Indirect Self-Destructive Behavior Research Articles

Primary Prevention Research in Suicide

At the American Association of Suicidology’s (AAS) 46th Annual Conference in Austin, Texas (http://www.suicidology.org/web/guest/education-and-training/annualconference), participants were challenged to address why there has not been more progress in reducing the rates of completed suicides (Berman, 2013). A draft of recommendations from the National Action Alliance for Suicide Prevention’s Research Prioritization Task Force was presented at the meeting and subsequently published in this journal (National Action Alliance for Suicide Prevention [NAASP], 2013a, 2013b). The purpose of this commentary is to address this challenge by emphasizing the importance of employing a disease etiology strategy that integrates molecular data with clinical data, environmental data, and health outcomes in a dynamic, iterative fashion. The recommendations of the Research Prioritization Task Force tackle important public health program issues and are embedded within seven key questions, summarized as: 1. Why do people become suicidal? 2. How do we better detect/predict risk? 3. What interventions prevent suicidal behavior? 4. What are the effective services for treating suicidal persons and preventing suicidal behavior? 5. How do we reduce stigma? 6. What are the suicide prevention interventions outside of health-care settings? 7. Which existing and new infrastructure needs are required to further reduce suicidal behavior? (NAASP, 2013b; Silverman et al., 2013)

Manifestations of Indirect Self-destructiveness and Methods of Suicide Attempts

The method of suicide attempt is related to motivational processes and the psycho(patho)logical mechanisms and traits of an individual. Indirect self-destructiveness is related to direct self-destructiveness. It is presumed that it can transform to the latter thus leading to suicide attempts or death by suicide. The study objective was to examine the relationship between individual manifestations of indirect self-destructiveness and the methods of suicide attempt as well as to explore the indirect predictors of particular suicide methods. The study was conducted among 147 persons (114 females, 33 males) who attempted suicide. The research instrument was the Polish version of the “Chronic Self-Destructiveness Scale” (CS-DS), including Transgression and Risk, Poor Health Maintenance, Personal and Social Neglects, Lack of Planfulness, and Helplessness and Passiveness in the face of problems. Correlation and regression analyses were applied. A number of statistically significant correlations were found between indirect self-destructiveness, or its manifestations, and the methods of suicide attempt. Moreover, the particular categories of indirect self-destructive behaviour were found to largely determine the choice of the method of suicide attempt. Among these categories, the strongest predictor appeared to be Helplessness and Passiveness in the face of problems. The method of suicide attempt is a variable related to psychosocial determinants of suicidal behaviour. The findings of this study may prove useful in the design and implementation of therapeutic activities focused on persons who attempted suicide. Recognising the particular manifestations of indirect self-destructive behaviours of an attempter can guide implementation of therapeutic measures, for him/her e.g. via strengthening coping skills and eliminating risk factors for self-harm.

Impact of Depression and Cardiovascular Disease

CME Educational Objectives 1. Assess the impact of depression in cardiovascular disease (CVD) patients. 2. Determine the relationship of depression and CVD, including biological and behavioral factors. 3. Explain the significance of early recognition of depression in CVD patients and the role of indirect self-destructive behavior as an independent risk factor for morbidity and mortality in these patients.

Suicidality in nursing home residents: Part II. Special issues.

Professional psychologists working with suicidal nursing home residents often deal with a host of specialissues that may not be relevant to other populations. This review article (Part 2 of a series) was writtento acquaint professionals with the concept of indirect self-destructive behavior and dealing with ethicalconcerns. This article also summarizes health care systems issues, including how to involve staff andfamily members in assessment and management, as well as understanding Medicare/Medicaid relatedconcerns and public policy regarding long-term care. The article concludes with information abouttraining and continuing education offerings for psychologists who need more information about workingin nursing home settings.Keywords: nursing home residents, older adults, suicide, indirect self-destructive behavior, long termcare

Indirect Self-Destructive Behavior and Overt Suicidality in Patients With Complicated Grief

