Suicidal Threats Research Articles

Air Rescue Missions for Suicide: A Retrospective Analysis of a 12-Year Period From a German Rescue Helicopter Base

ObjectiveTypical reasons for calling the rescue helicopter are medical emergencies, such as heart disease, trauma, and neurologic emergencies. However, there are also a small number of patients with attempted or completed suicide. The aim of this article was a general analysis and evaluation of the specific circumstances of emergencies related to suicide or attempted suicide in the prehospital environment involving the rescue helicopter (helicopter emergency medical services) Christoph 38 of the DRF Stiftung Luftrettung gAG based in Dresden, Germany. MethodsThe data of all emergency interventions performed by the helicopter emergency medical services in Dresden, Germany, between January 1, 2008, and December 31, 2020, were analyzed by examining the DIVI rescue protocols and electronic data (MEDAT and HEMSDER (Convexis, Germany)) with regard to suicide-related variables. The time, methods and information about the reason, sociodemographic data, and results of medical treatment were recorded and retrospectively analyzed. ResultsThere were a total of 17,754 emergencies during the study period. Of these, 277 cases (1.56%) were due to suicide. The average time for the emergency services to arrive at the scene of the emergency was 11.14 minutes. There were 52 patients with a completed suicide, 183 with a suicide attempt, and 42 patients with a suicide threat. Eleven were pronounced dead before or at the time of arrival of the emergency doctor. Of the 241 patients who were still alive when the emergency physician arrived, 101 were endotracheally intubated and mechanically ventilated, and 25 patients received cardiopulmonary resuscitation. In 19.57% of the patients, health problems were noted as the primary reason for attempted/completed suicide. In a further 12.68%, partnership problems or the loss of a partner were cited. The most common method used was an overdose (49.39%) followed by leaping from a great height (20%) and hanging (15.51%). Stab wounds and gunshot wounds were observed in 24% of the cases. The overall mortality rate was 18.77%. The method used, sex, and a suicide note were identified as possible influencing factors for the fatal outcome of a suicide. ConclusionThe number of suicide victims is low compared with the total number of 17,754 deployments. However, the mortality rate for these missions is quite high at 18%. Although some factors and circumstances could be identified in this study, many backgrounds and explanations are still missing. Therefore, this study shows a general need for more research in regard to better prevention as well as improved education and training of emergency response teams.

Crisis negotiation techniques in interactional context: Managing a suicide threat in an emergency service call

Background: Previous research reveals that standard crisis negotiation techniques are useful in assisting suicidal persons, but how routine interactional procedures impact their implementation has not yet been sufficiently examined. Aim: This paper investigates how routine interactional procedures impact the effectiveness of crisis negotiation techniques in an emergency services call involving a suicide announcement. Methods: A publicly released emergency service call was transcribed and analyzed using the qualitative technique of conversation analysis. Results: The call taker used crisis negotiation techniques such as maximizing autonomy, displaying active listening, and distracting the caller to keep them on the phone. These techniques were implemented successfully through routine interactional procedures such as topic shifts, requests, and listener responses. Interrupting or overlapping the caller's speech or replacing requests with demands were less effective. Discussion: Instruction in the routine procedures of interaction may be as important as instruction in standard crisis negotiation techniques when training call takers to handle suicide announcement calls. Conclusions: Qualitative analysis of suicide announcement calls can be an effective means of learning how crisis negotiation techniques are used in practice and how emergency call takers can help prevent suicide by keeping callers on the phone and persuading them to abandon their suicidal plans.

Emotion mining for early suicidal threat detection on both social media and suicide notes using context dynamic masking-based transformer with deep learning

Emotion mining for early suicidal threat detection on both social media and suicide notes using context dynamic masking-based transformer with deep learning

Policing perpetrator suicide threats in family violence cases: competing priorities and contemporary challenges

