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Kabir H, Wayland S, Maple M. Qualitative research in suicidology: a systematic review of the literature of low-and middle-income countries. BMC Public Health 2023; 23:918. [PMID: 37208634 DOI: 10.1186/s12889-023-15767-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/26/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Suicide is more prevalent among disadvantaged, discriminated, and marginalised people with the majority of global suicide deaths occurring in the low-and middle-income countries (LMICs). This can be attributed to sociocultural contexts and exacerbated by access to limited resources and services that can assist with early identification, treatment, and support. Accurate information on the personal experiences of suicide is lacking, as many LMICs legislate that suicide is illegal. METHODS This study aims to review the qualitative literature to explore the experiences of suicide in LMICs from the first-person perspective. Following the PRISMA-2020 guidelines, the search for qualitative literature published between January 2010 and December 2021 was undertaken. A total number of 110 qualitative articles from 2569 primary studies met the inclusion criteria. Included records were appraised, extracted, and synthesised. RESULTS The results provide lived experience insight into suicide from those living in LMICs, including understanding variations of the causes of suicides, the impacts on others exposed to suicide, existing support systems, and prevention measures to reduce suicide among LMICs. The study offers a contemporaryunderstanding of how people in LMIC experience suicide. CONCLUSIONS The findings and recommendations are derived from the similarities and differences within the existing knowledge base that is dominated by evidence from high-income countries. Timely suggestions for future researchers, stakeholders, and policymakers are provided.
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Affiliation(s)
- Humayun Kabir
- Department of Sociology, University of Dhaka, 1000, Dhaka, Bangladesh.
- School of Health, Faculty of Medicine and Health, University of New England, 2351, Armidale, NSW, Australia.
| | - Sarah Wayland
- School of Health, Faculty of Medicine and Health, University of New England, 2351, Armidale, NSW, Australia
| | - Myfanwy Maple
- School of Health, Faculty of Medicine and Health, University of New England, 2351, Armidale, NSW, Australia
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Biermann M, Schulze A, Vonderlin R, Bohus M, Lyssenko L, Lis S. Shame, self-disgust, and envy: An experimental study on negative emotional response in borderline personality disorder during the confrontation with the own face. Front Psychiatry 2023; 14:1082785. [PMID: 36970260 PMCID: PMC10030617 DOI: 10.3389/fpsyt.2023.1082785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/13/2023] [Indexed: 03/10/2023] Open
Abstract
BackgroundA markedly negative self-image and pervasive shame proneness have consistently been associated with borderline personality disorder (BPD). The present experimental study investigated the intensity of negative emotional responses with a focus on shame in BPD compared to healthy control persons (HCs) during an experimental paradigm promoting self-awareness, self-reflection, and self-evaluation. Furthermore, the relationship between levels of state shame during the experiment and shame proneness in BPD compared to HCs was examined.MethodsA sample of 62 individuals with BPD and 47 HCs participated in the study. During the experimental paradigm, participants were presented with photos of (i) the own face, (ii) the face of a well-known person, and (iii) of an unknown person. They were asked to describe positive facets of these faces. Participants rated the intensity of negative emotions induced by the experimental task as well the pleasantness of the presented faces. Shame-proneness was assessed using the Test of the Self-Conscious Affect (TOSCA-3).ResultsIndividuals with BPD experienced significantly higher levels of negative emotions than HCs both before and during the experimental task. While HC participants responded to their own face particularly with an increase in shame compared to the other-referential condition, the BPD patients responded above all with a strong increase of disgust. Furthermore, the confrontation with an unknown or well-known face resulted in a strong increase of envy in BPD compared to HC. Individuals with BPD reported higher levels of shame-proneness than HCs. Higher levels of shame-proneness were related to higher levels of state shame during the experiment across all participants.ConclusionOur study is the first experimental study on negative emotional responses and its relationship to shame proneness in BPD compared to HC using the own face as a cue promoting self-awareness, self-reflection, and self-evaluation. Our data confirm a prominent role of shame when describing positive features of the own face, but they emphasize also disgust and envy as distinct emotional experience characterizing individuals with BPD when being confronted with the self.
