help: the mediating role of emotional intelligence. BMC psychology. 2025;13(1):144.(BMC psychology).(http://dx.doi.org/10.1186/s40359-025-02474-w)\u003c/li\u003e\n\u003cli\u003eHan J, Batterham PJ, Calear AL, Ma J. Seeking professional help for suicidal ideation: A comparison between Chinese and Australian university students. Psychiatry Res. 2018;270:807-14.(Psychiatry Res).(https://doi.org/10.1016/j.psychres.2018.10.080)\u003c/li\u003e\n\u003cli\u003eHom MA, Stanley IH, Joiner TE, Jr. Evaluating factors and interventions that influence help-seeking and mental health service utilization among suicidal individuals: A review of the literature. Clin Psychol Rev. 2015;40:28-39.(Clin Psychol Rev).(http://dx.doi.org/10.1016/j.cpr.2015.05.006)\u003c/li\u003e\n\u003cli\u003eBoukouvalas E, El-Den S, Murphy AL, Salvador-Carulla L, O'Reilly CL. Exploring Health Care Professionals' Knowledge of, Attitudes Towards, and Confidence in Caring for People at Risk of Suicide: a Systematic Review. Arch Suicide Res. 2020;24(sup2):S1-s31.(Arch Suicide Res).(https://doi.org/10.1080/13811118.2019.1586608)\u003c/li\u003e\n\u003cli\u003eJahanbakhsh F, Raaii F, Mohammadi A, Aminaie M, Shamspour M. Suicide literacy and attitudes toward seeking psychological help among medical residents. Archives of Iranian medicine. 2024;27(7):385.(Archives of Iranian medicine).(http://dx.doi.org/10.34172/aim.28839)\u003c/li\u003e\n\u003cli\u003eŽilinskas E, Lesinskienė S. Suicide literacy and attitudes toward psychological help-seeking: a cross-sectional study of students. Journal of international medical research. 2023;51(5):03000605231172452.(Journal of international medical research).(http://dx.doi.org/10.1177/03000605231172452)\u003c/li\u003e\n\u003cli\u003eKarakaya D, \u0026Ouml;zparlak A, \u0026Ouml;nder M. Suicide literacy in nurses: A cross-sectional study. J Clin Nurs. 2023;32(1-2):115-25.(J Clin Nurs).(https://doi.org/10.1111/jocn.16205)\u003c/li\u003e\n\u003cli\u003eHe X, Chen S, Zhang Q, He S, Yang L, Ma J. Mental Health Literacy and Professional Psychological Help-Seeking Attitudes Among Primary Healthcare Workers: The Mediating Role of Social Support and Mental Illness Stigma. Risk Management and Healthcare Policy. 2025:703-18.(Risk Management and Healthcare Policy).(http://dx.doi.org/10.2147/RMHP.S512458)\u003c/li\u003e\n\u003cli\u003eCalear AL, Batterham PJ, Trias A, Christensen H. The literacy of suicide scale. Crisis. 2021.(Crisis).(https://doi.org/10.1027/0227-5910/a000798)\u003c/li\u003e\n\u003cli\u003eSaeed F, Zangenehnia N, Zabihi Poursaadati M, Noroozi M, Kazemi Khaledi E, Mousavi SB. Psychometric properties of Persian Short forms of the literacy and stigma of suicide scales on the Iranian Population. Iran J Psychiatry Behav Sci. 2024;18(1):e143381.(Iran J Psychiatry Behav Sci).(https://doi.org/10.5812/ijpbs-143381)\u003c/li\u003e\n\u003cli\u003eTabari HO, Marznaki ZH, Moudi S, Kashi MA, Fendereski A, Kalal N, et al. Suicide Literacy and Stigmatising Attitude Among Poisoning Wards Nurses and Physicians Towards Patients With Suicide Attempts: A Cross‐Sectional Study. Nursing Open. 2025;12(5):e70182.(Nursing Open).(http://dx.doi.org/10.1002/nop2.70182)\u003c/li\u003e\n\u003cli\u003eFischer EH, Farina A. Attitudes toward seeking professional psychologial help: A shortened form and considerations for research. Journal of college student development. 1995.(Journal of college student development).(\u003c/li\u003e\n\u003cli\u003eKhoie K. Predictors of attitudes of Iranian males toward seeking psychological help: Alliant International University, Los Angeles; 2002.\u003c/li\u003e\n\u003cli\u003eNazari A, Garmaroudi G, Foroushani AR, Askari A. Psychometric assessment of the Persian adaptation of the attitudes toward seeking professional psychological help scale-short form. BMC psychiatry. 2024;24(1):75.(BMC psychiatry).(https://doi.org/10.1186/s12888-023-05388-2)\u003c/li\u003e\n\u003cli\u003eFitzpatrick SJ. Epistemic justice and the struggle for critical suicide literacy. Social Epistemology. 2020;34(6):555-65.(Social Epistemology).(https://doi.org/10.1080/02691728.2020.1725921)\u003c/li\u003e\n\u003cli\u003eQutishat MG. Psychological distress and attitudes toward seeking professional psychological help among Omani nurses: Strategies for nursing practice. Journal of Education and Health Promotion. 2024;13(1):325.(Journal of Education and Health Promotion).(https://doi.org/10.4103/jehp.jehp_209_24)\u003c/li\u003e\n\u003cli\u003eAmit Aharon A, Fariba M, Shoshana F, Melnikov S. Nurses as \u0026lsquo;second victims\u0026rsquo; to their patients\u0026rsquo; suicidal attempts: A mixed‐method study. Journal of clinical nursing. 2021;30(21-22):3290-300.(Journal of clinical nursing).(https://doi.org/10.1111/jocn.15839)\u003c/li\u003e\n\u003cli\u003eClua‐Garc\u0026iacute;a R, Casanova‐Garrig\u0026oacute;s G, Moreno‐Poyato AR. Suicide care from the nursing perspective: A meta‐synthesis of qualitative studies. Journal of advanced nursing. 2021;77(7):2995-3007.(Journal of advanced nursing).( https://doi.org/10.1111/jan.14789)\u003c/li\u003e\n\u003cli\u003eLETHO Z. KNOWLEDGE AND ATTITUDE TOWARDS SUICIDE AMONG NURSES IN NATIONAL REFERRAL HOSPITAL, BHUTAN: BURAPHA UNIVERSITY; 2017.\u003c/li\u003e\n\u003cli\u003eNagai S, Kimura M, Honda M, Iida T, Mizuno H. Gender Differences in Help‐Seeking: A Meta‐analysis of Japanese Studies, Including Unreported Data 1. Japanese Psychological Research. 