Death Wishes Research Articles

Role of access to personal protective equipment, treatment prioritization decisions, and changes in job functions on health workers’ mental health outcomes during the initial outbreak of the COVID-19 pandemic.

BackgroundDuring the initial COVID-19 outbreak, organizational changes were required to ensure adequate staffing in healthcare facilities. The extent to which organizational changes impacted the mental wellbeing of healthcare workers (HCWs) remains unexplored. Here we analyzed the association between three work-related stressors (reported access to protective equipment, change in job functions, and patient prioritization decision-making) and mental health outcomes (depression symptoms, psychological distress, suicidal thoughts, and fear of infection) in a large sample of Spanish HCWs during the initial COVID-19 outbreak. MethodsWe conducted a cross-sectional study including HCWs from three regions of Spain between April 24th and June 22nd, 2020. An online survey measured sociodemographic characteristics, work-related stressors, fear of infection, and mental health outcomes (depression [PHQ-9], psychological distress [GHQ-12], death wishes [C-SSRS]). We conducted mixed-effects regression models to adjust all associations for relevant individual- and region-level sources of confounding. ResultsWe recruited 2,370 HCWs. Twenty-seven percent screened positive for depression and 74% for psychological distress. Seven percent reported death wishes. Respondents were more afraid of infecting their loved ones than of getting infected themselves. All work-related stressors were associated with depression symptoms and psychological distress in adjusted models. LimitationsNon-probabilistic sampling, potential reverse causation. ConclusionsModifiable work-related stressors are associated with worse mental health among HCWs. Our results suggest that workplace prevention strategies for HCWs should provide sufficient protective equipment, minimize changes in job functions, favor the implementation of criteria for patient triage and on-call bioethics committees, and facilitate access to stepped-care, evidence-based mental health treatment.

Suicidal Ideations and Behavior in Patients With Young and Late Onset Dementia.

Background and Objectives: Data on suicidal ideation, behavior and the risk factors in patients with dementia is scarce. To evaluate the prevalence of death wishes, suicidal ideation, and suicidal behavior of young (YOD) and late onset dementia (LOD) and to identify risk factors for suicidal ideation and behavior.Methods: We interviewed 157 family caregivers of patients with advanced dementia using questions from the Columbia-Suicide Severity Rating Scale to gather information about suicidal ideation and behavior before the onset of symptoms of dementia, after the onset of dementia and within 30 days prior to the interview. At the time of the interview, we also assessed disease severity, cognitive function, and other psychological, behavioral and physical symptoms of the patients as well as the caregivers' psychological well-being.Results: Forty four (28%) of the patients expressed suicidal ideation or behavior at some time after the onset of symptoms, and 14 (9%) of these within the month prior to the assessment. Two patients had attempted suicide after the onset of dementia. There were no statistically significant differences between patients with and without suicidal ideations or behavior with regards to demographics or age at onset of dementia. In patients with advanced dementia, Alzheimer's disease (rather than frontotemporal lobar degeneration), better cognitive function, more severe psychological, behavioral, and physical symptoms, and a reduced quality of life were associated with the expression of suicidal ideation.Conclusions: According to caregivers' reports, majority of patients with dementia did not express suicidal ideation or show suicidal behavior. Patients who expressed suicidal ideation during early stages of dementia often stopped expressing them in advanced stages. It remains unclear if this was due to reduced communication abilities, a reduction of disease awareness, and/ or an adjustment to their situation.

Fear of a Black City: Gender and Postracial Sovereignty in Death Wish (2018)

This essay reads the 2018 remake of the vigilante film Death Wish (directed by Eli Roth). Situating the film within the ideological context of postracialism and the proximate context of the Movement for Black Lives, #MeToo, anti-gun activism, and the Trump presidency, I suggest that the film figures Chicago as a racial threat to white, feminized, suburban life. Mostly dispensing with conventional racial markers, Roth’s film paints Chicago as a space of immiseration and death to generate a racialized threat of sexual assault, conjuring an uncanny scene of sexual violence followed by a lynching. The film models postracial sovereignty, a model of authority constantly producing death to ward off the threat of Blackness and preserve the white and masculine prerogatives of political liberalism. The film illustrates how political liberalism wields the threat of death to attempt the suppression of antiracist, feminist rebellions offering understandings of life that diverge from liberalism’s white masculinity.

