Suicide Care Research Articles

Former suicidal inpatients’ experiences of treatment and care in psychiatric wards in Norway

ABSTRACTPurpose: The purpose of this study is to explore how former suicidal inpatients experienced treatment and care in psychiatric wards in Norway following the implementation of the National guidelines for prevention of suicide in mental health care. The focus of the analysis was on aspects of treatment and care with potential for improvement. Method: We interviewed five former inpatients and analysed the data by means of Interpretative Phenomenological Analysis. Results: Experiencing a sense of companionship with the staff and receiving individualized treatment and care was important for the participants. This involved establishing trusting connections with mental health workers who treated them with respect, made them feel valued, and who recognized their suffering and needs. The formerly suicidal patients experienced being in a recovery process, which was promoted by the support of mental health workers. Although the participants reported mostly positive experiences, there were examples of insufficient care. Sometimes, they felt that their suffering and suicidality were not sufficiently recognized. Conclusion: Our study indicates that although there has been increased focus on suicidality in the mental health services, among other through clinical guidelines, some mental health workers still lack competence and should focus more fully on how to provide individualized care for suicidal inpatients.

Suicidality in emergency medicine: Results from a retrospective analysis of emergency documentation forms.

To analyze suicidal care episodes in emergency medical responses in Germany. Anonymized data from emergency care episodes in Ulm from 2004 to 2013 were analyzed retrospectively. 158 of 933 psychiatric emergencies (16 %) were suicide related, including 14 completed suicides, 25care episodes with suicidal ideation, and 119 suicide attempts. Significantly more men than women completed suicide (χ²(2,N= 934)= 12.70, p= 0.02). 93 % of the total psychiatric emergencies received any medication at all, and only about 33 % were transported to apsychiatric hospital. Psychiatric treatment for suicidality in emergency medicine requires improvement to ensure that patients receive adequate therapy.

Caring stress, suicidal attitude and suicide care ability among family caregivers of suicidal individuals: a path analysis.

What is known on the subject? Suicide is a global mental health issue. Taking care of suicidal individuals is a substantial challenge. Most studies emphasize the suicidal individual. Few studies have emphasized the family caregivers of suicidal individuals. No study has explored the relationship between family caregivers' caring stress with suicidal attitudes and suicide care ability. What this paper adds to existing knowledge? The main results indicated that the older family caregivers tended to have a more negative attitude towards suicidal individuals. Female family caregivers' stress was higher than that of male family caregivers. A mild level of caring stress would help family caregivers have a more positive attitude towards suicidal individuals. Furthermore, a positive attitude would help family caregivers improve their caring ability. What are the implications for practice? Mental health nurses could help family caregivers, especially female family caregivers, reduce their holistic caring burden by looking for support resources and enhancing their coping strategies. Mental health nurses could help family caregivers promote positive attitudes towards suicidal relatives by understanding suicidal individuals' suffering. Suicide is a global mental health issue. Family caregivers play a key role in preventing suicide attempts. The aim of this study was to examine the relationship among stress due to the family caregiver's role, suicidal attitude of the family caregiver and suicide care ability among family caregivers. Additionally, instruments of caring stress, attitudes towards suicidal relatives and caring abilities used in the study were tested to measure construct validity. A cross-sectional correlational study was conducted with 164 family caregivers of people who are suicidal. The following three questionnaires were used: the Caring Stress Scale, the Suicidal Attitudes Scale and the Suicidal Caring Ability Scale. Structural equation modelling was performed using SPSS AMOS 19.0 to examine the path relationships among variables. Bivariate analyses showed that age was negatively correlated with suicidal attitude. In the final path model, caring stress had a positive effect on suicidal attitudes. Suicidal attitude and suicide care ability were highly positively correlated. Gender had a direct effect on caring stress, which indicated that female family caregivers experienced more stress from their role. Mental health nurses could help family caregivers become aware of the emotional pain that suicidal people experience and then promote their positive attitudes towards their suicidal relatives. Furthermore, family caregivers could increase their ability to care for their suicidal relatives, which could reduce the numbers of suicides.

