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Contemporary Definitions of Suicidal Behavior: A Systematic Literature Review
Abstract
To address the lack of comparability around the world, we conducted a systematic review of existing definitions of suicide and suicidal behaviors. In the literature, four key features appear to cover the vast majority of concepts underpinning definitions: agency, knowledge of a potential fatal outcome, intent, and outcome. Intent and outcome appear to be the most consensual features of definitions of suicide, albeit revealing interesting conceptual variations. The four key features could be used to devise a research tool able to explore the meanings of suicide across different countries and different cultures.
... Suicidal behaviour is any behaviour that may lead to self-inflicted death (Goodfellow, Kõlves, and de Leo 2019). ...
... In Western societies, defining a death as a suicide usually relies on ascribing a voluntary and wilful nature to the act; that is, that a person is killing themselves of their own free will and is not intimidated, coerced or tricked. As an example, euthanasia (an intentional self-injury intended to end life) is not suicide because of the limited agency available to people living with extreme pain (Goodfellow, Kõlves, and de Leo 2019); in such circumstances, people have restricted palatable choices to end their suffering. For a death to be wilful, people must be aware that their actions will lead to their death (Goodfellow, Kõlves, and de Leo 2019). ...
... As an example, euthanasia (an intentional self-injury intended to end life) is not suicide because of the limited agency available to people living with extreme pain (Goodfellow, Kõlves, and de Leo 2019); in such circumstances, people have restricted palatable choices to end their suffering. For a death to be wilful, people must be aware that their actions will lead to their death (Goodfellow, Kõlves, and de Leo 2019). This means that deaths involving extreme risk and likelihood of death, such as the many actions that occur during warfare or disasters, are not considered suicide because the intent is to survive (Nugent et al. 2019). ...
This thesis examines the effectiveness of online suicide discussion boards as a tool for suicide prevention by focusing on the lived experience of suicidality. Severe mental illness and suicide are global health concerns, yet there is limited evidence on how current and emerging online technologies might support those contemplating suicide. A key challenge for people experiencing severe mental illness and suicide ideation is the stigma attached to these issues. Consequently, individuals who may be considering suicide or who have survived a suicide attempt often avoid sharing their experiences and stories with others.
The growth in online communication technologies may benefit those experiencing
suicidal thoughts by providing anonymity, thereby alleviating the shame associated with suicide. One method of online communication is websites known as ‘online suicide discussion boards’. These websites can offer privacy and may effectively improve the social connections and mental health of individuals at risk of suicide. However, concerns remain that online suicide discussion boards do not replicate genuine social connections and may even contribute to an increased likelihood of suicide.
Understanding the benefits and shortcomings of online suicide discussion boards
and other internet-based communication technologies in suicide prevention is essential. Furthermore, enabling people to share their experiences of suicide ideation and survival may provide additional means of suicide prevention outside the dominant biomedical approach. Some scholars have suggested that greater inclusion of lived experience in suicide prevention is needed to de-stigmatise and normalise the topic, which is often considered taboo.
To elucidate the risks and benefits of sharing lived experience of suicidality
online, my research investigated two years of conversations on an anonymous online
suicide discussion board to understand its usefulness as a suicide prevention tool. The data analysis involved three phases. First, thematic analysis was applied to
conversations in which 349 people took part. Second, a descriptive statistical analysis of the online suicide discussion board was undertaken, investigating the website’s design, rules, and functions. Finally, social network analysis (SNA) was used to understand the frequency of interaction between people, their posts, and their comments.
Results suggest that online suicide discussion boards can be beneficial for suicide
prevention, but they also have notable limitations. The main benefits people
experienced using the online suicide discussion board were forming social connections when suicidal, experiencing positive impacts from sharing highly stigmatised experiences, and feeling their lived experience of suicidality was valued by others. Conversely, the main limitations of using the online suicide discussion board were that only a small number of meaningful social connections were formed, complex issues relating to design, rules, and functions inhibited connectedness, and that the boards were unable to replicate authentic social connections.
To analyse these findings, I applied a micro-, meso-, and macro-level framework
to contextualise the discussion. The framework provides a comprehensive
understanding of how online communication technologies function at different levels, offering insights for social workers in direct practice, organisations, policymakers, and others to enhance future suicide prevention. At the very least, this thesis can inform and guide the development of more effective and supportive online environments in an increasingly digitised world.
... However, the literature evidences the existence of sufficient agreement around the main criteria characterising fatal suicidal behaviour (ie, 'suicide'): agency (self-inflicted or other inflicted), knowledge (of the consequences of the act), intent and outcome. 6 The reviews mentioned before [5][6][7] found that today it would not be possible to elaborate and standardise a universal set of terms and definitions describing the whole range of suicidal ideation and behaviours. Apparently, there are two main reasons for this. ...
... However, the literature evidences the existence of sufficient agreement around the main criteria characterising fatal suicidal behaviour (ie, 'suicide'): agency (self-inflicted or other inflicted), knowledge (of the consequences of the act), intent and outcome. 6 The reviews mentioned before [5][6][7] found that today it would not be possible to elaborate and standardise a universal set of terms and definitions describing the whole range of suicidal ideation and behaviours. Apparently, there are two main reasons for this. ...
... A systematic review of the literature on nomenclatures, definitions and classifications for suicidal ideation and behaviours was undertaken to provide the necessary background for the study. The outputs of this review 6 were then used to create a questionnaire that would enable the assessment of the most widely used terms and definitions around the world which is the final aim of the research. The aim of the current paper is to describe the methodology of the International Study of Definitions of English-Language Terms for Suicidal Behaviours (ISDELTSB), that is, the selection of participants, the questionnaire design and validation process, and the planned analysis of results. ...
Introduction
The objective of present paper is to outline the methodology of the International Study of Definitions of English-Language Terms for Suicidal Behaviours (ISDELTSB). The aim of the study is to survey existing English language terms and definitions used around the world for suicidal behaviour.
Methods and analysis
The ISDELTSB is a worldwide survey based on one ‘designated expert’ per each WHO-registered country. ‘Experts’ were contacted through the International Association for Suicide Prevention (IASP), the World Psychiatric Association and the World Organization of Family Doctors. Each individual was sent an invitation to participate and a link to an online questionnaire. A comparison sample was created by inviting all IASP members to respond to the questionnaire. The questionnaire was designed to assess respondents’ preferences about a particular set of terms and definitions by using the four major criteria of the definition of suicide identified in the literature (outcome, intent, knowledge and agency). The questionnaire used a multiple-choice question format. Participants were asked to choose one term in the list for each of the proposed definitions. Statements and definitions in the questionnaire were elaborated using the four main features of the definition of suicide, starting by the definitions and terms for which there is already a certain degree of consensus and then progressing to definitions and terms less agreed on.
Ethics and dissemination
The study protocol obtained approval of Griffith University’s Ethics Committee (ethics reference number 2017/601) and in accordance with the Australian National Statement on Ethical Conduct in Human Research. Respondents are asked if they accept to be personally acknowledged in any output originating from this study, and if so to provide their full name, title and affiliations. If respondents do not accept, they are informed that the conduct of this research respects Griffith University’s Privacy Plan and that identified personal information is confidential and that anonymity will at all times be safeguarded. As detailed in the questionnaire cover letter, by answering the online or paper version of the questionnaire, respondents express their consent to participate. Dissemination of results will be done through a peer-reviewed journal article publication. This study aims to map the international use of definitions and terms for suicidal behaviour and ideation and favour the future use of an internationally shared set of terms and definitions. This will hopefully avoid undue duplication of efforts and reliably permit meta-analysis of data produced in different countries.
... Suicidal behavior encompasses a desire to hasten death, indirect self-destructive behavior, parasuicide, deliberate selfharm, suicide attempt, self-mutilation, and suicide (Goodfellow et al., 2019;. According to the World Health Organization [WHO] (2021), suicide is considered a global public health issue, with further studies being required on this phenomenon. ...
... This review included documents reporting suicidal behavior in graduate students. Suicidal behavior encompasses a desire to hasten death, indirect self-destructive behavior, parasuicide, deliberate self-harm, suicide attempt, self-mutilation, and suicide (Goodfellow et al., 2019;Goodfellow et al., 2018). ...
Background. Graduate students experienced mental distress during the pandemic. This was perceived through the narration of students’ frustrations and the emergence of new situations to which both students and advisors were forced to adapt. Objective. To map evidence of suicidal behavior in graduate students in the context of the COVID-19 pandemic. Method. This is a scoping review. The eligibility criteria were: Participants—graduate students. Concept—suicidal behavior. Context—COVID-19 pandemic. The search strategy was applied to MEDLINE®/PubMed® and adapted for the following databases: EMBASE® (Elsevier), CINAHL®/EBSCO, LILACS®/BVS, PsycINFO®, and Web of Science. The review considered primary research studies with quantitative and qualitative designs. Although there were no language restrictions, there was a limit regarding the start of the new coronavirus in December 2019. Results. Eleven articles were included in the analysis of this review. It was found that the majority of studies were published in 2022. Master’s students were more frequently investigated for the presence of suicidal ideation, while doctoral students were studied for the presence of suicidal ideation, suicide plan, suicide attempt, and suicide. The presence of suicidal ideation ranged from 6.87% to 40%. The PHQ-9 questionnaire was the most commonly used instrument to assess suicidal ideation. Discussion and conclusion. The findings provide support for institutional strategies to prevent suicidal behavior in graduate students.
... O comportamento suicida engloba desejo de apressar a morte, comportamento autodestrutivo indireto, parassuicídio, autoagressão deliberada, tentativa de suicídio, automutilação e o suicídio. (7) Um inquérito comunitário realizado na Austrália destaca a presença de taxas mais elevadas de tentativa de suicídio, automutilação e depressão na comunidade trans. As tentativas de suicídio ocorrem devido a uma complexa interação entre fatores de risco sociopolíticos, ambientais, interpessoais e estruturais. ...