Make America Hate Again? The Politics of Vigilante Geriaction

The article explores the politics of the vigilante geriaction film, with specific focus on the remake of Death Wish (Eli Roth, 2018). In its construction of a nation under mortal threat from within and without, the subgenre is uncritical in its reinforcement of Trumpian rhetoric regarding the marginalization, precarity, and obsolescence of the older white male. Typical of the contemporary vigilante film, through its visual style, representation of masculinity, and aging star (Bruce Willis), Death Wish attempts to resuscitate a form of authoritarian heroism considered outmoded in the contemporary cultural landscape.

A Study to Assess the Suicide Risk of Patients Admitted in t Psychiatric Ward with a View to Develop a Guideline for Staff Nurses on the Nursing Care of Patients with Suicide Risk, in a Tertiary Hospital, Kochi

Background: Everyone in the mental health system may be at one time or the other, at risk for self harm and suicide. This study was done to assess the suicidal risk of patients who are admitted in psychiatric ward of a tertiary care hospital at Kochi, Kerala and to develop a guidelines for suicidal prevention for staff nurses. Materials and Methods: The research design adopted for this study was non-experimental descriptive design. The sample for the present study consisted of 30 patients who are admitted in psychiatry ward of Amrita Institute of Medical Science, Kochi. The sampling technique used is convenience sampling. The researchers developed a suicide risk assessment scale. The validity and reliability of the tool was tested. The method used in this study was interview with structured questionnaire. Result: Results shown that 100% did not have suicidal plan as such, but 13.3% of them had death wishes. Majority of the subjects i.e 96.6% had symptoms such as guilt, hopelessness, helplessness, shame, impaired problem solving. In 69%of the subjects there were more than 4 symptoms, 90% of the subjects had significant life events such as financial loss, loss of loved one, love failure, failure in examination, majority of them i.e 74.1% had at least 2 events. History of suicide attempt is seen only in 6.7% of the subjects, 93.3% of them didn’t have any such attempts. Moreover 16.7% of them have family history of suicide and 83,3% of them didn’t have any significant history. There was a significant association between suicidal risk and educational level. Conclusion: Many patients had expressed the depressive symptoms and also it has been observed that there was a significant association between suicidal risk and educational level. A guideline for suicidal prevention has been distributed to all staff nurses working in the psychiatric ward after getting validated from experts. Keywords: Suicidal risk, Staff nurses guidelines, psychiatric patients, nursing care of suicidal risk.

Thoughts of death and suicidality among patients with cancer: Examining subtypes and their association with mental disorders.

Cancer is associated with an increased risk for completed suicide. We explored subtypes of thoughts of death, death wishes, suicidal ideation and behavior and their association with mental disorders and demographic and disease-related characteristics. We studied 2,141 cancer patients with the standardized Composite International Diagnostic Interview-Oncology (CIDI-O). Assessment included 4-weeks-prevalences of thoughts of death, wish to die, suicidal ideation, suicide plans, and lifetime suicide attempts. We further assessed 4-weeks-prevalences of mood, anxiety, adjustment, somatoform, substance use, and disorders due to general medical condition. We conducted latent class analyses (LCA). The LCA identified three classes with distinct patterns of suicidality. Class 1 (89.0% of the sample) showed no suicidality. Class 2 (6.9%) was characterized by thoughts of death without suicidal ideation. Class 3 (4.1%) was characterized by thoughts of death, suicidal ideation, and suicide plans. Death wishes occurred in both classes 2 and 3. Classes 2 and 3 were associated with a significantly higher risk for any mental disorder (OR from 4.22, adjustment disorder, to 10.20, mood disorders, p<0.001) compared to class 1. Patients with mental disorders were equally likely in classes 2 and 3. Patients with incurable cancer were significantly more likely in class 2, and less likely in class 3. Cancer patients with suicidal ideation are not distinctly characterized by mental disorders. Further study of concepts that consider problematic adjustment to the cancer stressor such as death anxiety and demoralization may contribute to understand psychological distress underlying subtypes of thoughts of death and suicidality in cancer.