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Affiliation(s)
- Miriam Biermann
- Department of Psychiatric and Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- *Correspondence: Miriam Biermann,
| | - Anna Schulze
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ruben Vonderlin
- Department of Psychiatric and Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Bohus
- Department of Psychiatric and Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Clinical Psychology, Ruhr University Bochum, Bochum, Germany
- McLean Hospital, Harvard Medical School, Boston, MA, United States
| | - Lisa Lyssenko
- Department of Public Health, Freiburg University of Education, Freiburg, Germany
| | - Stefanie Lis
- Department of Psychiatric and Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Szeto EH, Ammendola E, Starkey A, Hay J, McClung JG, Bryan CJ. Differences in Guilt, Shame, Self-Anger, and Suicide Cognitions Based on Recent Suicide Ideation and Lifetime Suicide Attempt History. J Nerv Ment Dis 2023; 211:226-232. [PMID: 36166283 DOI: 10.1097/nmd.0000000000001592] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Suicide risk factors such as hopelessness and psychiatric disorders can predict suicide ideation (SI) but cannot distinguish between those with SI and those who attempt suicide (SA). The fluid vulnerability theory of suicide posits that a person's activation of the suicidal mode is predicated on one's predisposition, triggers, and baseline/acute risks. This study compared guilt, shame, self-anger, and suicidal beliefs based on recent SI and lifetime SA. In a total of 2222 primary care patients in this cross-sectional, observational study reported no recent SI or lifetime SA (SI-SA-), 161 reported recent SI only (SI-SA+), 145 reported lifetime SA only (SI+SA-), and 56 reported both recent SI and lifetime SA (SI+SA+). Kruskal-Wallis test showed that the four risk factors were the highest for SI+SA+, followed by SI+SA-, then SI-SA+, and lastly SI-SA-. The study shows that risk factors may be worse in those with recent SI than those with SA history.
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Affiliation(s)
- Edwin H Szeto
- The Ohio State University Wexner Medical Center, Columbus, Ohio
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Manouchehri A, Marznaki ZH, Atim LM, Mohammadian amiri M, Kaggwa MM. The relationship between causes of suicidal attempts in Iran and individual and social variables: a retrospective study. BMC Psychiatry 2022; 22:780. [PMID: 36503535 PMCID: PMC9743690 DOI: 10.1186/s12888-022-04449-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Determine the prevalence of suicide attempts and the relationships between the different causes of attempts with sociodemographic and clinical characteristics among individuals in Iran. METHODS A retrospective review of data about suicide attempts from poisoning care centers in Babol city between 2017 and 2021. Multinomial regression analysis (with mental illness being the reference variable) was used to determine the factors associated with the different causes of suicide attempts (addiction, romantic relationship problems, and economic problems). RESULTS The overall prevalence of completed suicide in the population sampled was 10.8% (95% confidence interval 9.5-12.1) (244/2,263). Relative to mental disorder, given that other variables in the model are held constant the following were associated with suicide attempts. A previous history of suicide attempts was associated with increasing the relative risk ratio of attempting suicide while having no positive history of smoking was associated with reducing the relative risk ratio of a suicidal attempt. However, the use of multiple drugs to attempt suicide was associated with an increased relative risk ratio of attempting suicide with romantic relationship problems and addiction as causes of suicide attempts. The first year of data collection (2017) and the female gender were both associated with an increased relative risk ratio of having a suicide attempt due to romantic relationships and economic problems. A family history of suicide was associated with an increased relative risk ratio of suicide attempts due to romantic relationship problems. However, using Pesticides-aluminum phosphide and detergent and javel water to attempt reduced the relative risk ratio of attempting due to romantic relationship problems. Age, self-employment, middle income, and married were associated with an increased relative risk ratio of suicide attempts among individuals due to addiction. However, staying longer at the emergency department was associated with a reduced relative risk ratio of having had a suicide attempt due to addiction. CONCLUSIONS This study highlights the interplay between romantic hardships, addiction, economic hardships as reasons for suicide attempts and various sociable variables in a population in Northern Iran. The most associated reason for suicide attempts was romantic relationship hardships. Therefore, interventions such as sessions on conflict resolution, boundary setting, and management of grieving would greatly benefit this society and reduce the rate of suicide, especially among individuals with a history of suicide attempts.
