Helping Parents Cope with Suicide Threats: An Approach Based on Nonviolent Resistance

Experiences and needs of adult informal carers of adults at risk of suicide: A systematic review with mixed methods analysis

AIM

To systematically review and synthesize primary research on experiences and needs of adult informal caregivers of adults at risk of suicide.

DESIGN

Systematic review with a data-based convergent synthesis.

DATA SOURCES

MEDLINE, PsychINFO and CINAHL were searched in April 2022 and February 2023. English language research focusing on experiences of adult carers of adults was included.

METHODS

Articles were screened by title (n = 9077) and abstract (n = 132) with additional articles (n = 6) obtained via citation and hand searching. Thirty-one included studies were quality assessed using the Mixed Methods Appraisal Tool and study data were systematically extracted prior to thematic synthesis.

RESULTS

Five interconnected themes resulted: transitions; living with fear and uncertainty; changing relationships; interface with healthcare professionals and services; what carers need and want. Caring impacts mental, physical and social wellbeing. Relationships are affected in ways which might not be evident when caring for a minor. Repeated suicidal behaviour is particularly challenging with ongoing hypervigilance contributing to burden, burnout and interpersonal strain. Poor carer support exacerbates negative effects; carers need to feel informed, educated, involved and holistically supported.

CONCLUSION

Timely support for carers is essential. Interventions should address emotional responses, relational changes and effective care recipient support. Longitudinal research is required to understand effects of ongoing caring where there are multiple suicide attempts.

IMPLICATIONS

Nurses can provide carers with early support and information and longer term psychosocial interventions. If carers are adequately equipped and supported patient safety and wellbeing will be improved.

IMPACT

Findings of this systematic review include relational changes due to carer hypervigilance reducing autonomy and living with the possibility of suicide. Clinician awareness of the potential for relational shifts will help them prepare and support carers.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution.

"Turning back the clock": A positive strategy for changing unacceptable youth behavior

This paper describes "Turning back the clock" (TBC)-an innovative strategy addressing unacceptable or coercive youth behavior based on nonviolent principles, inspired by the nonviolent resistance movement (NVR)-also called connecting authority or caring authority (CA) approaches to guidance and supervision of parents and other adults. Variants of NVR/CA have been evaluated as effective in RCT and pre-post designs. TBC has not been evaluated regarding its effectiveness but shows promising usability in case studies. The aim of this description of the TBC strategy is to encourage development and testing of its usability on large scale to improve it and pave the way for effectiveness evaluations. The core of TBC is to create possibilities for improving behavior without delay by negotiating the social timeline narrative. This allows improvement through reenactment of events immediately after having said or done something unfortunate or unacceptable instead of waiting for the next comparable situation. Adults introduce the strategy by modeling it before youths are encouraged to improve their own misbehavior immediately without waiting for a later opportunity. Finally, adults declare that a set of unacceptable behaviors will be considered disqualifying to any request or demand, but that attempting again as if it had not happened can be a possibility: Using the TBC strategy. This declaration is intended to increase youth's interest in using TBC themselves, and with successful use reduce escalation of conflicts into coercion and threats.

The prevalence and correlates of suicidal behaviours (ideation, plan and attempt) among adolescents in senior high schools in Ghana

Suicide is recognised as the third leading cause of death among adolescents globally. There is however limited data on the prevalence and factors associated with suicide particularly in Ghana. To explore the prevalence and risk and protective factors associated with suicide in Ghana, a nationwide Global School-based Student Health Survey data collected among senior high school adolescents in Ghana was used. The prevalence of suicidal behaviours was 18.2%, 22.5% and 22.2% for suicidal ideation, suicidal plan and suicidal attempt respectively. In the final analysis, anxiety increases the odds of suicidal behaviour, even after controlling for other variables. Loneliness increases the odds of suicidal behaviour but after adjusting for other factors the odds remained for only suicidal plan. Being bullied, physically attacked, involved in a physical fight and food insecurity remained risk factors for suicidal behaviour (i.e. ideation, plan and attempt) after adjusting for other factors. Truancy was found as a risk factor for both suicidal ideation and plans but such effect diminished for suicidal plan after adjusting for other variables. Increasing number of close friends remained a risk factor for both suicidal plan and attempt but such effect diminished for suicidal ideation after adjusting for other variables. Parental understanding of adolescents’ problems and worries remained a significant protective factor for all the indices of suicidal behaviour after adjusting for other variables. Parental respect for privacy was protective of suicidal attempt but was not significant after adjusting for other variables. Early identification and intervention for at-risk adolescents in senior high schools, for example those experiencing different forms of physical abuse, drug and substance use and hunger can potentially reduce the prevalence of suicide among this population in Ghana.

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The study showed high prevalence of suicidal behaviour among school-going adolescents.

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Anxiety, loneliness, hunger, physical abuse, bullying and the lack of parental understanding were strongly related suicidal behaviour.

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Interventions for suicide prevention should take into consideration the school and family settings.

Nonviolent Resistance: Helping Caregivers Reduce Problematic Behaviors in Children and Adolescents

In this review, the principles of nonviolent resistance (NVR) and studies examining its acceptability and efficacy are reviewed. Originating in the sociopolitical field, NVR has been adapted for numerous settings including parents of youth with externalizing and other problems, foster parents, teachers and school personnel, and caregivers of psychiatric inpatients. NVR has also been applied to reduce accommodation of highly dependent adult children and to improve novice driving habits. The principles of NVR include refraining from violence, reducing escalation, utilizing outside support, and maintaining respect for the other.