Suicidal Persons Research Articles

Homicide or Suicide: The Killing of Suicidal Persons by Law Enforcement Officers

This paper presents 15 deaths of suicidal persons in Oregon and Florida who, by their behavior, sufficiently provoked law enforcement officers into killing them. Four deaths were certified as suicide, one as undetermined and ten as homicide. All of the deaths are individually described in detail and their case characteristics are presented in a table. The method of study is a descriptive analysis of the case characteristics, including 21 variables which are determined to be relevant to the classification of death. The variables were grouped into six categories: (a) personal information; (b) criminal behavior during the fatal incident; (c) dangerous behavior during the fatal incident; (d) toxicological data; (e) mental illness information; and (f) certification data. From the analysis, reasons for the opinions on manner of death classification are presented. All incidents were perceived as life-threatening to law officers, family members, or hostages. All victims were male except one, and all were Caucasian except two. All victims resisted arrest and verbally threatened homicide during the fatal incident. Two-thirds of the victims took hostages. All victims possessed an apparent handgun or other weapon (knife, iron bar). All victims posed their weapon and threatened others during the incident, 60% of victims actually used the weapon with apparent intent to inflict damage to others. 40% of victims were intoxicated with alcohol but other drug-involvement was uncommon. Seven of 15 had previous suicide attempts, 40% had medically documented psychiatric diagnoses and 60% had reasonable historical evidence of psychiatric diagnoses, most commonly depression or substance abuse. One of the co-authors presents the case for some of the deaths to be certified as suicides, whereas two present the case for all to be certified as homicide. A brief discussion of psychiatric issues is also presented concerning individuals who use others to commit suicide and who may engage in dangerous and/or criminal behavior to do so. A major conclusion is that there is lack of a unified opinion on death certification procedures for individuals who have provoked law enforcement officers to kill them. For such cases, it is recommended that professional organizations of medical examiners/coroners develop guidelines to promote consistency in death certification practices including manner of death classification and selection of death certificate wording so that "police-assisted suicide" may be appropriately reported and studied.

Meanings of gender and suicidal behavior during adolescence.

In the United States, gender differences in suicidal behavior rates emerge during adolescence, when females are more likely to engage in suicidal behavior, but are less likely to die as a result of a suicidal act than males. These gender patterns of suicidal behavior are common but not universal, suggesting cultural influences. This article reviews the highlights of the research on cultural meanings of gender and suicidal behavior. Studies suggest that U.S. adolescents perceive nonfatal suicidal behavior as more "feminine" and less potent than killing oneself. Persons who are suicidal in response to a relationship problem are considered more "feminine" than persons who become suicidal in response to an achievement failure. Males are more critical and avoidant of suicidal persons than females, especially when the suicidal person is a male. These beliefs may play a role in decisions about suicidal behavior (what kinds of suicidal behavior are chosen, and under what conditions). Cultural narratives of gender and suicidal behavior may be particularly influential for adolescents because adolescents are in the process of defining their identity, and often take cultural messages about "appropriate" gender behavior more seriously and more literally than adults. The implications of the findings from the research on cultural meanings of gender and suicidal behavior for prevention programs are outlined.

Effects of different telephone intervention styles with suicidal callers at two suicide prevention centers: an empirical investigation.

To determine the relative effectiveness of telephone intervention styles with suicidal callers, researchers listened unobtrusively to 617 calls by suicidal persons at two suicide prevention centers and categorized all 66,953 responses by the 110 volunteer helpers according to a reliable 20-category checklist. Outcome measures showed observer evaluations of decreased depressive mood from the beginning to the end in 14% of calls, decreased suicidal urgency ratings from the beginning to the end in 27% of calls, and reaching a contract in 68% of calls, of which 54% of contracts were upheld according to follow-up data. Within the context of relatively directive interventions, a greater proportion of "Rogerian" nondirective responses was related to significantly more decreases in depression. Reduction in urgency and reaching a contract were related to greater use of Rogerian response categories only with nonchronic callers.