“Collateral Damages”: Preparing Residents for Coping With Patient Suicide

Losingapatienttosuicideisone ofthemost taxing emotional issues psychiatrists, psychiatry trainees, and other mental health workers ever face. Balon (1) noted that “we find it emotionally more tolerable to see our patients dying of cancer than of suicide.” Some psychiatrists reported stress levels in the weeks after a patient’s suicide comparable to levels reported in people seeking treatment after the death of a parent (2). Younger, less-experienced clinicians are more affected by patient suicide than older clinicians (2), and the psychological impact of patient suicide may be especiallypronounced in trainees (3). The most junior psychiatry trainees often care for the most challenging patients in minimally-structured settings (3). Poor outcomes may have profound effects on the trainee’s developing sense of self and may trigger feelings of personal failure. Reactions such as shock and disbelief, self-appraisal, and working through to a resolution have been described (4), as have feelings of shame, guilt, isolation, anger, abandonment, and fear of litigation (5). Despite patients’ suicide being an “occupational risk” for anyone caring for severely ill psychiatric patients, most training programs provide relatively little educational attention on helping trainees learn about and cope with the completed suicide of one of their patients (4, 6–8). Furthermore, a national survey of chief residents of psychiatry residency programsidentified lack of audio or video teachingmaterials as common barriers to education on suicide care (9). In an effort to fill this important training gap, we have developed an interactive curriculum to help psychiatrists, psychiatry trainees, and training programs cope with patient suicide. We developed a DVD, “Collateral Damages,” that provides multimodalteachingmaterialstoeducate,inform,and,most important, stimulate discussion in the aftermath of patient suicide. The Collateral Damages DVD consists of 1) a video program that includes introductory comments; five brief vignettes (two from senior faculty, two from junior faculty, and one from a trainee) on patients who killed themselves and the clinicians’ immediate emotions, thoughts, and behaviors; a panel discussion of the five psychiatrists who have provided their narratives plus two training directors, that focuses on universal themes, processes, and procedures to follow after a patient suicide, principles of dealing with families, critical-incident review, risk-management, and the roles of counseling/support trainees and colleagues, and closingcomments;2)aPowerPointpresentationemphasizing suicide-related basic epidemiological facts, emotional reactions to patient suicide,and a brief overviewofresources available to grieving individuals; 3) a patient-based case learning exercise covering Accreditation Council for GraduateMedicalEducation(ACGME)competenciesasameans

Short‐term effects of a suicide education intervention for family caregivers of people who are suicidal

To evaluate the short-term effects of a suicide care educational intervention on the family's ability to care, family's caring stress levels and family's attitudes towards attempted suicide. Research has demonstrated that suicide prevention educational programmes are provided mostly for professional staff and not for the family caregivers of people who are suicidal. A experimental design, using two groups and a pre- and postintervention survey method, was used. A randomised controlled study was conducted with 74 family caregivers of people who are suicidal (37 using suicide education and 37 in the control group). The experimental group was provided with a two-hour suicide care education intervention, and the control group received normal suicide care support. Participants were recruited at a Suicide Prevention Centre and two acute psychiatric hospitals between October 2009-December 2010. Three questionnaires were collected: (1) the Suicidal Caring Ability Scale (2) the Caring Stress Scale and (3) the Suicide Attitudes Scale. Descriptive statistics, independent t-tests or Mann-Whitney U-tests were used to analyse the data. The results demonstrated that there were statistically significant differences in the Suicidal Caring Ability Scale and the Suicide Attitudes Scale but no statistically significant differences in the Caring Stress Scale. That is, the suicide education programme can promote the ability to care for people who are suicidal and can generate a positive attitude towards people who are suicidal from their caregivers. Family caregivers of suicidal individuals who attended the psycho-education programme had an increased caring ability and positive attitudes for their suicidal relatives. Nurses could use the two-hour personal suicidal education programme to increase one's ability to care for their relatives who had attempted suicide and promote one's positive attitudes towards attempted suicide.

An Update on Perfect Depression Care

An Update on Perfect Depression Care

A suicide education programme for nurses to educate the family caregivers of suicidal individuals: A longitudinal study