Depressed Older Patients with Death Wishes: Experimental Evidence for Psychotherapists’ Age and Health Bias

ABSTRACT Objectives: When psychotherapists encounter an older patient with depression and death wishes, especially when burdened by physical illness, they may be subject to judgmental biases. This study investigates how this group of patients with highest suicide risk may experience discrimination both on age and health status. Methods: Using a 2 × 2 [chronological age x physical health status] vignette design, psychotherapists (N = 147) were randomly presented with one of the four variants of a case describing a patient with depression and death wishes (i.e., 78 years old + poor physical health; 78 years old + normal physical health; 48 years old + poor physical health; 48 years old + normal physical health). Afterward, participants’ attitudes toward the case were assessed. Results: In case of the hypothetical patient’s old age and poor health status, participants did not underestimate the pathological significance of his death wishes, but nevertheless showed less optimistic treatment attitudes and less confidence in psychotherapeutic treatment. Conclusions: Psychotherapists’ age bias and health bias may serve as two potentially fatal factors influencing the provision of mental health services. Clinical Implications: Psychotherapists may contribute to better mental health-care provision of older adults with depression and the prevention of late-life suicide by increasing awareness of their age and health bias.

Prevalence and characteristics of older adults with a persistent death wish without severe illness: a large cross-sectional survey

BackgroundSome older persons develop a persistent death wish without being severely ill, often referred to as “completed life” or “tiredness of life”. In the Netherlands and Belgium, the question whether these persons should have legal options for euthanasia or physician-assisted suicide (EAS) is intensely debated. Our main aim was to investigate the prevalence and characteristics of older adults with a persistent death wish without severe illness, as the lack of this knowledge is a crucial problem in de debate.MethodsWe conducted a survey among a representative sample of 32,477 Dutch citizens aged 55+, comprising questions about health, existential issues and the nature of the death wish. Descriptive statistics were used to describe the group with a persistent death wish and no severe illness (PDW-NSI) and several subgroups.ResultsA total of 21,294 respondents completed the questionnaire (response rate 65.6%). We identified 267 respondents (1.25%) as having a persistent death wish and no severe illness (PDW-NSI). PDW-NSI did not only occur among the oldest old. Although qualifying themselves as “not severely ill”, those with PDW-NSI reported considerable health problems. A substantial minority of the PDW-NSI-group reported having had a death wish their whole lives. Within the group PDW-NSI 155 (0.73%) respondents had an active death wish, of which 36 (0.17% of the total response) reported a wish to actually end their lives. Thus, a death wish did not always equal a wish to actually end one’s life. Moreover, the death wishes were often ambiguous. For example, almost half of the PDW-NSI-group (49.1%) indicated finding life worthwhile at this moment.ConclusionsThe identified characteristics challenge the dominant “completed life” or “tiredness of life” image of healthy persons over the age of 75 who, overseeing their lives, reasonably decide they would prefer to die. The results also show that death wishes without severe illness are often ambiguous and do not necessarily signify a wish to end one’s life. It is of great importance to acknowledge these nuances and variety in the debate and in clinical practice, to be able to adequately recognize the persons involved and tailor to their needs.

Do Doctors Differentiate Between Suicide and Physician-Assisted Death? A Qualitative Study into the Views of Psychiatrists and General Practitioners

