New Developments in the Understanding and Treatment of Suicidal Behaviour

Suicide

Suicide is a major mental health problem in the United States and an issue that significantly impacts the mental health treatment community. Although the suicide rate remains relatively stable, the discipline of counseling psychology has broadened in scope and work settings have diversified. Thus, counseling psychology trainees are increasingly exposed to suicidal clients. Despite this reality, research suggests that comprehensive, systematic training in suicidology in counseling psychology programs rarely occurs. One reason for this state of affairs may be that the suicide literature is spread across a variety of disciplines, making it difficult for educators and practitioners to stay informed about the knowledge base in suicidology. The purpose of this contribution, therefore, is to provide counseling psychology educators and practitioners with an overview of the field of suicidology as it applies to the training and practice of counseling psychology.

Intra-personal and extra-personal predictors of suicide attempts of South Korean adolescents

The purpose of this study was to explore significant variables predicting adolescent suicidal attempts. Socio-environmental variables such as gender, school record, school grade, school adaptation, and family intimacy together with intra-individual variables including depression, anxiety, delinquency, stress, and self-esteem were considered as candidates. Data from 1481 adolescents were collected from Korea National Youth Policy Institute. For statistical analyses, hierarchical logistic regression analysis was performed. Results of hierarchical logistic regression analysis showed that gender, school grade, depression, delinquent, stress, and family intimacy were significant predictors of suicidal attempts of adolescents. Among those, the most powerful predictor was depression, and the second was delinquency. Classification accuracy by the model of our study was 87.6%. Implications and limitations of present study and suggestions for future study were discussed.

When the solution is part of the problem: problem solving in elderly suicide attempters

OBJECTIVES

Depression, loss, and physical illness are associated with suicide in the elderly. However, the nature of individual vulnerability remains poorly understood. Poor problem solving has been suggested as a risk factor for suicide in younger adults. Unresolved problems may create an accumulation of stressors. Thus, those with perceived deficits in problem-solving ability may be predisposed to suicidal behavior. To test this hypothesis, we investigated whether elderly suicide attempters perceived their problem solving as deficient.

METHODS

Sixty-four individuals aged 60 and older participated in the study including depressed suicide attempters, depressed non-attempters, and non-depressed controls. The social problem solving inventory-revised: short-version was used to measure participants' perceived social problem solving, assessing both adaptive problem-solving dimensions (positive problem orientation and rational problem solving) and dysfunctional dimensions (negative problem orientation, impulsivity/carelessness, and avoidance).

RESULTS

Depressed elderly who had attempted suicide perceived their overall problem solving as deficient, compared to non-suicidal depressed and non-depressed elderly. Suicide attempters perceived their problems more negatively and approached them in a more impulsive manner. On rational problem solving and avoidant style sub-scales, suicide attempters did not differ from non-suicidal depressed. However, both depressed groups reported lower rational problem solving and higher avoidance compared to non-depressed controls.

CONCLUSIONS

A perception of life problems as threatening and unsolvable and an impulsive approach to problem solving appear to predispose vulnerable elderly to suicide attempts.

The Relationship Between Problem-Solving and Autobiographical Memory in Parasuicide Patients

The relationship between effectiveness of interpersonal problem-solving and specificity of autobiographical memory was examined for 35 patients admitted to an inner-city District General Hospital following a deliberate drug-overdose. The results replicated those of Evans, Williams, O'Loughlin and Howells (1992) in finding a significant correlation between ineffective problem-solving and the over-general retrieval of autobiographical memories, giving further support to the suggestion that an over-general memory database may underpin the problem-solving deficits characteristic of parasuicide patients. However, the correlation coefficient computed was notably lower than in the Evans et al. study and an attempt is made to explain this discrepancy on the basis of differences in the levels of psychopathology between the patients involved in each study.

A 20-year review of trends in deliberate self-harm in a British town, 1981-2000

BACKGROUND

It is important to identify trends in deliberate self-harm because of potential links both with complex mental health problems and with suicide itself, and because of its significant impact on resources in both mental health and acute health services.

METHOD

Patients presenting at the A&E department at Kidderminster General Hospital following an act of deliberate self-harm between the years 1981 and 2000 were assessed by the Parasuicide Counselling Group. These data were used to examine trends in deliberate self-harm and patient characteristics.

RESULTS

The 20-year study examined 4,474 episodes of deliberate self-harm in the Kidderminster district. Rates of deliberate self-harm were higher in females throughout, although the difference between the genders narrowed in the second half of the 1990s. In both males and females, the rate of deliberate self-harm was highest in those aged 15-24. Since the mid-1990s, there have been increases in the rate of deliberate self-harm in males aged 45-54 and in females aged 25-44. Rates were highest in males and females who were separated. Although the most common method of deliberate self-harm in both males and females was overdose, males used cutting and other methods of deliberate self-harm proportionally more than females. There was a relentless rise in paracetamol use until a decline at the end of the study period following the introduction of a restriction on sales. Alcohol use at the time of deliberate self-harm rose markedly in both genders. There was a significant increase in deliberate self-harm repetition in both males and females over the study period. In males and females, psychiatric involvement or admission increased in the 1990s compared to the 1980s.

CONCLUSIONS

Higher levels of deliberate self-harm repetition and psychiatric involvement suggest increasing pressures on health services and a continuing need to develop understanding of deliberate self-harm.