ABSTRACT There has been increasing attention afforded to how a perpetrator of family violence may engage in coercive and controlling behaviour. As a form of coercive control, perpetrators may threaten to take their own life, impacting the thoughts and behaviours of victim/survivors, as well as their decision to leave the relationship. This form of coercive control challenges police in the way they manage and respond to perceived risk. In Victoria, Australia, section 232 of the Mental Health and Wellbeing Act 2022 (Vic) allows police to place a person who shows signs of mental illness under the care of medical practitioners for assessment, to prevent violence towards themselves or another person. This may present challenges in the investigation of family violence matters and serving protection orders (referred to as family violence intervention orders (FVIOs) in Victoria), as police are required to balance the needs of perpetrators, victim/survivors, and the community at large. This article examines the competing priorities of police as they attend a family violence incident where the perpetrator has threatened to take their own life. Drawing from the perspectives of ten specialist family violence officers from Victoria Police, this paper will provide critical insight into the policing of suicide threats in the context of coercive control. Further, it explores how current collaboration with the health sector may reduce police capacity to ensure victim/survivors’ safety through FVIOs.

Predictors of suicidal behaviors among school-going adolescents: a cross sectional study in Indonesia

BackgroundAdolescents are a high-risk age group for committing suicide, and the risk substantially increases from early to late adolescence. Adolescence also serves as critical time period for early detection and intervention to prevent suicidal behaviors. This study aimed to assess the prevalence of suicidality and identify significant predictors of suicidality among adolescents.MethodsA cross-sectional observational study was conducted between January-December 2023. Adolescents aged 14–18 years old (n = 2317) were consecutively recruited from 15 high schools across four provinces on Java Island in Indonesia. Self-reported validated instruments in Indonesian were used to assess sociodemographic profiles, self-esteem (RSES), hopelessness (BHS), loneliness (ULS-3), perceived social support (MSPSS), depression (PHQ-9), resilience (CD-RISC-10), suicidality (SBQ-R). With adjusted odds ratio (AOR) and 95% confidence interval (CI), binary logistic regression analysis was used to determine significant predictors of suicidality.ResultsThe prevalence of lifetime suicide ideation was 26.5%, lifetime suicide plans were 18.2%, lifetime suicide threat was 14.1%, and lifetime suicide attempt was 4.4%. The prevalence of 12-month suicide ideation was 43.1%. The following variables were identified and significantly associated with suicidality (p < 0.05): female students (AOR = 1.912; 95%CI:1.507–2.425), chronic illness (AOR = 2.886; 95%CI:1.545–5.389), low resilience (AOR = 1.347; 95%CI:1.036–1.750), low self-esteem (AOR = 2.020; 95%CI:1.578–2.585), low family support (AOR = 3.532; 95%CI:2.486–5.017), loneliness (AOR = 1.611; 95%CI:1.211–2.143), depression (AOR = 4.882; 95%CI = 3.861–6.175), and hopelessness (AOR = 1.602; 95%CI:1.154–2.224). Nagelkerke R square was 0.364 indicating the regression model explained 36.4% of variance in suicidality.ConclusionsOur study revealed several significant predictors of suicidality among adolescents which can be targeted to develop suicide prevention strategies.

ViolHelp: results of a pilot study to identify potential warning signs and risk factors for self- and hetero-directed violence in the calls received by the Helplines of the Italian National Institute of Health.

Self- and hetero-directed violence (SHDV) is a serious public health problem and a complex phenomenon, influenced by individual and environmental factors. SHDV may occur particularly in moments of personal, economic and/or social crisis. During the COVID-19 pandemic, the ISS-Helplines operators have perceived an increase in psychological distress and self-isolation among callers. The ViolHelp project aimed at identifying potential warning signs and risk factors of SHDV emerging in the activity of the ISS-Helplines (Istituto Superiore di Sanità, ISS, Italian National Institute of Health). A dashboard collecting warning signs and risk factors of SHDV was developed to be used during the ISS-Helplines activity. In one year of data collection, 135 calls were compiled. In 106 calls, callers referred experienced violence: 72 self-directed violence (SDV), 20 hetero-directed violence (HDV), 14 both. The most frequent warning signs and risk factors for SDV were desire to die (68.6%), previous suicide attempts (31.4%) and threat of self-harm (25.6%); for HDV were depressed mood (32.4%), diagnosis of pathology and/or psychiatric disorders, desire to die, use of psychotropic drugs, and alcohol abuse (29.4%). The results of this pilot project show the importance of being able to read the warning signs and to create a network that can improve information, prevention and support activities for people at risk of violence and their families.