2023.(Japanese Psychological Research).(https://doi.org/10.1111/jpr.12467)\u003c/li\u003e\n\u003cli\u003eWyllie JM, Robb KA, Sandford D, Etherson ME, Belkadi N, O\u0026rsquo;Connor RC. Suicide-related stigma and its relationship with help-seeking, mental health, suicidality and grief: scoping review. BJPsych Open. 2025;11(2):e60.(BJPsych Open).(https://doi.org/10.1192/bjo.2024.857)\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"attitude, emergency nursing, literacy, professional help-seeking behavior, suicide","lastPublishedDoi":"10.21203/rs.3.rs-8041607/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8041607/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSuicide is a major public health concern, particularly among healthcare professionals, with nurses at increased risk due to occupational stress, long shifts, and close patient contact. Mental health literacy, including suicide literacy, plays a crucial role in recognizing risk factors, identifying warning signs, and encouraging timely help-seeking. Despite international evidence on the importance of suicide literacy and attitudes toward professional psychological support, limited research exists among emergency nurses, particularly in Iran. This study aimed to examine the association between suicide literacy and attitudes toward seeking professional psychological help in this high-risk group.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethod\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA convenience sample of emergency nurses was recruited. Participants completed a demographic questionnaire, the Short Literacy of Suicide Scale, and the Attitudes Toward Seeking Professional Psychological Help questionnaire. Statistical analyses included independent-samples t tests, one-way analysis of variance (ANOVA), Mann\u0026ndash;Whitney U tests, Pearson\u0026rsquo;s correlation, and multivariable linear regression to identify predictors of suicide literacy and attitudes toward seeking professional psychological help. All analyses were performed using SPSS version 19, with statistical significance set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 280 nurses participated. The mean suicide literacy and attitudes toward seeking professional psychological help were at a moderate level. The lowest awareness was observed in the domain of \u0026ldquo;causes and nature of suicide.\u0026rdquo; Age and clinical work experience were negatively associated with suicide literacy, whereas being female, higher education, and contractual or temporary employment were positively associated. Women and participants with higher income demonstrated more positive attitudes toward seeking professional psychological help, while a family history of suicide was associated with lower attitudes. Suicide literacy, particularly the domains of \u0026ldquo;signs and symptoms\u0026rdquo; and \u0026ldquo;prevention and treatment strategies,\u0026rdquo; showed a significant positive correlation with attitudes toward seeking professional psychological help.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study highlights the significant role of suicide literacy in shaping emergency nurses\u0026rsquo; attitudes toward seeking professional psychological help. Nurses with greater knowledge of suicide warning signs and prevention strategies demonstrated more positive attitudes toward help-seeking. Enhancing suicide literacy through targeted education and ongoing psychological support can improve both nurses\u0026rsquo; well-being and patient care. Incorporating suicide literacy into training programs and considering demographic factors such as age, gender, and work experience can further strengthen intervention effectiveness.\u003c/p\u003e","manuscriptTitle":"Suicide Literacy and Attitudes Toward Seeking Professional Psychological Help: A Cross-Sectional Study Among Emergency Nurses","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-01 18:14:31","doi":"10.21203/rs.3.rs-8041607/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"212372034458475596444616619924131422782","date":"2025-12-06T06:54:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-05T15:57:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"187967095653695299367912262692585471296","date":"2025-12-04T23:53:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50870431754157994787840198972194417699","date":"2025-12-04T13:57:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-01T09:48:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"201286328881619825860195533403367582567","date":"2025-11-27T12:19:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-27T07:12:26+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-07T12:17:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-07T08:43:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-07T08:38:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-11-05T20:07:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d0311cb1-7643-416d-a756-54e586d824e2","owner":[],"postedDate":"December 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T18:14:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-01 18:14:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8041607","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8041607","identity":"rs-8041607","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}