Do Patients Volunteer Their Life Weariness and Suicidal Ideations? A Sri Lankan Study

Tiredness of Life - Conceptualizing a Complex Phenomenon

A phenomenon referred to as 'tiredness of life' or 'weariness of life' appears in current discussions on the legitimacy of euthanasia for relatively healthy older adults as well as in research on suicidality more broadly. However, a consensus conceptualization of the phenomenon is lacking. In the current paper, we offer such a conceptualization by reviewing and integrating knowledge from terminology, available descriptions, and first qualitative findings. Boredom with life, aversion towards life, meaninglessness, and fatigue are identified as central components of the phenomenon. Per component, we describe how the component was identified, our definition of the component and its foundation in descriptions in the literature, and empirical studies on how the component relates to euthanasia requests and suicidality. Moreover, hypotheses on the structure of the phenomenon are outlined, such as on interactions among and the importance of the different components.

Older Adults Who Experience Their Lives to Be Completed and No Longer Worth Living: A Systematic Mini-Review Into Used Terminology, Definitions, and Interpretations

In the Netherlands and in Belgium, a political debate emerged regarding the possibility of euthanasia and assisted suicide (EAS) for older adults who experience their lives as completed and no longer worth living, despite being relatively healthy. This mini-review aimed to (1) present an overview of the terms used to denote this phenomenon as well as their definitions and to (2) explore how the underlying experiences are interpreted by the study authors. A systematic search was performed in Web of Science, MEDLINE, PsycINFO, and CINAHL, yielding 35 articles meeting the selection criteria. We selected empirical, English-language articles published in peer-reviewed journals. Participants had to have a first-person experience of the phenomenon or be assessed for it, or have a third-person experience of the phenomenon. Results show that the terms tiredness of life (ToL) and weariness of life (WoL) were used most frequently, also in the broader literature on suicidal expressions across the life span. Many studies mentioned operational definitions or synonyms rather than theoretical definitions. Moreover, inside the EAS debate, the term ToL was more common, its definition incorporated death wishes, and it was regularly framed existentially. Outside of this debate, the phenomenon was generally considered as a part of suicidal ideation distinct from death wishes, and its experience was often associated with underlying psychopathology. We discuss the need to establish consensus definitions and conclude that only a multidimensional view may be suitable to capture the complex nature of the phenomenon.

Genetic and other risk factors for suicidal ideation and the relationship with depression

BACKGROUND

There is a genetic contribution to the risk of suicide, but sparse prior research on the genetics of suicidal ideation.

METHODS

Active and passive suicidal ideation were assessed in a Sri Lankan population-based twin registry (n = 3906 twins) and a matched non-twin sample (n = 2016). Logistic regression models were used to examine associations with socio-demographic factors, environmental exposures and psychiatric symptoms. The heritability of suicidal ideation was assessed using structural equation modelling.

RESULTS

The lifetime prevalence of any suicidal ideation was 13.0% (11.7-14.3%) for men; 21.8% (20.3-23.2%) for women, with no significant difference between twins and non-twins. Factors that predicted suicidal ideation included female gender, termination of marital relationship, low education level, urban residence, losing a parent whilst young, low standard of living and stressful life events in the preceding 12 months. Suicidal ideation was strongly associated with depression, but also with abnormal fatigue and alcohol and tobacco use. The best fitting structural equation model indicated a substantial contribution from genetic factors (57%; CI 47-66) and from non-shared environmental factors (43%; CI 34-53) in both men and women. In women this genetic component was largely mediated through depression, but in men there was a significant heritable component to suicidal ideation that was independent of depression.

CONCLUSIONS

These are the first results to show a genetic contribution to suicidal ideation that is independent of depression outside of a high-income country. These phenomena may be generalizable, because previous research highlights similarities between the aetiology of mental disorders in Sri Lanka and higher-income countries.

The development and validation of the Peradeniya Depression Scale (PDS)--a culturally relevant tool for screening of depression in Sri Lanka

BACKGROUND

Cultural factors may influence the manner in which a given population interprets and conceptualizes their experience of depression. The aim of this study is to validate the Peradeniya Depression Scale (PDS), a locally created, culturally relevant tool for detection of depression in Sri Lanka.

METHOD

Fifty currently depressed patients (diagnosed via the Structured Clinical Interview for DSM Disorders) and 50 (non-depressed) controls were administered the PDS.

RESULTS

At a score of 10/25 the PDS showed a sensitivity 88.5% and specificity of 85.0% with regards to the detection of depression. Culturally appropriate statements, which referred to international criteria of depression and somatic symptoms, showed significantly higher odds of being positive in depressed patients compared to controls.

LIMITATIONS

The PDS was validated among an outpatient population presenting to a psychiatry clinic in a government hospital in Peradeniya, Sri Lanka. While this is fairly representative of patients presenting to government hospital clinics in this country, further multi-centre studies in different areas of the country maybe useful.

