Pathways to Suicide Among People With a Diagnosed Mental Illness in Victoria, Australia

"I haven't got a clue what policies are in place for this!": physiotherapy students' preparedness to deal with self-harm

OBJECTIVES

The prevalence of self-harm and the potential link with suicidal ideation highlights the need to prepare future physiotherapists to deal with the potentially catastrophic outcomes to which a lack of understanding in this area can lead. The aim of this research was to investigate if final year physiotherapy students felt prepared to assess risk of suicide or self-harm following patient disclosure, or showing signs of intention to harm themselves.

DESIGN

An interpretive phenomenological methodology (IPA) was implemented to aid in the understanding and interpretation of participants' own experiences. In conjunction with the overarching design, semi-structured interviews, via two focus groups, were used to explore participants' views.

SETTING

Focus groups were conducted via an online platform.

PARTICIPANTS

Purposive sampling was employed as a sampling method to recruit final year physiotherapy students. The final sample consisted of ten participants.

RESULTS

Four main themes were identified: Experiences of disclosure; Encountering mental health; Lack of mental health education, and Lack of knowledge regarding policy and procedure.

CONCLUSIONS

The findings highlight a deficit with regards to the preparedness of final year students in dealing with disclosure to self-harm. A lack of both formal education regarding mental illness and of practice experience in the field of mental health contribute to this. Therefore, a more rigorous and directed approach to education regarding mental illness is essential. Furthermore, involvement in mental health practice placements would allow for a greater level of experiential learning and understanding of the issues faced by those living with mental illness.

CONTRIBUTION OF THE PAPER

Contribution to the evidence: Contribution to knowledge.

Suicidal ideation in men during COVID-19: an examination of protective factors

BACKGROUND

Men account for three-quarters of all suicide deaths in many Western nations including Australia. Whilst extensive research has examined risk factors for suicidal ideation and behaviour in men, protective factors remain underexplored, particularly social support, resilience and coping behaviours. Such factors are important to examine particularly in the context of COVID-19, where enforced isolation (among other negative lifestyle effects) has created widespread risk for the development of suicidal ideation. This mixed-methods study aimed to examine associations of various protective factors with suicidal ideation in men, using data from an online survey conducted during the COVID-19 pandemic. In addition, we aimed to qualitatively investigate men's self-reported protective strategies when experiencing suicidal thoughts and behaviour.

METHODS

A convenience sample of 700 men (age M = 50.3 years; SD = 15.2 years) responded to an online survey including quantitative measures of suicidal ideation, planning and attempt, alongside employment and relationship status, coping, social support, resilience, and a qualitative free-text item gauging men's self-reported protective strategies. Multinomial logistic regression was applied to compare odds of sub-categories of suicide risk (ideation; planning) according to protective factors. Qualitative responses were analysed via thematic analysis.

RESULTS

Men in a relationship, and those lower in emotion-focused and avoidant coping reported lower odds of suicidal ideation. Maintaining employment throughout the pandemic was protective against suicidal ideation and planning; as was greater perceived social support from friends. Greater self-reported resilience was protective against suicidal ideation and planning. Qualitative analyses led to the development of two themes: coping and connecting, reflecting men's intra- and interpersonal management strategies; and sustaining selflessness, where men's imaginings of the collateral damage of their suicidal behaviour was protective against action on suicidal thoughts or plans.

CONCLUSIONS

Findings of this study speak to the nuanced roles of interpersonal connections, resilience and coping behaviours in protecting against suicidal ideation and planning in men. In addition, qualitative insights further cement men's identification with familial protector and/or provider roles as protective against suicidal action.

Fluid vulnerability theory as a framework for understanding the association between posttraumatic stress disorder and suicide: A narrative review

Suicide is a persistent issue in the United States and across the globe. A large body of published research shows that posttraumatic stress disorder (PTSD) increases the risk of suicidal ideation, suicidal behaviors, and death by suicide. However, the existing literature examining why that association might pertain is widely dispersed across disciplines (e.g., psychology, nursing) and lacks an integrative theoretical framework, making it difficult to conceptualize the current state of science in this area. Therefore, the primary aims of this narrative review were to (a) provide a comprehensive and interdisciplinary critique of the current state of knowledge regarding mechanisms that underlie the association between PTSD and suicide and (b) organize that knowledge according to a specified theoretical framework. The framework guiding this review is "fluid vulnerability theory," a diathesis-stress model of suicide that emphasizes the dynamic nature of suicide risk across cognitive, emotional, behavioral, and physiological domains. A summary of the findings, including patterns that emerged, gaps that remain, and recommendations for the advancement of science and practice in this area are addressed in this narrative review.