Suicidal Persons Research Articles

Evaluation of knowledge and competency among nurses after a brief suicide prevention educational program: A pilot study.

Background:Suicide is major public health issue worldwide. The educational interventions in enhancing the knowledge, modifying the attitudes, and raising the competence levels of healthcare professionals to prevent suicides have shown positive results. However, these education programs are under-evaluated, especially in India.Aim:The aim was to evaluate the effect on suicide prevention and management-related knowledge among nursing staff, attitudes, and competence for suicidal patients and their family members.Methods:A brief suicide educational intervention training program was prepared for the study participants. The outcomes of this study were evaluated through a single group pre-test–post-test questionnaire.Result:The mean age of the participants was 28.74 ± 5.73 years. Participants reported significant improvement in their attitude and knowledge about suicide after attending the training program.Conclusion:Empowering primary health care staff including nurses to identify, assess, manage, and refer the suicidal person should be considered as an important step in suicide prevention.

Attitude towards suicide among medical students in a medical college of rural south India

Background: Suicide is a psychiatric emergency. It contributes for substantial portion of preventive deaths. Medical professionals bear responsibility of providing optimal primary care to a suicidal person and reducing stigma towards suicide. Their attitudes towards suicide or a suicidal person determines the quality of care given to them. This study attempts to quantitatively assess attitudes of undergraduate medical students towards suicide and a suicidal person. Materials and methods: This cross-sectional study was conducted in a medical college hospital of Kerala. Total 287 first& second year medical students who were not exposed to psychiatry teaching were recruited for the study by total enumeration method. Eskin’s attitude towards suicide scale (E-ATSS) and Eskin’s Social Reactions to Suicidal Persons Scale (E-SRSPS) were administered. Responses were collected in 5 point likert scale ranging from ‘completely disagree' to ‘completely agree'. Results: On E- ATSS, Communicating psychological problems had a high mean score with minimal standard deviation( 4.25+/- 0.35) & acceptability of suicide scored the least(1.46+/- 0.62) while the social acceptance of a suicidal person & helping had high scores (4.34+/-0.82, 4.28+/- 0.23) on E-ATSPS. Conclusion: Students participated in this study have more of rejecting attitudes towards suicide. But less than half of them take it as a sign of mental illness. When it comes to attitude towards a suicidal person, our medical students have a very high acceptance score and also are ready to help them. Studies involving students who complete undergraduate psychiatry training will help to know about the change that the training brings into the attitudes.

Differences and similarities in instant countertransference towards patients with suicidal ideation and personality disorders

BackgroundPrevious findings showed that suicidal patients elicit mostly negative countertransference such as distress, hopelessness, feelings of inadequacy, and apprehension, and that a concurrent personality disorder is associated with more feelings of entrapment and mistreatment, among other adverse reactions. No studies were however conducted on instant countertransference (iCT), i.e., after a single encounter, for example in an emergency setting. We aimed to evaluate the impact of suicidal ideations, self-harm and presence of personality disorders on instant Countertransference (iCT). MethodsCaregivers rated their iCT with two validated and standardized questionnaires after a first emergency or outpatient consultation. Suicidal ideation, self-harm and personality disorders were tested as predictors for iCT in a multivariate and multilevel analysis. ResultsThirty caregivers rated their iCT towards 321 patients. Personality disorders and suicidal ideation, but neither recent nor past history of self-harm, predicted iCT. Common iCT included tension, lack of self-confidence and feeling of being tied. iCT specifically associated with suicidal ideation included distress, lack of hope, confusion, and sense that the patient's life had little worth. In contrast, iCT towards patients with personality disorders suggested tension in the therapeutic relationship (low affiliation with patient, anger, disappointment, devaluation). LimitationsCaregiver's characteristics were not considered in the analysis. Furthermore, while countertransference also includes unconscious phenomena, only conscious iCT was assessed. ConclusionsPatients with suicidal ideation and personality disorders elicit common but also specific negative iCT. Mental health institutions need to devote specific resources (such as clinical supervision and training) to help caregivers manage their iCT.