CONCLUSION

The PDS is the first screening tool for depression developed and validated in Sri Lanka, written in Sinhalese, taking into account cultural expressions and idioms of the illness. It shows satisfactory sensitivity and specificity as a screening tool for depression. The findings also suggest that it maybe worthwhile for Asian countries to consider adopting scales which are based on internationally accepted diagnostic criteria for depression, but which incorporate expressions that are more appropriate to their own culture and language.

Validation and normalization of the General Health Questionnaire 30 in parents with primary school children in China

OBJECTIVES

Parenting can be a stressful experience. Higher levels of parenting stress are predictive of parents' negative appraisal of children's behavior, the use of physical discipline, and poor child outcomes across a variety of domains. Assessment of parenting depression is needed in China. This study aims to standardize the Chinese version of the General Health Questionnaire (GHQ-30) for parents of primary school children.

METHOD

Stratified randomly selected parents of primary school children were selected from the cities of Nanjing and Shenyang in China. The Chinese version of the General Health Questionnaire 30 was administered to 7615 parents of primary school students aged between 8 and 12 years. A high response rate was achieved, with 6672 parents (88%) responding to the survey.

RESULTS

Exploratory factor analysis with a 5-factor solution showed that 5 factors were extracted from the scale, namely, depression, anxiety, inadequate coping, social dysfunctioning, and sleep disturbance. The 5-factor structures were confirmed by using confirmatory factor analysis (CFA). Overall, the 5-factor structure had a high level of reliability for each individual dimension. Confirmatory factor analysis showed that the 5-factor structure abstracted from this study had a good model fit.

CONCLUSIONS

The 5-factor structure derived from the present sample of parents, with good model fit in the CFA analysis, suggests that a 5-factor solution can be used to assess parent psychopathological symptoms in mainland Chinese parents of primary school children.

Reducing the scarcity in mental health research from low and middle income countries: a success story from Sri Lanka

There is an enormous inequity in global health as well as research. Less than 10% of research funds are spent on the diseases that account for 90% of the global disease burden. This case study of north-south, south-south collaborations in Sri Lanka is a classic example of the issues faced by mental health researchers in low and middle income countries (LMICs). In this paper, work carried out by the Institute of Psychiatry (IoP), King's College London and the Institute for Research and Development (IRD) partnership since 1997 in Sri Lanka is presented to show an example of a successful private research institution based in a LMIC as a product of south-south and north-south collaboration in mental health research. The evidence of scarcity of mental health research and resources is overwhelmingly abundant in the context of Sri Lanka. IRD-IoP partnership showcases a successful north-south partnership with equality and efficiency. It has moved beyond start-up phase and has become a sustainable initiative in terms of funding, collaboration, research output and policy impact. International funding agencies, academics, and other bodies need to address sustaining such initiatives as priorities in reducing scarcity and inequity in mental health research in developing countries.

Examining student perspectives on suicidal behaviour and its prevention in Sri Lanka

BACKGROUND

Suicidal behaviour, primarily through self-poisoning, is a major public health problem among youth in Sri Lanka.

METHODS

This article describes a qualitative study of student perspectives on suicidal behaviour and its prevention. Focus groups were held with students 17-20 years of age. A discussion of the perceived causes of suicidal behaviour provided the context for discussing prevention efforts.

CONCLUSION

Participants identified pathways to suicidal behaviour and emphasized experiential aspects and the variability of fatal intent. Suggestions for prevention tended to emphasize the strengthening of community-oriented actions in order to better realize lethal means restrictions.

Reaching for the bottle of pesticide--a cry for help. Self-inflicted poisonings in Sri Lanka

This long-term study in Sri Lanka explored the complexities behind self-inflicted pesticide poisonings by 166 Sri Lankans. Using or threatening to use pesticides for self-harm has become a response to stressful events and a powerful message towards a specific individual, or to the outside world in general, conveying misgiving, anger, sadness, hopelessness, frustration, or simply a way to manipulate a situation to one's own advantage. The effects of alcohol misuse are especially important in understanding self-harm at the community level in terms of the impact they have on the domestic environment. Also, issues around "love affairs," arranged marriages and domestic physical, sexual or psychological abuse in the domestic environment are referred to by many self-harmers or their relatives as a reason for ingesting poison. Clearly, easy access to lethal pesticides by impulsive individuals often living under economically or psychosocially stressful conditions, combined with insufficient treatment facilities and limited outreach programs, can be a deadly blend. A strategy aimed at reducing the availability of the most toxic pesticides and improving case management should be implemented, as it is likely to reduce death from pesticides although unlikely to impact on the number of episodes. Support to families plagued by domestic violence and male alcohol misuse is essential to improve the quality of life for the most vulnerable and to reduce the number of self-harm episodes in the long-term.