The suicidal process in suicides among young people.
ABSTRACT Fifty-eight consecutive suicides among 15- to 29-year-olds (42 men and 16 women) were investigated by modified psychological autopsies and examined from the perspective of the suicidal process. Previous suicide attempts were evident in 66% and more than two suicide attempts found in 17% of men and in 56% of women. The median interval from first suicidal communication to the suicide was shorter in men than in women (12 vs 42 months). The median interval was 47 months in schizophrenia, 30 months in borderline personality disorder, 3 months in major depression and < 1 month in adjustment disorder. There were also differences in the prevalence of next-of kin models for suicidal behavior, previous suicidal communication and in the characteristics of the suicide. We conclude that focusing on the process heightens understanding of serious suicidal behavior in young people.
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ABSTRACT: Little is known about suicidal ideation and behaviours in adjustment disorder (AD). In this paper we sought to examine the variables independently associated with suicidal ideation and behaviour in patients diagnosed with AD or depressive (DE) episode among psychiatric outpatients and in liaison psychiatry. 370 patients who were referred to the liaison psychiatry services (including those seen in the Emergency Department) at 3 Dublin hospitals, and were clinically diagnosed with either DE or AD, based on the ICD 10 diagnostic criteria, were recruited to the study. We examined their demographic and clinical characteristics, and the associations between these and suicidal ideation and behaviour on multivariate analysis. Younger age, single marital status, and greater severity of depressive symptoms were significantly associated with suicidality across both diagnoses. On multivariate analysis, greater severity of depressive symptoms was associated with suicidality in those with AD (p=0.012) and DE (p=0.009). Those with AD exhibited suicidality at lower symptom scores than did those with DE but in both groups it still occurred at the highest level of severity. There were differences in the objective circumstances measure of suicide intent. We used clinical diagnosis rather as the main diagnostic classification. The generalisability of this paper may be limited to consultation-liaison psychiatry settings, where suicidal ideation and behaviours are common. Suicidality in AD and DE has broadly similar risk factors but differ in aspects of suicide intent. Different mechanisms may underpin suicidality in those with AD compared to DE. Copyright © 2014. Published by Elsevier B.V.Journal of Affective Disorders 12/2014; 174C:441-446. DOI:10.1016/j.jad.2014.12.003 · 3.71 Impact Factor
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ABSTRACT: Approximately 45% of mentally disordered offenders relapse into violence. Although much is known about factors related to the risk of future violence, the violence relapse process is still in many aspects an unexplored area. The aim of this study was to increase the knowledge of the recidivism process and risk communication of the repeatingly violent mentally disordered offender. A qualitative study using open-ended, semi-structured interviews was conducted with 14 mentally disordered offenders who had relapsed into violent behaviour. Important risk markers, pointed out by the informants, such as separations, drug problems, homelessness, and lack of sleep, were presented in a situational context. All but one of the informants were of the opinion that they directly or indirectly had communicated their violent intent or the experience of an intolerable situation. These results may help practitioners to target interventions and prevent further violence.Psychology Crime and Law 05/2005; 11(2):199-222. DOI:10.1080/10683160500036905 · 0.69 Impact Factor
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ABSTRACT: The suicidal process is a common underlying perspective on suicidal behaviour, but the process has hardly been empirically studied. This study investigates the process from suicidal thoughts to suicidal planning among physicians; an occupational group with a raised risk of suicide. The process is studied in two ways: First, predictors at medical school of postgraduate suicidal planning are identified. Second, the transition from suicidal thoughts to planning over three to four years is explored. A nationwide cohort of Norwegian medical students (N=631) were approached initially in their final semester (T1), and then again in the first (T2) and fourth (T3) postgraduate years. The average observation time was 3.6 years. Twenty-eight participants (6%) reported suicidal planning in the postgraduate years. Adjusted predictors at T1 were vulnerability trait (neuroticism), severe depressive symptoms, and negative life events. Among those with previous suicidal thoughts at T1, 13 (8%) reported suicidal planning at T2 or T3. Adjusted predictors of transition from thoughts to planning were reality weakness trait, severe depressive symptoms, and a low level of perceived medical school stress. A minority of the postgraduate planners had sought professional care. The effect of severe depressive symptoms may be overestimated, and the sample size is relatively small. Common predictors for both postgraduate suicidal planning and transition from thoughts to planning were depressive symptoms and personality traits. Reality weakness was the most decisive trait for aggravation in suicidal ideation, and this personality trait needs further study in suicidal research and clinical awareness.Journal of Affective Disorders 07/2004; 80(2-3):191-8. DOI:10.1016/S0165-0327(03)00091-0 · 3.71 Impact Factor