... Como os transtornos mentais influenciam no comportamento suicida, (7) faz-se necessário a sua avaliação em todas as pessoas que apresentem sofrimento mental. Sendo assim, a presença de ideação suicida no último ano foi relatada por 48,6% das pessoas participantes deste estudo. ...
Resumo Objetivo Identificar a presença de sofrimento mental, o suporte familiar e o empoderamento de pessoas transgênero residentes no Estado de Alagoas, Brasil. Métodos Estudo transversal, descritivo, quantitativo. Pessoas transgênero maiores de 18 anos que residiam no Estado de Alagoas foram incluídas no estudo. As entrevistas foram realizadas na plataforma Google Meet, mediante agendamento telefônico e WhatsApp. Foram utilizados: Questionário de identificação, Inventário de Ansiedade Traço-Estado, Escala de Depressão, Inventário de Percepção de Suporte Familiar e Escala de Empoderamento. Os dados foram inseridos no software Statistical Package For The Social Sciences 23, e analisados por meio de cálculo de frequências, médias, desvio-padrão e teste de Pearson Chi-Square. Resultados Foram entrevistadas 37 pessoas transgênero, com idade média de 27,35 anos, cor autorreferida preta/parda (91,8%), apresentando ideação suicida no último ano (48,6%), tentativa de suicídio (35,1%), risco para depressão (64,9%) e baixo suporte familiar (94,6%). Mulheres transgênero e pansexuais apresentaram maior traço de personalidade ansiosa e mulheres transgênero e bissexuais vivenciavam um maior estado ansioso. Houve maior comprometimento em pessoas heterossexuais na dimensão Afetivo-Consistente; em pessoas pansexuais, na dimensão Adaptação Familiar; em pessoas bissexuais, na dimensão Autonomia Familiar. O Ativismo Comunitário apresentou-se mais comprometido no empoderamento de pessoas transgênero. Conclusão As fragilidades nas relações familiares, aliado às condições de violência e preconceito vivenciados frente à dificuldade de muitos em conviver com a diversidade pode estar contribuindo para o sofrimento mental de pessoas transgênero. É preciso pensar em ações voltadas para a promoção do seu empoderamento, numa rede de apoio interna e externa à família.
... Suicidal behavior encompasses the desire to hasten death, indirect self-destructive behavior, parasuicide, deliberate self-harm, attempted suicide, self-mutilation and suicide. (7) A community survey carried out in Australia highlights the presence of higher rates of attempted suicide, self-mutilation and depression in the trans community. Suicide attempts occur due to a complex interaction between sociopolitical, environmental, interpersonal and structural risk factors. ...
... As mental disorders influence suicidal behavior, (7) assessing them specifically is essential for those who present mental suffering. Therefore, the presence of suicidal ideation in the last year was reported by 48.6% of the people participating in this study. ...
Objective Identify the presence of mental suffering, family support and empowerment of transgender people living in the State of Alagoas, Brazil. Methods Cross-sectional, descriptive, quantitative study. Transgender people over 18 years old who lived in the State of Alagoas were included in the study. The interviews were carried out on the Google Meet platform, through telephone and WhatsApp. The following instruments were used: Identification Questionnaire, State-Trait Anxiety Inventory, Depression Scale, Perceived Family Support Inventory and Empowerment Scale. The data were entered into the Statistical Package for the Social Sciences 23 software, and analyzed by calculating frequencies, means, standard deviation and the Pearson Chi-Square test. Results 37 transgender people were interviewed, with an average age of 27.35 years, self-reported black/brown color (91.8%), presenting suicidal ideation in the last year (48.6%), attempted suicide (35.1%), risk for depression (64.9%) and low family support (94.6%). Transgender and pansexual women presented a greater anxious personality trait and transgender and bisexual women experienced a greater anxious state. There was greater impairment in heterosexual people in the Affective-Consistent dimension; in pansexual people, in the Family Adaptation dimension; in bisexual people, in the Family Autonomy dimension. Community Activism was more committed to empowering transgender people. Conclusion The weaknesses in family relationships, combined with the conditions of violence and prejudice experienced in the face of the difficulty of many in living with diversity, may be contributing to the mental suffering of transgender people. Thoughts about actions aimed at promoting their empowerment are essential, in a support network that can be internal and external to their family.
... A more recent systematic review on the definition of suicide was conducted on 8,240 articles published between 1966 and 2017 (Goodfellow, Kõlves, & de Leo, 2019). A total of 26 definitions from 29 articles were included in the study, where authors provided an original definition for suicide or made developments to an existing definition, and the fundamental concepts underlying the definition were comprehensively reflected. ...
... In the systematic table presented by Goodfellow et al. (2019), more than fifty terms are evident, which vary or overlap in some aspects under thirteen terminological approaches. However, the fundamental structures upon which these numerous terms and definitions are based are consistent across all approaches: Intention and outcome 5 . ...
Suicide is a public health issue with legal, medical, economic, social, and individual consequences. Simultaneously, it is a multidimensional phenomenon that requires examination from psychological and sociological perspectives in terms of cause-and-effect relationships. Over the years, numerous studies have been conducted on suicide using various methods; however, there is still a need for research in predicting suicide risk and effectively preventing suicide. Theoretical groundwork is required for the execution of these studies, necessitating an understanding of definitions and terminology. This review aims to exploring the origin of suicide word specifically in Turkish and English, examining the attempts to definition, and classification the suicide phenomenon.
... Although several efforts have been made to propose a standardised language of suicidology (O 'Carroll et al., 1996;Posner et al., 2007;Silverman et al., 2007), there currently is no agreed-upon set of terms, definitions, and classifications for the spectrum of thoughts and behaviours that are related to suicide (Goodfellow et al., 2018(Goodfellow et al., , 2019(Goodfellow et al., , 2020, despite uniformity and transparency being critical for academic research, clinical practice, and suicide prevention (Silverman & De Leo, 2016). One major barrier in the study of suicide is that researchers often use a diverse and inconsistent terminology to describe similar phenomena under investigation (Chappell et al., 2017). ...
... Suicide is commonly defined as "a fatal self-injurious act with some evidence of intent to die" (Turecki & Brent, 2016). The fact that a person desires a certain outcome-he or she intends to die-is a central feature in most definitions of suicide (e.g., Goodfellow et al., 2019). When it comes to non-fatal suicidal behaviour, however, the literature particularly remains replete with confusing and vague terminology. ...
Preventing suicide in prisons is an international priority which necessitates a thorough evidence base. This dissertation reports on findings from a case file analysis, questionnaire survey, systematic review, meta-analysis, diagnostic interviews, and qualitative methods. Results indicate that suicidal thoughts and behaviour are four times more prevalent in prisoners than in the general population, contributing to substantial morbidity and mortality, with a range of modifiable risk factors. Specifically, data suggest that prison-specific stressors increase the likelihood of developing suicidal thoughts, whereas imported vulnerabilities characterised by behavioural disinhibition facilitate the transition towards suicidal behaviour. Given that risk of suicide is determined by a complex web of synergistically interacting factors, there is a need for a multi-level approach to suicide prevention that incorporates targeted strategies aimed at high-risk individuals in combination with population strategies that promote the health and wellbeing of all prisoners, with multi-agency collaboration having a key role.
... 7 According to official mortality statistics, 793 000 people worldwide died by suicide in 2016; 79% of these cases were from low/ middle-income countries (LMIC), 8 while most research outputs on suicidal behaviour are produced in high-income countries (HIC). Furthermore, most definitions and terms of common use originate from HIC. 9 However, since LMICs are increasingly producing research on suicide and its prevention, it would be important to obtain a clearer Strengths and limitations of this study ► The strength of the study is the inclusion of a range of countries and professional backgrounds. ► The main limitations are the relatively low participation rate and restriction to the English language. ...
... Generally, they expressed the choice for a definition excluding the possibility of an outside agent. This appears in contradiction with most literature (eg, Goodfellow et al 9 ). According to most respondents in this study, suicide is an act initiated and carried out by oneself to the end of the action. ...
Objectives
Explore international consensus on nomenclatures of suicidal behaviours and analyse differences in terminology between high-income countries (HICs) and low/middle-income countries (LMICs).
Design
An online survey of members of the International Organisation for Suicide Prevention (IASP) used multiple-choice questions and vignettes to assess the four dimensions of the definition of suicidal behaviour: outcome, intent, knowledge and agency.
Setting
International.
Participants
Respondents included 126 individuals, 37 from 30 LMICs and 89 from 33 HICs. They included 40 IASP national representatives (65% response rate), IASP regular members (20% response rate) and six respondents from six additional countries identified by other organisations.
Outcome measures
Definitions of English-language terms for suicidal behaviours.
Results
The recommended definition of ‘suicide’ describes a fatal act initiated and carried out by the actors themselves. The definition of ‘suicide attempt’ was restricted to non-fatal acts with intent to die, whereas definition of ‘self-harm’ more broadly referred to acts with varying motives, including the wish to die. Almost all respondents agreed about the definitions of ‘suicidal ideation’, ‘death wishes’ and ‘suicide plan’. ‘Aborted suicide attempt’ and ‘interrupted suicide attempt’ were not considered components of ‘preparatory suicidal behaviour’. There were several differences between representatives from HICs and LMICs.
Conclusion
This international opinion survey provided the basis for developing a transcultural nomenclature of suicidal behaviour. Future developments of this nomenclature should be tested in larger samples of professionals, including LMICs may be a challenge.
... El comportamiento suicida implica tres niveles de riesgo: la ideación suicida, la cual se refiere a pensar y considerar el suicidio, incluyendo pensamientos sobre querer morir y formas de suicidarse; la planificación del suicidio, que implica la elaboración cognitiva de un proyecto suicida, anticipando la ocasión, los medios y las medidas para prevenir el rescate; y el intento de suicidio, que es un acto de autolesión, con la intención de causar la propia muerte, pero que no resulta en ello, representando un paso más allá de la ideación y la planificación, e involucra una acción concreta para terminar con la vida [1,2]. ...