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Affiliation(s)
- Aliasghar Manouchehri
- grid.411495.c0000 0004 0421 4102Department of Internal Medicine, Shahid Beheshti Hospital Babol University of Medical Sciences, Babol, Iran
| | | | - Letizia Maria Atim
- African Centre for Suicide Prevention and Research, Mbarara, Uganda ,grid.33440.300000 0001 0232 6272Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mehdi Mohammadian amiri
- grid.411495.c0000 0004 0421 4102Department of Emergency Medicine, School of Medicine, Babol University of Medical Sciences, Mazandaran, Iran
| | - Mark Mohan Kaggwa
- African Centre for Suicide Prevention and Research, Mbarara, Uganda ,grid.33440.300000 0001 0232 6272Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda ,grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Sciences, McMaster University, Hamilton, Ontario Canada
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Lin YC, Wee JY, Marks RB, O'Connell KL, Hassler ME, Law KC. Shame-proneness and suicidal ideation: The roles of depressive and anger rumination. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2021.100303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Borderline personality disorder: from understanding ontological addiction to psychotherapeutic revolution. Eur Arch Psychiatry Clin Neurosci 2020; 270:941-945. [PMID: 31165236 DOI: 10.1007/s00406-019-01029-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/30/2019] [Indexed: 12/25/2022]
Abstract
Bypassing a reductionist view of existing diagnostic categories, ontological addiction theory (OAT) is a new psychological model of human functioning. Borderline Personality Disorder (BPD), defined as "a pattern of instability in interpersonal relationships, self-image and affects, and marked impulsivity", is not only common (up to 20% of psychiatric inpatients), but also strongly associated with suicide attempts and death by suicide. Therefore, BPD constitutes a major public health concern. As a consequence of an underlying condition of ontological addiction, self-harming behaviors can be conceptualized as addictions, suicidal acts reflecting an experiential avoidance strategy against unbearable psychological pain. The present paper aims at: (1) understanding BPD daily life experiences from the perspective of OAT; (2) offering psychotherapeutic perspectives for this mental disorder. The diagnostic category of BDP may be understood as a simple label reflecting several extreme types of manifestations resulting from the Self-grasping ignorance that underpins ontological addiction. Therefore, development of psychotherapeutic interventions targeting ontological addiction appears to be a promising future direction.
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Krishnamoorthy G, Davis P, O'Donovan A, McDermott B, Mullens A. Through Benevolent Eyes: the Differential Efficacy of Perspective Taking and Cognitive Reappraisal on the Regulation of Shame. Int J Cogn Ther 2020; 14:263-288. [PMID: 32904830 PMCID: PMC7462113 DOI: 10.1007/s41811-020-00085-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Difficulties in regulating feelings of shame is a risk factor for the onset and recurrence of mental health disorders. The present research investigated the impact of the individual differences in propensity to experience shame (or shame-proneness) on two emotion regulation strategies-perspective taking and positive reappraisal. A total of 228 participants, undergraduate students, were allocated randomly to one of the eight experimental conditions. The results revealed that for high shame-prone participants, the use of perspective taking, without positive reappraisal, led to a heightened experience of shame. In contrast, the combination of perspective taking and positive reappraisal led to reductions in shame among high shame-prone participants. The findings highlight the relationship between individual differences, and the separate and combined effects of affect regulation strategies on the experience of shame.
