Suicidal Behaviours among Polish Youth in Light of the following Papers: Suicidal Behaviour in Children and Adolescents. Parts 1 and 2

Abstract

Dear Editor: It appears from the literature reviews by Dr Margaret M Steele and Dr Tamison Doey1'2 that, both in America and in Europe, a broad definition of attempted suicide (AS) prevails, interchangeably replaced by deliberate self-harm (DSH), which is not, however, informative as to whether any suicidal intentions are associated with a self-harm action.3 Polish studies4 suggest that psychiatric patients with multiple DSH incidents without suicidal intentions differ from AS patients, for example, by personality profiles and emotional intelligence levels, what prompts an immediate assumption that differentiation between these 2 groups of patients is of therapeutic significance. Data from questionnaire enquiries, targeting more than 3000 school students in the Lodz Region (from 2002 to 2006), have demonstrated that DSH in history is really associated with high suicidal risk. Students with confirmed DSH reported suicidal thoughts (in lifespan) twice as often as those without DSH. Regarding other suicidal, risk-related factors, for example, psychiatric therapy, self-destruction acts in a closed environment, violence records, substance addiction, law violation, feeling sadness, fear or hopelessness, and a lack of impulse control should focus clinicians' attention, while prompting appropriate therapy.5 According to Polish standards (see the review),2 any teenager who has AS should be referred for psychiatric examination; this is rather difficult in practice with 1 psychiatrist per 40 000 population at a developmental age in the Lodz Region, while to European standards there is an assumption of 1 psychiatrist per 25 000 population. The second part of the report by Dr Steele and Dr Doey2 is an example of a scientific thesis combined with a practical approach. The presented knowledge on the management of suicidal patients may be a kind of guideline, especially for Polish psychiatrists. National questionnaire enquiries, addressing practising psychiatrists, have revealed that over 50% have faced at least 1 suicidal case among their patients. In that group, two-thirds of the psychiatrists evaluated their qualifications as low. Despite Poland's accession to the European Union in 2004, no suicide prevention program has been implemented at the central level. It may then be assumed that the to-date unconfirmed efficacy of hospital therapy for minors who have AS, as indicated by the authors of the report, should rather be accounted for by methodological impediments. Following the standards of the American Academy of Child and Adolescent Psychiatry,6 hospitalization is the standard response in cases of identified high suicidal risk in youth. Some controversy may arise from questioning the efficacy of the so-called no-suicide contract. According to some suicidologists, such a contract is a consequence of a long-term process of developing a strategy to suppress suicidal prompts in crisis situations, among others, by building new relations and developing new solutions. In Poland, the internationally accepted view (presented in the review1) that suicidal behaviours in children may be elevated by medications of the selective serotonin reuptake inhibitors group has reduced the number of minors medically treated for depression. Prediction of the consequences, which may emerge from such therapeutic decisions, such as their effect on the prevalence of suicidal behaviours in this population of Polish adolescents, is rather difficult owing to the lack of an AS register at the central level. …