Risk Factors for Suicide and Suicide Attempts Among Patients With Treatment-Resistant Depression: Nested Case-Control Study

The risk of suicide is elevated among patients with treatment-resistant depression (TRD). Risk factors for suicide and suicide attempts among cases and controls with TRD were investigated using data from nationwide Swedish registers. Among 119,407 antidepressant initiators with a diagnosis of depression, 15,631 patients who started a third sequential treatment trial during the same depressive episode were classified with TRD. A nested case-control study compared cases with suicide and suicide attempts with up to three closely matched controls. Sociodemographic and clinical risk factors were assessed using conditional logistic regression analyses. In all, 178 patients died by suicide and 1,242 experienced a suicide attempt during follow-up. History of suicide attempts, especially if <1 year after the attempt, was a significant independent risk factor for suicide (adjusted odds ratio [aOR], 8.9; 95% confidence interval [CI], 5.1–15.7) as were 10 to 12 years of education compared to lower education (aOR, 1.69; 95% CI, 1.02–2.81). For attempted suicide, the strongest independent risk factors were history of suicide attempts (<1 year aOR, 5.1; 95% CI, 4.0–6.5), substance abuse (aOR, 2.6; 95% CI, 2.2–3.1), personality disorders (aOR, 1.9; 95% CI, 1.5–2.3), and somatic comorbidity (aOR, 2.0; 95% CI, 1.04–3.9). Suicide attempts, especially if recent, are strong risk factors for completed suicide among patients with TRD. Established risk factors for suicide attempts were confirmed for patients with TRD.

When delayed responses are productive: Being persuaded following resistance in conversation

Conversation analysts have long since demonstrated that, in responding to an initiating action (e.g., question), recipients have at least two ways to respond; response options (e.g., answer, non-answer) are not equivalent, and ‘preferred’ responses are typically delivered more rapidly than ‘dispreferred’ responses. This paper examines cases in which ‘preferred’ responses, which progress the preceding actions in productive alignment, are delayed. We combined and analysed four British and American English datasets: mediators talking to potential clients; police negotiators talking to suicidal persons in crisis; calls to emergency services from suicidal persons, and salespeople talking to potential customers. Our analysis revealed that, when one party has resisted the project of the other, delay may indicate an upcoming productive response. Such delays break the sequence's contiguity, thus producing (some) structural independence from a previously dismissed course of action and enabling the speaker to maintain (some) ‘face’, in Goffman's terms. We discuss the implications of these findings for understanding alignment and preference in conversation analysis, and the practices of resistance and persuasion more generally.

Intervening to prevent a suicide in a public place: a qualitative study of effective interventions by lay people

ObjectivesMany suicides take place in public locations, usually involving jumping from high places or use of transport networks. Previous research has largely focused on the effectiveness of physical barriers at...

Negotiating in the skies of Hong Kong: The efficacy of the Behavioral Influence Stairway Model (BISM) in suicidal crisis situations