Objetivo: Identificar las características de consumo de sustancias psicoactivas asociadas a niveles de riesgo de comportamiento suicida en adolescentes argentinos. Métodos: Estudio de corte basado en la Encuesta Mundial de Salud Escolar argentina del año 2018 como fuente secundaria, cuyo muestreo probabilista estuvo conformado por 56 981 escolares de 13 a 17 años. Se analizaron los tres niveles de comportamiento suicida (ideación, planeación e intento). Como instrumentos, se emplearon el árbol de clasificación mediante detección automática de interacciones de ji al cuadrado, la Odds Ratio (OR) crudo y ajustado por medio de regresión logística binaria, la sensibilidad, la especificidad, y el valor predictivo positivo y negativo. Resultados: La frecuencia global de ideación suicida en los últimos 12 meses fue 21,50 % (n = 11 962), mientras que el 17,30 % (n = 9734) tuvo planeación suicida y el 15,10 % (n = 8507) intentó suicidarse al menos una vez durante el mismo periodo. Para ideación, planeación e intento suicida, el perfil común de mayor asociación fueron los antecedentes de fumar cigarros, consumir anfetaminas/metanfetaminas y tomar bebidas alcohólicas en solitario. Con base en este perfil, se observó que, para ideación suicida, los adolescentes tuvieron una OR ajustada de 8,10 (IC 95 % = 5,22-10,55). La especificidad fue del 99,11 %; el valor predictivo positivo, del 63 %, y negativo, del 80 %. Para la planeación suicida, los adolescentes presentaron una OR ajustada de 7,13 (IC 95 % = 4,70-9,84). La especificidad fue del 99,10 %, con valor predictivo positivo del 60 %, y negativo, del 83 %. En cuanto al intento suicida, los adolescentes tuvieron una OR ajustada de 8,14 (IC 95 % = 5,69-10,64). La especificidad fue del 99,80 %, con valor predictivo positivo y negativo de 62 y 85 %, respectivamente. Conclusiones: Esta investigación aporta evidencia sobre la fuerte asociación entre el consumo de alcohol en soledad, el uso de anfetaminas/metanfetaminas y el tabaquismo con el comportamiento suicida en adolescentes argentinos. Además, el tabaquismo predispone al consumo de psicoestimulantes. Se destaca la importancia de elaborar estrategias preventivas y políticas públicas para reducir este comportamiento en adolescentes.
... Az öngyilkossági kísérlet, az egyén önmaga elleni önsértô magatartását jelenti, amelynek szándéka -akár expliciten akár impliciten -a személy saját életének kioltása, aminek kimenetele nem végzetes, azonban járhat sérülésekkel. Befejezett öngyilkosságról akkor beszélünk, amikor az öngyilkossági kísérlet kimenetele halálos (8,9). A szuicídium multikauzális jelenség. ...
... Az öngyilkossági kísérlet, az egyén önmaga elleni önsértô magatartását jelenti, amelynek szándéka -akár expliciten akár impliciten -a személy saját életének kioltása, aminek kimenetele nem végzetes, azonban járhat sérülésekkel. Befejezett öngyilkosságról akkor beszélünk, amikor az öngyilkossági kísérlet kimenetele halálos (8,9). A szuicídium multikauzális jelenség. ...
Bevezetés: A szuicídium világszerte súlyos népegészségügyi problémát jelent. A gyermekkori traumák, felnôtt kötôdési stílusok és személyiségdimenziók öngyilkossági kísérletre gyakorolt hatása több évtizede foglalkoztatja a kutatókat. A kutatás célja a felnôtt pszichiátriai osztályon kezelt, anamnézisében szuicid tentámennel rendelkezô és nem rendelkezô populáción felmérni az öngyilkossági kísérlet rizikótényezôit a személyiségjellemzôk, gyermekkori tra-umák és felnôtt kötôdési stílusok relációiban.
Módszerek: A vizsgálat során a Gyermekkori Trauma Kérdôív (CTQ), a Felnôtt Kötôdés Kérdôív (AAS) és a Temperamen-tum és Karakter Kérdôív (TCI) magyar validált változatait és egy demográfiai és általános kérdéseket tartalmazó kér-déssort töltöttek ki a vizsgálatban résztvevôk. A vizsgálati csoportot (N=215) olyan pszichiátria minta alkotta, akiknek anamnézisében szerepel az öngyilkossági kísérlet, és olyan pszichiátriai diagnózissal rendelkezô betegek, akik nem ren-delkeznek szuicid kórtörténettel. Az adatok bináris logisztikus regresszióval, Spearman korrelációval, Mann-Whitney próbával és ANOVA modellel kerültek elemzésre.
Eredmények: A két csoportotot vizsgálva az újdonságkeresés [EH=1,043; 95% C.I.=(0,950-1,145)] p=0,376; a gyermekkori érzelmi elhanyagolás [EH=1,022; 95% C.I.=(0,936-1,116)] p=0,626; érzelmi bántalmazás [EH=1,034; 95% C.I.=(0,966-1,107)] p=0,336; szexuális bántalmazás mértéke [EH=1,047; 95% C.I.=(0,959-1,142)] p=0,305 tendenciaszerûen hozzá-járul az öngyilkossági kísérlet kialakulásának valószínûségéhez, azonban szignifikánsan nem befolyásolják azt. A biztonságos kötôdési stílus [EH=0,908; 95% C.I.=(0,842-0,980)] p=0,013 mértéke az eredmények szerint szignifikánsan csökkenti az öngyilkossági kísérlet megjelenésének valószínûségét (c 2 (1)=6,515 p=0,011). Továbbá a szorongó kötôdés az érzelmi bántalmazással (rs(197)=0,293) p<0,001, az elkerülô kötôdés az érzelmi elhanyagolással (rs(197)=0,273) p<0,001 mutat pozitív irányú kapcsolatot. Következtetés: Eredményeink alapján a biztonságos kötôdést a szuicídium kialakulásának protektív faktoraként te-kinthetjük. A kutatás gyakorlati jelentôsége megjelenhet azon ellátásokban, ahol a kötôdés stabilitása alakítható, hoz-zájárulva a késôbbi öngyilkosság kockázatának csökkentéséhez.
Kulcsszavak: öngyilkossági kísérlet; gyermekkori trauma; felnôtt kötôdési stílus; temperamentum-és karakterdimen-ziók
Introduction: Suicide is a severe public health problem. Impacts of childhood traumas, unsecure adult attachment styles and personality traits have been suggested as possible risk factors for suicide attempts. The aim of this cross-sectional, case-controlled study is to investigate the impact of childhood traumas, adult attachment styles and personality traits on suicide attempt. Methods: The sample consisted of psychiatric patients who attempted suicide (n=101) on the one hand and those who did not attempt suicide (n=114) on the other. The questionnaires used were the Hungarian validated versions of Adult Attachment Scale (AAS), Childhood Trauma Questionnaire (CTQ), Temperament and Character Inventory (TCI) and a demographic questionnaire. Results: Results indicated that Novelty Seeking (NS) temperament trait [EH=1.043; 95% C.I.=(0.950-1.145)] p=0.376; emotional abuse [EH=1.034; 95% C.I.=(0.966-1.107)] p=0.336; emotional neglect [EH=1.022; 95% C.I.=(0.936-1.116)] p=0.626; and sexual abuse [EH=1.047; 95% C.I.=(0.959-1.142)] p=0.305 were associated with nonsignificant increases in the odds of suicide attempts. Whereas secure attachment style [EH=0.908; 95% C.I.=(0.842-0.980)] p=0.013 appeared to be a significantly protective factor (c 2 (1)=6.515 p=0.011). Furthermore, when examining the connection between childhood traumas and adult attachment styles it was found that the anxious attachment style had a positive significant
... Suicidal behavior is complex. The complexity lies in the suicidal process itself (Wasserman & Sokolowski, 2016), the large repertoire of behaviors that comprise suicidal behaviors (Goodfellow et al., 2019), the absence of a singular cause and thus multiple contributing risk factors for different subgroups (Franklin et al., 2017), and the social context within which suicidal behavior is patterned and expressed (Batty et al., 2018). Hence, by extension, preventing suicides is challenging and complex. ...
Complex interventions combining multiple evidence-based strategies have gained substantial traction in suicide prevention across the world. However, implementing these interventions in real-life settings is fraught with several challenges, significant resource demands, and evidence on the merits of implementing complex interventions remains a topic of debate. This study explores the real-world experiences of implementing complex interventions, including challenges, lessons learned, and the way forward. Sixteen participants (nine leaders, five implementors, and two lived experience advocates) from varied professional backgrounds and experiences were purposively recruited from six high-income countries and one low- and middle-income country. Participants were encouraged to reflect on their experiences of implementing complex suicide prevention interventions in their specific country contexts. Thematic analysis was conducted to identify, organize, and offer real-world insights into challenges, lessons learned, and what is needed as the way forward. Important themes related to challenges and lessons learned emerged: (a) stakeholder characteristics, engagement, and dynamics; (b) resources such as funding priorities and capacity; (c) contextual factors including larger sociocultural beliefs, policies, and legislation surrounding suicide and its prevention; (d) nature of lived experience engagement; (e) design and approach to interventions; (f) delivery of interventions; and (g) the scope of evaluation. The study yielded important insights into practice recommendations related to the implementation of complex suicide prevention interventions on the ground. Important pathways for designing interventions, collaboration, and stakeholder engagement for future implementation efforts were discussed. These real-life experiences and lessons learned from international experts are critical in understanding and bridging the know–do gap.
... Suicide is a continuum from suicidal intention to suicide planning, suicide attempts and death by suicide (Klonsky et al., 2018;Sunderland et al., 2021). Suicidal intention, the intent to end one's life through suicide, is one of the types of suicidal behaviour (Goodfellow et al., 2018(Goodfellow et al., , 2019Silverman et al., 2007). According to the Interpersonal Theory of Suicide, suicidal intention is conceptualised as a separate type of suicidal ideation that is most likely to be transformed into suicidal behaviour. ...