Coping Mechanisms Used by Farmers to Encounter Psychosocial Problems: Literature Review

Psychosocial problems in farmers are big problems that are often experienced by farmers and can have a significant impact on their overall welfare. Psychosocial problems that are often found in farmers are climate change, industrial restructuring, crop failure, and even family responsibilities. This study aims to analyze the description of the coping mechanisms used by farmers in dealing with psychosocial problems. The method used in this study was a literature review article from article search engines such as PubMed, Google Scholar, and Science Direct which was analyzed using the PRISMA technique by including articles published in the last 5 years. The results of the study found that the impact of psychosocial problems experienced by farmers includes stress, worry and fear at work, can cause burnout, even threats of suicide because of the demands of the head of the family. Therefore it is necessary to have an appropriate coping mechanism in solving psychosocial problems experienced by farmers. The forms of coping strategies applied are problem focused coping strategies and emotion focused coping strategies.&#x0D;

Arnold-Chiari Malformation-I Borderline Personality Disorder

Introduction: Arnold-Chiari Malformation I (AM-I) is a congenital anomaly that manifests with cerebellar dysfunction. There is a displacement of cerebellar tonsils into the foramen magnum. Several mood disorders, personality disorders, and intellectual disabilities are associated with AM-I. Borderline personality disorder (BPD) is characterized by symptoms of mood lability, impulsivity, extreme efforts of abandonment, splitting and dysfunctional relationships. Case Description: The patient is an early aged adult with a past medical history of AM-I, hypothyroidism, Wolff-Parkinson-White syndrome, and diabetes mellitus type II. The patient was admitted to the hospital after ingesting foreign bodies. He/she presented with mood lability, sad mood, anhedonia, insomnia, panic attacks, ruminative worries, feelings of emptiness, and recurrent suicidal gestures and threats. The patient was eventually diagnosed with borderline personality disorder. This case suggests a possible connection between AM-I and BPD. Discussion: Emerging from contemporary research involving the cerebellum, it is important to acknowledge that the current definition of control of fine motor and balance is inadequate. Symptoms associated with AM-I and BPD may be better explained by Cerebellar Cognitive Affective Syndrome (CCAS), a condition that ties the cerebellum with the higher cognitive functioning in the brain.

Suicidal crisis in the adolescent: About 3 clinical cases

IntroductionSuicide is the third most common cause of death among adolescents. It is linked to several mental pathologies. Early detection and effective and rapid management are essential elements to improve the mental health of the adolescent and prevent suicidal behaviour.ObjectivesOur objective is :-To discuss through these medical observations the risk factors and pathologies at high risk of suicide,-To detail the urgent course of action to be taken in the event of suicide attempts and-To underline the importance of early management to prevent suicide in adolescentsMethodsWe report hereafter the clinical cases of 3 adolescents followed in child psychiatry for the management of a suicidal crisis.Results1st clinical case :This is a 13 year old girl, brought back by the staff of the Lalla Meryem child protection centre, where she has been living since her separation from her family following abuse by her mother. She reports a reliving of scenes where her mother burned her private parts. She reports disturbed sleep with night terrors and nightmares. In addition, the centre’s staff reported irritability, crying spells and verbalized suicidal threats.2nd clinical case:This is a 15 year old girl referred by the paediatric service for management of a suicide attempt by ingestion of rat poison. She stopped her schooling 2 years ago to take care of her mother who had cervical cancer and died 6 months ago. Since then, she has experienced sadness of mood, low self-esteem with ideas of devaluation. During the first psychiatric interview, she did not criticize her suicidal act and said that she wanted to kill herself, which she considered the only solution to her suffering.3rd clinical case:This is a 12-year-old adolescent, followed in child psychiatry for conduct disorder with problematic use of tobacco, cannabis and benzodiazepines. He had stopped going to school since the third grade.He consulted for a suicide attempt by ingesting 30 antihypertensive tablets. After somatic care, he was referred to us from the medical emergency department for psychiatric care.ConclusionsSuicide among adolescents is on the increase in Morocco. It is necessary to take into account the risk of suicide in the face of any mental or somatic pathology. A rapid and urgent course of action is necessary to avoid recurrence.Disclosure of InterestNone Declared

Nipple Day

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Detecting and Prevention Emerging Suicide Threat Rates and Violence Using Machine Learning

Detecting and Prevention Emerging Suicide Threat Rates and Violence Using Machine Learning

Clinical Practice Guidelines for Assessment and Management of Patients with Borderline Personality Disorder.