Seduced by Death: Doctors, Patients, and the Dutch Cure

Dr Herbert Hendin, a psychoanalyst, suicidologist, and executive director of the American Suicide Foundation, is a passionate critic of assisted suicide and euthanasia.<i>Seduced by Death</i>presents his views on many aspects of the euthanasia debate developed from his experience as a therapist of suicidal patients, his investigation of euthanasia in the Netherlands, and his study of legal, ethical, and social issues pertaining to endof-life decision making. The book has two major strengths. First, Hendin is an expert on the psychology of suicidal persons, and his insights into how suicidal persons view their world are woven throughout the text. He contends that terminal illness is not dissimilar to other life crises that provoke suicidality. With cases from his experience as a therapist, he explores the psyches of the suicidal: their ambivalence toward death, the inflexibility of their thinking and difficulties considering alternatives, and the influence of subtle pressures from others

Psychometric characteristics of the Self-Expression and Control Scale in a sample of recurrent suicide attempters

The Self-Expression and Control Scale (SECS), constructed to investigate the role of anger expression and anger control in somatic and mental diseases, was administered to patients with recurrent suicide attempts. The psychometric properties of the SECS proved to be highly acceptable and comparable with the psychometric properties of the instrument administered to a community sample. Suicide attempters scored higher on trait anger, higher on the internalization of anger and lower on both control of the internalization and the externalization of anger than controls in a community sample. Additionally, suicide attempters with a diagnosis of borderline personality disorder scored higher on the externalization of anger, and lower on both control of the internalization and the externalization of anger than suicide attempters without this diagnosis. Finally, the subgroup of patients with a psychiatric diagnosis of a“recurrent deliberate self-harm” scored higher on the internalization of anger than other patients with recurrent suicide attempts. These results show that the SECS is able to make a distinction between several subgroups of suicide attempters, and between suicide attempters and persons in a community sample with respect to the expression and control of anger. As such, the SECS can give indication for optimal psychotherapeutic treatment.

Laxative abuse among women with eating disorders: an indication of psychopathology?

The results of the scant research on laxative abuse among women with eating disorders suggest that laxative abuse is a diagnostic indicator of greater psychopathology. We further investigated the relationship of history of laxative abuse to eating and related attitudes, impulsivity, and personality pathology. Women assessed in an outpatient clinical setting and diagnosed with anorexia nervosa, binge-eating/purging type (n = 51) or bulimia nervosa, purging type (n = 280) completed measures of laxative abuse, eating and related attitudes, and personality psychopathology at intake. More than one-half of both groups had abused laxatives at some point. History of laxative abuse was unrelated to eating disorder diagnostic category, current age or body weight, history of stealing, self-induced injury, having attempted suicide, interpersonal distrust, maturity fears, or compulsive or dependent personality features. Compared to nonabusers, laxative abusers demonstrated more perfectionism and avoidant personality features. Significant statistical interactions among variables revealed that bulimia nervosa patients who had abused laxatives exhibited the most pathological scores on scales measuring drive for thinness, body dissatisfaction, ineffectiveness, lack of interoceptive awareness, and passive-aggressive and borderline personality features. Anorexia nervosa patients who had abused laxatives had the highest scores on the histrionic scale. Results are discussed with regard to past research and clinical implications. We propose that laxative abuse among eating disordered women may serve different functions depending on diagnosis and underlying personality dynamics.

The problem of suicidal personality in current suicidology

This paper aims to examine the current state of research of suicidal personality in suicidology. Methodological precautions are discussed emphasizing the multicausal nature of the suicidal process and the processional nature of personality. Specific character traits as a high level of aggression and hopelessness, low self-integration and self-esteem, and cognitive disturbances were often found to be correlated with suicidal tendencies. Suicidal persons were considered to be weak problem solvers. Emotionally-oriented stress coping strategies and maladaptive coping and survival skills were prevalent among them. The problem of one-dimensionality of suicidological research is brought up and elaborated upon in this article. The possibility of integrating the noetic (noological) dimension of personality into suicidological surveys is suggested, emphasizing a multidimensional point of view. Future prospectives concerning the link between some other noetic phenomena such as the fear of death, the awareness of freedom and responsibility, or the experience of existential isolation and suicidal behaviour are drawn.

Risk Factors for Adolescent Suicide and Suicidal Behavior: Mental and Substance Abuse Disorders, Family Environmental Factors, and Life Stress

This review focuses on psychopathologic risk factors for adolescent suicide and suicidal behavior, namely, affective, disruptive, substance abuse, psychotic, and personality disorders. The interaction of psychopathology with age and gender is discussed. The role of family environmental risk factors and stress events in suicide and suicidal behavior, both alone, and in interaction with psychopathology are reviewed. Research reviewed will include psychological; autopsy studies, longitudinal studies examining predictors of suicide, and epidemiologic studies of suicide attempts.

