Gender roles, suicide attempts, and substance abuse

"I'm Not Afraid of Dying Because I've Got Nothing to Lose": Young Men in South Africa Talk About Nonfatal Suicidal Behavior

First-person narratives of suicidal behavior may provide novel insights into how individuals with lived experience of suicide understand and narrate their behavior. Our aim was to explore the narratives of young men hospitalized following nonfatal suicidal behavior (NFSB), in order to understand how young suicidal men construct and understand their actions. Data were collected via narrative interviews with 14 men (aged 18–34 years) admitted to hospital following an act of NFSB in Cape Town, South Africa. Narrative analysis was used to analyze the data. Two dominant narratives emerged in which participants drew on tropes of the “great escape” and “heroic resistance,” performing elements of hegemonic masculinity in the way they narrated their experiences. Participants position themselves as rational heroic agents and present their suicidal behavior as goal-directed action to solve problems, assert control, and enact resistance. This dominant narrative is incongruent with the mainstream biomedical account of suicide as a symptom of psychopathology. The young men also articulated two counter-narratives, in which they deny responsibility for their actions and position themselves as defeated, overpowered, wary, and unheroic. The findings lend support to the idea that there is not only one narrative of young men’s suicide, and that competing and contradictory narratives can be found even within a dominant hyper-masculine account of suicidal behavior. Gender-sensitive suicide prevention strategies should not assume that all men share a common understanding of suicide. Suicide can be enacted as both a performance of masculinity and as a resistance to hegemonic gender roles.

Regional cortical thickness and neuroticism across the lifespan

Neuroticism is associated with greater reactivity to stress and lifetime psychopathology. In the present study we examined the association between neuroticism and regional and total cortical thickness (CT) across the lifespan, accounting for gender. We also assessed interactions among these factors. 450 subjects between 19 and 80 years were included. Participants completed the International Personality Item Pool and a structural MRI scan. Total CT and the mean values of CT in five regions of interest were examined. We also investigated the interaction effect among age, gender and neuroticism on CT. There was no significant association between neuroticism and regional/total CT. A significant interaction between neuroticism, age, and gender on the thickness of the anterior cingulate was found. Women high in neuroticism showed a thinner anterior cingulate cortex than women low in neuroticism, with increasing age. In contrast, men high in neuroticism had a thicker anterior cingulate cortex compared to men low in neuroticism, with increasing age. Overall, high neuroticism was associated with differential cortical thickness in the anterior cingulate among men and women with increasing age.

Refining Suicide Prevention: a Narrative Review on Advances in Psychotherapeutic Tools

PURPOSE OF REVIEW

Since psychotherapies for suicide prevention are receiving increasing attention, our purpose was to evaluate the related literature [meta-analyses and reviews on their effect on suicidal outcomes (A), perspective reviews concerning specific socio-demographic and clinical features (B), original studies with particular interest (C)] published over the last 3 years.

RECENT FINDINGS

(A) Across different diagnoses, particularly, efficacious psychotherapies were cognitive behavioral therapy-based ones and interventions directly addressing suicidal thoughts and behaviors during the treatment. When the focus was restricted to specific diagnoses, results were different: for example, in borderline patients, dialectical behavior therapy and psychodynamic psychotherapies were the only efficacious interventions. (B) Family therapies for adolescents and treatments for elderly depressed patients with disability/cognitive impairment should be further developed. (C) General long-term effects seem to be present, but specific interventions and treatment duration should be considered. Results indicated the presence of a number of promising interventions.

The Mismeasure of Woman

Psychology, like society at large, continues to be baffled by the persistent belief that men and women differ in important psychological ways, in spite of countless studies that fail to demonstrate such differences or that capture them for only a brief moment. New approaches avoid the polarization of `male' and female' traits, emphasizing how and why these qualities change over the life span, across cultures and throughout history. To understand where the differences are, we must look to narrative, power, and the conditions of our lives.

Physical distress and relationship problems: exploring the psychosocial and intrapsychic world of suicidal geriatric patients

BACKGROUND

Suicide is a serious mental health problem in old age. Suicide ideation and life weariness are important psychopathological issues in geriatric medicine, although suicide ideation does not primarily depend on the severity of any physical disease. Despite these facts, insight into the internal psychological state of suicidal geriatric patients is still limited.

MATERIAL AND METHODS

This study examines intrapsychic and psychosocial issues in suicidal geriatric inpatients. A semistructured interview concerning suicide ideation in old age was used to interview 20 randomly chosen, acutely suicidal clinically geriatric inpatients aged 60 years and older. The control group comprised 20 nonsuicidal patients.