Law enforcement agencies often deal with difficult, dangerous, and disordered individuals by applying the theory and practice of tactical negotiation, which is composed of a unique application of communication techniques aimed at obtaining voluntary compliance. Known as hostage or crisis negotiation, law enforcement tactical negotiation (LETN) has shown to be an effective technique for resolving barricaded hostage and crisis situations, kidnappings, and suicidal incidents. Over the years, there have been several models of LETN, however; most of them are based on the assumption that the 1) subject is rational and 2) the subject views the officer as credible; however, in situations where people are in crisis, emotions control their actions rather than reason. Therefore, being successful requires the officer to return the subject to a rational state of mind and establish trust (credibility). If either of these, elements are missing, then traditional negotiation will most likely fail in gaining voluntary compliance in a timely manner. This is especially true with suicidal persons who have exceeded their ability to cope with their situation and believe that no one will help them. The Behavioral Influence Stairway Model (BISM) operates on the premise that a state of personal crisis occurs when coping and social support mechanisms fail and that to end the crisis, at least one of these elements must be restored. In these situations, the BISM provides a method by which the officer can re-establish social support through effectively dealing with emotions (thus returning the individual to a rational state of mind) and demonstrating empathy (thus obtaining trust). In Hong Kong, the Police Negotiation Cadre (PNC) routinely deals with a unique form of suicide where persons in crisis frequently choose jumping off high-rise buildings as their preferred means of suicide. Unlike in the United States, where a significant number of suicides involve barricaded individuals with firearms, most LETN in Hong Kong is accomplished face-to-face, since officer safety relating to firearms is atypical. Despite these differences in structure, culture, and language, the BISM is routinely used to successfully resolve suicidal situations in Hong Kong, based on the theory that emotions and relationship needs are universal and not contingent on context. Therefore, this article will present an updated version of the BISM and extend the principles of the BISM cross-culturally by providing evidence of its efficacy in negotiating with suicidal persons who threaten to jump from multi-story buildings in Hong Kong, as well as its proactive application to non-police intervenors.

Correlations Among the HLA-DQB1 Alleles and Suicidal Behavior.

Suicide is a worldwide health problem with multiple causes, including genetic factors. The major histocompatibility complex (MHC) is represented by an assembly of gene encoding the human leukocyte antigen (HLA). The purpose of our study was to determine associations between the HLA profiles and predisposition for suicidal behavior. We harvested blood samples from persons with history of suicidal attempts (case group) and persons never exhibiting such behavior (control group). The DNA was extracted and amplified via polymerase chain reaction (PCR) to determine the HLA-DQB1 profiles. Statistical data processing was performed with the Epi Info program. We found that the presence of the HLA-DQB1*02 allele increases the risk of suicidal behavior, while HLA-DQB1*05 alleviates such risk. The genotype that presented the most increased risk for suicidal behavior was found to be HLA-DQB1*02/HLA-DQB1*03. Our study has demonstrated the presence of several associations between HLA profiles and suicidal behavior.

Análise do perfil do paciente suicida: revisão integrativa

Objetivo: Identificar por meio da literatura qual o perfil do paciente suicida. Metodos: O presente estudo trata-se de uma revisão integrativa da literatura, elaborada através da consulta de descritores nas bases de dados PubMed; BVS (Biblioteca Virtual da Saúde), e EBSCO no período de novembro 2018 a janeiro de 2019. Os critérios de inclusão foram estudos disponíveis em sua totalidade, publicados nos últimos cinco anos (2014 a 2019), e estudos publicados nos idiomas Português, Espanhol e Inglês. Foram excluídas outras formas de publicação que não fossem artigos científicos completos. Resultados: A maioria das vítimas de tentativa de suicídio são jovens do gênero masculino. Quanto ao perfil emocional da pessoa suicida segundo os estudos, foi relacionado um perfil de pessoas com depressão, ansiedade, melancolismo, com baixo autoestima, sentindo-se desamparados, e com desesperança em relação a vida. Considerações finais: Conclui-se que os jovens do gênero masculino são mais propensos a tentarem suicídio, e que os profissionais de saúde têm importante papel na prevenção do suicídio, pois eles garantem uma assistência de qualidade e de acordo com as necessidades físicas e psicoemocionais dos pacientes.

Suicide risk, personality disorder and hospital admission after assessment by psychiatric emergency services