Objective
Guided by the ecosystem theory model framework, we aimed to explore the influence of three ecological dimensions (social, family and psychological factors) on suicidal intention in people with severe mental illness (SMI). We hypothesized that three factors influence suicidal intention, and that psychological factors may play a mediating role in the influence of social and family factors on suicidal intention.
Methods
We collected 994 patients with SMI aged 18 and above from May 2021 to March 2022 in the Fourth Hospital of Fuzhou City. We used logistic regression to analyse the association between social, family, psychological factors and suicidal intention. Furthermore, we explored the mediating effects among the influencing factors.
Results
Younger male patients with schizophrenia were more likely to have suicidal intention due to psychosocial family factors (p < .05). Social factors (poor interpersonal relations, social retreat, social activities outside the home), family factors (parental functions, activities within the family, family functions), psychological factors (anxiety, depression, interest in the outside world, overt aggression, lack of accountability and planning) were all independent risk factors for suicidal intention in patients. Mediation analysis showed anxiety and depression mediated the role of social and family factors on suicidal intention (p < .05).
Conclusion
Social, family and psychological factors were important risk factors for suicidal intention, with anxiety and depression being partial mediators for suicidal intention. Therefore, interventions that enhance family and social functioning and reduce anxiety and depression may be effective in reducing suicidal intention in SMI.
... Regardless of whether Hunger Striker intended to die, reasoning by exclusion or applying legal causation would lead us to classify his death as suicide. In contrast, nearly all definitions of suicide rely on intent, be they written by philosophers (for a review see Cholbi, 2021) or clinical researchers (Goodfellow et al., 2019(Goodfellow et al., , 2020. According to definitions by these groups, a death is considered suicide if it is an intentional act of self-killing. ...
Conventional thinking holds that most inmates who hunger strike do not desire to die. Rather, they want prison officials to concede to their demands. In this paper, I examine whether death by hunger strike can be classified as suicide. After reviewing definitions of suicide and suicidal intent, I conclude that some deaths by hunger strike can be readily classified as suicides. I further propose that conditional intention is a useful way to understand the complex motivations of hunger strikers. I close by discussing the implications of conditional intention for the assessment of suicidal intent among hunger strikers and for the duty of mental health providers to prevent suicide.
... It is further complicated by the absence of a universally accepted definition and the breadth of the phenomenon, spanning from a general tiredness of life and desire for death through to active suicide planning, from fleeting thoughts to incessant and disturbing ruminations. Consequently, estimates of both prevalence and the associated outcomes makes comparisons across studies difficult (Berman, 2018;Goodfellow et al., 2019;Harmer et al., 2023). A recent meta-analysis found an overall threefold increased risk of suicide (McHugh et al., 2019) though noted very high and unexplained levels of between-study heterogeneity which was attributed to differences in methodological design, with studies 2 E. Ross et al. ...
Aims:
Suicidal ideation constitutes a central element of most theories of suicide and is the defining facet separating suicide from other causes of death such as accidents. However, despite a high worldwide prevalence, most research has focused on suicidal behaviours, such as completed suicide and suicide attempts, while the greater proportion who experienced ideation, which frequently precedes suicidal behaviour, have received much less attention. This study aims to examine the characteristics of those presenting to EDs with suicidal ideation and quantify the associated risk of suicide and other causes of death.
Methods:
Retrospective cohort study was performed based on population-wide health administration data linked to data from the Northern Ireland Registry of Self-Harm and centrally held mortality records from April 2012 to December 2019. Mortality data, coded as suicide, all-external causes and all-cause mortality were analysed using Cox proportional hazards. Additional cause-specific analyses included accidental deaths, deaths from natural causes and drug and alcohol-related causes.
Results:
There were 1,662,118 individuals aged over 10 years, of whom 15,267 presented to the ED with ideation during the study period. Individuals with ideation had a 10-fold increased risk of death from suicide (hazard ratio [HRadj] = 10.84, 95% confidence interval [CI] 9.18, 12.80) and from all-external causes (HRadj = 10.65, 95% CI 9.66, 11.74) and a threefold risk of death from all-causes (HRadj = 3.01, 95% CI 2.84, 3.20). Further cause-specific analyses indicated that risk of accidental death (HRadj = 8.24, 95% CI 6.29, 10.81), drug-related (HRadj = 15.17, 95% CI 11.36, 20.26) and alcohol-related (HRadj = 10.57, 95% CI 9.07, 12.31) has also significantly increased. There were few socio-demographic and economic characteristics that would identify which of these patients are most at risk of suicide or other causes of death.
Conclusions:
Identifying people with suicidal ideation is recognized to be both important but difficult in practice; this study shows that presentations to EDs with self-harm or suicide ideation represent an important potential intervention point for this hard-to-reach vulnerable population. However, and unlike individuals presenting with self-harm, clinical guidelines for the management and recommended best practice and care of these individuals are lacking. Whilst suicide prevention may be the primary focus of interventions aimed at those experiencing self-harm and suicide ideation, death from other preventable causes, especially substance misuse, should also be a cause of concern.
... In the present study, such suicide behaviors are considered to involve ideation, planning, and attempts [9][10][11]. Ideation is defined as the contemplations, wishes, and preoccupations with death and suicide; planning is the precursor of potentially lethal attempts; while attempts involve self-inflicted behaviors with non-fatal outcomes [12,13]. ...
Objective
Workers of the Australian entertainment industry exhibit disproportionately high rates of impaired psychological wellbeing and suicidal behaviors, with such rates being exacerbated by the negative impact of working long and odd hours (Work Scheduling Impact; WSI). Nonetheless, stable and secure social support networks may buffer the risks associated with such systemic difficulties.
Methods
The responses of 1302 Australian entertainment industry workers (50.3% females, M age 38.39 years) on the Multidimensional Scale of Perceived Social Support, the Short Form Health Survey, WSI, and suicidal behaviors questions were examined via moderation analyses.
Results
Higher social support and lower WSI appeared to reduce the suicidal ideation of those experiencing poorer mental health, while lower WSI further enhanced social support’s positive effect.
Conclusions
Findings highlight the likely detrimental effect of WSI regarding the suicidal ideation reported by vulnerable Australian entertainment industry workers and stress the importance of the social support they experience.
Public health implications
Interventions attempting to increase social support could improve inherent conditions associated with the Australian entertainment industry. Similarly, the negative effect of working long and odd hours on workers’ mental health and suicidal behaviors indicates the need to regulate the industry appropriately.
... The numbers are even more serious when considering suicidal behavior, defined as any act by which a person causes injuries to themselves, regardless of the lethality degree and the reason for this act. It is evidenced in this conception that suicidal behavior is interpreted as a process: threats, self-injury, frustrations, despair, social escape, depressive symptoms, thoughts of self-destruction, suicide attempts and suicide itself [4][5] . ...
Objective
to analyze the attitudes of health professionals working in Primary Health Care before and after participating in workshops about how to approach people with suicidal behavior.
Method
a before-and-after quantitative and quasi-experimental study, conducted in a municipality in the inland of the state of São Paulo from August to September 2019. The sample consisted of 34 workers who answered a Sociodemographic Questionnaire and the Questionnaire on Attitudes towards Suicidal Behavior, applied before and after three workshops on how to approach people with suicidal behavior in the Primary Health Care context. The data were analyzed by means of the Wilcoxon and McNemar tests, considering p<0.05.
Results
a statistically significant difference was identified before and after the workshops regarding professional ability (p=0.011), negative feelings towards the patient (p=0.025) and without a category (p=0.006), evidencing the effectiveness of the workshops on how to approach people with suicidal behavior for management and care professionals working in Primary Health Care.
Conclusion
the short-term results observed after the workshops point to a change in the professionals' conception and management in relation to people with suicidal behavior. Permanent and continuous training strategies as spaces for learning, reflection and action are fundamental to qualify the approach to people with suicidal behavior.
DESCRIPTORS:
Suicide. Attempted suicide. Training of human resources in health. Primary health care. Knowledge; attitudes and practice in health
... O quantitativo é ainda mais grave quando se considera o comportamento suicida, definido como todo ato pelo qual uma pessoa causa lesão a si mesma, independentemente, do grau de letalidade e do motivo deste ato. Evidencia-se nessa concepção que o comportamento suicida é interpretado como um processo: ameaças, autolesões, frustrações, desesperança, fuga social, sintomas depressivos, pensamentos de autodestruição, tentativas de suicídio e o suicídio em si [4][5] . ...
Objective
to analyze the attitudes of health professionals working in Primary Health Care before and after participating in workshops about how to approach people with suicidal behavior.
Method
a before-and-after quantitative and quasi-experimental study, conducted in a municipality in the inland of the state of São Paulo from August to September 2019. The sample consisted of 34 workers who answered a Sociodemographic Questionnaire and the Questionnaire on Attitudes towards Suicidal Behavior, applied before and after three workshops on how to approach people with suicidal behavior in the Primary Health Care context. The data were analyzed by means of the Wilcoxon and McNemar tests, considering p<0.05.
Results
a statistically significant difference was identified before and after the workshops regarding professional ability (p=0.011), negative feelings towards the patient (p=0.025) and without a category (p=0.006), evidencing the effectiveness of the workshops on how to approach people with suicidal behavior for management and care professionals working in Primary Health Care.
Conclusion
the short-term results observed after the workshops point to a change in the professionals' conception and management in relation to people with suicidal behavior. Permanent and continuous training strategies as spaces for learning, reflection and action are fundamental to qualify the approach to people with suicidal behavior.
DESCRIPTORS:
Suicide. Attempted suicide. Training of human resources in health. Primary health care. Knowledge; attitudes and practice in health
... Nevertheless, the exploration of suicidal behavior among individuals on the spectrum has encountered challenges, particularly the definition of suicide and methodological concerns at various research stages. Similar to ASD and the spectrum of symptoms associated with it, we can examine suicidal ideation and attempts on a spectrum from mild thoughts to death by suicide or completion, and there are currently more than 19 different definitions of suicide [21]. Concerns regarding intentionality, ideation, and behaviors all play a role in designing an exhaustive definition. ...