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Affiliation(s)
- Govind Krishnamoorthy
- University of Southern Queensland, 11 Salisbury Road, Ipswich, Queensland 4305 Australia
| | - Penelope Davis
- Griffith University, 176 Messines Ridge Road, Mount Gravatt, Queensland 4122 Australia
| | - Analise O'Donovan
- Griffith University, 176 Messines Ridge Road, Mount Gravatt, Queensland 4122 Australia
| | - Brett McDermott
- James Cook University, James Cook Drive, Douglas, Queensland 4814 Australia
| | - Amy Mullens
- University of Southern Queensland, 11 Salisbury Road, Ipswich, Queensland 4305 Australia
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Sheehy K, Noureen A, Khaliq A, Dhingra K, Husain N, Pontin EE, Cawley R, Taylor PJ. An examination of the relationship between shame, guilt and self-harm: A systematic review and meta-analysis. Clin Psychol Rev 2019; 73:101779. [PMID: 31707184 PMCID: PMC6891258 DOI: 10.1016/j.cpr.2019.101779] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/12/2019] [Accepted: 09/14/2019] [Indexed: 01/29/2023]
Abstract
Self-harm is a major public health concern associated with suicide risk and significant psychological distress. Theories suggest that aversive emotional states are an important process that drives self-harm. Shame and guilt may, in particular, be important emotions in self-harm. This review therefore sought to provide a systematic review and meta-analysis of the relationship between shame, guilt, and self-harm. A systematic search of electronic databases (PsycINFO; Medline; CINAHL Plus; Web of Science and ProQuest) was undertaken to identify studies measuring shame, guilt and self-harm (including suicidal and non-suicidal behaviour). Meta-analysis was undertaken where papers focused on the same subtype of shame or guilt and shared a common outcome. Thirty studies were identified for inclusion. Most forms of shame were associated with non-suicidal self-injury (NSSI), but research was sparse concerning suicidal behaviour. Fewer studies examined guilt and findings were more varied. Methodological issues included a paucity of longitudinal designs and lack of justification for sample sizes. Results of this review support the link between shame and self-harm, particularly NSSI. The direction of this relationship is yet to be established. Clinically, consideration should be given to the role of shame amongst individuals who present with NSSI. This review was pre-registered on PROSPERO (CRD42017056165).
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Affiliation(s)
- Kate Sheehy
- Institute of Psychology, Health and Society, University of Liverpool, United Kingdom.
| | - Amna Noureen
- Pakistan Institute of Living & Learning, Karachi, Pakistan.
| | - Ayesha Khaliq
- Pakistan Institute of Living & Learning, Karachi, Pakistan.
| | - Katie Dhingra
- School of Social Sciences, Leeds Beckett University, LS1 3HE England, United Kingdom
| | - Nusrat Husain
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.
| | - Eleanor E Pontin
- Institute of Psychology, Health and Society, University of Liverpool, United Kingdom.
| | - Rosanne Cawley
- Institute of Psychology, Health and Society, University of Liverpool, United Kingdom.
| | - Peter J Taylor
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.
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Azizpour M, Taghizadeh Z, Mohammadi N, Vedadhir A. Being at the center of attention: Iranian women's experience after suicide attempts. Perspect Psychiatr Care 2019; 55:445-452. [PMID: 30506683 DOI: 10.1111/ppc.12337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 10/25/2018] [Accepted: 10/28/2018] [Indexed: 12/01/2022] Open
Abstract
PURPOSE A history of suicide attempts is the most important predictor of suicide. The aim of this study was to understand the experience of women after suicide attempts. DESIGN AND METHODS A purposive sampling method using semistructured in-depth interviews with seven Iranian women was implemented for data collection, and an interpretative phenomenological approach with the van Manen method was used for data analysis. FINDINGS The main theme was "being at the center of attention," from which emerged two subthemes: "loved ones keeping an eye on them" and "rain of love." PRACTICAL IMPLICATIONS The study participants experienced satisfaction with their suicide attempt, and some of them felt that they are now being restricted. The study recommends that a special caregiver training program would be beneficial to educate the families in appropriate behavior after a loved one's suicide attempt.
