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Abstract

In this paper we explore the relationship between current psychiatric thinking on suicide and service users' accounts of suicidal ideation and suicide attempts. The data comes from recordings of psychiatric interviews collected in three psychiatric hospitals in Poland. Assuming a constructionist view of discourse we argue that the literature on suicide ignores and simplifies the experience of those who think about suicide and attempt to commit it, and constructs their experiences as a homogeneous group of 'thoughts' with only limited content. We also offer a preliminary insight into the complexity of 'suicide thoughts', as narrated by those reporting them. We demonstrate that they are marginalized and made relatively irrelevant in the accounts of attempted suicide. Additionally, we demonstrate that while women construct suicide attempts (whether actually attempted in the end or not) as at least potentially beyond their control, men's narratives show them in control of the attempt, as if choosing an available option. We conclude by exploring possibilities of further qualitative discourse analytic research which builds on the findings we present here.

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... Such a conclusion would be erroneous, though. Juxtaposing the interviews with the notes which were made on its basis suggests at least that: a. doctors ignore the experiential aspects of suicide thoughts, treating them as a homogeneous group of cognitive activities (see also Galasiński & Ziólkowska, 2013); b. even if they do explore the ideation's intensity, duration or frequency, such information does not find its way into medical records. ...
... In an earlier study (Galasiński & Ziólkowska, 2013), we argued that patients' narratives in clinical contexts construct their suicidal thoughts as a heterogeneous group of activities. We also suggested that they are predominantly narrative, as the only access to "suicidal thoughts" can be through narrative constructions of those who speak about them. ...
Article
In this paper we are interested in exploring discursive transformation of patients' stories of suicidal ideation into medical discourses. In other words, we focus on how the narrated experience of suicidal thoughts made during the psychiatric assessment interview is recorded in the patients' medical record. Our data come from recordings of psychiatric interviews, as well as the doctors' notes in the medical records made after the interviews, collected in psychiatric hospitals in Poland. Assuming a constructionist view of discourse, we demonstrate that lived experience of suicide ideation resulting in stories of a complex and homogeneous group of "thoughts" is reduced to brief statements of fact of presence/existence. Exploration of the relationship between the interviews and the notes suggest a stark imposition of the medical gaze upon them. We end with arguments that discursive practices relegating lived experience from the focus of clinical practice deprives it of information which is meaningful and clinically significant.
... All too often, this sense of futility had seemingly been reinforced by interpretations of inconsistencies perpetuated by mental health services. Hopelessness inevitably features in multiple models of suicide [59][60][61]. The present study strengthens understanding of the pathways to suicide attempts, enhancing the interpretations of how attachment [62] and agency [63] are likely mediators in the development of 'suicidal exhaustion' [58]. ...
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Most police Mental Health Act (Section 136) detentions in England and Wales relate to suicide prevention. Despite attempts to reduce detention rates, numbers have risen almost continually. Although Section 136 has been subject to much academic and public policy scrutiny, the topic of individuals being detained on multiple occasions remains under-researched and thus poorly understood. A mixed methods study combined six in-depth interviews with people who had experienced numerous suicidal crises and police intervention, with detailed police and mental health records. A national police survey provided wider context. Consultants with lived experience of complex mental health problems jointly analysed interviews. Repeated detention is a nationally recognised issue. In South East England, it almost exclusively relates to suicide or self-harm and accounts for a third of all detentions. Females are detained with the highest frequencies. The qualitative accounts revealed complex histories of unresolved trauma that had catastrophically damaged interviewee’s relational foundations, rendering them disenfranchised from services and consigned to relying on police intervention in repeated suicidal crises. A model is proposed that offers a way to conceptualise the phenomenon of repeated detention, highlighting that long-term solutions to sustain change are imperative, as reactive-only responses can perpetuate crisis cycles.