The Inventory of Altered Self-Capacities (IASC): a standardized measure of identity, affect regulation, and relationship disturbance

This article describes the Inventory of Altered Self-Capacities (IASC), a 63-item standardized measure of disturbed functioning in relation to self and others. The seven scales of the IASC are Interpersonal Conflicts, Idealization-Disillusionment, Abandonment Concerns, Identity Impairment, Susceptibility to Influence, Affect Dysregulation, and Tension Reduction Activities. The psychometric properties of the IASC were examined in general population, clinical, and university samples. The IASC was found to have internal consistency/reliability and validity in all three samples. Generally as predicted, IASC scales were associated with existing measures tapping borderline and antisocial personality features, depression, suicidality, substance abuse, somatization, and dysfunctional sexual behavior

Effective problem solving in suicide attempters depends on specific autobiographical recall

The relationship between over-general autobiographical memory and interpersonal problem solving was investigated by comparing a group of suicide attempters with a nonsuicidal psychiatric control group and a normal control group. Results showed that suicide attempters were more over-general in memory and displayed significantly poorer problem solving than the other two groups. Furthermore, suicide attempters who were more over-general displayed greater deficits in problem solving. It was concluded that effective problem solving in suicide attempters depends on specific autobiographical recall.

Developing A&E nursing responses to people who deliberately self-harm: the provision and evaluation of a series of reflective workshops

Accident & Emergency (A&E) departments and Medical Admission Units (MAUs) are an essential part of emergency mental health care in the UK. Deliberate self-harm and attempted suicide are particular challenges to nursing staff in such departments. Two registered mental nurses with experience of education facilitated a series of workshops with nurses from four A&E departments, two Minor Injuries Units and two MAUs. These were focused upon the assessment and management of deliberate self-harm and attempted suicide. During the workshops, participants provided systematic information on presentations of deliberate self-harm and attempted suicide, and on their professional responses to such presentations. These accounts provided invaluable information on deliberate self-harm and attempted suicide as seen by nursing staff in A&E and MAUs. Critical reflection upon nursing responses to these presentations revealed particular concerns nurses had relating to their experience with this client group which might inform future practice. Evaluation of the workshops indicated a subsequent decrease in work-related stress, which was probably a consequence of improved professional coping responses by the nurses concerned.

Suicide in the People's Republic of China categorized by age and gender: evidence of the influence of culture on suicide

Throughout the developed world suicide is predominantly associated with psychiatric disorders and substance misuse. The main social factors are age, as suicide increases with each decade, and gender, as suicide is more frequent among men than women, and proportionately more young men die than their female peers. An analysis of suicide in the People's Republic of China found that the profile was the opposite to that reported in the rest of the world, as more female subjects kill themselves than males, particularly younger women. Also, unlike the situation in other countries, suicide occurred more often in rural than in urban areas. It is argued that the Chinese data provide evidence of a greater cultural influence upon suicide rates than had previously been realized.

Affect instability in adults with a borderline personality disorder

This study describes the pattern of affect instability in adults with borderline personality disorder (BPD). Clinical histories and the Diagnostic Inventory for Borderlines were used to identify 3 groups: 1) BPD (N = 15), 2) Asymptomatic (N = 10), and 3) Non-BPD, Anorexia Nervosa Clinical Control (N = 4). An experience sampling procedure (Hormuth, 1986) was used to obtain 50 measures of affect over 10 days. The findings showed that BPD subjects experienced higher levels of unpleasant affects and greater short-term fluctuations in unpleasant affects than the asymptomatic subjects. However, BPD and asymptomatic subjects experienced more fluctuations in the pleasant affects than the AN subjects. These findings support the hypothesis that BPD is associated with a unique pattern of affect dysregulation.

The Strategy for Action on Farmers' Emotions (SAFE): working to address the mental health needs of the farming community

Within the United Kingdom farmers are considered to be the fourth highest occupation group at risk of committing suicide. However, the mental health needs of the farming community are currently poorly understood or addressed by mental health nurses and community mental health teams. This is unacceptable both in terms of the presented level of risk, and in the direction of the most recent mental health review, which suggests that mental health nurses have unique skills in identifying and responding to suicidal behaviour. By building upon the practice of the first author, this paper outlines the Strategy for Action on Farmers' Emotions (SAFE), which develops a comprehensive strategy to respond to the mental health needs of the farming community. Where it is applicable, it is vital that these needs are brought from the margins to the mainstream of policy and service provision. This paper suggests that this position will only be achieved once an increased understanding of farming life and culture is gained.

The specificity of autobiographical memory and imageability of the future

Three studies examined whether the specificity with which people retrieve episodes from their past determines the specificity with which they imagine the future. In the first study, suicidal patients and nondepressed controls generated autobiographical events and possible future events in response to cues. Suicidal subjects' memory and future responses were more generic, and specificity level for the past and the future was significantly correlated for both groups. In the second and third studies, the effect of experimental manipulation of retrieval style was examined by instructing subjects to retrieve specific events or summaries of events from their past (Experiment 2) or by giving high- or low-imageable words to cue memories (Experiment 3). Results showed that induction of a generic retrieval style reduced the specificity of images of the future. It is suggested that the association between memory retrieval and future imaging arises because the intermediate descriptions used in searching autobiographical memory are also used to generate images of possible events in the future.