Complicated grief is associated with increased suicidal ideation in samples of bereaved individuals; however, suicidal behavior has not been assessed in these patients. Additionally, there are no reports of suicidality among help-seeking individuals with complicated grief. Therefore, we examined suicidal behavior and its correlates in 149 patients who signed informed consent statements to participate in a National Institute of Mental Health-funded treatment study of complicated grief. All patients met criteria for complicated grief (Inventory of Complicated Grief score>or=25). Suicidality was assessed using a structured clinical interview administered prior to beginning treatment. Participants also completed self-report questionnaires and interview assessment measures rating the presence or absence of DSM-IV Axis I diagnosis and symptom severity. Data were gathered between April 2001 and April 2004. Thoughts of wanting to die following the death of a loved one were reported by 65% of participants. More than half of this group (38% of the study sample) engaged in self-destructive behavior, including 9% who made a suicide attempt and 29% who engaged in indirect suicidal behavior. In a multiple logistic regression model, only the severity of complicated grief symptoms (p<.0001) and history of a suicide attempt (p<.02) were significantly associated with postloss suicidal behavior. Consistent with reports of non-help-seeking bereaved people, a high rate of individuals seeking treatment for complicated grief endorsed a wish to die. Notably, 13% of this group made at least 1 suicide attempt, and 44% engaged in indirect self-destructive behavior. Given its frequency, this behavior should be included in assessment of bereaved people.

A Profile of Psychologists' Views of Critical Risk Factors for Completed Suicide in Older Adults.

The ability to accurately and reliably predict whether an older adult will commit suicide has eluded clinicians and researchers. A random national sample of psychologists who work with older adults was surveyed regarding their perception of 36 risk factors for completed suicide and indirect self-destructive behavior in older adults. This study produced a profile of psychologists' assessment and treatment practices when working with suicidal older adults. Determining what psychologists consider to be the most salient risk factors for completed suicide is important in identifying a minimum standard that clinicians should follow when assessing older adults.

Indirect Self-Destructive Behavior Among Elderly Patients in Nursing Homes: A Research Agenda

Although suicide is rare in nursing homes, indirect self-destructive behaviors (ISDBs), such as the refusal to eat or take life-sustaining medications, are commonplace. For some, ISDB represents a cry for help, whereas in others it is a reasoned behavioral expression of legitimate preference for an earlier death. This article reports on the proceedings of a workshop held in May 1994 to discuss ISDB in long-term care settings. After a historical review, issues discussed by workshop participants are presented and a research agenda proposed. Future studies are advocated with regard to correlates for ISDB that are relevant to the patient and characteristic of the nursing home environment.

Indirect Self-Destructive Behavior Among the Elderly

Overt suicide rates by age are highest among the elderly. In addition to these direct and quick forms of suicide, however, the aged also employ covert, less obvious and slow methods of self-destruction. The scant literature on indirect self-destructive behavior (ISDB) among the elderly is reviewed. Case examples illustrating ISDB are presented as are implications of such behavior by the aged.

Compliance: The Dilemma of the Chronically Ill,

This book reflects the experiences of a group of clinical psychologists working with a variety of medical patients in a large general hospital. Its complex focus is the result of several convictions, shared by the authors, that noncompliance is (1) a nonspecific symptom, (2) a multifactorial process generally unresponsive to a unifactorial solution, and (3) frequently a conscious, self-affirmative choice of independence and personal value. Eight authors contribute 11 chapters that emphasize the special situations of the chronically ill, such as indirect self-destructive behavior, quality of survival, family relationships, staff perceptions of noncompliance, physician-patient communication, cognitive-behavioral relationships, and societal contributions to noncompliance. Their explicit audience consists of physicians and staff, both those in training and those in established practices, who harbor unrealistic and often self-defeating expectations and approaches in dealing with noncompliance. Collectively, they bemoan many health professionals' attitudes of treating patients as a homogeneous group whose behavior should be

Relationships between measures of direct and indirect hostility and self-destructive behaviour by hospitalized schizophrenics.