The occurrence of mood- and anxiety-related conditions among family members of individuals diagnosed with autism spectrum disorder (ASD) increases the risk of suicide attempts and has also created assessment and treatment issues for clinicians and parents. Recorded rates of mental health disorders comorbid with suicide attempts among individuals on the spectrum range from 29% to 52%. The purpose of this study was to investigate the presence of predictors of suicide attempts among sibling dyads (pairs of siblings in which one sibling is on the autism spectrum). Growing evidence in the literature indicates a link between a diagnosis of autism and mental health. A web-based survey was used to collect data from individuals on the spectrum and their siblings. A sample of 144 individuals was finalized for the analyses. Logistic regression analysis was conducted to assess the predictors of suicide attempts in the sample. Depression, anxiety, sexual orientation, and marital status were all used as predictors in the logistic regression analyses. Both levels of anxiety and sexual orientation were found to be significant predictors for suicide attempts. Recommendations for future research, assessment, and treatment are presented.
... In this study, we rely on clinicians' evaluations about intentionality. Individuals were labelled as "attempted suicide" if they harmed their body and consciously realized that such an act could kill them (e.g., Goodfellow, Kõlves and de Leo (2019)). During hospitalisation, clinicians submit self-reported questionnaires to each patient to supervise their psychological evolution over time. ...
Psychiatric studies of suicide provide fundamental insights on the evolution of severe psychopathologies, and contribute to the development of early treatment interventions. Our focus is on modelling different traits of psychosis and their interconnections, focusing on a case study on suicide attempt survivors. Such aspects are recorded via multivariate categorical data, involving a large numbers of items for multiple subjects. Current methods for multivariate categorical data-such as penalized log-linear models and latent structure analysis-are either limited to low-dimensional settings or include parameters with difficult interpretation. Motivated by this application, this article proposes a new class of approaches, which we refer to as Mixture of Log Linear models (mills). Combining latent class analysis and log-linear models, mills defines a novel Bayesian approach to model complex multivariate categorical data with flexibility and interpretability, providing interesting insights on the relationship between psychotic diseases and psychological aspects in suicide attempt survivors.
... Research on suicide has been blocked for many decades (Goodfellow et al., 2020). According to the World Health Organization (2014), 'suicidal behaviour is understood as a diversity of behaviour that includes thinking about suicide (or suicidal ideation), planning suicide, attempting suicide and committing an act of suicide' . ...
Background
Pregnancy is a period when women are particularly vulnerable to suicidal ideation and a great opportunity for suicide risk prevention.
Aims
This study aimed to establish a comprehensive understanding of suicidal ideation prevalence, risk factors, screening tools, consequences and management during pregnancy.
Method
A literature search was performed in MEDLINE and PsycInfo databases from 2016 to 2021. A narrative synthesis of the literature and a critical overview of the current issues/questions to be addressed within the topic of suicidal ideation during pregnancy was performed.
Results
The prevalence of suicidal ideation during pregnancy was between 2.73 and 18% internationally. The risk factors identified were major depressive disorder, anxiety disorder, difficulties with sleep, previous suicide attempts, high rumination, low incomes, being black, being young, low educational level, partner violence, having poor support, food insecurity, history of child abuse, high obstetric risk, multiparity, previous induced abortion and exposure to tobacco or human immunodeficiency virus diagnosis. The screening tools used for suicidal ideation during pregnancy were item 10 of the Edinburgh Postpartum Depression Scale and item 9 of the Patient Health Questionnaire. Results showed that suicidal ideation during pregnancy is associated with poor cognitive development in children and low birth weight. No case management studies on suicidal ideation were found.
Limitations
The main limitation of the available studies was the lack of articles with a high degree of methodological rigour on this subject.
Conclusions
This narrative review is a state-of-the-art paper about suicidal ideation during pregnancy. Further research is needed, and researchers should carry out systematic reviews and meta-analyses, leading to Clinical Practice Guidelines in this area. This effort would improve our evidence-based practice in Perinatal Psychology and prevent associated suicidal behaviour.
... Ongoing redefinition occurs at an alarming rate, leading to changes in psychological terminology and conceptualization. For example, recent articles have suggested changes in psychological terminology or conceptualization regarding plants as cognitive agents (Castiello, 2021), auditory processing disorder (Wilson, 2019), mental health (Fusar-Poli et al., 2020), vitality (Lavrusheva, 2020), intellectual attention (Fortney, 2019), schizophrenia (Dua & Singh, 2019), brain injuries (Garavito, Reyna, & DeTello, 2018), psychoanalytic concepts (Haslam & Ye, 2019), orthorexia nervosa (Cena et al., 2019), suicidal behavior (Goodfellow, Kõlves, & Leo, 2019), palliative care (Lindblad, Helgesson, & Sj€ ostrand, 2019), obedience (Gibson, 2019). How is one to make sense of ongoing changes in terminology? ...
The language psychologists and other mental health professionals utilize impacts the formation of public perceptions concerning the practice of psychology. Psychologists from Warren, Calkins, Dunlap, Gardiner, and Ruckmich to Lilienfeld et al. have raised concerns about the clarity and use of problematic psychological terms. This study measured 309 mental health professionals’ (1) recognition and use of 50 psychological terms identified as problematic by Lilienfeld et al., and (2) explored the jangle fallacy by providing potentially synonymous word-pairs for participants to rate for synonymity. Results of Part I indicated that 34 out of the 50 terms were not recognized as problematic by a significant majority of participants. Participants disagreed about whether or not six terms were problematic, and the remaining 10 terms were rated by a majority to be problematic. Results of Part II indicated a disagreement between participants regarding the synonymity of four word-pairs, and agreement regarding the synonymity (or lack thereof) of the remaining 16 word-pairs. These findings support the suggestion by Lilienfeld and colleagues that greater attention is needed in regard to problematic psychological terminology, including synonymous or jangling terminology.
... Beyond age and sex, another crucial risk factor for suicide is the presence of psychiatric disorders such as MDD and SCZ (see Table 1 for full definitions of abbreviations), which are associated with at least 43.2 and 9.2% of suicide deaths, respectively, in North America (Arsenault-Lapierre et al., 2004). Although the categorization of SB is subject to debate (Goodfellow et al., 2019), in this Review we use this term to refer to suicide, suicide attempts and preparatory acts (Nock, 2014), while suicidal ideation is used to specify active or passive thoughts about ending one's own life (Turecki et al., 2019). ...
Suicide is a complex public health challenge associated worldwide with one death every 40 s. Research advances in the neuropathology of suicidal behaviors (SB) have defined discrete brain changes which may hold the key to suicide prevention. Physiological differences in microglia, the resident immune cells of the brain, are present in post-mortem tissue samples of individuals who died by suicide. Furthermore, microglia are mechanistically implicated in the outcomes of important risk factors for SB, including early-life adversity, stressful life events, and psychiatric disorders. SB risk factors result in inflammatory and oxidative stress activities which could converge to microglial synaptic remodeling affecting susceptibility or resistance to SB. To push further this perspective, in this Review we summarize current areas of opportunity that could untangle the functional participation of microglia in the context of suicide. Our discussion centers around microglial state diversity in respect to morphology, gene and protein expression, as well as function, depending on various factors, namely brain region, age, and sex.
... Apesar de não haver um consenso sobre a definição de comportamento suicida, ele pode ser considerado como um conjunto de atitudes que abrange desde a ideação suicida, passando pela tentativa e chegando ao desfecho. Assim, o suicídio pode ser entendido como um ato autoinfligido que ocasiona intencionalmente a morte do próprio indivíduo, e a tentativa de suicídio como autolesão intencional cujo objetivo é pôr fim à própria vida, mas sem atingir o desfecho (Centers for Disease Control and Prevention -CDC, 2018) (De Leo, Burgis, Bertolote, Kerkhof, & Bille-Brahe, 2006;Goodfellow, Kõlves, & Leo, 2018). ...
Suicide involves ideations and/or attempts that can lead to death. Its increase in adolescence demands preventive and health-promoting public policies. Objectives: 1) to disclose, by means of documentary analysis, the indexes and methods of suicide by sex in a city of Goiás between the years of 2005 and 2012; 2) to endorse the prevalence of ideation and attempted suicide among adolescents; 3) to assess a relationship between idea and suicide attempt and behavioral problems, and 4) to analyze sociodemographic and clinical risks associated with suicide attempts. A probabilistic sample of 368 adolescents (13 to 18 years old), responded to the Youth Self Report. There is a high prevalence of suicide in the city (M = 2.37 cases/year in a city with approximately 2,200 adolescents). 12.8% of the sample reported attempting suicide, and 18,2% thought to commit suicide, of which 47.8% actually attempted suicide. Ideation and attempted suicide correlated significantly with all behavioral problems surveyed. Variables such as suicidal ideation and type of school were predictors of suicide attempts.
... A despeito das distintas definições, o comportamento suicida se conforma em um continuum: ameaças, autolesões, frustrações, desesperança, fuga social, depressão, pensamentos de autodestruição, tentativas de suicídio e o suicídio em si (7)(8) . Em face desse comportamento, ações que objetivem sua prevenção e sua detecção são possíveis de serem ofertadas pelos profissionais de saúde da APS, e dentre os desafios para sua operacionalização, as estratégias de formação têm sido objeto de investigação. ...
Objective:
to describe the implementation of workshops on the approach of people in psychological distress with suicidal behavior for Primary Health Care workers and managers.
Methods:
this is an action research developed for Primary Health Care professionals in a city in the countryside of São Paulo. Charles Maguerez’s Arch methodology was used as a theoretical framework to construct the workshops.
Results:
through active strategies and the exercise of reflection-action, the workshops enabled participants to raise awareness on the topic, articulation between professionals and managers, and the co-responsibility required to care for users with suicidal behavior assisted in Primary Health Care.
Final considerations:
the workshops broadened knowledge, facilitating skill development to qualify Primary Health Care professionals in caring for people with suicidal behavior.