Clinical Practice Guidelines for Assessment and Management of Patients with Borderline Personality Disorder.

Self-Harm Behavior among Nursing Students

The majority of college students are in the phase of emerging adulthood of human development. In this transition period, the students are susceptible to experiencing psychological instability due to many changes in their lives. Nursing students are presumed to be at risk of high-stress levels because of the high demands, expectations and activities during their study. Therefore, some students struggle to adapt to their college life and choose to avoid their responsibilities or make some dangerous decisions (self-harm behavior) as it is believed to be a form of coping mechanism to release their stress. This study used a cross sectional approach with the aim of finding the prevalence of self-harm behavior among nursing students. This study involved 236 students from Faculty of Nursing, University of Indonesia with probability proportionate sampling technique. The instrument used is the modified Indonesian version of Self-Harm Behavior Questionnaire (SHBQ). The results showed that nursing students engaged in self-harm behavior, including self-harm (34.3%), suicide attempted (8.1%), suicide threat (7.2%), and suicide ideation (30.5%). The existence of prevalence of self-harm behavior among nursing students is needed to improve prevention and treatment at the university level.

Frontline Support: Responding to the COVID-19 mental health crisis in South Africa through online arts and music therapy

COVID-19 rendered South Africa reeling from the ramifications of the pandemic. Lockdown restricted movement, placed significant strain on healthcare workers, and profoundly impacted the socio-economic state of the country. Increased unemployment, reports of gender-based violence and suicide threats were among some indications of a resultant mental health crisis. In response, Frontline Support (FS), a collaborative volunteer-based arts therapy initiative was established. This report presents the documented process of establishing and implementing FS. The concept and structure of the organisation as well as the triage and treatment intervention are described. Descriptive statistics drawn from triage data, a client evaluation, and a therapist survey, as well as the themes emerging from the thematic analysis thereof are presented. The inclusion of two vignettes, drawn from documented clinical case studies, illustrate the online therapeutic offering of FS. A summary of quantitative data includes: the triage allocation, number of clients accessing FS, breakdown of sessions and geographical reach for the period March 2020 to July 2021. The thematic analysis of the client evaluation yielded five themes: i) Perceived personal gains through online therapy, ii) Enhanced personal insight, iii) Clients’ experience of the therapist, iv) Difficulties experienced by clients, and v) Reflections and recommendations. The therapist survey yielded the following six themes: i) Access and awareness, ii) Client access to and engagement with therapeutic arts resources, iii) Possibilities and restrictions of the Online Platform (OLP), iv) Arts therapies techniques adapted for the OLP, v) Therapists’ challenges, and vi) Establishing and maintaining the therapeutic relationship. The discussion reflects on the benefits, challenges and learnings of FS, and concludes with recommendations for its ongoing development, sustainability and accessibility within South Africa.

Practising Hope With a Client Who Speaks Suicide

Suicide issues have been a consistent concern in Malaysia and everyone within the society has a moral obligation to intervene to prevent suicide. Counsellors are one of the many professional groups charged with this responsibility. The practice of counselling clients in the context of suicidal ideation is a complex and challenging therapeutic process with professional, personal, social, legal, medical, and ethical issues, and with shades of uncertainties inherent to the suicidal threat shaping the counsellor-client relationship. This is a time when it is clear that responsibilities for and influences on practice go beyond the client in the room where counsellors negotiate roles and responsibilities, make difficult clinical judgements and ethical decisions, and take responsible actions. Decisions are not simple and straightforward, and care must be delicately considered for each individual in his or her specific context. In this paper, I present an experience-near account of how professional practice could be shaped by the value of a counsellor’s personal lived experience. A qualitative with discursive approach was employed to examine a counsellor’s personal lived experience and how she practised hope by taking small steps to support a client presented with suicidal ideation. I show how feminists value positions a counsellor’s personal experiential knowledge in her practice to work alongside her preferred theoretical model which she was taught. I argue that the feminist principle of personal-political-professional offers a framework to recognise the shaping effect of counsellors’ lived experience in their response to clients with suicidal ideation. My witnessing of counsellor’s act of practice provokes me to re-examine my views of professional practice and the relationship between theory and practice. From the perspective of practice epistemology, I question how do one accounts for the kinds of knowledge one acquire from past experiences in life, within the landscape of professional practice?