Is the gender of a suicide note writer associated with judgments made about the suicide?

The gender of a suicide note writer did not affect 44 undergraduate students' judgments of the emotional upset, mental illness, likelihood of death, or rationality of the suicidal person.

Suicide prevention in a treatment setting.

Reducing the suicide rate through treatment depends on the development of new knowledge and new technology with emphasis on early intervention and continuing low-intensity contact for many troubled suicidal people, rather than the current preoccupation with detecting and hospitalizing the "highest risk." I anticipate that sophisticated interactive computer programs will be effective in improving screening and case finding, thus bringing many more suicidal persons into contact with primary care physicians and outpatient mental health services for the purpose of relieving psychological pain. Computer programs will be invaluable in improving training for both primary care providers and outpatient mental health workers. Improved communication networks will prove to be useful resources for maintaining continuity of care and consultation, which is important in long-term treatment. Other technical developments include simplifying and making explicit various treatment approaches, in both psychotherapy and drug therapy, so that research can proceed to clarify what type of treatment helps which type of suicidal patient.

Rational suicide reconsidered: AIDS as an impetus for change.

At the present time, there does not appear to be an acceptable alternative to intervening to prevent the suicide of persons who display suicidal ideation. This absolutist and, at times, paternalistic view may change, however, as a result of professionals' contact with persons with AIDS. The growing number of persons with AIDS and the incidence of suicide within this population make it increasingly likely that individuals in a number of professions that subscribe to the policy of mandatory suicide intervention will have contact with a suicidal person with AIDS. Given the life circumstances and implications associated with a diagnosis of AIDS, there is the possibility that some of these suicidal persons with AIDS may have made what could be considered to be a rational decision to end their own lives. By taking into account the circumstances that precipitated the suicidal ideation and allowing some individuals to follow through with their plans, professionals will be empowering and returning autonomy to these individuals. Thus, by forcing professionals to think about and deal with the issue of rational suicide, AIDS may provide an impetus to change the traditional absolutist approach of suicide intervention and prevention into a contextual approach in which the intensity of suicide intervention required is viewed as varying along a continuum.

Suicide prevention in the genetic counseling context

Utilizing a case report, this paper explores psychosocial aspects of suicidal intent in a woman seeking prenatal diagnosis. Using knowledge and practice of appropriate assessment, referral, and intervention procedures, the therapy team of genetic counselor and psychotherapist facilitated successful identification and management of this potentially suicidal client. The main counseling goals for the genetic counselor are to assess the situation adequately, decrease the immediate danger, and, with supervision and/or consultation, stabilize the seriously suicidal person until that individual can be triaged to mental health or medical professionals for treatment. The prevalence of suicide issues in genetic counseling contexts is unknown and reports mentioning suicidal ideation unusual in the genetic counseling literature. Is this reported case a rarity among genetic counseling referrals? Systematically collected information on the prevalence and resolution of suicidal issues in genetic counseling contexts would be helpful for those setting curricula for genetic counseling training programs, standards for professional certification exams, and policy and procedures manuals for clinical units.

Suicidal behaviour in the elderly

AbstractIn a retrospective study of 69 elderly (65 years and over) cases of attempted suicide (deliberate self‐harm) referred for psychiatric assessment in southern Sydney, 81% of took overdoses, 64% involving benzodiazepines. Depressive illness was present in 87% of cases, alcohol/substance abuse in 32%, organic syndromes in 29% and personality dysfunction in 26%. Multiple psychosocial, psychological, medical and psychiatric risk factors for suicide were identified. ‘Major’ functional psychiatric disorders (41%) were found predominantly in females and were associated with higher levels of suicidal intent, psychosis and fewer chronic physical illnesses. ‘Minor’ functional disorders (30%) were associated with lower degrees of suicidal intent, personality dysfunction and higher numbers of psychosocial stressors. Organic brain syndromes were associated with males over 75 years, chronic physical illness, and were often comorbid with depression. These findings indicate that there are several patterns of suicidal behaviour in the elderly that require further prospective research.