... Suicidal behavior is a complex phenomenon that is associated with a set of ideas, intentions and actions related to the desire to cause one's own death (2) . In youth, different factors can contribute to a greater exposure of this population to this phenomenon, such as variables related to work, family life, group experiences, pre-existing psychopathological conditions, greater consumption of substances, future prospects and own conflicts that manifest in this phase of development, which marks the transition between adolescence and the challenges of adult life, representing a period of greater emotional mobilization and also of greater fragility facing various challenges. ...
Objetivo: avaliar as evidências científicas referentes à relação entre religiosidade/espiritualidade (R/E) e o comportamento suicida. Método: estudo de revisão integrativa da literatura, nas bases de dados: LILACS, PubMed e CINAHL, de janeiro de 2011 a fevereiro de 2020. Foram identificados 1044 artigos, dos quais sete foram incluídos no estudo. Resultados: Predominaram estudos quantitativos (71,4%), realizados com universitários (57,14%), que investigaram a religião (71,43%) e diferentes dimensões do comportamento suicida (85,7%). A maioria dos estudos retratara benefícios da religião e da espiritualidade, mesmo que indiretamente na vida dos jovens e apontaram para efeitos protetivos da R/E em relação ao comportamento suicida. Conclusão: A R/E pode ser um fator importante para adolescentes e adultos jovens que merece ser explorada em investigações e ações que fortaleçam os fatores protetores contra o comportamento suicida e permitam o aumento da literacia em saúde mental entre lideranças religiosas.
... 1. Suicidal behaviour was classified [29,30] as follows: ...
Suicidal behaviour is a major public health problem that needs to be tackled by all health agents including mental health nurses.
Aims:
The purpose of this study was to analyse the relationship between demographic and clinical characteristics and different kinds of suicidal behaviour with a nurse-led suicide prevention programme.
Methods:
The design was a cross-sectional study, performed in the region of Osona (Catalonia) in the five-year period 2013-2017. Suicidal behaviour was classified as suicidal ideation, interrupted self-directed violence, suicide attempt or completed suicide.
Results:
The sample included 753 patients (of whom 53 completed suicide) who experienced 931 suicidal behaviour episodes. Men represented only 38.4% of the sample but 81.1% of completed suicides. Mental disorders were associated with suicidal behaviour in 75.4% of the sample. Two thirds (66.4%) of the individuals (0.8% (n = 4) of whom completed suicide) were participants in a nurse-led suicidal behaviour case management programme.
Conclusion:
The main risk factors were being a woman for suicidal behaviour and being a man and being older for completed suicide. Mental disorders, widowhood and retirement were also associated with completed suicide. The completed suicide rate was lower among participants in the nurse-led programme.
... The variables were classified into 4 main categories: Suicidal behaviour. Classified as: [28,29] o Suicidal ideation: thinking about, considering, or planning suicide o ...
(1) Aims: To analyse the relationship between demographic and clinical characteristics and particular kinds of suicidal behaviour and its relationship with a nurse-led suicide prevention program. (2) Methods: A 5-year cross-sectional study design. Study performed in the region of Osona (Catalonia) during 2013-2017. Suicidal behaviour was classified as suicidal ideation, interrupted self-directed violence, suicide attempt and completed suicide. (3) Results: The sample included 753 patients ─ of whom 53 died by suicide─ and encompassed 931 suicidal behaviour episodes. Men represented 38.4% of the sample but 81.1% of deaths by suicide. Mental disorders were associated with suicidal behaviour in 75.4% of the sample. 66.4% of the individuals were engaged in the nurse-led Suicidal Behaviour Case Management Program, of which 0.8% (n=4) died by suicide. (4) Conclusion: The main risk factors were female sex for suicidal behaviour, and male sex and older age for suicide. Mental disorders, widowhood and retirement were also associated with suicide. A high proportion of patients was engaged to the nurse-led suicide prevention program with a low proportion of suicides.
... Data from other regions of Spain [19] have shown a much wider gender gap. These discrepancies may be attributable to differences in methodology, type of study population, and the definition of attempted suicide [5,46]. ...
Discrepant results have been published by studies comparing deaths by suicide with attempted suicides. This study aimed to determine factors associated with suicides and attempted suicides in Andalusia (Spain) between 2007 and 2013, comparing sex, age, year, and suicide method between these populations. A retrospective study was conducted of data on deaths by suicide and attempted suicides over a seven-year period, calculating the sex and age rates for each behavior. Adjusted Poisson regression was used to analyze the association with study variables, and incidence rate ratios were estimated. During the seven-year study period, 20,254 attempted suicides and 5202 deaths by suicide were recorded. The prevalence of attempted suicide did not differ between the sexes, whereas the prevalence of deaths by suicide was three-fold higher among males than among females and increased with higher age. The most frequently used method was the same in males and females for suicide attempts, but differed between the sexes for suicides. The combined influence of sex and age was greater in the model for death by suicide than in the model for attempted suicide. The key differentiating factor was the method used, while the finding of greatest concern was the suicide behavior among the elderly. Preventive strategies should take these differences into account.
Este artigo tem por objetivo descrever o perfil epidemiológico e analisar a tendência temporal dos óbitos por suicídio no estado do Acre e no Brasil no período de 2010 a 2022. Trata-se de um estudo de série temporal que incluiu dados sobre óbitos que tiveram como causa básica o suicídio coletados do Sistema de Informações sobre Mortalidade (SIM). A análise de dados incluiu o cálculo das taxas de mortalidade por suicídio; razão de sexo; análise da tendência temporal por meio de modelos de regressão linear generalizados segundo o método de Prais-Winsten; frequência absoluta e relativa de óbitos segundo variáveis selecionadas. No Acre, as taxas de mortalidade por suicídio por 100 mil habitantes variaram de 5,35 a 8,94, com tendência crescente de 4,03% ao ano (p<0,001). No Brasil, o valor mínimo e máximo da mortalidade foram observados nos anos de 2010 (5,23) e 2022 (7,72) respectivamente; houve tendência crescente com variação percentual anual (APC) de 3,16% (p<0,001). As taxas de mortalidade por suicídio foram superiores entre os homens com razão de sexo variando de 2,58 a 7,08 no Acre e 4,74 a 5,08 no Brasil. Houve crescimento estatisticamente significante da mortalidade para ambos os sexos com maior crescimento entre as mulheres no estado do Acre (APC= 6,95%). Indivíduos com escolaridade entre 8 e 11 anos e solteiros foram mais afetados. No Acre, maior incidência foi observada entre jovens de 15 a 24 anos e raça parda, enquanto no Brasil, houve predominância entre pessoas de 25 a 34 anos e raça branca. A tendência crescente de suicídios observada no Acre e no Brasil se manifesta de maneira preocupante considerando as elevadas taxas entre homens e crescimento acentuado entre as mulheres. O aumento observado contraria a tendência global de redução demandando uma reavaliação das estratégias de prevenção e promoção da saúde mental, com ênfase na criação de políticas públicas mais assertivas e equitativas, alinhadas aos desafios regionais e nacionais.
Background: Despite the exposure to a wide combination of risk factors, evidence concerning risk of suicide among refugees is mixed.
Aims: We aimed to establish more precise estimates of suicide and suicidal behavior in refugees and asylum seekers, investigate the role of somatic and psychiatric
comorbidities, and the effectiveness of preventative interventions.
Methods: We searched PubMed/Medline, EMBASE, CINAHL, and PsycInfo without time limitations from inception until June 5, 2024. Studies were included if
systematic reviews or meta-analyses reporting data on suicide or suicidal behavior in refugees or asylum seekers, or detailing the results of preventive interventions.
Quality was assessed using the National Institutes of Health Quality Assessment Tool for Systematic Reviews and Meta-Analyses.
Results: Out of 49 papers, 10 systematic reviews and meta-analyses were included. Refugees showed significantly higher suicide death rates and suicidal ideation,
suicide plan and suicide attempt prevalence compared to people living in the host countries. Refugees who arrived in low-income and lower-middle-income countries
displayed lower suicidal ideation, but higher suicide death rates and suicide attempt prevalence compared to refugees who arrived in high-income and upper-middleincome countries. However, no review provided data regarding somatic comorbidity, psychiatric comorbidity, or the effectiveness of treatments, and evidence on
specific categories of refugees is scarce.
Conclusion: Refugees have been proven to be at risk for suicide and suicidal behavior. More research is required to identify the targets and procedures of intervention
Introduction:
European countries use various terminologies for self-harm and attempted suicide, which are sometimes used interchangeably. This complicates cross-country comparisons of incidence rates. This scoping review aimed to examine the definitions used and the possibilities to identify and compare incidence rates of self-harm and attempted suicide in Europe.
Methods:
A literature search was conducted in Embase, Medline and PsycINFO for studies published from 1990 to 2021, followed by grey literature searches. Data were collected for total populations originating from health care institutions or registries. Results were presented in tabular form supplemented by a qualitative summary by area.
Results:
A total of 3160 articles were screened, resulting in 43 studies included from databases and further 29 studies from other sources. Most studies used the term 'suicide attempt' rather than 'self-harm' and reported person-based rates with annual incidence rates from age 15+. None of the rates were considered comparable due to different reporting traditions related to classification codes and statistical approaches.
Conclusion:
The present extensive literature on self-harm and attempted suicide cannot be used to compare findings between countries because of the high degree of heterogeneity among studies. International agreement on definitions and registration practices is needed to improve knowledge and understanding of suicidal behaviour.
Both the quality and utility of youth suicide research depend on how we assess our outcomes of interest: suicidal thoughts and behaviors (STBs). We now have access to more STB assessments than ever before, with measures for youth that vary in what exact experiences are asked about, how such measures elicit information, when and how frequently measures are administered, and who the informants are. This growing armamentarium of assessments has the potential to improve the study and treatment of STBs among youth, but it hinges on meaningful interpretation of assessment responses. Interpretation can be especially challenging when different STB assessments yield conflicting information. Determining how to manage discrepant reports of STBs is a pivotal step toward achieving meaningfully comprehensive STB assessment batteries. Here, we outline several discrepant reporting patterns that have been detected, discuss the potential significance of these observed discrepancies, and present initial steps to formally investigate discrepant reports of STBs among youth. Developing coherent, interpretable, and comprehensive batteries assessing STBs among youth would address a fundamental step to uncovering etiology, improving clinical decision-making and case management, informing intervention development, and tracking prognosis.