BackgroundThe main objectives of the mobile Psychiatric Emergency Services (PES) in the Netherlands are to assess the presence of a mental disorder, to estimate risk to self or others, and to initiate continuity of care, including psychiatric hospital admission. The aim of this study was to assess the associations between the level of suicidality and risk of voluntary or involuntary admission in patients with and without a personality disorder who were presented to mobile PES.MethodsObservational data were obtained in three areas of the Netherlands from 2007 to 2016. In total, we included 71,707 contacts of patients aged 18 to 65 years. The outcome variable was voluntary or involuntary psychiatric admission. Suicide risk and personality disorder were assessed by PES-clinicians. Multivariable regression analysis was used to explore associations between suicide risk, personality disorder, and voluntary or involuntary admission.ResultsIndependently of the level of suicide risk, suicidal patients diagnosed with personality disorder were less likely to be admitted voluntarily than those without such a diagnosis (admission rate .37 versus .46 respectively). However, when the level of suicide risk was moderate or high, those with a personality disorder who were admitted involuntarily had the same probability of involuntary admission as those without such a disorder.ConclusionsWhile the probability of voluntary admission was lower in those diagnosed with a personality disorder, independent of the level of suicidality, the probability of involuntary admission was only lower in those whose risk of suicide was low. Future longitudinal studies should investigate the associations between (involuntary) admission and course of suicidality in personality disorder.

Development and evaluation of e-mental health interventions to reduce stigmatization of suicidality \u2013 a study protocol

BackgroundWorldwide, approximately 800,000 persons die by suicide every year; with rates of suicide attempts estimated to be much higher. Suicidal persons often suffer from a mental disorder but stigma, lack of available and suitable support, and insufficient information on mental health limit help seeking. The use of internet-based applications can help individuals inform themselves about mental disorders, assess the extent of their own concerns, find local treatment options, and prepare for contact with health care professionals. This project aims to develop and evaluate e-mental health interventions to improve knowledge about suicidality and to reduce stigmatization of those affected. In developing these interventions, a representative telephone survey was conducted to detect knowledge gaps and stigmatizing attitudes in the general population.MethodsFirst, a national representative telephone survey with N = 2000 participants in Germany was conducted. Second, e-mental health interventions are developed to address knowledge gaps and public stigma detected in the survey. These comprise an evidence-based health information package about suicidality, information on regional support services, a self-administered depression test—including suicidality—and an interactive online intervention including personal stories. The development is based on a trialogical exchange of experience between persons affected by suicidality, relatives of affected persons, and clinical experts. Australian researchers who developed an e-mental health intervention for individuals affected by rural suicide were invited to a workshop in order to contribute their knowledge and expertise. Third, the online intervention will be evaluated by a mixed methods design.DiscussionFrom representative telephone survey data, content can be developed to address specific attitudes and knowledge via the e-mental health interventions. These interventions will be easily accessed and provide an opportunity to reach people who tend not to seek professional services, prefer to inform themselves in advance and/or wish to remain anonymous. Evaluation of the online intervention will provide information on any changes in participants’ self-stigma and perceived-stigma of suicidality, and any increase in participants’ knowledge on suicidality or self-efficacy expectations.Trial registrationGerman Clinical Trial Register DRKS00015071 on August 6, 2018.

Investigating harmful and helpful effects of watching season 2 of 13 Reasons Why: Results of a two-wave U.S. panel survey

RationaleThe Netflix show 13 Reasons Why (2017) aroused widespread concern regarding potential contagious effects of its graphic depiction of an adolescent girl’s suicide and the events that led to her death. ObjectiveTo explore the effects of the second season of the show in 2018. MethodWe recruited a sample of young adults (ages 18–29; N = 729) with access to Netflix who completed surveys shortly before and one month after the release of the show’s second season. Based on theories of narrative empathy, we hypothesized that those who discontinued watching the show would be most vulnerable to its adverse effects on suicide-relevant outcomes. We further identified a higher risk subset of viewers who were more likely to have stopped watching the first season (those currently enrolled in school) in order to observe if the show had more adverse effects on this audience. Finally, we examined effects of the show on all viewers’ intentions to help a suicidal person as a prosocial consequence of viewing the entire second season. We used both covariance and “genetic” matching to control for selection effects. ResultsIn support of predictions, viewers who stopped watching the second season exhibited greater suicide risk and less optimism about the future than those who continued to the end. However, unexpectedly, current students who watched the entire second season reported declines in suicide ideation and self-harm relative to those who did not watch the show at all (ps < .01). Moreover, those who watched the entire second season were also more likely to express interest in helping a suicidal person, especially compared to those who stopped watching. ConclusionThe results suggest that a fictional story with a focus on suicidal content can have both harmful and helpful effects.