RESULTS

Hamilton Depression Scale 21 scores (HAMD 21; patient mean 17.3, control mean 6.1), suicidal ideation and psychiatric treatments differed significantly between the groups. In contrast to lifetime suicidal ideation, the discovery of a physical disease was the primary trigger for current suicidal ideation, followed by interactional conflicts. Patients would rather speak with family or friends than professionals about their suicidal ideation.

CONCLUSION

Suicidal ideation should be recognised as an important psychological problem in geriatric patients with interpersonal conflicts. Specific help and training for relatives is recommended.

Gender differences in mental disorders and suicidality in Europe: results from a large cross-sectional population-based study

INTRODUCTION

When evaluating gender differences in mental disorders and suicidality, specifically between European countries, studies are sparse and frequently hindered by methodological issues, such as the limited items evaluated and inconsistent sampling designs.

METHODS

In ten European countries participating in the World Mental Health Survey Initiative, lifetime internalizing and externalizing disorders and suicidality were assessed among 37,289 respondents. Disorders were classified using DMS-IV criteria. Odds ratios (OR) for gender differences were calculated using logistic regression, while trends across age-groups were tested via gender × age interaction.

RESULTS

Within countries, prevalence of any lifetime internalizing disorder ranged from 10.8% to 44.5% among women and 5.9% to 26.5% among men, with women having consistently higher odds than men (OR range: 1.52-2.73). Prevalence of any lifetime externalizing disorders ranged from 0.2% to 6.6% among women and 2.2% to 22.4% among men, with women having consistently lower odds than men (OR range: 0.05-0.35). Any lifetime suicide attempt was found in 0.8-5.4% of women and 0.3-2.4% of men, showing inconsistent relative gender-differences across countries (OR range: 0.77-4.72). Significant effects in gender OR across age-groups were not observed for any internalizing disorder or suicide attempt, yet were present for any externalizing disorder in France (p = 0.01), the Netherlands (p = 0.05), and Spain (p = 0.02).

LIMITATIONS

Mental disorders were assessed with the CIDI 3.0 and not psychiatric evaluations. Suicidality does not fully represent more important clinical events, such as suicide mortality.

CONCLUSIONS

Consistent across European countries, internalizing disorders are more common among women and externalizing disorders among men, whereas gender differences in suicidality varied.

The Cultural Meaning of Suicide: What Does That Mean?

Scholars sometimes stress that it is important to know the individual meaning of suicide and the cultural meaning of suicide, but the meaning of these terms remains unclear. The present article discusses this problem and suggests that the individual meaning of suicide is best based on the motives for suicide, while the cultural meaning of suicide is best rooted in the lay theories of suicide in which the members of cultures and subcultures believe.

Factors Associated with Repeated Suicide Attempts

Background: This study compares sociodemographic and clinical characteristics of 102 first-time hospital-treated suicide attempters (first-evers) with a group of 101 repeat suicide attempters (repeaters) consecutively admitted to a general hospital in Brazil, during the intake phase of the WHO Multisite Intervention Study on Suicidal Behaviors (SUPRE-MISS). Aims: To compare sociodemographic and clinical characteristics of first-time hospital-treated suicide attempters (first-evers) with a group of repeat suicide attempters (repeaters). Methods: A standardized interview and psychometric scales were administered to all patients. Results: Repetition was associated with being of female sex (OR = 2.7; 95% confidence interval (CI) = 1.2–6.2), a housewife (OR = 3.8; 95% CI = 1.2–11.8), and having a score above median on the Beck Depression Inventory (OR = 5.2; 95% CI = 1.7–15.6). Conclusions: The findings suggest that repeaters, namely, depressed housewives who have attempted suicide previously, need specific treatment strategies in order to avoid future suicide attempts.

Predictors of suicidal ideation among "at risk" cocaine-using African American women

The focus of this study was to identify factors that differentiate women drug abusers who had experienced suicidal ideation from those who did not. Face-to-face interviews were conducted with 221 cocaine-using women in Atlanta, GA, 88 (39.8%) of whom reported thinking about committing suicide at least once during the 90 days prior to interview and 133 (60.2%) of whom did not. Multivariate logistic regression was used to identify predictors of suicidal ideation, and post hoc goodness-of-fit tests were conducted to assess the robustness of final models derived. Model 1 excluded all psychosocial functioning measures and Model 2 included these items. Both models showed that suicidal ideation was more common among women who were unemployed, had been abused sexually, engaged in sexual relations to cope with stresses, or had less helpful relatives. In addition, Model 1 revealed a heightened risk for women experiencing financial problems and those who had a previous mental health diagnosis, whereas Model 2 showed an elevated risk among women who experienced anxiety and those who had lower levels of self-esteem. These findings suggest the need for prevention and intervention programs that target at-risk women, and for such programs to include an emphasis on suicidal ideation in addition to focusing on risk factors that are addressed more commonly.

Feminist conceptualizations of women's madness: a review of the literature

BACKGROUND

Gender is one aspect of an individual's identity that has been widely debated and discussed in relation to many different aspects of social life. The literature review explores how gender stereotypes affect women and their experience of mental illness. The aim is to demonstrate how a feminist perspective provides a useful lens through which women's experience of mental illness can be viewed.

METHODS

The papers were identified by a computerized search of the CINAHL, Medline, BIDS ISI and Mental Health Nursing Collection databases and a hand search. All papers were screened and subjected to critical review.

RESULTS

A theoretical framework was developed that reflected two key themes to emerge from the feminist literature on women and mental illness, namely psychiatry as a method of socially controlling women and the medicalization of women's unhappiness. In addition the complexities and contradictions in the feminist arguments are highlighted.

CONCLUSION

The paper concludes by considering the implications of the issues raised for nursing practice by drawing attention to the current debates on the need to focus on gender relations rather than just on women's issues.

Gender Differences in Attributions about Suicide and Alcohol Use

This research examined attributions that female and male college students made about an individual who committed suicide. The gender of the victim and whether alcohol use was involved were systematically varied. Results indicated that female and male respondents see the issues involved in suicide differently. Female respondents appear to place more emphasis on contextual clues such as alcohol use and gender of the actor. In addition, both female and male respondents tended to associate alcohol use and suicide for male actors but not for female actors. These results are discussed in terms of stereotypes that may be held for females and males vis-a-vis emotional expression and alcohol use. The use of population base rates in attributions about suicide and alcohol use is also considered. Directions for future research are also presented.

Covert and Overt Dependence in Suicidal Women and Their Male Partners

Dependence has traditionally been associated with suicidal behavior, especially in women. According to recent psychodynamic formulations, overt expression of dependence is influenced by covert mental representations and context-interactional variables. This study explored the covert mental representations and the interactional context of dependence in suicidal women and their male nonsuicidal partners. On the basis of theory, we hypothesized that suicidal women and their partners would have similar covert dependent needs, but opposite styles of dealing with these needs. The suicidal women would express these needs directly through overt dependent behavior while their partners would manifest their dependent needs indirectly through reinforcing dependent behavior in suicidal women. As predicted by theory, suicidal women and their partners were found to be similar in terms of covert dependence and different with regard to overt behavior—male partners tending to foster dependence in suicidal women. Contrary to prediction, most suicidal women did not directly express excessive dependence.

Challenges in preventing suicide

The success of traditional suicide prevention efforts is evaluated and found wanting. Some encouraging recent developments are noted, and it is suggested that suicidologists might also profitably consider the strategies used by professionals dealing with other public health and social problems, such as drug abuse and delinquency.

Substance use among Hungarian students

There is very little empirical data on drug and alcohol use among Hungarian adolescents. The purpose of this pilot project was to develop instrumentation and methods that could be used to assess legal and illegal substance use among Hungarian adolescents. A Hungarian translation of The American Drug and Alcohol Survey was developed and adapted to the unique circumstances of Hungarian patterns of use. This survey was tested with 234 students, 135 females and 99 males, from Grades 8 and 11 enrolled in public schools, in Györ, Hungary during 1991-1992. The students reported little or no substance use other than use of alcohol and tobacco. Older students were more likely than younger students to be involved with alcohol and cigarettes. Females and males were equally likely to try alcohol, but males were more likely to have been drunk than females. Despite the low reported use of substances other than alcohol and tobacco, students demonstrated attitudes toward drug use that may place them "at risk" for future use.

College women and alcohol: a relational perspective

Little attention has been paid to college women's drinking, partly because women drink less than college men do, partly because they are less likely to get into trouble with the authorities, and partly because women have only recently been understood to develop differently and to have different needs from those of men. Recent theories stress the importance of relationships in women's development, identity, and self-esteem and failures in mutuality and intimacy as contributing to subjective pain and dysfunction. These theoretical formulations suggest a new understanding for women's use of alcohol, one that emphasizes drinking as a way of being with others, of seeking acceptance from peers, and of numbing the pain that comes from relationships that do not work. Women are at greater risk of being abused when drinking, and women who have been sexually or physically abused are at greater risk for abusing alcohol.

Gender differences in completed and attempted suicides

Attempted suicides occur primarily among women, while completed suicides occur primarily among men. Risk factors for both attempted and completed suicides include mental and addictive disorders, disrupted family environments, and precipitating events. This article presents an overview of findings on gender differences from epidemiologic studies of completed and attempted suicides, with a focus on suicide attempts among women, and discusses possible reasons for gender differences in suicidal behaviors.