Preprint
Most police Mental Health Act (Section 136) detentions in England and Wales relate to suicide prevention. Despite attempts to reduce detention rates, numbers have risen almost continually. Although Section 136 has been subject to much academic and public policy scrutiny, the topic of individuals being detained on multiple occasions remains under-researched and thus poorly understood. A mixed methods study combined six in-depth interviews with people who had experienced numerous suicidal crises and police intervention, with detailed police and mental health records. A national police survey provided wider context. Consultants with lived experience of complex mental health problems jointly analysed interviews. Repeated detention is a nationally recognised issue. In South East England it almost exclusively relates to suicide or self-harm and accounts for a third of all detentions. Females are detained with the highest frequencies. The qualitative accounts revealed complex histories of unresolved trauma that had catastrophically damaged interviewee’s relational foundations, rendering them disenfranchised from services and consigned to relying on police intervention in repeated suicidal crises. A model is proposed that offers a way to conceptualise the phenomenon of repeated detention, highlighting that long-term solutions to sustain change are imperative, as reactive-only responses can perpetuate crisis cycles.
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Background There is need for deeper understanding of the processes by which suicidal thoughts lead to action. Examination of morbid ideation and the emotional sequelae of such ideation that may feed suicide ideation (SI) and attempts (SA) have been limited. Method Adult psychiatric outpatients (N = 385) were administered the Response to Morbid Ideation Questionnaire (RMI‐Q) and measures of SI, suicidal thoughts and behaviors (STB), and other psychiatric symptom severity. We examined (1) incidence and prevalence in mentation of morbid ideations and emotional responses to these ideations, (2) differences in emotional responses between individuals of varying levels of suicide history, and (3) the relationships of different types of morbid ideations and emotional responses with concurrent SI and symptom severity. Results Morbid ideation was reported by 87.5% of participants and associated with lifetime and concurrent levels of SI/STB. Calm/relieved emotional responses were associated with lifetime and concurrent levels of SI/STB, while negative‐valence responses to morbid ideations were associated with concurrent severity of psychopathology. Conclusions Our results suggest that the role of morbid ideation and its emotional sequelae in the development of suicidal motivation and action deserves further attention and may be a treatment target for suicide risk reduction.
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Suicidal ideation is the most common of all suicidal behavior, but only a minority of ideators ever engages in overt self-harm. If ideation is to prove useful in the assessment of suicide intent and risk, factors creating continuity between suicidal ideation and action need to be carefully examined. The relationship between ideation and intent may resolve this dilemma, as intent is assessed by examining thoughts of self-harm in the distressed person, yet there is debate as to whether ideation must involve intent. Applying ideation as a risk factor is complicated by the failure to agree upon its definition within the nomenclature of suicidology (Leenaars et al., 1997; Shneidman, 1995). Suicide ideators are an important group because most suicides and parasuicides have engaged in suicidal thoughts prior to their acts (Shneidman, 1996). Identification of those ideators most likely to attempt or commit suicide is therefore a clinical priority (Bagley, 1975).
Article
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Differences in the ways that men and women use language have long been of interest in the study of discourse. Despite extensive theorizing, actual empirical investigations have yet to converge on a coherent picture of gender differences in language. A significant reason is the lack of agreement over the best way to analyze language. In this research, gender differences in language use were examined using standardized categories to analyze a database of over 14,000 text files from 70 separate studies. Women used more words related to psychological and social processes. Men referred more to object properties and impersonal topics. Although these effects were largely consistent across different contexts, the pattern of variation suggests that gender differences are larger on tasks that place fewer constraints on language use.
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Austrian immigration authorities frequently reject the family reunion applications of immigrant workers. They justify their decisions not only on legal grounds but also on the basis of their own often prejudiced judgements of the applicants' ability to `integrate' into Austrian society. A discourse-historical method is combined with systemic-functionally oriented methods of text analysis to study the official letters which notify immigrant workers of the rejection of their family reunion applications. The systemic-functionally oriented methods are used in a detailed analysis of a sample of rejection letters while the discourse-historical method allows this analysis to be intertextually connected to other related genres of discourse and strategies of argumentation, and to the history of post-war immigration in Austria generally.
