Suicide: a literature review and its implications for nursing practice in Taiwan

[Relationships among Knowledge and Skills about Suicide Prevention, Attitudes toward Suicide, and Burnout of Suicide Prevention Work of Nurses at Mental Health Welfare Centers: A Mixed Methods Study]

PURPOSE

This study aimed to identify relationships among knowledge and skills about suicide prevention, attitudes toward suicide, and burnout of suicide prevention work of nurses at mental health welfare centers.

METHODS

An explanatory sequential mixed-method research was conducted. For the quantitative study, the subjects (nurses) were 133 nurses executing suicide prevention work. The data were analyzed using the SPSS 25.0 program. For the qualitative research, 13 nurses with high burnout scores were interviewed. The data were analyzed using theme analysis method.

RESULTS

Quantitative results showed the average burnout of suicide prevention work was 54.62 ± 12.51. The burnout of suicide prevention work had significant correlations with attitudes toward suicide (r = .30, p < .001) and suicide prevention skills (r = -.18, p = .037). Qualitative results showed six themes related to burnout of suicide prevention work. They were 'feeling a lack of confidence in one's suicide counselling skills', 'feeling of the limits of one's ability to cope with a suicide crisis','feeling regret for not being able to help the clients', 'being over-empathetic to the clients', 'Not being able to understand the clients because the subjects (nurses) opposes committing suicide', and 'thinking that the suicidal thoughts of suicide attempters do not improve'.

CONCLUSION

To reduce burnout of nurses' suicide prevention work at mental health welfare centers, there is a need to develop an educational program considering nurses' attitudes toward suicide and one to enhance their confidence in suicide prevention skills.

Patients' Experiences After Attempted Suicide: A Literature Review

The aim of this study has been to synthesize research on suicidal patients' experiences of the suicide process. A literature search was performed in CINAHL, PubMed, and PsycINFO, and the analysis of the 15 articles covered was based on meta-synthesis. Patients experience a wide variety of feelings regarding their situation during the suicide process, and these exist on two levels: they relate to the different aspects of care that the patients receive and the patients' need to communicate with others and regain hope. The patients in this study described the struggle to maintain hope when life became too difficult and their suffering despite a sense of security, and they sought to achieve emotional balance. A good understanding of how suicidal individuals live with and manage suicidal ideation, while maintaining hope is important for planning effective nursing care. Further research from the patient perspective is needed to further develop psychiatric care for people at risk of suicide.

Hopelessness and Loneliness Among Suicide Attempters in School-Based Samples of Taiwanese, Philippine and Thai Adolescents

The aim of this study was to assess the level of suicide attempts in three school-based samples of Southeast Asian adolescents (Taipei, Taiwan; the Philippines; Chiang Mai, Thailand) and determine whether adolescent suicide attempters score higher on measures of hopelessness and loneliness relative to nonattempters. It was hypothesized that hopelessness and loneliness would be related to suicide attempts, and that hopelessness would continue to be associated with suicide attempts when controlling for loneliness. The prevalence of suicide attempts across the three samples of Asian youth were not consistent with Taiwanese girls and boys as the most likely to have ever attempted suicide. As expected, results showed that suicide attempters (in past 12 months and ever) scored higher on hopelessness and loneliness than nonattempters across all three samples and for both genders. However, the statistical control of loneliness demonstrably weakened the association between suicide attempt behaviour and hopelessness across the samples and for both genders, and resulted in nonsignificant ANCOVA tests for some of the sample-gender groups. These results attest to the need for more research investigating connections between youth suicide attempts, hopelessness and loneliness in adolescent populations. Loneliness should be included as a potential determinant of youth suicidal behaviour in future research.

Understanding the attitudes of paramedics towards suicidal patients

Introduction: Since it is almost impossible to identify every suicidal person, the timely intervention of an emergency medical team is of the most importance for preventing suicide attempts. Yet its success depends not only on timely help, but also on the treatment of the suicidal individual, the quality of which is to a large degree determined by the attitudes of the paramedics to the suicide. Hence, this article addresses the issue of how Slovenian paramedics experience suicidal patients, or in other words, what their attitudes to suicidal patients are when treating them. Methods: This study is based on a descriptive qualitative method of empirical research, in which inductive analysis has been used. To collect the empirical material, semi-structured interviews with ten paramedics were conducted between December 2012 and January 2013. Results: Despite their professional conduct in working with suicidal patients, Slovenian paramedics often experience various unpleasant emotions while treating them. Although they show understanding, the paramedics are often caught in dilemma while treating suicidal patients, especially those that refuse help or are aggressive. During the treatment, the paramedics act according to their subjective risk assessment and previous work experience, yet they lack the expertise to work with suicidal patients, particularly communication skills. Discussion and conclusion: The attitude of the participants to suicidal patients is based primarily on the emotional aspect of their work. The research showed that a negative attitude may appear, but is not permanent. It appears only in certain conditions when caring for patients who are aggressive or threaten others and when the participants have not received help from other services.

Suicídio e internet: análise de resultados em ferramentas de busca

Embora seja ainda um assunto incipiente no Brasil, a mídia pode exercer influência sobre diferentes atitudes dos sujeitos e, especificamente, sobre suicídio. Este estudo buscou replicar, com adaptações, uma pesquisa inglesa sobre conteúdos relacionados ao suicídio acessados na internet. Foram utilizadas, em três sites de busca, doze expressões-chave, como por exemplo, suicídio; métodos de suicídio; suicídio indolor; suicídio rápido entre outras. Foram analisadas as dez primeiras indicações de cada pesquisa; retirando-se os resultados repetidos, a amostra foi composta por 209 sites. A análise do conteúdo das páginas eletr™nicas se pautou em 19 critérios de classificação, sendo os de maior frequência os sites acadêmicos; os de conteúdo religioso; o que retratam o suicídio em termos elegantes; e os sites mantidos por psicólogos ou profissionais de saúde. Como conclusão, observou-se que, diferente do descrito no artigo original, no Brasil não foram encontradas páginas com conteúdo pró-suicídio, promovendo, encorajando ou facilitando atos suicidas.

A suicide education programme for nurses to educate the family caregivers of suicidal individuals: a longitudinal study

Family members lack the ability to care for suicidal relatives. Nurses have a responsibility to improve family members' ability to care for their suicidal relatives. The aims of this study were to design a suicide education programme for nurses to educate family caregivers and to evaluate the longitudinal (12 months after the educational programme) effects of a suicide care education programme on the ability of families to care for suicidal relatives. A randomised controlled trial was conducted. The study population (n=61) was composed of the family caregivers of suicidal individuals. Several caregivers (n=26) were randomly allocated to an experimental group who attended a two-hour suicide care education programme, and the other caregivers (n=35) represented a control group who did not attend the education programme. All of the participants were given a questionnaire at baseline, 3 months, and 12 months during the period from 2009 to 2011. The results of the longitudinal effects of the suicide care education programme demonstrated that there were statistically significant differences after the educational programme as compared to before the programme with regard to "seeking assistance from resources" and the ability to care for those who were once suicidal. The longitudinal results of both groups showed that there was a significant difference in terms of "caring ability" at 12 months. The results of a multiple linear regression analysis indicated that evaluations performed at the three-month time point were able to effectively predict success in "seeking assistance from resources", "caring ability"; caring ability was also significantly improved among those who engaged in the educational programme at the 12-month time point. The suicide care education programme had long-term effects for family caregivers caring for their suicidal relatives. Nurses could employ this suicide care education programme to improve the ability of family caregivers to care for their suicidal relatives.

Sense of coherence and suicidality in suicide attempters: a prospective study

The usefulness of the Sense of Coherence (SOC) scale in the nursing setting is well-established, and an association between SOC and suicidality has been suggested. The aim was to test whether low SOC at index attempt is an independent predictor of suicidality at 2-month follow-up and of risk for repeat attempt. The study, which had a prospective cross-sectional design, included patients admitted to hospital after a suicide attempt. They were interviewed by means of Structured Clinical Interview for DSM-IV. Participants (n=155) completed the SOC scale and the Comprehensive Psychopathological Self-rating Scale for Affective Syndromes. Suicidality was rated with the Suicide Assessment Scale. Instruments were employed again at follow-up. Non-fatal/fatal repetition within 3 years was determined by review of hospital records. Low SOC at baseline predicted high suicidality at follow-up. The association remained after adjustment for major depression and affective symptom burden. Repeat attempts were made by 54 persons. Low baseline SOC was associated with repeat attempt, but the association did not remain after adjustment for major depression and symptom burden. Low SOC ratings could be a marker of risk for high suicidality in the aftermath of a suicide attempt. The SOC scale could be incorporated in nursing assessments of suicide attempters.

Development and evaluation of a guideline for nursing care of suicidal patients with schizophrenia

PURPOSE

The purpose of this study was to develop and test an evidence-based guideline that would support nursing care for suicidal patients with schizophrenia.

DESIGN AND METHODS

Systematic review of the literature and consultation of experts preceded completion of the guideline. Twenty-one nurses from two mental health institutions tested the guideline for feasibility in nursing practice.

FINDINGS

The guideline was found to support discussing suicidality with patients and assessing suicide risk. Participants endorsed implementation of the guideline in mental health care.

PRACTICE IMPLICATIONS

Nurses who care for patients with schizophrenia are advised to use this guideline as a foundation for their care.

Suicidal behavior in the Western Pacific region: characteristics and trends

Current knowledge of suicidal behavior in the Western Pacific region is relatively limited when compared to other areas of the world. This area is characterized by a wide diversity of social, economic, and cultural aspects that do not permit any homogenous reading of suicide phenomena. Data from countries of the region included in this article suggest the existence of important differences among nations in terms of gender, age, and methods of suicide, as well role of mental illness. In addition, the Western Pacific region appears to be affected by higher rates of suicide than other areas in the world, with signs of progressive worsening in recent years and worrying predictions for the next two decades. The Suicide Trends in At-Risk Territories (START) Study, initiated by the World Health Organization Regional Office in Manila, seeks to research the incidence of both fatal and nonfatal suicidal behavior in countries of the region and to implement interventions for suicide attempters. This ambitious project is expected to standardize data collection procedures and improve the knowledge cultural factors in suicide.