Family members lack the ability to care for suicidal relatives. Nurses have a responsibility to improve family members' ability to care for their suicidal relatives. The aims of this study were to design a suicide education programme for nurses to educate family caregivers and to evaluate the longitudinal (12 months after the educational programme) effects of a suicide care education programme on the ability of families to care for suicidal relatives. A randomised controlled trial was conducted. The study population (n=61) was composed of the family caregivers of suicidal individuals. Several caregivers (n=26) were randomly allocated to an experimental group who attended a two-hour suicide care education programme, and the other caregivers (n=35) represented a control group who did not attend the education programme. All of the participants were given a questionnaire at baseline, 3 months, and 12 months during the period from 2009 to 2011. The results of the longitudinal effects of the suicide care education programme demonstrated that there were statistically significant differences after the educational programme as compared to before the programme with regard to "seeking assistance from resources" and the ability to care for those who were once suicidal. The longitudinal results of both groups showed that there was a significant difference in terms of "caring ability" at 12 months. The results of a multiple linear regression analysis indicated that evaluations performed at the three-month time point were able to effectively predict success in "seeking assistance from resources", "caring ability"; caring ability was also significantly improved among those who engaged in the educational programme at the 12-month time point. The suicide care education programme had long-term effects for family caregivers caring for their suicidal relatives. Nurses could employ this suicide care education programme to improve the ability of family caregivers to care for their suicidal relatives.

Alleviating psychological distress of suicide survivors: evaluation of a volunteer care programme

The crisis level in the worldwide suicide rate has revealed a severe suicide problem in Taiwan that is now well above the world average of 16 per 100,000 individuals. Many countries have relied on suicide care volunteers training programmes to conduct suicide prevention programmes. However, there is a dearth of research evaluating the effect of volunteers on psychological distress and the impact of volunteer experience level. An evaluation of the impact of experienced and novice volunteers in alleviating psychological distress of suicide survivors was conducted. A supervised programme trained 15 volunteers at Years 1 and 2. Year 1 volunteers completed 400 h of service with continuing education. Programme evaluation occurred after Year 2 volunteers had completed training. Eighty-two suicide survivors were recruited. With 60 suicide survivors completing 3 month of volunteer care, a significant group difference with time interaction in suicide survivors who exhibited moderate to severe distress between the veteran care and novice care groups was found. Compared with novice volunteers, veteran volunteers with at least 1 year of experience are more effective with suicide survivors reporting higher psychological distress.

Bereaved by Suicide

Parents and family members are often treated as experimental or observational units from whom information can be gathered and inferences made about suicide survivors (family of a suicide case). Collecting data in this way limits the knowledge about suicide survivors’ needs and how they can contribute to the suicide debate for the development of a suicide policy. It is not helpful to claim mental illness as the cause of suicide when the suicide rate decreases, and then claim that suicide is a very complex health outcome caused by many factors when the suicide rate increases. In this discussion paper, we argue that a suicide prevention model that places mental illness at the centre of the suicide debate only leads to a policy of ‘more of the same’, and will have little effect on suicide prevention and care support post-suicide (for suicide survivors). Furthermore, we argue that the contribution that suicide survivors can make to understanding suicide should not be ignored.

The Sociocultural Contexts of Attempting Suicide Among Women in Iran

In this study, we investigated the sociocultural contexts of suicide attempts among women in Iran. Fifty women who attempted suicide and were admitted to the two main hospitals in Isfahan in 2006 were interviewed. The main themes identified were family problems, marriage and love, social stigma, pressure of high expectations, and poverty. We observed significant sociocultural influence on attempting suicide among the Iranian women in this study. Based on our findings we conclude that the women in the study were affected by social changes and the interplay between traditional and modern values and attitudes. Understanding sociocultural aspects of suicide in Iran is critical in providing effective and culturally sensitive suicide prevention and care programs.

The inner door: toward an understanding of suicidal patients

To describe the suicide care dilemmas that psychiatric nurses experience and how they respond to suicidal patients. Background. Psychiatric nurses play a major role in helping patients after suicide attempts. Little is known, however, about the ways nurses resolve their suicide care dilemmas. Focused ethnography was used to describe the meanings and patterns of actions of psychiatric nurses in a medical centre in Taipei, Taiwan. Fieldwork included two years of participant observation and individual interviews with 18 psychiatric nurses. Data from transcripts of observation field notes and interviews were transcribed verbatim and analysed. An important factor, the inner door (an invisible door inside the nurse's mind), determined the nurse's ability to understand the inner worlds of suicidal patients and the nurse himself or herself. In the absence of such understanding, nurses felt discouraged, labelled the patients and even restrained them, thus closing their inner doors. On the other hand, the nurses' willingness to reflect on their own experiences and receive the patients' teaching helped them understand the defensive patients and nurses themselves, thus opening the inner doors and enabling them to treat patients as their family or friends. The opening and closing of the inner door is a dynamic process. Nurses need to understand the essential meaning of a suicide experience to develop the insight to open the door and keep it open. The concept of an inner door helps nurses better understand why they distance themselves from patients when they encounter clinical dilemmas and offers a way to resolve their inner conflicts through self-reflection and appreciation of the patient's experiences.