Sequenced Relationship-Based Psychotherapy for Complex Posttraumatic Stress Disorder: Commentary on the Application of the Model to the Hybrid Case of "Chloe"

In this commentary, as authors of the Sequenced, Relationship Based Treatment Model—developed for complex posttraumatic stress disorders—we respond to its detailed application to the hybrid case of "Chloe," reported by Chloe’s therapist, Dr. Phoebe Shepherd (2022). Shepherd reviewed different treatment approaches before choosing our model, due to its sequenced and hierarchical approach, comprehensive description in the literature of its application in a primary text by the model’s authors, and flexibility of utility and choice of technique. The latter are based on the judgment and training of the therapist and on the client’s unique situation and needs, as well as preference.&#x0D; As in the model, Chloe’s treatment takes place in a sequenced and chronological form over a two-year period while Shepherd worked at a psychological training clinic. Shepherd received ongoing expert supervision while conducting this treatment. She not only described the model and the techniques she selected, but also how they were applied and adapted to the client’s status over the course of the treatment. She also described her own process over the course of the treatment, as she addressed its challenges and its starts and stops as she experienced the client. Appropriately, Shepherd began the treatment with assessment, which was repeated several times over its course to document progress and change. As discussed in descriptions of the model, although it is linear on paper, the actual progression of treatment is instead flexible and recursive, returning as needed to the tasks of the early phase of treatment (i.e., emotional regulation skills and personal stabilization).&#x0D; In this commentary, we support Shepherd’s primary interventions and their rationale while also offering cautions and re-direction for some of them. All told, the case description offers endorsement of the sequenced, relationship-based treatment model, and how it guides the therapist in working with the multi-problem and challenging population of Complex PTSD as represented by the hybrid case of Chloe. Chloe’s history encompassed adverse and potentially traumatizing experiences in childhood, including: father’s alcoholism; mother’s emotional instability and unavailability and ongoing threats of suicide; parental divorce at age 10 with custody awarded to Chloe’s mother; paternal abandonment post-divorce; and suggestions by grandparents that Chloe was responsible for her mother’s problems and their lack of appropriate intervention on her behalf. These adverse experiences resulted in Chloe’s mistrust of and detachment from others and emotional fragility, including a tendency towards isolation and depression. Her major trauma occurred a year prior to the treatment when she interrupted her mother’s attempt to shoot herself in the head to commit suicide, the effects of which ultimately led Chloe to seek counseling. The treatment was directed not only at the effects and symptoms of the recent trauma (using trauma-focused, evidence-based techniques), but also more broadly at Chloe’s prior traumatic exposures and her developmental and skills deficits. The case description also demonstrates the impact of the therapeutic relationship as the context and as a healing factor in the treatment.

Detectives and technological frames: integrating technology and social media into everyday work

ABSTRACT Technology and social media have increasingly transformed contemporary policing. Yet, scarce research explores how detectives view and use technology and social media in their everyday work. This study of a mid-sized American police department fills this gap in research by exploring how technological frames inform how detectives use technology and social media. First, detectives view technology and social media as tools, yet acknowledge the barriers inherent to using them (i.e. time-consuming). Therefore, the task at hand will determine to what extent detectives use technology. Second, detectives embrace the use of technology and social media and use it more than just in their role as a crime fighter, as their job calls for them to handle a variety of tasks: (1) prioritising suicide threats; (2) acting as a school resource officer; and (3) conducting prostitution stings. I argue that technological frames can contribute to officers overcoming barriers inherent with using technology and social media and encourage proactive policing activities. The findings from this study bring about several practical and policy implications for police departments including how to adapt to technological barriers.

The Gender Anxiety of Otto von Bismarck, 1866–1898

Abstract Building on critical re-examinations of the ‘Bismarck myth’ and scholarship on the fin de siècle crisis of identity in Europe, this article examines key vignettes in the political career of Otto von Bismarck during Prussia’s era of expansion and consolidation, c.1866–1898, through the lens of gender. It finds the legendary ‘Iron Chancellor’ experienced extreme gender-anxiety to the point of social dysphoria until the 1870s. Assigned feminine roles and lacking political decision-making power, Bismarck resorted to tantrums, tears, threats of self-harm and suicide, suffered mental breakdowns and enacted the kinds of ‘feminine’ intrigue of which he accused Europe’s royal women throughout his life. To stabilize their own identity in the early 1870s, he and his contemporaries weaponized misogyny to deflect accusations of femininity away from themselves and onto women at court. Bismarck claimed to have led negotiations in a masculine manner in the era of Europe’s colonial cabinet diplomacy. After his death, contemporaries studied the shape and measurements of Bismarck’s head to find an explanation for his alleged genius and marketed the statesman as an example of potent masculinity. Early hagiographic instrumentalizations of Bismarck should be read as part of a wider attempt to legitimize forms of white masculine rule and justify limited political participation in this period.

Performance Appraisal of Tehran Firefighting Stations in Attempted and Threating Suicide with National and Global Standards (The First 6 Months of 2018)

Background:We aimed to compare the performance of Tehran firefighting stations in the incidents of suicide attempt and threats among Tehran citizens using international standards.Methods:A research method was a descriptive-analytical study based on library studies. The data were analyzed by descriptive and inferential methods such as single group t-test and independent t-test. The statistical population of this study included all citizens in 22 districts of Tehran City that committed or threated to commit suicide in the 2018 year. They were selected in a targeted manner. All data were extracted and analyzed through the fire department in the first half of 2018 in the action and threat of suicide.Results:Men commit suicide more than women do. Moreover, the average time of exit from station and the average travel time are shorter than Iranian and world standards. The people saved by firefighters outnumber the people who died in suicide, which indicates the satisfactory performance of firefighters in relief and rescue operations. In suicide operations, according to the general results obtained from statistical calculations of departure time from the station and the average travel time, which are the two main factors in evaluating the performance of firefighters in suicide accidents, which in comparison with international standards. It was significantly lower and the performance of firefighters was positive.Conclusion:The average duration of exit from station and the average travel time, are significantly lower than international standards, which demonstrates the good performance of firefighters.

Psychiatric Emergencies in Pediatrics

Key Points A youth’s mental health is highly dependent on the functioning of the family, school, and community; any disturbance in the functioning of these systems has the potential to precipitate an emergency requiring immediate mental health evaluation.Common types of psychiatric emergencies include suicidal threats or behavior; assaultive, destructive, otherwise violent behavior; and acute mental status changes (ie, intoxication, agitation, psychosis, delirium, or extreme anxiety with physical symptoms when a medical etiology has not been excluded).Circumstances warranting urgent (within 48–72 hours), but not necessarily emergent, evaluation include significant exacerbation of symptoms, distress, and/or functional impairment, which may be accompanied by highly concerning contextual circumstances, and/or overwhelming caregiver distress.Exposure to trauma (eg, violence, disaster) may precipitate a spectrum of psychological effects that vary according to developmental stage and, in some circumstances, present as a psychiatric emergency.Preparation of the pediatric practice for an effective emergency response includes an office emergency protocol (equivalent to a "code") and well-established connections to community mental health specialists and emergency service providers.The pediatric clinician’s roles may includeScreening for symptoms warranting emergent or urgent assessmentGathering of data from multiple informants (as available) when a youth is identified with potentially emergent or urgent symptomsConsensus with the caregiver, other referring party, and the patient on the nature of the encountered problem, its precipitants, and optimal next stepsReferral for emergency or urgent assessment and ongoing specialty management, as indicatedFollow-up to ensure completion of the referral and to support specialty management