Short- and Long-Term Impact of an Undergraduate Suicidology Course.

Suicide prevention models emphasize the importance of education as a foundational element for success. Yet, courses on suicidology are rare and those that do exist focus on clinical intervention skills at the graduate level, missing a critical population of undergraduate students. The current study evaluated the short and long-term impact of a semester long liberal education undergraduate course in suicidology. Students enrolled in either the experimental (Understanding Suicide) or control course completed pre- post- and 4-month follow-up surveys assessing objective knowledge about suicide, suicide stigma, attitudes towards suicidal persons, and suicide prevention advocacy. Mixed repeated measures ANCOVAs indicated significant interactions between course enrollment over time for all the outcome variables. Students in the suicidology course showed significant pre- to post- increases in knowledge and suicide prevention advocacy, alongside reductions in suicide stigma and negative attitudes compared to students in the control course, who showed no significant pre-/post changes. All effects were maintained over time. Providing general education undergraduate courses in suicidology may be an important avenue for building a motivated and informed public that can sustain suicide prevention efforts in their communities.

Caring Practices May Save a Life.

Caring Practices May Save a Life.

Évaluation des facteurs prédictifs de la survenue d’une symptomatologie psychotraumatique chez l’entourage du suicidant

IntroductionPrevious studies showed the psychotraumatic repercussion of a suicide attempt on the nearly entourage, especially when it was witnessed of the suicidal scene. However, factors influencing the onset of PTSD, has not been yet clearly identified. Aim of the studyThe main purpose of this study was to highlight the link between the lapse of time of recontact since the suicide attempt and the occurrence of psychotraumatic symptoms on the significant others. The secondary purpose was to analyze the role of the sociodemographics factors, as the age, the sex, how they are related to the suicidal person, the history of suicide attempt, the place of hospitalization. MethodsForty persons were included. They were living in the same dwelling as the person who was in hospital following a suicidal attempt, and witnessed of the suicidal scene or the calling of the assistance. They were recontacted by letter after three months, to gather the PTSD check list symptoms score. ResultsThe results show that 50% of the sample has significant psychotraumatic symptoms. The average time for recontact was 2.93 days. No significant link was found between the time for recontact and onset of PTSD. In the same way, we did not find psychotraumatic symptoms to be significantly associated with the age, the sex, the relationship to the suicidal person, the history of suicide attempt or the place of hospitalization. DiscussionPCL-s scores were significantly higher among the entourage when it was the first suicide case, which seems to be a category of vulnerable population for onset a PTSD. In that case, entourage should deserve increasing vigilance, according to the postvention principles, implemented for the close entourage of suicide victims.

Overcoming Suicidal Persons’ Resistance Using Productive Communicative Challenges during Police Crisis Negotiations

Abstract This paper reveals how negotiators, from the police and emergency call centres, overcome resistance towards the negotiation from suicidal persons in crisis. Communication guidance to hostage and crisis negotiators recommends against challenging the person in crisis, focusing instead on a softer, rapportful approach. Using conversation analysis, we investigate how negotiators deal with resistance, turn by turn, in encounters collected from British police negotiators’ field recordings, and American police 9-1-1 dispatch telephone calls. In contrast to existing communication guidance, we show that and how challenges can be productive for bringing about positive shifts in suicidal persons’ behaviour. We demonstrate how negotiators challenge the reasoning in their interlocutors’ resistant responses and leverage these challenges productively in the next turn. By studying real (rather than hypothetical or simulated) negotiations, the study reveals the tacit expertise of negotiators and the communicative practices that optimize negotiation outcomes. These research findings have significant implications for existing communication guidance showing how negotiations are managed locally through the linguistic design of turns of talk.