The prevalence of frailty, which is significantly associated with late-life suicidality, increases with age in older adults. This review addresses the compiled evidence on the relationship between suicidality and frailty within older populations, explores the latest findings, weighs the effectiveness of various intervention strategies, and outlines potential future investigations in this area. Growing evidence suggests that identifying and addressing risk factors, including mood disorders, prior suicide attempts, poor physical health, and social isolation/problems can decrease the risk of late-in-life suicide. Various studies have shown that interventions such as diet improvements, cognitive training, psychosocial programs, and depression medication could reduce the severity of frailty and suicidality, with physical exercise being the most effective intervention. Combined programs with multiple interventions can have an even greater impact on combating depression, lowering risk of falls, and improving gait speed in older adults.
Objectives
While extant research indicates an inverse association between self-compassion and mindfulness with non-suicidal self-injury (NSSI) and suicidal thoughts and behaviors (STBs), estimates of magnitude remain unknown. The present systematic review and meta-analysis aim to quantify the relationship between self-compassion and mindfulness with engagement in NSSI and STBs.
Methods
Literature searches in four electronic databases (PsycINFO, MEDLINE, Scopus, ProQuest Dissertations, and Theses Global) were conducted. Effect sizes were estimated using pooled correlation coefficients and a random effects model. Meta-regressions with mixed-effect models were used to determine the moderators of the associations.
Results
Sixty-eight independent samples from 62 different articles (N = 53,797) met inclusion criteria. Analyses yielded a medium negative correlation between self-compassion and mindfulness with both NSSI and STBs. Among mindfulness facets, the nonjudging, acting with awareness, and describing facets demonstrated the largest significant correlations with both STBs and NSSI. The self-coldness dimension (vs self-warmth dimension) of self-compassion demonstrated the largest correlation to STBs. There was a stronger negative correlation between self-compassion and mindfulness with engagement in NSSI and STBs in adolescent samples (than in clinical and college student samples) and with STBs’ recency (reported within the past 12 months vs lifetime). Associations between NSSI and STBs with self-compassion and mindfulness were greater in lower-quality studies and studies with younger or male samples, although effect sizes remained modest.
Conclusions
Findings suggest that self-compassion and mindfulness may buffer against NSSI and STBs. Future study regarding the efficacy and effectiveness of self-compassion and mindfulness-based interventions among NSSI and STB populations is warranted.
Meta-analysis registration
PROSPERO CRD42020167823.
Objective Suicide attempts represent a crucial problem for public health services. The
aim of this study was to determine the demographic and characteristics of patients with
attempted suicide presenting to Chiang Rai Prachanukroh Hospital.
Methods A cross-sectional, retrospective study was conducted including all episodes
of attempted suicide attending the emergency department of the hospital from January
2012 to December 2016. Data was collected from the hospital information system, patient medical records, self-harm surveillance registration forms, counselling record forms and death certifi cates.
Results A total of 1,376 suicide attempt presentations were made to the emergency
department by 1,339 individuals. 619 cases were population from capital district (amphoe
mueang) of Chiang Rai and 757 cases were referred from other hospitals. The mortality
rate of study participants was 13.1%, with 116 death (64.4%) from paraquat ingestion.
Analysis of cases within the capital district revealed the mean age of 30.6 years (SD 14.6)
and the largest numbers by age groups were 15-24 year-old (40.7%). The female-to-male
ratio was 1.5:1. The most common method used in female was drug overdose (47.2%),
mainly with paracetamol, whereas men more commonly ingested pesticides (28.2%). Men
had higher rates of hospital admission and mortality than women. 28.2% of patients
suffered from adjustment disorder and 13.1% of them were diagnosed with depressive
disorders. The most frequently reported reason for attempting suicide was family/interpersonal problems (63%).
Conclusion Suicide attempts were prevalent in adolescents aged 15-24 years. The findings suggest a link with impulsivity together with family and relationship problems. Positive coping skills, good social relationships and support for these vulnerable individuals should be promoted.
Introduction:
Suicide is the second leading cause of death in the ages 15-29 worldwide, exceeded only by road injury. However, fatalities in road traffic may be either accidents or suicides. In 2010 Sweden began efforts to separately report deaths in road traffic as either accidents or suicides.
Method:
Three alternative criteria defining what constitutes a fatality by suicide were introduced. After exclusion of natural deaths, fatalities were also classified on a five-level graded scale, which distinguished between accident, undetermined, and suicide. The investigations of fatalities were complemented by extended psychosocial investigations in 2012. The improvement in the classification of suicide deaths was evaluated by an intra-year 2012 comparison, as well as using the 2010-2012 period as a control to evaluate the continued use of extended psychosocial investigations during the 2013-2019 period.
Results:
The 2012 intra-year comparison showed a 63% increase in the number of identified suicides when using extended psychosocial investigations. The additional 14 suicides identified in 2012 were mainly attributed to a resolution of 12 "undetermined" causes of deaths. Suicides of all road fatalities increased from 5.7-6.8% in 2010-2011, to 11.2% in 2012. Over the subsequent period 2013-2019 with extended psychosocial investigations, suicides of all road fatalities averaged 10%, a 60% increase over prior years. An average of ∼9 additional suicides was identified each year during 2013-2019, which was accompanied by an annual reduction of ∼6 "undetermined" fatalities.
Conclusion:
The use of extended psychosocial investigations is of major importance for our knowledge about the occurrence of suicides in road traffic. Practical applications: A standardized and in-depth classification of suicide deaths is a basic prerequisite needed for the cooperation, implementation, and effect-evaluations of suicide intervention and prevention efforts, with potential to include the entire Swedish transportation system.
The above statement is of a well-known researcher of the subject of suicide. Suicide points to consider the phenomenon of various perspectives: philosophical, theological , sociological, clinical, psychological, and psycho-pedagogical. The choice of this direction of analysis depends on the theoretical and methodological assumptions adopted by the researcher. My study, focus on psycho-pedagogical. I will try to combine the phenomenon of suicide with the so-called "Young people with difficulties." My analysis will be carried out in the area of bio-psycho-ecological theory, which allows me to approach this subject in a multidimensional way, because I am of the opinion of multidimensional approach brings the best results.
Warto pamiętać, że ludzie nie zabijają się dlatego, że nie chcą żyć. Raczej dlatego, że nie wiedzą, jak dalej żyć(Brunon Hołyst)
Powyższe stwierdzenie znanego badacza problematyki samobójstw pozwala na rozpatrywanie tego zjawiska z różnych perspektyw: filozoficzno-teologicznej, socjologicznej, klinicznej, psychologicznej, i psychopedagogicznej. Wybór
kierunku analizy zależy od przyjętych przez badacza założeń teoretycznych i metodologicznych. W moim opracowaniu uprzywilejowanym kierunkiem rozważań
będzie ten ostatni, czyli psychopedagogiczny.
Spróbuję połączyć zjawisko samobójstwa z problematyką tzw. „młodzieży
z trudnościami” (potocznie określanej „młodzieżą trudną”). Moja analiza przebiegać będzie przez obszar teorii biopsychoekologicznej, która pozwala mi na
wielowymiarowe podejście do tej tematyki, gdyż uważam, iż taką ona właśnie jest.
All aspects of illness and healthcare are mediated by language: experiences of illness, death and healthcare provision are talked and written about (face-to-face or online), while medical consultations, research interviews, public health communications and even some diagnostic instruments are all inherently linguistic in nature. How we talk to, about and for each other in such a sensitive context has consequences for our relationships, our sense of self, how we understand and reason about our health, as well as for the quality care we receive. Yet, linguistic analysis has been conspicuously absent from the mainstream of medical education, health communication training and even the medical or health humanities.
The chapters in this volume bring together applied linguistic work using discourse analysis, corpus methods, conversation analysis, metaphor analysis, cognitive linguistics, multiculturalism research, interactional sociolinguistics, narrative analysis, and (im)politeness to make sense of a variety of international healthcare contexts and situations. These include:
-clinician-patient interactions
-receptionist-patient interactions
-online support forums
-online counselling
-public health communication
-media representations
-medical accounts
-diagnostic tools and definitions
-research interviews with doctors and patients
The volume demonstrates how linguistic analysis can not only improve understandings of the lived-experience of different illnesses, but also has implications for communications training, disease prevention, treatment and self-management, the effectiveness of public health messaging, access to appropriate care, professional mobility and professional terminology, among others..
Background: The absence of agreed-upon terminology, definitions, and operational classifications has hampered research in the field of suicidology for many decades. Aims and Method: We systematically reviewed contemporary classifications of suicidal behavior using the scope of the classification (comprehensive vs. restricted or single behaviors), and the presence or absence of a classification scheme and an operational definition of intent as features to enable analysis and comparison. Results: A chronological perspective shows that classification systems tend to be more and more precise and operational for clinical and research field work. However, on an international level, the development of classifications appears to precede the establishment of agreed-upon definitions and terms to describe suicidal behavior. Limitations: The review was conducted in English only. Conclusion: Universal agreement on definitions and terms for suicidal behavior should precede the development of classifications.
Background:
The desire for hastened death or wish to hasten death (WTHD) that is experienced by some patients with advanced illness is a complex phenomenon for which no widely accepted definition exists. This lack of a common conceptualization hinders understanding and cooperation between clinicians and researchers. The aim of this study was to develop an internationally agreed definition of the WTHD.
Methods:
Following an exhaustive literature review, a modified nominal group process and an international, modified Delphi process were carried out. The nominal group served to produce a preliminary definition that was then subjected to a Delphi process in which 24 experts from 19 institutions from Europe, Canada and the USA participated. Delphi responses and comments were analysed using a pre-established strategy.
Findings:
All 24 experts completed the three rounds of the Delphi process, and all the proposed statements achieved at least 79% agreement. Key concepts in the final definition include the WTHD as a reaction to suffering, the fact that such a wish is not always expressed spontaneously, and the need to distinguish the WTHD from the acceptance of impending death or from a wish to die naturally, although preferably soon. The proposed definition also makes reference to possible factors related to the WTHD.
Conclusions:
This international consensus definition of the WTHD should make it easier for clinicians and researchers to share their knowledge. This would foster an improved understanding of the phenomenon and help in developing strategies for early therapeutic intervention.
Systematic reviews and meta-analyses have become increasingly important in health care. Clinicians read them to keep up to date with their field [1],[2], and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research [3], and some health care journals are moving in this direction [4]. As with all research, the value of a systematic review depends on what was done, what was found, and the clarity of reporting. As with other publications, the reporting quality of systematic reviews varies, limiting readers' ability to assess the strengths and weaknesses of those reviews.
Several early studies evaluated the quality of review reports. In 1987, Mulrow examined 50 review articles published in four leading medical journals in 1985 and 1986 and found that none met all eight explicit scientific criteria, such as a quality assessment of included studies [5]. In 1987, Sacks and colleagues [6] evaluated the adequacy of reporting of 83 meta-analyses on 23 characteristics in six domains. Reporting was generally poor; between one and 14 characteristics were adequately reported (mean = 7.7; standard deviation = 2.7). A 1996 update of this study found little improvement [7].
In 1996, to address the suboptimal reporting of meta-analyses, an international group developed a guidance called the QUOROM Statement (QUality Of Reporting Of Meta-analyses), which focused on the reporting of meta-analyses of randomized controlled trials [8]. In this article, we summarize a revision of these guidelines, renamed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), which have been updated to address several conceptual and practical advances in the science of systematic reviews (Box 1).
Box 1: Conceptual Issues in the Evolution from QUOROM to PRISMA
Completing a Systematic Review Is an Iterative Process
The conduct of a systematic review depends heavily on the scope and quality of included studies: thus systematic reviewers may need to modify their original review protocol during its conduct. Any systematic review reporting guideline should recommend that such changes can be reported and explained without suggesting that they are inappropriate. The PRISMA Statement (Items 5, 11, 16, and 23) acknowledges this iterative process. Aside from Cochrane reviews, all of which should have a protocol, only about 10% of systematic reviewers report working from a protocol [22]. Without a protocol that is publicly accessible, it is difficult to judge between appropriate and inappropriate modifications.
Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users.
Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement—a reporting guideline published in 1999—there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions.
The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
Intimate Partner Violence Surveillance: Uniform Definitions and Recommended Data Elements, Version 1.0 is a set of recommendations designed to promote consistency in
the use of terminology and data collection related to intimate partner violence. This document was developed through an extensive consultation process. It is published by the National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention.
It appears that the attitudes of health professionals differ towards suicide and voluntary active euthanasia. An acceptance of, if not an agreement with, voluntary active eutha nasia exists, while there is a general consensus that suicide should be prevented.
This paper searches for a working definition of suicide, to discover ethical reasons for the negative value that suicide assumes, and also to provide a term of reference when comparing suicide with euthanasia.
On arriving at a working definition of suicide, it is compared with voluntary active euthanasia. An analysis of utilitarian and deontological considerations is provided and proves to be inconclusive with respect to the ethical principles informing the attitudes of professionals. Therefore, a search for other influences is attempted; this indicates that psychological influences inform attitudes to a greater degree than ethical principles.
Based on the experience matured during the 15 years of the WHO/EURO Multicentre Study on Suicidal Behavior, this paper provides an excursus on main elements that characterize components for definitional needs. It describes the rationale for choosing the initial set of definitions within the study and the subsequent problems and developments. As a result, unifying terminologies are proposed.
Addressing the lack of comparability of research results around the world, a systematic literature review of existing nomenclatures was conducted. After distinguishing the concepts of nomenclature and classification, 13 contributions to nomenclature of suicidal behavior are described and summarized using outcome and intent as guiding concepts for analysis. The issue of what is being defined in nomenclatures is fundamental and impacts the way intent and outcome are used. The existing confusion between classification and nomenclature stems from conflicting purposes of the nature of definition; that is, to communicate concepts versus to be descriptive of reality.
There is no internationally agreed-upon set of terms, definitions, or classifications for the range of thoughts, communications and behaviours that are related to self-injurious behaviours, with or without the intent to die. Nor is there an agreed taxonomy that encompasses the full spectrum of what is clinically defined as suicide-related behaviours. The suicide literature remains replete with confusing (and sometimes derogatory or pejorative) terms, definitions, descriptors, and classifications that make it difficult, if not impossible, to compare and contrast different research studies, clinical reports or epidemiological surveys, or to make comparisons, generalisations or extrapolations. This chapter will briefly review these issues from a historical perspective and highlight some of the more contentious and confusing terminologies and definitional obfuscations that are currently being used, including distinctions between and among parasuicide, non-suicidal self-injury and deliberate self-harm. The chapter will present some of the current efforts to improve our ability to communicate clearly, consistently and confidently about those elements that define the suicidal state – ideations, emotions, and behaviours. Key questions and challenges for the future – and their relevance for the advancement of suicide prevention – are presented. Recommendations are made as to next steps in the process of developing and implementing a standardised nomenclature and classification system for the field of suicidology.
Suicide is devastating. It is an assault on our ideas of what living is about. In Contemplating Suicide Gavin Fairbairn takes fresh look at suicidal self harm. His view is distinctive in not emphasising external facts: the presence or absence of a corpse, along with evidence that the person who has become a corpse, intended to do so. It emphasises the intentions that the person had in acting, rather than the consequences that follow from those actions. Much of the book is devoted to an attempt to construct a natural history of suicidal self harm and to examine some of the ethical issues that it raises. Fairbairn sets his philosophical reflections against a background of practical experience in the caring professions and uses a storytelling approach in offering a critique of the current language of self harm along with some new ways of thinking. Among other things he offers cogent reasons for abandoning the mindless use of terms such as attempted suicide and parasuicide , and introduces a number of new terms including cosmic roulette , which he uses to describe a family of human acts in which people gamble with their lives. By elaborating a richer model of suicidal self harm than most philosophers and most practitioners of caring professions currently inhabit, Fairbairn has contributed to the development of understanding in this area. Among other things a richer model and vocabulary may reduce the likelihood that those who come into contact with suicidal self harm, will believe that familiarity with the physical facts of the matter - the actions of the suicider and the presence or absence of a corpse - is always sufficient to justify a definite conclusion about the nature of the self harming act.
The most common view of suicide today is that it is intentional self-killing.1 Because of the self-killing component, suicide is often described as self-inflicted death or as dying by one's own hand, and the victim is in turn often described as having done himself to death or as having taken his own life. But must one's death be self-inflicted in order to be suicide? The answer, I want to suggest, is arguably no.
In this article I defend a new definition of what it is to commit suicide:
(D) A commits suicide by performing an act x if and only if A intends that he or she kill himself or herself by performing x (under the description ‘I kill myself’), and this intention is fully satisfied.
The definition has some surprising implications: various real-life examples often referred to as ‘suicides’ (e.g. ‘suicide bombers’) may well turn out not to be suicides after all.1
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)
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.
Information obtained at interview from 1,646 parasuicide patients in 14 regions in 13 European countries participating in the WHO/EURO Multicentre Study on Suicidal Behaviour was used to study self-reported intentions involved in parasuicide. Comparisons were made across cultures, genders, and age groups. Although some statistically significant differences were found, the effect sizes were very small. The main finding from this study is thus that parasuicide patients in different countries tend to indicate that similar types of intentions are involved in their acts of parasuicide, and that the intentions do not vary greatly with gender or age. The hypothesis that rates of suicide and parasuicide vary between regions with the frequency with which suicidal intention is indicated by the patients was also tested, but was supported only for women and in relation to national suicide rates. The findings from this study are likely to be generalizable to other settings and have implications for clinical practice.
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)
The confusing and inconsistent employment of the terms intentions and motives in the literature of suicidology is exemplified and discussed. It is concluded that when nonfatal suicidal acts are explained in terms of something the patients wanted to achieve by the act (which mainly is the case), whether it was to die or something else, the appropriate term will be intention(s), not motive(s).
Suicide is an important public health problem for which we have an inadequate public health database. In the United States, decisions about whether deaths are listed as suicides on death certificates are usually made by a coroner or medical examiner. These certification decisions are frequently marked by a lack of consistency and clarity, and laws and procedures for guiding these decisions vary from state to state and even from county to county.
Without explicit criteria to aid in this decision making, coroners or medical examiners may be more susceptible to pressures from families or communities not to certify specific deaths as suicide. In addition, coroners or medical examiners may certify similar deaths differently at different times. The degree to which suicides may be underreported or misclassified is unknown. This makes it impossible to estimate accurately the number of deaths by suicide, to identify risk factors, or to plan and evaluate preventive interventions.
To remedy these problems, a working group representing coroners, medical examiners, statisticians, and public health agencies developed operational criteria to assist in the determination of suicide. These criteria are based on a definition of suicide as “death arising from an act inflicted upon oneself with the intent to kill oneself.” The purpose of these criteria is to improve the validity and reliability of suicide statistics by: (1) promoting consistent and uniform classifications; (2) making the criteria for decision making in death certification explicit; (3) increasing the amount of information used in decision making; (4) aiding certifiers in exercising their professional judgment; and (5) establishing common standards of practice for the determination of suicide.
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.
Despite agreement across disciplines regarding the significance of deliberate self-harm (DSH), there continues to be a lack of consensus regarding what DSH is and is not. The purpose of this literature review was to determine the current state of understanding of this complex phenomenon.
There remains a problem of definitional ambiguity regarding DSH, and a definition derived from the literature is offered. Using Rodger's framework for the evolutionary approach to concept analysis, the attributes, antecedents, and consequences of DSH are developed.
Therapeutic approaches that are based on open-minded, non-judgmental listening and on harm minimization rather than abstinence may be more effective than current treatment approaches that forbid any form of DSH.
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