Physician-assisted death for patients suffering from psychiatric disorders is allowed in the Netherlands under certain circumstances. One of the central problems that arise with regard to this practice is the question of whether it is possible to distinguish between suicidality and a request for physician-assisted death. We set up this study to gain insight into how psychiatrists and general practitioners distinguish between suicidality and physician-assisted death. The data for this study were collected through qualitative interviews with 20 general practitioners and 17 psychiatrists in the Netherlands. From the interviews, we conclude that physicians distinguish three types of death wishes among patients suffering from psychiatric disorders: ‘impulsive suicidality,’ ‘chronic suicidality,’ and ‘rational death wishes.’ To discern between them they evaluate whether the death wish is seen as part of the psychopathology, whether it is consistent over time, and whether they consider it treatable. Some considered physician-assisted death an alternative to a ‘rational suicide,’ as this was perceived to be a more humane manner of death for the patient and their relatives. We argue that physician-assisted death can be justified also in some cases in which the death wish is part of the psychopathology, as the patient’s suffering can be unbearable and irremediable. Physician-assisted death in these cases may remain the only option left to relieve the suffering.

Psychometric Properties and Dimensionality of the German Beck Scale for Suicide Ideation (BSS): Validation in a Sample of Psychiatric Patients

The present study examines dimensionality, reliability and convergent validity of the German Beck Scale for Suicidal Ideation (BSS) in a clinical sample. 308 inpatients after suicide attempts/acute suicidality participated in the study (53,6% female). Of those, 224 completed the full BSS and self-report questionnaires assessing depression (DESC), hopelessness (BHS), interpersonal variables (INQ) and defeat (DS-d)/entrapment (ES-d). Dimensionality was investigated by confirmatory factor analysis (CFA, models with 1, 2, 3 and 5 factors) and convergent validity was investigated by correlational analysis (Pearson). In total, the 5-factor model achieved the best fit. Yet, model fit is comparable between all tested models without considering the RMSEA model. The multidimensional models result in similar subscales. Subscales reflecting passive death wishes (α>0,80), active suicidal ideation (α>0,73) and suicide-related behaviors (α>0,70) achieve acceptable internal consistency. The BSS sum score and the subscales assessing passive and active suididal thoughts correlate moderately positive with DESC, BHS, INQ and DS-d/ES-d (r between 0,25 and 0,66) while the behavior-related scale shows smaller (r between 0,14 und 0,27) or no associations (INQ, thwarted belongingness). The CFAs do not provide clear evidence for either an uni- or a multidimensional structure of the BSS. In the light of this finding, use of the BSS score is limited despite evidence supporting its reliability and convergent validity.

Dinamika Kepribadian Tokoh Utama Dalam Novel Jisatsu Yotei Bi Karya Akiyoshi Rikako

Abstract&#x0D; This study aims to explain death wish in the characterization of the main character. This research uses a descriptive analysis method with the psychology literature approach. The sources of data used were the novel Jisatsu Yotei Bi by Akiyoshi Rikako (2016) and the Indonesian translation of the novel, Scheduled Suicide Day (2017). The object of this research is a quotation in the form of narrative. The results of this study are the main character has a desire to die and it is shown by her always thinking about death and finding out in one website about ways to die that she thinks are comfortable and appropriate.&#x0D; &#x0D; Keywords: Personality Dynamics, Death Wish, Characterization, Psychology Literature.

Visiting Nurses' Perspectives on Practices to Achieve End-of-Life Cancer Patients' Wishes for Death at Home: A Qualitative Study

Objective:This study aimed to clarify visiting nurses’ perspectives on critical practices to ensure they could advocate for patients who prefer to die at home.Methods:Sixteen nurses, working at home-visit nursing agencies in Japan, participated in this study. Data were generated by interviews with the nurses and participant observations from nursing home-visits for six end-of-life cancer patients and were analyzed using content analysis.Results:Five themes emerged: (1) nursing assessment, (2) support for comfortable daily life of the patient and their family, (3) advocating for the patient's views about continuing homecare until death, (4) supporting the patient's preparedness for death, and (5) coordination with other health professionals and related facilities for a comfortable environment for the patient. In addition, the nurses sometimes used humorous responses to death-related work to change the patient's melancholy thoughts.Conclusion:The present study found that the participants advocated for the patient's views about continuing homecare until death while coordinating views between the patient and their family; they further supported the patient's daily life while helping them prepare for death to achieve their wish for death at home. In addition, our study uncovered the visiting nurses’ unconscious practical wisdom of using humorous responses to death-related work to alleviate the patients’ feelings of hopelessness. To develop practical wisdom for using humor effectively in end-of-life care, nurses need to verbalize unconscious practices, and accumulate empirical knowledge about nursing interventions using humor, including cultural attitudes, through case study analysis.

Perception of a “good death” in Thai patients with cancer and their relatives

BackgroundUnderstanding the perceptions regarding what constitutes a "good death" among cancer patients and their families could help healthcare teams to ensure proper palliative and supportive care. ObjectivesTo demonstrate and compare the wishes cancer patients and the perceptions of their relatives regarding end-of-life care, and to identify factors associated with patients' preferences regarding place of death. MethodsA sample of cancer patients and their relatives who attended the Srinagarind Hospital (Thailand) oncology clinic or day chemotherapy from September 2017 to August 2018 were enrolled. Questionnaires were given to the participants, in which the patients were asked to respond based on their own end-of-life preferences, and relatives were asked to imagine how the patients would respond to the questions. ResultsOne hundred eighty pairs of patients and relatives were recruited. Respondents in both groups placed importance on place of death, relationship with family, physical and psychological comfort, and relationship with the medical staff. Both groups generally agreed with the statements on the questionnaire (10/13 statements). Relatives underestimated the preferences of the patients in 3 areas: “not being a burden to others,” “preparation for death,” and “physical and psychological comfort.” Being married (adjusted odds ratio (AOD) 6.4, 95%confidence interval (CI) 1.1,36.5), having had more than 6 years of education (AOD 6.5, 95%CI 1.8,23.7), having lung cancer compared to colon cancer (AOD 12, 95%CI 1.2,118.7), duration after cancer diagnosis (AOD 0.9, 95%CI 0.93,0.99), previous hospital admission (AOD 5.7, 95%CI 1.5,21.2), and life satisfaction (AOD 17.6, 95%CI 2.9,104.9) were factors associated with preference for home death. ConclusionThai cancer patients and their relatives indicated similar preferences with regard to what constitutes a good death and patients' wishes for their end-of-life period. However, the patients' relatives underestimated the importance patients placed on statements in three domains. Factors that influenced a preference for a home death were identified.

Typifying and Characterizing Suicide and its Dynamics of Progression towards Completion: A Model

Suicide has its own trends and path. An emotional set back may leads to suicide is seemed to happen instantly but it is not true, it takes times to complete .All most all of us have to experience death wishes but never reach to that point when said completed. Very few will reach to that point where assessed. This study has aim to decide the path by which completion occurs. Study has used the various discrete data of various studies freely available on internet. They were analyzed and arranged logically in sequence to set the path and trends. Conclusion: Everyone in their life at least has to wish to die but very few complete it. It progress in certain path as wish further strengthen by idea following celebrate self-harm may repeat or accidentally completed if not further proceeded to take attempt. It may be completed or rest as further are risk of suicide.

Typifying and Characterizing Suicide and its Dynamics of Progression towards Completion: A Model

Suicide has its own trends and path. An emotional set back may leads to suicide is seemed to happen instantly but it is not true, it takes times to complete .All most all of us have to experience death wishes but never reach to that point when said completed. Very few will reach to that point where assessed. This study has aim to decide the path by which completion occurs. Study has used the various discrete data of various studies freely available on internet. They were analyzed and arranged logically in sequence to set the path and trends. Conclusion: Everyone in their life at least has to wish to die but very few complete it. It progress in certain path as wish further strengthen by idea following celebrate self-harm may repeat or accidentally completed if not further proceeded to take attempt. It may be completed or rest as further are risk of suicide.