Sense of Solidarity Among Parents of Sons or Daughters Who Have Attempted Suicide: An In-depth Interview Study

A suicide attempt is a significant burden on the suicidal person, the family, and the community. The psychosocial strain on parents after their offspring’s suicide attempt is significant. The aim of this study was to gain insight into how a parent’s relationship with a partner was affected after their son or daughter’s suicide attempt or serious suicide threats. Individual in-depth interviews were made of 19 parents recruited through a Danish non-governmental organisation in 2013. Data were analysed using a generic thematic analysis. A key category “Sense of solidarity” and two sub-categories “Challenges to the relationship” and “Responding to different reactions and coping strategies” were constructed. Sense of solidarity was important for the parents’ co-parenting and how they engaged with the situation as a couple. The group of participants was heterogeneous and had learned to manage the stressful situation in different ways. Interventions to support parents of sons or daughters who have attempted suicide should include a stronger focus on parents’ co-parenting abilities in the family system in order to support the well-being of the whole family.

Perspectives on Suicide Prevention Amongst Members of Christian Faith-Based Organizations.

The purpose of this study was to explore perspectives on suicide prevention held by members of Christian faith-based organizations (FBOs). Eight focus groups were facilitated, and five major themes were identified: perceptions of responsibility, connection to suicidal persons, equipping for suicide prevention, collaboration with professional services, and hope. Overall, Christian FBO members considered suicide prevention to be an important demonstration of their faith and values. They perceived themselves to be currently adding to suicide prevention efforts through spiritual practices and interpersonal skills, but regarded these as insufficient if considered stand-alone responses. They recognized the receipt of suicide prevention training and collaboration with professional services as necessary to be fittingly engaged as a resource for suicide prevention.

"Attenuating Anxieties": A grounded theory study of mental health nurses' responses to clients with suicidal behaviour.

To develop a grounded theory to explain mental health nurses' responses to clients with suicidal behaviour. Mental health nurses are an integral part of the multi-disciplinary teams supporting people who experience suicidal behaviour, yet limited research is available that explores how nurses respond to the needs of people at risk of suicide and what factors influence their responses and actions. Grounded theory was the methodology for this study. Interviews were conducted with 33 mental health nurses working in an urban area in the Republic of Ireland. Data were analysed using the concurrent processes of comparative analysis, theoretical sampling, theoretical sensitivity and memo writing. COREQ 32-item checklist was used. The core category from the data was "Attenuating Anxieties." Participants' main concerns about caring for suicidal clients were related to their feelings of professional and personal vulnerability and the need to protect clients and themselves. This theory "Attenuating Anxieties" highlights the way in which nurses allay their anxieties by utilising historically known risk adverse strategies to care for the suicidal person. Acquisition of further psychotherapeutic training, clinical supervision as well as increased reflexivity protected some participants and enabled them to work creatively and collaboratively while supporting and facilitating therapeutic risk-taking. The theory of "Attenuating Anxieties" identifies how participants worked within the context of mental health as members of the "risk society," wherein they worried about the possibility and probability of a negative or adverse effect for both the client and self, leaving them to feel constantly vulnerable and unsafe. This theory highlights the need for a culture of openness that acknowledges nurses' and organisations' anxieties surrounding suicide and promotes a discourse among nurses that moves from a position of risk aversion to a relational and recovery-orientated approach.

Reasons for attempting suicide: An exploratory study in Ghana.

This study examined the reasons for suicide attempts among patients in Ghana. Semi-structured interviews were conducted among 30 informants who had been hospitalized for attempted suicide. Interpretative Phenomenological Analysis (IPA) was used to analyse the transcribed narratives, and five main themes emerged: 1) lack of support; 2) abandonment; 3) shame; 4) existential struggles; and 5) supernatural reasons. There were gender differences with abandonment reported by only women and shame associated with economic difficulties reported only by men. Findings are discussed within the context of a socio-cultural theory of suicide behaviour, and implications for the prevention of suicide and care of suicidal persons are suggested.