Exploring suicide resilience experiences in Chinese youth after self-poisoning: A qualitative study

OBJECTIVE

This inquiry probes the suicide resilience experiences in suicide attempts by self-poisoning among Chinese youth. The study's goal is to provide healthcare professionals with critical insights to develop effective interventions that enhance suicide prevention measures and diminish the likelihood of subsequent attempts.

METHODS

Utilizing a qualitative phenomenological approach, we conducted semi-structured interviews with 12 youths (Mean age = 21.1 ± 2.8 years; n = 7 females) who survived suicide attempts by self-poisoning. Data analysis was performed using Colaizzi's seven-step method, a rigorous method entailing iterative reading for the extraction of key statements and the distillation of thematic essence.

RESULTS

Four primary themes with ten sub-themes were extracted: (1) New understanding of life (cherish life, and meaning of life), (2) Self-Reconciliation (self-acceptance, self-understanding, and self-openness), (3) Personal empowerment (increased self-reliance, increased responsibility, and increased emotional regulation), and (4) Life redesigning (faith in the future, and plan for the future).

CONCLUSIONS

The findings reveal a potential for psychological growth and beneficial transformation in youth following suicide attempts by self-poisoning. These insights advocate for the integration of positive psychology principles in therapeutic interventions for this demographic.

Protective and Risk Factors for Suicidal Behaviour in Self-Declared LGBTIQ+ Adolescents

BACKGROUND

Adolescents who identify as sexual minorities often face social stigmatisation, which can lead to increased adversity and a higher risk of suicidal behaviours. However, there are also protective factors that may promote resilience to these risk behaviours. This study aims to identify factors that predict resilience in sexual minority adolescents with high suicidal vulnerability.

METHODS

The study sample comprised 78 self-reported LGBTIQ+ adolescents aged between 13 and 18 years old (M = 16.11, SD = 1.56) who had previously attempted suicide. They completed several psychosocial instruments to measure risk and protective variables related to suicidal vulnerability.

RESULTS

Entrapment was found to be the most predictive risk variable for suicide attempts. However, protective variables promoting resilience were also found, such as adequate parental communication, life satisfaction, and cognitive reframing.

DISCUSSION

The findings related to prevention of suicide attempts are discussed and we highlight the urgent need to enhance certain internal and contextual protective factors to promote resilience in the face of suicidal vulnerability in certain clinical subpopulations exposed to highly adverse situations.

Developing a consensus of recovery from suicidal ideations and behaviours: A Delphi study with experts by experience

BACKGROUND

Understanding recovery in mental health has received significant attention and consequently, recovery has been incorporated into health policy across many countries in the Global North. In comparison, the concept of 'recovery' from suicidal thoughts and behaviours has received little attention. However, the few studies in this area appear to suggest that recovery is a complex and an idiosyncratic process with many contributing factors. This can present a challenge for clinicians and services seeking to become more recovery focused. Thus, it seems of importance to develop a consensus on how recovery from suicidal thoughts and behaviours is conceptualised.

AIM

The study aimed to use the Delphi design to establish a consensus of how recovery is defined by those with lived experience of suicidal thoughts and behaviours. The Delphi method draws on the expertise of a panel, often involving clinicians, researchers and lived experience experts to develop consensus over a topic by inviting them to rate the importance of, often a series of statements to a given topic area.

METHOD

Lived experience experts were asked to complete two rounds of questionnaires distributed online to capture their views on recovery.

RESULTS

A total of 196 individuals gave their views on the first round of the study and 97 gave their views on the second round. A final list of 110 statements was developed that 80% or more of participants defined as essential or important. Statements covered items that were important in defining, facilitation and hindering the process of recovery.

CONCLUSION

Findings are consistent with the wider literature that suggests that recovery is an idiosyncratic process, but with many commonly shared features. Here we also show that a comprehensive definition of recovery must include factors that hinder the process of recovery. Implications and recommendations for practice, policy development and future research are discussed.