Article
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Depression is an endemic disease with high morbidity, and a high mortality in depression-related suicide. Suicidal tendencies, especially among males, are increasing today in East European countries. General practitioners are considered to have a very important role in the prevention and treatment of depression. Matters of depression are more openly discussed in society. Patients showing up in primary care are nowadays less reluctant to see depression as a causative factor behind their symptoms. Taboos concerning the stigma of depression and suicidality are weaker. In spite of this, important problems still exist regarding poor diagnostic and treatment routines in primary care and the inability of depressive and suicidal men to seek for help or to be recognized. In the years 1983-1984, the Swedish Committee for Prevention and Treatment of Depression (PTD) offered an educational programme to all general practitioners (GPs) on the Swedish island of Gotland. During the 1980s this education was shown to lead to a significant decrease in inpatient care, morbidity, suicide, mortality and costs of depressive illness on the island. The use of anxiolytic and sedative medication decreased and that of antidepressant medication increased. This all showed that an educational programme in primary care on depression and suicide was effective. However, the effects faded and, unexpectedly, the number of male suicides was almost unaffected by the educational programme and by the GPs' ability to diagnose and treat depression. Repeated educational activities during the 1990s again led to a decrease in suicides, mainly in females. Also, the increase in antidepressant prescriptions following GP education in the 1990s was mostly in the treatment of female patients. One of the reasons was that few suicidal males are known to the medical services although many of these people are known to the police and social welfare services. The reasons why depressed and suicidal men do not show up in the medical services are discussed, and found to lie in the differences between the male and the female depressive syndrome, leading to difficulties in reaching, diagnosing and treating these patients. Strategies for finding and treating suicidal depressives are discussed. One conclusion is that males are as often depressed as females, but in different ways, and that one of the reasons behind the dramatic over-representation of males amongst suicide victims may be found in the low rate of diagnosis and treatment of the male depressive syndrome, (hit J Psych Clin Pract 1997; 1: 39–46)
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are greatly appreciated. The author is also grateful to the authors of the assessment measures in this review who provided assistance.
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Describes the rationale, development, and validation of the Scale for Suicide Ideation, a 19-item clinical research instrument designed to quantify and assess suicidal intention. In a sample with 90 hospitalized Ss, the scale was found to have high internal consistency and moderately high correlations with clinical ratings of suicidal risk and self-administered measures of self-harm. Furthermore, it was sensitive to changes in levels of depression and hopelessness (Beck Depression Inventory and Hopelessness Scale, respectively) over time. Its construct validity was supported by 2 studies by different investigators testing the relationship between hopelessness, depression, and suicidal ideation and by a study demonstrating a significant relationship between high level of suicidal ideation and "dichotomous" attitudes about life and related concepts on a semantic differential test. Factor analysis yielded 3 meaningful factors: Active Suicidal Desire, Specific Plans for Suicide, and Passive Suicidal Desire. (29 ref)
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In most Western countries females have higher rates of suicidal ideation and behavior than males, yet mortality from suicide is typically lower for females than for males. This article explores the gender paradox of suicidal behavior, examines its validity, and critically examines some of the explanations, concluding that the gender paradox of suicidal behavior is a real phenomenon and not a mere artifact of data collection. At the same time, the gender paradox in suicide is a more culture-bound phenomenon than has been traditionally assumed; cultural expectations about gender and suicidal behavior strongly determine its existence. Evidence from the United States and Canada suggests that the gender gap may be more prominent in communities where different suicidal behaviors are expected of females and males. These divergent expectations may affect the scenarios chosen by females and males, once suicide becomes a possibility, as well as the interpretations of those who are charged with determining whether a particular behavior is suicidal (e.g., coroners). The realization that cultural influences play an important role in the gender paradox of suicidal behaviors holds important implications for research and for public policy.