Training Mental Health Professionals to Assess and Manage Suicidal Behavior: Can Provider Confidence and Practice Behaviors be Altered?

Remarkably little systematic research has studied the effects of clinical suicidology training on changing practitioner attitudes and behaviors. In the current study we investigated whether training in an empirically-based assessment and treatment approach to suicidal patients administered through a continuing education workshop could meaningfully impact professional practices, clinic policy, clinician confidence, and beliefs posttraining and 6 months later. At the 6 month follow-up we found that 44% of practitioners reported increased confidence in assessing suicide risk, 54% reported increased confidence in managing suicidal patients, 83% reported changing suicide care practices, and 66% reported changing clinic policy. These results suggest that a brief and carefully developed workshop training experience can potentially change provider perceptions and behaviors with a possible impact on clinical care therein.

What Do We Teach Psychiatric Residents About Suicide? A National Survey of Chief Residents

Because of the clinical significance of patient suicide for trainees and current limited information on this essential educational subject, the authors sought to determine what topics involving the care of suicidal patients were taught to residents in psychiatry training programs. Chief residents of psychiatry training programs across the United States (response rate 59%) anonymously completed questions on what and how the care of suicidal patients was taught. Topics that required more attention and barriers to teaching were also identified. A vast majority of the national programs (91%) offered formal teaching on suicide care; grand rounds (85%) and case conferences (80%) were also popular methods for teaching. Even the topics most commonly taught, such as risk factors, recognizing early warning signs, and standards of clinical care, were judged to warrant more attention by many residents. Commonly identified barriers to teaching included the lack of audio or video teaching materials and relevant texts. Only 19% of chief residents reported that they felt prepared for the possibility of having to manage the aftermath of a patient suicide. The chief residents identified a need for programs to focus even more attention on teaching of the care of suicidal patients in training programs.

Emergency suicide care in France: The psychiatrist's liability as seen in case law

In France, in general emergency departments, psychiatric consultations are on the increase and suicidal behavior represents a frequent reason for consultation. Psychiatrists treat patients whose behavior may be impulsive and irrational, and whose critical judgment is impaired. In emergency units, the reception and initial assessment of the patient determines his or her future pathway through the healthcare system. By its very nature, emergency medicine deals with inherently unstable situations, which may lead to the risk of medical malpractice. The aim of this article is to provide a summary of the initial management of suicidal patients by general emergency units and to comment on the medical malpractice that may expose the practitioner to risk of liability. An analysis of case history has shown that in suicide cases, malpractice due to inadequate supervision is the most frequent ruling. Résumé en français En France, dans les services d'urgences générales, les consultations psychiatriques sont en constante augmentation et les conduites suicidaires sont un motif fréquent de consultation. Les psychiatres traitent des patients dont le comportement peut être impulsif et déraisonné, et dont le jugement critique est affaibli. L'accueil et l'évaluation initiale du patient conditionnent son orientation secondaire dans le réseau de soins. L'instabilité de cette situation associée à la particularité de l'exercice médical en urgence exposent à la faute médicale. Le but de cet article est de réaliser une synthèse de la prise en charge initiale du patient suicidaire aux urgences générales et de commenter les fautes médicales qui exposent le praticien à la mise en jeu de sa responsabilité. Il a été réalisé une analyse la jurisprudence qui montre que dans le domaine du suicide, la faute pour défaut de surveillance est la plus souvent sanctionnée.

The identification and management of suicide risk in local prisons

This study aimed to examine rates of mental illness and suicidal ideation in a random sample of prisoners in four UK prisons, and to examine the characteristics and quality of care received by prisoners identified as at current risk of suicide/self harm. Methods used were: cross-sectional study of mental illness and suicidal ideation in a random sample of prisoners, and in all prisoners specifically managed as a suicide risk; examination of suicide risk care plans; and comparative study of information sharing across suicide risk and healthcare documentation. Results showed that prisoners identified as at risk of suicide/self harm had significantly higher rates of clinically significant symptoms of mental illness, as measured by a standardized instrument, than the general prison population. There was a high level of suicide risk that had not been identified. Problems with the delivery of planned care interventions were revealed and little congruence was found between systems of documentation. The suicide care planning system was correctly targeting a proportion of those at risk but high levels of unmet need remained. The care planning and information sharing processes within prisons and between prisons and other agencies should be improved.