Caring for a friend or family member who has experienced suicidal behaviour: A systematic review and qualitative synthesis

PURPOSE

Friends and family members can be important sources of support for people who are or have been suicidal. This review aimed to synthesise qualitative evidence regarding carers' perspectives of supporting someone who has experienced suicidal behaviour.

METHODS

Five electronic databases (Web of Science, CINAHL, PsychINFO, MEDLINE, and SocINDEX) were searched from inception to May 2022. Eligible qualitative studies were published in English and investigated the caring experiences of friends or family members of people who had experienced suicidal behaviour, defined as any form of suicidal ideation and/or attempts. Studies focused on non-suicidal self-injury or suicide bereavement were excluded. Data from 19 eligible studies were analysed using thematic synthesis.

RESULTS

Initial carer reactions to suicidal behaviour included profound anxiety and intensive monitoring for signs of increased suicide risk amongst those they supported. Carers also reported significant challenges with understanding how to provide effective interpersonal support following suicidal crises. Professional support was perceived to be most effective when provided in a timely, interpersonally sensitive and safety-focused manner. However, several studies detailed carers' difficulties accessing appropriate support and challenges managing their own distress.

CONCLUSIONS

Carers face significant challenges with knowing how to respond to suicidal behaviour, where to find appropriate help, and how to manage their own distress. Future research should seek to investigate the effectiveness of easily accessible methods of information provision and support tailored for carers of people who have experienced suicidal behaviour.

Exploring the role of religion in the recovery experiences of suicide attempt survivors in Ghana

BACKGROUND

Religion performs a doubled edged role in a suicide crisis. On the one hand, it elicits empathic responses towards suicidal persons. On the other, it condemns and shames them. Although there is evidence that religion promotes better health and general wellbeing, little attention has been given to its role in recovery, especially after a suicide attempt. The current study explored how religion facilitated recovery among suicide attempt survivors.

METHODS

Using a semi-structured interview guide, we interviewed suicide attempt survivors who had attended a psychiatric unit. Thematic analysis was used to analyse the data.

RESULTS

Ten suicide attempters were interviewed, six females and four males. Three major themes were identified: Reasons in context, Religion in the recovery process and Renewed commitment to religious rituals/practices.

CONCLUSIONS

The role of religion in suicide prevention as a resource, is a complex one. Suicide preventionists need to carefully guide and gauge their prevention efforts in context where religion is rife to provide suicide attempt survivors the most effective religious resource in their recovery trajectory.

Theoretical model of recovery following a suicidal episode (COURAGE): scoping review and narrative synthesis

BACKGROUND

Despite a significant need, there are currently no rigorously developed empirically based models for what personal recovery from a suicidal episode looks like.

AIMS

To develop a theoretical model of personal recovery after a suicidal episode, based on a comprehensive literature review and stakeholder feedback.

METHOD

A scoping review of all empirical studies on this topic was conducted, followed by a thematic analysis to create a preliminary framework. Consultation-based revisions were then made based on feedback from a stakeholder panel to develop the final theoretical model.

RESULTS

The final model comprised seven themes: choosing life, optimising identity, understanding oneself, rediscovering meaning, acceptance, growing connectedness and empowerment (acronym 'COURAGE'). Although there are some similarities between COURAGE and other models of personal recovery, there are components, such as 'choosing life' and 'understanding oneself', that are specific to recovery after an acute suicidal episode.

CONCLUSIONS

To our knowledge, this is the first study to use a comprehensive literature review with stakeholder feedback to develop a conceptual model of personal recovery after an acute suicidal episode. This model has important implications for both researchers and clinicians to consider. Looking ahead, COURAGE can inform the reconceptualisation of assessment, research and clinical care of individuals who have experienced a suicidal episode.

The meaning of life after a suicide attempt

INTRODUCTION

Understanding the meaning of life after a suicide attempt experience provides greater knowledge about the process of resignification, connections and commitment to life, which can be useful in different therapeutic approaches.