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To determine the risk factors for suicide, 6,891 psychiatric outpatients were evaluated in a prospective study. Subsequent deaths for the sample were identified through the National Death Index. Forty-nine (1%) suicides were determined from death certificates obtained from state vital statistics offices. Specific psychological variables that could be modified by clinical intervention were measured using standardized scales. Univariate survival analyses revealed that the severity of depression, hopelessness, and suicide ideation were significant risk factors for eventual suicide. A multivariate survival analysis indicated that several modifiable variables were significant and unique risk factors for suicide, including suicide ideation, major depressive disorder, bipolar disorder, and unemployment status.
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Precise knowledge of the epidemiology of suicidality provides necessary information for designing prevention programs. The aims of the present study were to investigate the prevalence and correlates of suicidal ideas and attempts in the general population of Europe. The European Study on the Epidemiology of Mental Disorders (ESEMED) is a cross-sectional household survey carried out in a probability representative sample of non-institutionalised adults (aged 18 years or older) of six European countries (Belgium, France, Germany, Italy, the Netherlands and Spain). The Composite International Diagnostic Interview (CIDI 3.0) was administered to 21,425 individuals. Lifetime prevalence of suicidal ideation was 7.8% and of suicidal attempts 1.3%. Being women, younger and divorced or widowed were associated with a higher prevalence of suicide ideation and attempts. Psychiatric diagnoses were strongly related to suicidality. Among them, major depressive episode (Rate ratio 2.9 for lifetime ideas and 4.8 for lifetime attempts), dysthymia (RR 2.0 and 1.6), GAD (RR 1.8 and 2.3 for lifetime), PTSD (RR 1.9 and 2.0) and alcohol dependence (RR 1.7 and 2.5) were the most important. Population attributable risks for lifetime suicidal attempt was 28% for major depression. Information about suicidal ideas and attempts was self reported, psychiatric diagnoses were made using fully structured lay interviews rather than clinician-administered interviews. In spite of meaningful country variation in prevalence, risk factors for suicidality are consistent in the European countries. Population prevention programmes should focus on early diagnosis and treatment of major depression and alcohol abuse and in those individuals with recent appearance of suicidal ideas.
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A personal goal intervention program was offered to early retirees aged 50 to 65 years with the objective of increasing their subjective well-being. The program was aimed at helping the participants set, plan, pursue, and realize their personal goals. A subsample of 21 participants with suicidal ideas was identified from a larger sample (N = 354) of retirees living in the community who took part in the study to evaluate the program. The experimental (n = 10) and control (n = 11) groups were compared on their answers to 16 goal and psychological well-being questionnaires. By the end of the program, the experimental group had improved significantly more than the control group on hope, goal realization process, serenity, flexibility, and positive attitude toward retirement. The levels of depression and psychological distress significantly decreased. These gains were maintained 6 months later. The positive results obtained from this study could lead to an innovative way to help people with suicidal ideations.
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To determine the self reported prevalence of suicidal ideation in South Australia and to examine the relationship of suicidal ideation with a range of risk, social and demographic factors and related health issues using data collected in a risk factor surveillance system. Data were collected using a monthly risk factor surveillance system where each month a representative random sample of South Australian is selected from the Electronic White Pages with interviews conducted using computer assisted telephone interviewing (CATI). In total, 4.7% of South Australian, aged 16 years and over, were determined to have suicidal ideation. There was no change in the trend over the years when surveys between 1997 and 2005 were compared. A wide range of variables were significant with suicidal ideation at the univariate level. In the final multivariate model, marital status, money situation, psychosocial stress (K10), physical activity, fruit consumption, health service use and mental health service use proved to be best joint predictors of suicidal ideation. Suicidal ideation in the community has not increased (or decreased) over time and questions assessing suicidal ideation can be used effectively in a surveillance system.
Book
Almost a million people die by suicide every year (WHO estimate) The sheer numbers have made suicide prevention a major health target, but effective prevention is not straightforward. Suicide is a complex event, more complex than most of us imagine, calling for an equally complex response. Psychotherapy with Suicidal People provides a multi-component approach, with rich clinical data including many case histories, to guide the reader. Based on decades of research from across the globe, Antoon A. Leenaars takes the reader into the mind of the suicidal person, from the young to the elderly, from the anonymous to the famous. There is no better way to know, and thus to treat, a person. A plethora of special features makes this volume an international classic and includes: Reflections of many suicidologists such as Heraclitus, Plato, Sigmund Freud, Emile Durkheim and Edwin Shneidman. A unique window on the clinical mind of the author. Empirically supported definition, with applications across age, gender, historical time, as well as culture. The report of the International Working Group on Ethical and Legal Issues in Suicidology.
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An original and timely study of men's experiences of depression in which the author tackles the discursively constructed relationship between the self and depression showing its linguistic and social complexity and analyses the relationship between depression and masculinity.
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Symptoms are a major reason for patients to see doctors. Modern medicine and modern psychiatry both conceptualize symptoms in terms of pathology. For medicine it is organic bodily pathology and for psychiatry it is psychopathology. However, these simple pathology-based approaches to symptoms are increasingly found to be both scientifically and clinically inadequate. An alternative is to regard symptoms not simply as a manfestation of pathology but rather as the expression of a combination of biological, psychological and social factors. This comprehensive approach transcends the traditional division of symptoms into medical and psychiatric, has major implication for the organization of services and provides new opportunities for research.
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This study deals with the linguistic study of texts as a way of understanding how language functions in its immensely varied range of social contexts. The authors adopt a functional approach to language, in which the different registers or functional varieties of a language are explained by reference to the different contexts in which they occur. Their analysis reveals how, on the one hand, each text is unique, while on the other, the way a text is organized and the kinds of coherence it displays are closely related to the place and the value that it has in its social and cultural environment.
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This paper discusses some principles of critical discourse analysis, such as the explicit sociopolitical stance of discourse analysts, and a focus on dominance relations by elite groups and institutions as they are being enacted, legitimated or otherwise reproduced by text and talk. One of the crucial elements of this analysis of the relations between power and discourse is the patterns of access to (public) discourse for different social groups. Theoretically it is shown that in order to be able to relate power and discourse in an explicit way, we need the `cognitive interface' of models, knowledge, attitudes and ideologies and other social representations of the social mind, which also relate the individual and the social, and the micro- and the macro-levels of social structure. Finally, the argument is illustrated with an analysis of parliamentary debates about ethnic affairs.
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Developed a modified version of the Modified Scale for Suicidal Ideation (MSSI) for use by paraprofessionals. Modifications included prompt questions, a standardized sequence of administration, modification of the rating points, development of initial screening scores, and selection of items based on internal consistency and relationships with clinical ratings. In 2 studies, 163 psychiatric patients were administered the MSSI and other measures including the Beck Depression Inventory. The MSSI demonstrated excellent internal consistency and interrater reliability, correlated highly with clinician's ratings of suicidal ideation and risk, and discriminated between suicide attempters and nonattempters prior to hospitalization. (3 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
suicide notes (and other personal communications) constitute a microcosm of human ideation / they are an invaluable starting point . . . for assessing and predicting suicide and parasuicidal behavior appendix: Thematic Guide for Suicide Prediction (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The author argues that in almost every case, suicide is caused by psychological pain, termed "psychache," which stems from thwarted or distorted psychological needs. He notes that most suicides tend to fall into one of 5 clusters of psychological needs, each of which reflect different kinds of psychological pain. These are: thwarted love, acceptance, and belonging; fractured control, predictability, and arrangement; assaulted self-image and the avoidance of shame, defeat, humility, and disgrace; ruptured key relationships and the attendant grief and bereftness and excessive anger, rage, and hostility. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Women who commit suicide use less violent methods, such as drugs and carbon monoxide poisoning, than do men, who more often use violent methods such as guns and hanging. Theories that attempt to explain this finding focus on gender differences in suicidal intent, socialization, emotions, interpersonal relationships, orientation and access to methods, and neurobiological factors. Data from a psychological autopsy study were used to test the theory that women who commit suicide use less violent means because they are less intent on dying. Although women were significantly less likely to use a violent method than men, there was no difference in the lethality of their suicidal intent.
Article
Since the publication of the O'Carroll et al. (1996) nomenclature for suicidology, there have been a number of published letters and articles, as well as an active e-mail dialogue, in response to, and elaborating upon, this effort to establish a standard nomenclature for suicidology. This new nomenclature has been presented on a number of occasions at both national and international meetings. In this paper we provide the background, rationale, and methodology involved in the process of revising the O'Carroll et al. nomenclature, based on the feedback and discussions that have ensued over the past 10 years.Those who have written and studied the phenomenon of suicide have not defined the term so simply … how the word is defined has implications and large effects for statistics that are compiled on the official number of suicides, and for researchers, so that there is clear communication regarding what and who is being studied.Among writers in the field of suicidology there is no single common accepted definition … the term suicide refers not to a single action but more broadly to a great many varied behaviors. For example, one can speak of suicidal thoughts, intentions, ideation, gestures, attempts, completions, equivalents.Thus far, no single term, definition, or taxonomy has served to sufficiently represent the complex set of behaviors that have been suggested as suicidal. A standard set of terms and definitions are greatly needed to advance the science of suicidology and aid communication and understanding of the field.McIntosh (1985, pp. 18–19)
Article
Suicidology finds itself confused and stagnated for lack of a standard nomenclature. This paper proposes a nomenclature for suicide-related behavior in the hope of improving the clarity and precision of communications, advancing suicidological research and knowledge, and improving the efficacy of clinical interventions.
Article
A revised and refined version of the O'Carroll et al. (1996) nomenclature for suicidology is presented, with a focus on suicide-related ideations, communications, and behaviors. The hope is that this refinement will result in the development of operational definitions and field testing of this nomenclature in clinical and research settings. This revision would not have been possible without the international collaboration and dialogue addressing the nomenclature of suicidology since the O'Carroll et al. nomenclature appeared in 1996.Although it is doubtful that we will ever be able to construct universally unambiguous criteria to comprehensively characterize suicidal behaviors (and, overall, firmly establish the intention behind them), for scientific clarity it would be highly desirable that the set of definitions and the associated terminology be explicit and generalizable.De Leo, Burgis, Bertolote, Kerkhof, & Bille-Brahe, 2006, p. 5)
Article
Suicidal ideation is an important risk factor for suicide attempts and completions, and early identification of the likely presence of self-harm cognitions would benefit clients and clinicians alike. This study examined the clinical utility of the Kessler K10 psychological distress score as an indicator of suicidal ideation. Suicidal ideation was assessed on the basis of four relevant questions contained in the General Health Questionnaire (GHQ-28), and these were subsequently analyzed against the K10 scores. The data were collected using a monthly risk-factor surveillance system where each month a representative random sample of South Australians over the age of 16 years is interviewed. The cumulative data covered the period 2002 to 2007 (n = 12,884). Psychological distress and suicidal ideation were reported by 9.9% and 5.1% of the participants, respectively. Univariate analysis demonstrated a positive linear relationship between the K10 score and suicidal ideation. Participants scoring in the very high range of the K10 were more likely to report suicidal ideation and this was experienced with greater frequency than by those who were less distressed. A logistic regression analysis revealed that even those in the moderate category were four times more likely to experience suicidal ideation than those in the low category, and those in the high and very high categories were 21 and 77 times more likely, respectively. Separate models based on sex and using odds-ratios based on very high vs. low K10 scores showed that males were 104 times more likely to report suicidal ideation compared to a 63 times higher rate for females. Both sexes had a 52% probability of experiencing suicidal ideation if they fell into the very high distress group. The K10 score is a clinically useful indicator of the presence of suicidal ideation.
Article
This study examined the association between pain and suicidality in the general US population. Using data from the National Comorbidity Survey-Replication, we assessed relationships between four measures of pain (back and neck, headache, other nonarthritic pain and a summary score of the count of these conditions) and 12-month suicidal thoughts, plans and attempts using chi-square tests and logistic regression models. Multivariate logistic regression models controlled for demographic characteristics, chronic health conditions, mood, anxiety and substance use disorders. In multivariate models adjusting for concurrent psychiatric disorders and other chronic medical conditions, suicidal ideation was associated with head pain (OR 1.9, 95% CI: 1.2, 3.0) and the pain summary score (OR 1.2, 95% CI: 1.0, 1.4). Suicide attempt was also associated with head pain (OR 2.3, 95% CI: 1.2, 4.4) and pain summary score (OR 1.7, 95% CI: 1.1, 2.6). Other nonarthritic pain was associated with suicide attempts (OR4.0, 95% CI: 1.8, 9.1). These findings highlight the importance of pain as a potentially independent risk factor for suicide, particularly among those with head pain or multiple forms of co-occurring pain. Individuals suffering from chronic pain may be particularly appropriate for suicide screening and intervention efforts.
Article
A total of 720 subjects from a general population survey were interviewed as to the occurrence of suicidal feelings of 5 different degrees. A total of 8.9% reported suicidal feelings of some degree in the past yr. Responses ranged along a continuum such that subjects reporting more intense feelings also reported the less intense. For 3.5% the maximum intensity consisted only of feelings that life was not worthwhile; 2.8% reached the point of wishing themselves dead, 1% the point of having thought of taking their lives, 1% seriously considered suicide or made such plans, and 0.6% made an actual suicide attempt. Subjects experiencing suicidal feelings in the last yr reported more minor psychiatric symptoms, particularly of depression, were more socially isolated, less religious, and to a lesser extent had experienced more stressful events and more somatic illness. In these respects they resembled descriptions of completed suicides.
Article
A study of 100 patients who made a severe suicide attempt suggested that the managed care criteria often applied for approving admission to hospitals for potentially suicidal patients were not, in fact, predictive of features seen in patients who actually made such attempts. Severe anxiety, panic attacks, a depressed mood, a diagnosis of major affective disorder, recent loss of an interpersonal relationship, recent abuse of alcohol or illicit substances coupled with feelings of hopelessness, helplessness, worthlessness, global or partial insomnia, anhedonia, inability to maintain a job, and the recent onset of impulsive behavior were excellent predictors of suicidal behavior. The presence of a specific suicide plan or suicide note were not. Patients with managed care were overrepresented by 245% in the study.
Article
There are few cross-national comparisons of the rates of suicide ideation and attempts across diverse countries. Nine independently conducted epidemiological surveys using similar diagnostic assessment and criteria provided an opportunity to obtain that data. Suicide ideation and attempts were assessed on the Diagnostic Interview Schedule in over 40000 subjects drawn from the United States, Canada, Puerto Rico, France, West Germany, Lebanon, Taiwan, Korea and New Zealand. The lifetime prevalence rates/100 for suicide ideation ranged from 2.09 (Beirut) to 18.51 (Christchurch, New Zealand). Lifetime prevalence rates/100 for suicide attempts ranged from 0.72 (Beirut) to 5.93 (Puerto Rico). Females as compared to males had only marginally higher rates of suicidal ideation in most countries, reaching a two-fold increase in Taiwan. Females as compared to males had more consistently higher rates for suicide attempts, reaching a two- to three-fold increase in most countries. Suicide ideation and attempts in most countries were associated with being currently divorced/separated as compared to currently married. While the rates of suicide ideation varied widely by country, the rates of suicide attempts were more consistent across most countries. The variations were only partly explained by variation in rates of psychiatric disorders, divorce or separation among countries and are probably due to cultural features that we do not, as yet, understand.
Article
Women who commit suicide use less violent methods, such as drugs and carbon monoxide poisoning, than do men, who more often use violent methods such as guns and hanging. Theories that attempt to explain this finding focus on gender differences in suicidal intent, socialization, emotions, interpersonal relationships, orientation and access to methods, and neurobiological factors. Data from a psychological autopsy study were used to test the theory that women who commit suicide use less violent means because they are less intent on dying. Although women were significantly less likely to use a violent method than men, there was no difference in the lethality of their suicidal intent.
Article
Qin et al 's ([2000][1], this issue) epidemiological study of risk factors for suicide in males and females in Denmark reminds us that there are important gender differences in suicidal behaviour. These reflect not only differences in aetiology, which were the primary focus of the Danish study, but
Article
A four-item suicidal ideation subscale of the GHQ-28 has been used previously to assess suicidal ideation on the basis of its face validity. In order to further validate its use, this study compared scores on this scale with scores on a well-established suicidal intent scale. There was a significant correlation between scores of that subscale and the self-report component as well as the overall score of the suicidal intent scale, thereby confirming its validity in providing a standardized method for comparing suicidal ideation in different populations.
Article
There have been quite a number of community studies in recent years, with surveys being conducted among the general population, in schools, and among the elderly. While all of these studies have greatly contributed to our understanding of suicidal behavior, because of different approaches toward methodology and definitions, they also have some limitations. These limitations spring mainly from the fact that definitions of suicidal ideation and behavior vary widely across studies, which makes comparisons between studies unreliable. The different utilization of methodology is another problem that can impact the comparability of the community studies.
Article
This review article outlines the research basis for an effective approach to psychotherapy with suicidal people. It answers the question, “Is psychotherapy effective with suicidal people?” Based on the notable historical publications and the most recent (Lambert, 200437. Lambert , M. , Bergin , A. , & Garfield , S. (2004). Introduction and historical overview. In M. Lambert (Ed.), Bergin and Garfield's handbook of psychotherapy and behavior change () , 5th edition (pp. 3–15). New York : John Wiley & Sons. View all references), it is shown that psychotherapy works, largely because there are commonalities (i.e., common factors) that may be the overriding important factor in all forms of psychotherapy. The therapeutic relationship is primary; this and other common factors are illustrated with suicidal people. Patient qualities, therapist qualities, and a multi-modal or multi-component approach are reviewed. On an empirical basis, it is concluded that one has to be person-centered (or patient centered): You have to know whom you are treating.
Article
This 2005 Louis I. Dublin Award Address explores some of the basic difficulties and controversies inherent in the development and universal acceptance of a nomenclature for suicidology. Highlighted are some of the unresolved challenges with agreeing upon a mutually exclusive set of terms to describe suicidal thoughts, intentions, motivations, and self-destructive behaviors.
Article
This is a prospective longitudinal study examining recollections of suicidal content and correlates of accurate and inaccurate recollection. A primarily at-risk group of young adults (N = 78) who were initially assessed for suicidal ideation and behavior in adolescence, were asked to recall whether they had reported sui- cidal ideation or behavior about six years earlier. In recalling the previous inter- view, the majority of the participants provided consistent reports. However, with regard to those who had previously reported suicidal ideation or behavior, 38% failed to recall prior adolescent suicidal reports. Those who provided accurate reports of prior suicidal content were more symptomatic and were functioning more poorly than those who failed to recall past suicidal content. The implications for clinical assessment practices, research, and theory development are discussed.
The language of psychiatry: A time for a change.
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Berrios, G. E. (1994) The language of psychiatry: a time for a change. Journal of Hong Kong College of Psychiatry 4: 5-10.
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Beck, a. T. and Steer, r. a. (1991) Manual for the Beck Scale for Suicide Ideation. San antonio, TX: Psychological Corporation.