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Affiliation(s)
- Maryam Azizpour
- Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ziba Taghizadeh
- Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nooredin Mohammadi
- Department of Critical Care Nursing, Faculty of Nursing & Midwifery, Center for Nursing Care Research, Iran University of Medical Sciences, Tehran, Iran
| | - Abouali Vedadhir
- Department of Anthropology, Faculty of Social Sciences, University of Tehran, Tehran, Iran
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Mereish EH, Peters JR, Yen S. Minority Stress and Relational Mechanisms of Suicide among Sexual Minorities: Subgroup Differences in the Associations Between Heterosexist Victimization, Shame, Rejection Sensitivity, and Suicide Risk. Suicide Life Threat Behav 2019; 49:547-560. [PMID: 29604113 PMCID: PMC6167193 DOI: 10.1111/sltb.12458] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/10/2018] [Indexed: 12/01/2022]
Abstract
Despite sexual orientation disparities in suicide, there is limited research examining factors associated with suicide risk among sexual minorities while considering subgroup differences within this group. This study identified differences between sexual minorities at risk for suicide and those not at risk. The study also examined heterosexist victimization, as one form of minority stress, and two relational mechanisms (i.e., shame and rejection sensitivity) as risk factors for suicidality. We examined a moderated-mediation model, in which we tested gender and sexual orientation differences in the mediating effects of the relational mechanisms on the association between heterosexist victimization and suicide risk. Participants were recruited online and completed an online survey. The sample included 719 sexual minority adults. Of the sample, 27.7% were at risk for suicide. Suicide risk varied by age, gender, sexual orientation, income, education, and relationship status. Heterosexist victimization, shame, and rejection sensitivity were significant risk factors for suicide. Shame and rejection sensitivity were mediators of the association between heterosexist victimization and suicide risk for subgroups of sexual minorities, mostly lesbian and gay individuals and to some extent bisexual individuals. The findings underscore minority stress, shame, and rejection sensitivity as key intervention points.
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Affiliation(s)
- Ethan H Mereish
- Department of Health Studies, American University, Washington, DC, USA
| | - Jessica R Peters
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Shirley Yen
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island
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Cameron AY, Erisman S, Palm Reed K. The Relationship Among Shame, Nonsuicidal Self-Injury, and Suicidal Behaviors in Borderline Personality Disorder. Psychol Rep 2019; 123:648-659. [PMID: 30654709 DOI: 10.1177/0033294118818091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Shame has been individually linked to nonsuicidal self-injury and suicidal ideation and behavior and is highly prevalent in individuals with borderline personality disorder. The current study investigated the relationship between shame, nonsuicidal self-injury, and suicidal ideation in a sample of women with borderline personality disorder. Participants were 40 women recruited from a Women's Dialectical Behavior Therapy Partial Hospital Program in a psychiatric hospital in New England as part of a larger, six-month treatment development study. Results indicated that shame-proneness predicts nonsuicidal self-injury and suicidal ideation and behavior above and beyond the severity of borderline personality disorder symptoms, suggesting that shame may be an important treatment target for individuals with borderline personality disorder. Clinical implications, limitations, and future directions are discussed.
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Affiliation(s)
- Amy Y Cameron
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Providence VA Medical Center, Providence, RI, USA
| | - Shannon Erisman
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Center for Women's Behavioral Health, Women and Infants Hospital, Providence, RI, USA
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Bantjes J, Tomlinson M, Weiss RE, Yen PK, Goldstone D, Stewart J, Qondela T, Rabie S, Rotheram-Borus MJ. Non-fatal suicidal behaviour, depression and poverty among young men living in low-resource communities in South Africa. BMC Public Health 2018; 18:1195. [PMID: 30348143 PMCID: PMC6198370 DOI: 10.1186/s12889-018-6104-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/10/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Suicide is a serious public health problem in low- and middle-income countries. Understanding the context- and gender-specific risk factors for non-fatal suicidal behaviour is the cornerstone of evidence-based public health interventions to reduce suicide. Poverty and symptoms of depression are well established risk factors for suicidal behaviour. However, little is understood about how proximal economic factors (such as losing one's job, or food insecurity) may confound the effects of symptoms of depression to increase the risk of non-fatal suicidal behaviour in vulnerable populations, such as young men living under conditions of endemic poverty. The aim of this study was to explore the extent to which a wide range of poverty-related variables account for non-fatal suicidal behaviour independent of, or in addition to, symptoms of depression among young men living in low-resource communities in South Africa (SA). METHODS Data were collected from a clustered sample of 647 young men living in low-resource communities in the Western Cape province of SA. Multivariate regressions were used to identify the associations between poverty-related measures, symptoms of depression, and past-month prevalence of non-fatal suicidal behaviour. RESULTS Non-fatal suicidal behaviour in the last month was reported by 47 (6.13%) participants: suicidal ideation (n = 43; 5.97%); suicide plan (n = 5; 0.77%); suicide attempt (n = 4; 0.62%), and deliberate self-harm without intent to die (n = 4; 0.62%). Past-month prevalence of non-fatal suicidal behaviour was significantly associated with particular dimensions of poverty (living in a home without a toilet on the premises, having previously been fired, and food insecurity), but not with other dimensions of poverty (such as prolonged unemployment and low levels of income). However, symptoms of depression were a more significant predictor of non-fatal suicidal behaviour than any measure of poverty (aOR=1.093, 95% CI=1.058-1.129, p < .000). CONCLUSIONS Depressive symptoms are more strongly associated with non-fatal suicidal behaviour than a range of proximal and distal economic factors among young men living under conditions of endemic poverty in South Africa. This has important public health implications and highlights the importance of increasing young men's access to psychiatric services and targeting depression as an integral component of suicide prevention in low resource communities.