To test the hypothesis that suicidal and self-destructive behaviour correlate with subjective and objective measures of hostility and violence, these behaviours in hospitalized schizophrenics were correlated to self-report (Buss-Durkee) and observer-rated (Lion Scale) measures. Self-destructive acts were significantly correlated with six of the seven of the Buss-Durkee self-report hostility subscales. The observed measures of hostility and violence correlated with seclusion and with restraint as a self-protective measure. Neither the Lion nor the Buss-Durkee measures correlated with depression measures. Thus, our data indicate that self-destructive acts in hospitalized schizophrenics may be better predicted by feelings of anger and hostility than by depression, a finding with relevance for clinicians who treat schizophrenic patients.

The development of an Indirect Self-Destructive Behaviour Scale for use with chronically ill medical patients.

The development and content of a scale to measure indirect self-destructive behaviour (ISDB) among chronically ill medical patients is described. Findings for a sample of predominantly elderly, male, chronically ill patients indicate a generally high incidence of ISDB over a seven-day period continuous observation. Most frequently observed were behaviours involving noncompliance with the treatment programme, and conflicts with the medical staff. Based upon an analysis of nine classes of behaviour included in the ISDB Scale, three groups of patients emerged with distinct patterns of indirect self-destructive activity: two consisting largely of noncompliant acting-out behaviours, and one involving more direct forms of self-injury.

The Many Faces of Suicide: Indirect Self-Destructive Behavior

The Many Faces of Suicide: Indirect Self-Destructive Behavior

The Many Faces of Suicide: Indirect Self-Destructive Behavior

The Many Faces of Suicide: Indirect Self-Destructive Behavior

Indirect Self-Destructive Behavior in the Elderly Nursing Home Patient

The incidence of indirect self-destructive behavior (ISDB) is explored in a sample of 99 male, predominantly elderly nursing home patients, using a rating scale (ISDB Scale) developed by the authors in a previous study. Scores from the ISDB Scale are correlated with psychological test material, background information, and other descriptive data for the sample of patients. Findings indicate that the use of ISDB in the elderly patient group is associated with direct suicide potential, dissatisfaction with the treatment program and with life in general, confused reasoning and judgment, poor prognosis for discharge, the absence of religious commitment, and significant losses in the patient's life. It appears from the findings that ISDB serves as an alternative form of suicide for many of these patients.

The Many Faces of Suicide: Indirect Self-Destructive Behavior

Back to table of contents Previous article Next article ArticleNo AccessThe Many Faces of Suicide: Indirect Self-Destructive BehaviorRUSSELL NOYES JR.RUSSELL NOYES JR.Search for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.137.10.1289AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "The Many Faces of Suicide: Indirect Self-Destructive Behavior." American Journal of Psychiatry, 137(10), pp. 1289–1290 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited ByNone Volume 137Issue 10 October 1980Pages 1289-1290 Metrics PDF download History Published online 1 April 2006 Published in print 1 October 1980

Book Review: The Many Faces of Suicide: Indirect Self-Destructive Behavior

Book Review: The Many Faces of Suicide: Indirect Self-Destructive Behavior

Indirect Self-Destructive Behavior in Patients with Buerger's Disease

Patients with Buerger's disease (a circulatory illness) were studied to evaluate indirect self-destructive behavior (ISDB), evidence by neglect in following medical regimen, disregard of suggestions for environmental imporvements (avoidance of undue exposure to cold) and refusal to abstain from smoking. Personality characteristics and behavioral phenomena associated with ISDB were obtained by comparison of the files of 26 uncooperative patients with 26 matched cooperative controls with Buerger's disease and with 25 Buerger's disease patients representing a unselected annual population in a Veterans Administration (VA) hospital. The experimental group was characterized as more often complaining, manipulative, and aggressive. They manifested denial, negligence, and a tendency to minimize their illness. They were more likely to complain of pain and to demand relief. In a second clinical investigation of patients still in the hospital, 12 experimentals were compared with 12 controls using interview data and psychological tests measuring attitudes toward time and toward death. The experimentals did not seem to value time nor to be interested in achievement. They felt that a dull life was worse than death.