The attitudes of casualty nurses in Taiwan to patients who have attempted suicide

The aims of this study were to investigate a sample group of casualty nurses' attitudes towards patients who have attempted suicide in the middle of Taiwan and to identify factors contributing to their attitudes towards attempted suicide. A quantitative study using a questionnaire containing 22 statements with a five-point Likert-type scale was developed from the Domino's Suicide Opinion Questionnaire, and from a comprehensive analysis of research literature on the area of attitudes towards suicide. The questionnaire was distributed to casualty nurses (n = 155) to investigate their attitudes toward patients who have attempted suicide. Seven large hospitals in the middle of Taiwan were targeted. This sample group of casualty nurses from the middle of Taiwan held positive attitudes toward patients who have attempted suicide. In addition, three statistically significant differences were identified: (i) The higher the level of nursing education the more positive the nurses' attitudes towards patients who had attempted suicide. (ii) The casualty nurses who did not have a religion held more positive attitudes towards suicidal behaviour than those who followed a religion. (3) Casualty nurses who had suicide care experience with 1-10 patients had more positive attitudes towards suicidal patients than nurses who had nursed above 10 patients who had attempted suicide. The results indicated that casualty nurses in Taiwan require further education on and training in all aspects of suicide to foster more positive attitudes towards patients who attempt suicide. The role of casualty nurses is pivotal to the front-line care of people who are suicidal and their attitudes play a major part in the provision of effective care.

Elderly Suicide: An analysis of coroner's inquests into two hundred cases in Cheshire 1989 - 2001

Elderly suicide is an index of more widespread disorder and discontent among the elderly, and furthermore is a potentially preventable cause of death. This study used coroner's inquest records of 200 elderly in Cheshire who killed themselves, and in which their unexpected deaths attracted a verdict of suicide. Sociodemographic characteristics, clinical aspects of the suicidal process and health care contact before death are reviewed. Unlike most available studies, cases of unexpected death in which an open verdict was given were not included in this study, which covered a 13 year period. The findings are interpreted and compared to the currently available literature on suicide in the elderly. Late life suicide is characterised by less warning, higher lethality and greater prevalence of depression and physical illness. However, suicide risk often remains undetected. All suicidal behaviour in the elderly should be taken seriously by psychiatric and primary care services, in order to reduce suicide rates in the elderly.

Attitudes of Physician Assistants to Hospice Care and Assisted Suicide

As primary health care providers, physician assistants (PAs) often treat patients with terminal illnesses. Surveys of physicians and nurse practitioners have shown hospice to be underutilized as a referral option, and requests for assisted suicide to be commonplace. A randomly selected group of PAs licensed in Illinois responded to a questionnaire concerning their attitudes toward hospice and assisted suicide. The survey examined demographic information about the PAs and their personal views, experience, and education with respect to assisted suicide and hospice care. The respondents reported that the main deterrents to hospice care were Medicare/insurance guidelines and lack of personal knowledge about hospice. The central reasons identified for opposition to the legalization of assisted suicide were fear of its abuse and religious/moral deterrents.

Suicide and home care: The important role of nursing

Suicide and home care: The important role of nursing

Suicide, ethnicity and psychiatric in-patient care: A case-control study

This study compares patients with controls concerning sociodemographic variables and describes Swedish and foreign-born patients concerning psychiatric disorders. suicide risk. history of attempted suicide, suicide method, number of parasuicides and time from discharge to suicide. It is based on 59 psychiatric in-patients who had committed suicide, of whom 46 were native Swedes and 13 foreign-born, and on a random sample of 630 controls living in the same area of Stockholm, Sweden. There was an excess suicide risk for being foreign-born with a crude odds ratio of 1.94 (CI = 1.01−3.76) in an unconditional logistic regression. In the final model, single living, having a somatic disease and being unemployed were major risk factors for committing suicide. There were no differences between Swedes and those of foreign birth concerning distribution of certain background variables (i.e., suicide risk, diagnoses and quality of care assessed via clinical records). Only 39% of the patients were classified as high risk by the doctor-in-charge at admission. This is significantly lower p<0.001) than the retrospectively rated risk. Planned aftercare was considered as satisfactory for about half of the patients. About two-thirds of the patients did not participate in aftercare or almost immediately discontinued the contact. More attention is necessary in order to motivate the patients to take part in aftercare and there is a need for better co-operation between hospital and out-patient clinics.