OBJECTIVE

Understand the meaning of life after a suicide attempt.

METHOD

Qualitative study with eight Brazilian adults assisted in mental health service. The data were collected in 2018 by semi-strutured interviews and group meetings that used artistic resources to facilitate expression.The Symbolic Interactionism was the theoretical reference used and the data were submitted to thematic analysis.

RESULTS

Three themes were identified: "Searches in the affective, relational and spiritual field" (manifestations of affection, zeal, understanding and welcome and seemed to increase the link and commitment to life, as well as the openness to resignify it); "Life and the constancy of impermanence" (life as an alternation between weakness and strength, crisis and well-being, problems and overcoming); and "Discoveries and relationship with one's own self" (a self previously self-destructive could be resigned as capable of overcoming, resisting and developing resilience).

CONCLUSIONS

The study provides important insights to be addressed in clinical practice, in the protocol design, institutional policies, as well as in the training of professionals.

Factors associated with symptoms of poor mental health among women factory workers in China's supply chain

OBJECTIVE

Foreign direct investment (FDI) to China has motivated increased labor migration to export processing zones (EPZs). Work environments with high occupational stress, such as production line jobs typical in EPZs, have been associated with adverse mental health symptoms.

METHODS

A cross-sectional survey that examined occupational stress and symptoms of poor mental health was implemented among Chinese women factory workers in three electronic factories in the Tianjin Economic-Technological Development Area. Symptoms of mental health measured in the survey were hopelessness, depression, not feeling useful or needed, and trouble concentrating. Crude and adjusted prevalence odds ratios and their 95% confidence intervals were calculated with logistic regression.

RESULTS

Responses were collected from 696 women factory workers. Participants were aged 18-56 years (mean 28 ± 5.8), 66% of whom were married and 25% of whom were migrants. Nearly 50% of participants reported at least one symptom of poor mental health. After adjusting for covariates associated with each outcome in the bivariate analysis, high job strain was associated with hopelessness (OR 2.68, 95% CI 1.58, 4.56), not feeling useful (OR 2.05, 95% CI 1.22, 3.43), and feeling depressed (OR 1.78, 95% CI 1.16, 2.72).

CONCLUSION

This study expands on the international body of research on the well-being of women working in the global supply chain and provides evidence on the associations between occupational stressors, migration, and social support on symptoms of poor mental health among women workers. Future research to better understand and improve psychological health and to prevent suicide among workers in China's factories is critical to improve the health of China's labor force.

Suicide resilience: A concept analysis

OBJECTIVE

Suicide resilience is gaining increasing attention from researchers because of its potential role in preventing suicide. However, it has not been clearly analyzed, and there are various meanings and terms regarding this issue. The purpose of this analysis, therefore, was to conceptualize the concept of suicide resilience.

METHODS

Walker and Avant's method of concept analysis was used to identify the antecedents, attributes, and consequences of suicide resilience. The literature was searched using PubMed, PsychINFO, Embase, Web of Science, CINAHL, CNKI, and WanFang databases with no limitation on publication date. The search included peer-reviewed journal articles and dissertations related to suicide resilience published in English or Chinese.

RESULTS

52 articles were identified to provide information for this concept analysis. Five defining attributes of suicide resilience were identified: social support, coping strategies, psychological capital, meaning in life, and sense of responsibility. Antecedents of suicide resilience were high suicide risk events, and consequences of suicide resilience were keeping vulnerable individuals stay away from or overcoming suicidality.

CONCLUSIONS

The result of the analysis provided a more clear definition of suicide resilience. The identified defining attributes, antecedents, and consequences can be further tested and used to develop potential interventions. Future research is needed and will help to advance our understanding of the scope.