The experience of transplantation as reflected in dream life: A case study illustrating the mental processing of a lung transplant

ABSTRACTAlthough it is well known that a lung transplant enhances the recipient’s quality of life, our knowledge of how it is processed mentally is limited. In this study, interviews were conducted with a lung-transplant patient two weeks, three months, and six months after surgery so as to investigate the relevant unconscious processing mechanisms. A dream reported in the first interview was analysed in accordance withapplying the Zurich Dream Process Coding System. A ‘transplantation complex’ was reconstructed on the basis of various sources of information (the dream and the waking narratives). The principal aspects of the transplantation complex that emerged from both the dream and the waking narratives concerned the oral-sadistic phantasy that the donor had been killed and that his lung, or soul, had been violently incorporated in the patient. The main unconscious themes involved in the processing of the transplant were found to have been already laid down in the dream and to have been presented in it in the form of visual analogues. According to our interpretation of the data analysed, powerful cannibalistic phantasies and death wishes played an important part in the processing of the transplant. These archaic phantasies may have been actualized by the transplant.

The Death Wish in Pakistan's Aid Dependence

Pakistani elites' aversion to paying taxes leaves the country dependent on foreign aid and beholden to donors. As Washington cools on its old ally, the Chinese and Saudis may fill the void.

Epidemiology of suicidal feelings in an ageing Swedish population: from old to very old age in the Gothenburg H70 Birth Cohort Studies.

The first aim of this study was to provide prevalence suicidal feelings over time (past week, past month, past year and lifetime) in a population-based sample of old to very old adults without dementia. Does prevalence change with rising age? The second aim was to examine the fluctuation of suicidal feelings over time. How does this coincide with depression status? Data were derived from the Gothenburg H70 Birth Cohort Studies (the H70 studies) which are multidisciplinary longitudinal studies on ageing. A representative sample of adults in Gothenburg, Sweden with birth years 1901-1944 were invited to take part in a longitudinal health study on ageing and participated at one or more occasions during 1986-2014. The sample consisted of 6668 observations originating from 3972 participants without dementia between the ages of 70 and 108, including 1604 participants with multiple examination times. Suicidal feelings were examined during a psychiatric interview using the Paykel questions (life not worth living, death wishes, thoughts of taking own life, seriously considered taking life, attempted suicide). Prevalence figures for suicidal feelings of any severity were as follows: past week 4.8%, past month 6.7%, past year 11.2% and lifetime 25.2%. Prevalence rates increased with age in the total group and in women but not in men. Suicidal feelings were common in participants with concurrent major or minor depression, but over a third of the participants who reported suicidal feelings did not fulfil criteria for these diagnoses nor did they present elevated mean depressive symptom scores. The majority of participants consistently reported no experience of suicidal feelings over multiple examination times, but fluctuation was more common in women compared with men. Suicidal feelings in late-life are uncommon in individuals without depression indicating that such behaviour is not a widespread, normative phenomenon. However, such feelings may occur outside the context of depression.

Acting Out: "Cage Rage" and the Morning After

Acting Out: "Cage Rage" and the Morning After

Developments in Revenge, Justice and Rape in the Cinema

The index to the 2018 VideoHound Guide to Films suggests that under the broad heading of “revenge” there have been something in excess of 1000 films. This appears to be the largest category in this comprehensive guide and suggests that this is, indeed, a theme which permeates the most influential sector of popular culture. These films range from influential and lauded films with major directors and stars like John Ford (The Searchers (1956) and Alejandro González Iñárritu (The Revenant (2015)) to “straight to video” gorefests with little artistic merit and a specific target audience (The Hills Have Eyes (1977)). There is, as the Film Guide numbers suggest much in between like Straw Dogs (1972) and Outrage (1993). The making and re-making of “revenge” films continues with contributions in 2018 from such major stars as Denzel Washington in The Equalizer 2 and Brue Willis in Death Wish. Within this body of film is a roster of films which allow us to speculate on the nature of the legal system and what individual and to a lesser extent community responses are likely where there appears to be a deficit of justice. One of the sub-groups within the revenge roster is a set of films which focus on revenge by the victim for rape which are discussed for their rather different approach to the issue of justice. Most unusually, the award winning film Elle (2016) has been described as a “rape revenge comedy”. Given the thriving nature of the overall sub-genre this causes pause for thought and justifies a closer look at what seems unlikely in an era of enhanced awareness of the trauma and damage of this kind of brutal criminality. This essay seeks to examine this film and locate it within the wider world of revenge films, notions of justice and assess it in context.