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Affiliation(s)
- J. Bantjes
- Department of Psychology, Stellenbosch University, PO Box X1, Matieland, 7602 South Africa
| | - M. Tomlinson
- Department of Psychology, Stellenbosch University, PO Box X1, Matieland, 7602 South Africa
| | - R. E. Weiss
- Department of Biostatistics, University of California Los Angeles, Fielding School of Public Health, Los Angeles, CA USA
| | - P. K. Yen
- Department of Biostatistics, University of California Los Angeles, Fielding School of Public Health, Los Angeles, CA USA
| | - D. Goldstone
- Department of Psychology, Stellenbosch University, PO Box X1, Matieland, 7602 South Africa
| | - J. Stewart
- Department of Psychology, Stellenbosch University, PO Box X1, Matieland, 7602 South Africa
| | - T. Qondela
- Department of Psychology, Stellenbosch University, PO Box X1, Matieland, 7602 South Africa
| | - S. Rabie
- Department of Psychology, Stellenbosch University, PO Box X1, Matieland, 7602 South Africa
| | - M.-J. Rotheram-Borus
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California Los Angeles, Los Angeles, CA USA
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Azizpour M, Taghizadeh Z, Mohammadi N, Vedadhir A. Fear of stigma: The lived experiences of Iranian women after suicide attempt. Perspect Psychiatr Care 2018; 54:293-299. [PMID: 29165826 DOI: 10.1111/ppc.12237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/09/2017] [Accepted: 08/06/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Suicide attempt is the most important predictor of completed suicide. The aim of this study was to explore the lived experiences of women after suicide attempts. METHODS This was an interpretative phenomenological study carried out through in-depth semi-structured interviews with 13 interviews. Data were analyzed using Van Manen method. RESULTS Women of this study experienced fears of stigma. Their fears were not only related to labels of being "unbelief and mentally illness but also being involved in illicit sexual affairs." On the other hand, they were afraid of labeling "mental illness" and also "doing an unacceptable action." CONCLUSION The women tried to hide their suicide attempts because they fear of being labeled by others. It is recommended that societies and families progress toward becoming free of stigma of suicide and suicide attempt.
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Affiliation(s)
- Maryam Azizpour
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Science, Tehran, Iran
| | - Ziba Taghizadeh
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Science, Tehran, Iran
| | - Nooredin Mohammadi
- Department of Critical Care Nursing, Faculty of Nursing & Midwifery, Center for Nursing Care Research, Iran University of Medical Sciences, Tehran, Iran
| | - Abouali Vedadhir
- Department of Anthropology, Faculty of Social Sciences, University of Tehran, Tehran, Iran
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Glenn CR, Cha CB, Kleiman EM, Nock MK. Understanding Suicide Risk within the Research Domain Criteria (RDoC) Framework: Insights, Challenges, and Future Research Considerations. Clin Psychol Sci 2017; 5:568-592. [PMID: 28670505 PMCID: PMC5487002 DOI: 10.1177/2167702616686854] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Suicide is a leading cause of death worldwide. Prior research has focused primarily on sociodemographic and psychiatric risk factors with little improvement in the prediction or prevention of suicidal behavior over time. The Research Domain Criteria (RDoC) may be an especially useful framework for advancing research in this area. This paper provides a brief and broad overview of research on suicidal behavior relating to each of the RDoC domains-highlighting the RDoC construct(s) where research has focused, construct(s) where research is lacking, and suggestions for future research directions. We also discuss major challenges for suicide research within the RDoC framework, including the intersection of RDoC domains, interaction of domains with the environment, incorporation of developmental stage, integration of distal and proximal processes, and inclusion of suicide-specific constructs. We conclude by underscoring important considerations for future research aimed at using the RDoC framework to study suicidal behavior and other forms of psychopathology.
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Affiliation(s)
- Catherine R. Glenn
- Department of Clinical and Social Sciences in Psychology, University of Rochester
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15
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Hu DY, Huang D, Xiong Y, Lu CH, Han YH, Ding XP, Wang SJ, Liu YL. Risk factors and precautions of inpatient suicide from the perspective of nurses: A qualitative study. ACTA ACUST UNITED AC 2015; 35:295-301. [DOI: 10.1007/s11596-015-1427-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 03/02/2015] [Indexed: 10/23/2022]
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16
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Ansell EB, Wright AGC, Markowitz JC, Sanislow CA, Hopwood CJ, Zanarini MC, Yen S, Pinto A, McGlashan TH, Grilo CM. Personality disorder risk factors for suicide attempts over 10 years of follow-up. Personal Disord 2015; 6:161-7. [PMID: 25705977 DOI: 10.1037/per0000089] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Identifying personality disorder (PD) risk factors for suicide attempts is an important consideration for research and clinical care alike. However, most prior research has focused on single PDs or categorical PD diagnoses without considering unique influences of different PDs or of severity (sum) of PD criteria on the risk for suicide-related outcomes. This has usually been done with cross-sectional or retrospective assessment methods. Rarely are dimensional models of PDs examined in longitudinal, naturalistic prospective designs. In addition, it is important to consider divergent risk factors in predicting the risk of ever making a suicide attempt versus the risk of making an increasing number of attempts within the same model. This study examined 431 participants who were followed for 10 years in the Collaborative Longitudinal Personality Disorders Study. Baseline assessments of personality disorder criteria were summed as dimensional counts of personality pathology and examined as predictors of suicide attempts reported at annual interviews throughout the 10-year follow-up period. We used univariate and multivariate zero-inflated Poisson regression models to simultaneously evaluate PD risk factors for ever attempting suicide and for increasing numbers of attempts among attempters. Consistent with prior research, borderline PD was uniquely associated with ever attempting. However, only narcissistic PD was uniquely associated with an increasing number of attempts. These findings highlight the relevance of both borderline and narcissistic personality pathology as unique contributors to suicide-related outcomes.
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Affiliation(s)
- Emily B Ansell
- Department of Psychiatry, Yale University School of Medicine
| | | | - John C Markowitz
- Department of Psychiatry, Columbia University College of Physicians and Surgeons
| | | | | | | | - Shirley Yen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
| | - Anthony Pinto
- Department of Psychiatry, Columbia University College of Physicians and Surgeons
| | | | - Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine
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Abstract
Background: Suicidality is a life-and-death struggle in deep loneliness and psychological pain. There is a lack of knowledge about what could help the suicidal patients’ struggle for continued life. The aim of this study was to develop a deeper understanding of suicidal patients in the aftermath of suicidal attempts. The research question was ‘What resources in the person himself or herself and his or her surroundings are crucial in a suicidal crisis to maintaining the will to live and hope for life’? Methodology: The study has a hermeneutic approach and an explorative design. Data were collected using semi-structured interviews with 10 participants: men and women 21–52 years of age. The context was two emergency psychiatric units and one crisis resolution team. Ethical considerations: The participants signed an informed consent before the interviews were conducted. Findings: This article presents three themes: (a) becoming aware of the desire to live, (b) an experience of connectedness and (c) someone who cares. Discussion: The suicidal person’s awareness of wishes, dreams, hopes and will, but also of their feelings in the aftermath of the suicide attempt, seemed to play a crucial role in a suicidal crisis. Experiences of connectedness remind the person of the responsibility in his or her own life and in the lives of others and seemed to strengthen the urge to go on. