Challenges in preventing suicide

Emergency telepsychiatry

Telepsychiatry can be used in two kinds of psychiatric emergencies: one-time clinical events and public health situations associated with mass disaster. Emergency telepsychiatry delivered by videoconferencing has the potential to improve patient care in many settings. Although experience is limited, it has been found to be safe and effective, as well as satisfactory to both emergency department staff and the psychiatric patients treated. The development of comprehensive and standardized guidelines is necessary. There has been little use of acute telemedicine in disaster situations to date. However, telemedicine is becoming part of routine emergency medical response planning in many jurisdictions. Emergency telepsychiatry has the potential to reduce emergency department overcrowding, provide much needed care in rural areas and improve access to psychiatric care in the event of a natural or man-made disaster.

Suicide note themes and suicide prevention

OBJECTIVE

The aim was to determine if suicide note themes might inform suicide prevention strategies.

METHOD

The themes of 42 suicide notes from the Northern Ireland Suicide Study (major psychological autopsy study) were examined.

RESULTS

The commonest themes were "apology/shame" (74%), "love for those left behind" (60%), "life too much to bear" (48%), "instructions regarding practical affairs post-mortem" (36%), "hopelessness/nothing to live for" (21%) and "advice for those left behind" (21%). Notes of suicides with major unipolar depression were more likely than notes of suicides without major unipolar depression to contain the themes "instructions regarding practical affairs post-mortem" (67% versus 19%, p = 0.005) and "hopelessness/nothing to live for" (40% versus 11%, p = 0.049). Notes of suicides with a previous history of deliberate self-harm were less likely than notes of suicides without a history of deliberate self-harm to contain the theme "apology/shame" (58% versus 87%, p = 0.04). Notes of elderly suicides were more likely than non-elderly notes to contain the theme "burden to others" (40% versus 3%, p = 0.03).

CONCLUSIONS

The fact that three quarters of suicide notes contained the theme "apology/shame" suggests that the deceased may have welcomed alternative solutions for their predicaments. Scrutiny of suicide note themes in the light of previous research findings suggests that cognitive therapy techniques, especially problem solving, may have an important role to play in suicide prevention and that potential major unipolar depressive (possibly less impulsive) suicides, in particular, may provide fertile ground for therapeutic intervention (physical and psychological). Ideally all primary care doctors and mental health professionals working with (potentially) suicidal people should be familiar with basic cognitive therapy techniques, especially problem solving skills training.

Is suicide bereavement different? A reassessment of the literature

The question of whether suicide bereavement is different from mourning after other types of deaths has important theoretical and clinical implications. Some recent literature reviews have argued that the differences may be minimal. In contrast, this article suggests that suicide bereavement is distinct in three significant ways: the thematic content of the grief, the social processes surrounding the survivor, and the impact suicide has on family systems. In addition, problems in the methodology used to compare different bereavement experiences are addressed. Some clinical implications of these conclusions, including the need for homogeneous support groups, psychoeducational services, and family and social network interventions are also discussed.

Preventing suicide in women and men

A review of gender differences in the response to suicide prevention strategies suggests that they may be more effective in helping suicidal women than suicidal men. More attention needs to be given to the problem of directing these strategies to suicidal men.