Future Well-Being Among People Who Attempt Suicide and Survive: Research Recommendations

Over 48,000 people died by suicide in 2018 in the United States, and more than 25 times that number attempted suicide. Research on suicide has focused much more on risk factors and adverse outcomes than on protective factors and more healthy functioning. Consequently, little is known regarding relatively positive long-term psychological adaptation among people who attempt suicide and survive. We recommend inquiry into the phenomenon of long-term well-being after nonfatal suicide attempts, and we explain how this inquiry complements traditional risk research by (a) providing a more comprehensive understanding of the sequelae of suicide attempts, (b) identifying protective factors for potential use in interventions and prevention, and (c) contributing to knowledge and public education that reduce the stigma associated with suicide-related behaviors.

Gender Differences in Recovery Needs After a Suicide Attempt: A National Qualitative Study of US Military Veterans

BACKGROUND

Appropriate after-care for the estimated 1.4 million people with nonfatal suicide attempts each year in the United States is critical, yet little research has focused on recovery needs after an attempt and whether important gender differences in those needs may exist. In this study, we examined gender differences in recovery needs after a suicide attempt among a national sample of women and men veterans.

METHODS

We interviewed 25 women and 25 men veterans from Veterans Health Administration health care systems across the country. Purposive sampling was used to obtain a demographically and clinically diverse sample. Transcripts were analyzed using thematic analysis.

RESULTS

Although some recovery topics were similar between genders, the participants' primary recovery needs, or goals, differed by gender. Women focused on developing connections with others and wanted to increase their self-knowledge and self-worth. Men were focused on trying to live up to their ideal selves by living and doing "right." Men also wanted to feel like they were needed by others. Both women and men also wanted to feel a stronger sense of purpose in their lives.

CONCLUSIONS

Findings suggest that recovery needs among veterans after a nonfatal suicide attempt vary by gender: women may benefit more from psychoeducational approaches in group settings with other women, whereas men may benefit more from approaches that help them focus on making changes in their lives towards becoming their ideal selves.

Lived experience peer support programs for suicide prevention: a systematic scoping review

BACKGROUND

Peer-led support models have gained increasing popularity in suicide prevention. While previous reviews show positive effects of peer-led support for people with mental health problems and those bereaved by suicide, little is known about the types of lived experience peer support programs in suicide prevention and whether these are effective in improving the health and wellbeing of people at risk of suicide. The aim of this paper is to provide an overview of peer support programs that aim to reduce suicidality and are led by people with lived experience of suicide.

METHOD

We conducted a systematic scoping review, involving a search of three academic (Medline, PsycINFO, Embase) and selected grey literature databases (Google Scholar, WHO Clinical Trials Registry) for publications between 2000 and 2019. We also contacted suicide prevention experts and relevant internet sites to identify peer support programs that exist but have not been evaluated. The screening of records followed a systematic two-stage process in alignment with PRISMA guidelines.

RESULTS

We identified 8 records accounting for 7 programs focussed on peer-led support programs in suicide prevention. These programs employed a range of different designs and included a variety of settings (schools, communities, rural and online). Only 3 of the 7 programs contained data on effectiveness. With the small number of eligible programs the findings from this review are limited and must be interpreted with caution.

CONCLUSIONS

Despite the increased focus of policymakers on the importance of peer support programs in suicide prevention, our scoping review confirms an evidence gap in research knowledge regarding program design, implementation, and effectiveness. More rigour is required in reporting peer-led support initiatives to clarify the underlying definition of peer support and lived experience and to enhance our understanding of the types of current peer support programs available to those experiencing suicidality. Further, we need formal and high-quality evaluations of peer support suicide prevention programs led by people with lived experience to better understand their effectiveness on participant health across different settings and delivery modalities and to allow for comprehensive systematic reviews and meta-analysis in future.

The Presence and the Search Constructs of Meaning in Life in Suicidal Patients Attending a Psychiatric Emergency Department

Meaning in Life (MiL) is considered protective against suicidal behavior (SB). However, few studies specifically addressed the role of the constructs, "presence of MiL" and "search for MiL," and their dynamic interplay. In this cross-sectional study of patients with SB (N = 199) visiting a psychiatric Emergency Department for either suicidal ideation (SI) or suicide attempt (SA), we pursued the following objectives: 1) to explore the relationship between the two constructs; 2) to verify the protective value of presence of MiL on SB; and 3) to assess the influence of search for MiL on the relationship between presence of MiL and SI. The two constructs were found to be independent of one another. Higher presence of MiL was globally associated with lower SB levels, particularly SI. Search for MiL was not related to SB and did not moderate the relationship between presence of MiL and SI. In conclusion, formal support for the role of presence of MiL against SB in a psychiatric sample was demonstrated. These findings, with a view toward refinement of SB risk assessment and new psychotherapeutic approaches, may lead to an enrichment of the dialogue with suicidal patients to help alleviate their unbearable suffering. Our conclusions must be replicated in psychiatric clinical populations in settings other than a psychiatric ED and by using a longitudinal prospective and case-control study design.

"I think I am worth it. I can give up committing suicide": Pathways to recovery for Chinese-Canadian women with a history of suicidal behaviour

This qualitative study explored the experiences and patterns of recovery of Chinese-born women living in Canada with a history of suicidal behaviour. It explores a number of dimensions of recovery including clinical, existential, functional, physical, and social. The women described engaging in "survival" recovery in the short term and "thriving" recovery in the long term, with survival strategies extending into the thriving phase of recovery during their complex path to it. The survival recovery phase included accessing culturally sensitive mental health care and obtaining social and instrumental support to help ensure safety, manage stress, and treat psychiatric symptoms. The thriving phase of recovery was described as involving six components: developing an explanatory model with their health care provider; undertaking a process of narrative reflection and prioritizing self-care; engaging in interdisciplinary care team support; engaging the support of family and friends; exploring spiritual and existential supports; and creating goals for the future and a sense of mastery. Through these six avenues, the women began to experience a sense of self-efficacy and agency that improved their ability to cope with stress and pressure, leading to building a life with meaning. The interviews provided insights into how clinical care can be improved and how practitioners can implement a more recovery-oriented approach to practice.

Protective factors for older suicide attempters: Finding reasons and experiences to live

This paper describes the nature and scope of protective factors that give older people reasons and experiences to live following a suicide attempt. In order to understand more about what protective factors influenced them, we conducted a multiple-case study of seven older people who attempted suicide. The main category from the within-case analysis was the self. Between-case analysis identified four main categories: interpersonal relationships, meaningful activities and interests, community engagement, and involvement of mental health services staff. These findings offer valuable insight into the meanings behind the reasons and experiences that promote survival of older people following a suicide attempt.

Caring for the suicidal person: A Delphi study of what characterizes a recovery-oriented caring approach

More research is needed for supporting mental health nurses in their caring for suicidal individuals. This study aimed to describe what characterizes a recovery-oriented caring approach, and how this can be expressed through caring acts involving suicidal patients and their relatives. Delphi methodology was used, and research participants were recruited as experts by experience to explore a recovery-oriented caring approach in a dialogical process between the experts and the researchers. The results highlight that it is important to acknowledge the view of the uniqueness of each person and reflected understanding of each individual person and experience. The results also reveal that a recovery-oriented caring approach is characterized by a 'communicative togetherness'. This communicative togetherness is associated with enabling a nurturing and caring space for suicidal patients to really express themselves and to reach for their own resources. The recovery-oriented caring approach has thereby potential to facilitate a mutual understanding of the complexities of the patient's situation, and supports patients in influencing their care and regaining authority over their own lives. Accordingly, mental health nurses need to listen sensitively to what suicidal patients really say by acknowledging their lifeworlds and being open to individual variations of their recovery processes. This includes recognizing available and supportive relatives as capable of contributing to the patient's life project to continue living.

Development and Psychometric Testing of the Suicidal Recovery Ability Scale (SRAS) for Assessing Individuals Who Have Attempted Suicide

Assessing the recovery ability of individuals who have attempted suicide is crucial for psychiatric health nurses. The purpose of this study was to develop and test a psychometric Suicidal Recovery Ability Scale (SRAS). Confirmatory factor analysis (CFA) indicated that three subscales with 15 items best fit the data. The global SRAS score showed significant negative correlation with the Beck Hopelessness Scale (BHS) score. The Cronbach's α and test-retest reliability scores for the global SRAS and the subscales all exceeded 0.70. Nurses can use the SRAS to assess the recovery ability of individuals who have attempted suicide and provide proper care to help them.

Factors predicting recovery from suicide in attempted suicide patients

AIMS AND OBJECTIVES

The aim of this study was to explore the factors predicting suicide recovery and to provide guidance for healthcare professionals when caring for individuals who have attempted suicide.

BACKGROUND

The high rate of suicide is a global health problem. Suicide prevention has become an important issue in contemporary mental health. Most suicide research has focused on suicidal prevention and care. There is a lack of research on the factors predicting suicidal recovery.

DESIGN

A cross-sectional design was adopted.

METHODS

A correlational study with a purposive sample of 160 individuals from a suicide prevention centre in southern Taiwan was conducted. The questionnaires included the Brief Symptom Rating Scale-5, Suicidal Recovery Assessment Scale and Beck Hopelessness Scale. Descriptive statistics and linear regressions were used for the analysis.

RESULTS

The mean age of the participants was 40.2 years. Many participants were striving to make changes to create a more stable and fulfilling life, had an improved recovery from suicide and had a good ability to adapt or solve problems. The linear regression showed that the Beck Hopelessness Scale scores (ß = -.551, p < .001) and Brief Symptom Rating Scale-5 (ß = -.218, p = .003) and past suicidal behaviour (ß = -.145, p = .008) were significant predictors of individuals' recovery from suicide. They accounted for 57.1% of the variance.

CONCLUSIONS

Suicidal individuals who have a lower level of hopelessness, a better ability to cope with their mental condition and fewer past suicidal behaviours may better recover from suicide attempts.

RELEVANCE TO CLINICAL PRACTICE

The nurses could use the results of this study to predict recovery from suicide in patients with attempted suicide.

Reconnecting with oneself while struggling between life and death: The phenomenon of recovery as experienced by persons at risk of suicide

The body of knowledge regarding health and recovery as experienced by patients at risk of suicide is limited. More research is needed into the meaning of recovery and what strengthens the desire to live. The aim of this study was to describe the phenomenon of recovery in a context of nursing care as experienced by persons at risk of suicide. In line with a reflective lifeworld research approach, 14 patients from a psychiatric clinic in Sweden participated in phenomenon-oriented interviews. Data were analyzed to describe the essence of the phenomenon. The results reveal that the phenomenon of recovery means 'reconnecting with oneself while struggling between life and death'. Three meaning constituents emerged: being in an expressive space and giving voice to oneself, regaining dignity through nurturing connectedness, and finding a balance in the tension between life and death. In conclusion, the meaning of recovery is to experience the ability to manage one's own life. Professional caregivers need to acknowledge patients' lifeworlds, in a way that enable patients to experience themselves as capable of managing their own lives. Professional caregivers should also facilitate the involvement of supportive relatives.

Taking care of oneself by regaining control - a key to continue living four to five decades after a suicide attempt in severe depression

BACKGROUND

Depression is a strong risk factor for suicide and suicide attempt. Several studies have examined the pathway to suicide attempt, but few studies have considered aspects important for overcoming being suicidal. The aim of the present study was to examine personal strategies to continue living after a suicide attempt.

METHODS

A qualitative grounded theory approach was used. Thirteen former inpatients diagnosed with severe depression (1956-1969) participated in a follow-up 42-56 years after their last suicide attempt, which occurred between the ages of 21 and 45. They were interviewed on one occasion between June 2013 and January 2014, using semi-structured interviews.

RESULTS

The pathway to a suicide attempt was defined as 'being trapped in an overwhelming situation'. Three categories described the recovery process: 'coming under professional care', 'experiencing relief in the personal situation', and 'making a decision to continue living'. These categories emerged in a core category, labelled 'taking care of oneself by regaining control'. Overcoming being suicidal occurred regardless of recovering from depression.

CONCLUSION

In the very long-term course following a suicide attempt, the process of recovery is multi-dimensional and fluctuating, and includes appropriate treatment, connecting with others, decision making, and overcoming existential issues.

Experiences that inspire hope: Perspectives of suicidal patients

Background:

Suffering in a suicidal crisis includes feelings such as despair, loneliness, anxiety, fear, shame, guilt and hopelessness. This study highlights the experiences of patients in the aftermath of suicide attempts. The research question was, what do suicidal patients see as meaningful help in care and treatment situations?

Methodology:

The methodology is inspired by Gadamer’s hermeneutics, where the parts are understood in light of the whole, and the whole is understood in light of the parts. Qualitative interviews were employed.

Participants and research context:

A total of 10 persons, 4 women and 6 men 21–52 years old, were informed and asked to participate by specialists in psychology at two emergency psychiatric wards and by one crisis resolution team. Nine of the participants had experienced one or more suicide attempts using drugs and alcohol. Forced hospitalization prevented one of the 10 participants from attempting suicide.

Ethical considerations:

Before the participants signed an informed consent form, the interviewer met all participants to provide the written information, talking about the interview. A meeting to terminate contact was arranged after the participants had read their own interviews.

Findings:

Three themes were generated by the methodology we applied: (1) experiencing hope through encounters, (2) experiencing hope through the atmosphere of wisdom and (3) experiencing a ray of hope from taking back responsibility.

Discussion:

The findings are discussed in the light of Eriksson’s suffering theory and Lindström’s theory about psychiatric care, as well as earlier research and theories about suicidality.

Conclusion:

The study reinforces possibilities that hope in suicidal patients can be inspired in encounters with healthcare personnel and within caring cultures. Through dialogue and cooperation, patients’ safety and ability to cope with suffering is created and thereby the hope and will to struggle for life.

Suicide in older people: Revisioning new approaches

This discussion paper identifies and examines several tensions inherent in traditional approaches to understanding older people's suicide. Predicted future increases in the absolute number of elderly suicides are subject to careful interpretation due to the underreporting of suicides in older age groups. Furthermore, a significant number of studies of older people's death by suicide examine risk factors or a combination of risk factors in retrospect only, while current approaches to suicide prevention in the elderly place disproportionate emphasis on the identification and treatment of depression. Taken together, such tensions give rise to a monologic view of research and practice, ultimately limiting our potential for understanding older people's experience of suicide and suicidal behaviour. New approaches are necessary if we are to move beyond the current narrow focus that prevails. Fresh thinking, which draws on older people's experience of attempting to die by suicide, might offer critical insight into socially-constructed meanings attributed to suicide and suicidal behaviour by older people. Specifically, identification through research into the protective mechanisms that are relevant and available to older people who have been suicidal is urgently needed to effectively guide mental health nurses and health-care professionals in therapeutic engagement and intervention.

The healing process following a suicide attempt: context and intervening conditions

The purpose of this study was to explore the context and the intervening conditions that impacted on individuals' healing from a suicide attempt. Patients who had survived a suicide attempt (n=14) and their caregivers (n=6) were interviewed in this study. Findings revealed that the suicidal individuals who lived in a sheltered, friendly environment, and had support systems helped their suicidal healing process. Conversely, suicidal individuals who experienced negative aspects of self, family predicaments, environmental difficulties, and the re-emergence of stressors impeded their suicidal healing process. Consequently, health professionals need to promote healthy internal and external environments for suicidal individuals.