Crisis intervention skills training for police negotiators in the 21st century

While Crisis Management training and intervention skills are not new areas for police officers or for police crisis negotiators, it is certainly true that such training must be included in the overall preparation for police officers in general and for police crisis negotiators in particular. Not to do so ignores the need for such skills in the day-to-day functions and calls-for-service of these groups. It has been the experience of this author, in talking with police negotiators, that more and more calls for their services are being made, in situations which are non-hostage related, than ever before. These areas continue to include barricaded individuals, suicidal persons, family disputes in which one member of the family is holding other members of the family against their will, and abuse situations including spouse abuse and child abuse. Additional areas include those in which there are juveniles involved as well as within school settings. Some of the latter may involve hostages while others do not. Finally, it is becoming less unusual for negotiators to be summoned only to find that the subject has engaged in acts designed to evoke fatal responses from those officers involved. This phenomenon is commonly referred to as “death by cop.”

Suicide in psychiatric care as seen by the survivors

Members of suicide survivor organizations are likely to have unique experiences of the psychiatric care of suicidal persons. The present study represents an attempt to provide a feedback of such experiences to the caregivers, through a collaborative research project with the Swedish organization for suicide survivors, the SPES. A questionnaire was mailed to the then 110 members of SPES, containing 25 general questions concerning their membership in the organization and their possible willingness to participate in a research project. Fifty-six per cent of the members returned the questionnaire. One year later a second questionnaire was mailed to the members, who had now increased to 150, with questions focusing on possible experiences of psychiatric care of their dead relatives. Sixty per cent answered, and two-thirds reported such experiences. Among those willing to be interviewed, we contacted 20 subjects who were judged, on the basis of their responses and comments to the questionnaires, to be represent...

Linkage agreements between mental health and law enforcement agencies: Managing suicidal persons

Linkage agreements have been developed between community mental health and law enforcement agencies to coordinate management of mental health emergencies. This paper analyzes one such linkage and the ramifications for assisting individuals experiencing suicidal episodes. The results indicate that police officers are in fact called upon to manage persons threatening suicide and need further training to do so. Further, police officers do contact mental health providers for assistance and linkage agreements are seen as an asset by police.

College students' hypothetical responses to suicidal individuals who are hiv positive, substance abusing, depressed, or anxious

Abstract To see if specific circumstances encourage or discourage helpful responses to suicide threats, 141 undergraduates read a one-paragraph vignette about a suicidal person with either AIDS, depression, drug abuse, anxiety, or adjustment problems. Students then wrote five responses, which on average were mildly unhelpful regardless of circumstance. A suicidal person who was HIV positive engendered significantly less helpful responses than a suicidal person who had panic attacks. Results suggest that, for suicidal persons, revealing life circumstances fails to engender increased empathy in college students.

Opinions about and reactions to suicide, and the social acceptance of a suicidal classmate among Turkish high school students.

The present study investigated the opinions about suicide and reactions to a suicidal peer among 89 female and 78 male Turkish high school students. Females more than males believed that suicide should be discussed among friends. More males than females perceived suicidal persons to be mentally ill and to be punished in the other world. Females showed greater acceptance for a suicidal classmate than males. An attitude for openly discussing suicide was associated with higher acceptance of a suicidal classmate. Perceiving suicidal individuals to be mentally ill was associated with lower acceptance of a suicidal peer.

Neuropsychological performance and suicidal behavior in adult psychiatric inpatients.

Although various studies have shown that suicidal persons exhibit greater cognitive deficiencies than both normals and other psychiatric patients, researchers as yet have been unable to account for the source(s) of the differences. Some of these differences (e.g., cognitive rigidity and impaired problem solving) hint of possible organic involvement. This study explored the relationship of neuropsychological functioning to suicidal behavior by comparing 20 suicidal and 27 nonsuicidal psychiatric inpatients on several tests of neuropsychological functioning. Although results showed no significant differences between the two groups on most measures, both groups showed evidence of notably high levels of cortical dysfunction relative to test norms. Thirty-five percent of suicidal patients and 44% of nonsuicidal patients scored in the impaired range. Implications of this high frequency of impairment for the treatment of suicidal and nonsuicidal psychiatric patients are discussed.

Adolescent depression and suicide: rising problems.

In adolescents, as in adults, most depressive persons are not suicidal, and many suicidal persons are not depressed. However, accurate diagnosis and treatment of depression in adolescent patients is essential to suicide prevention. Unfortunately, depression and suicidality remain widely undiagnosed and untreated in the adolescent population.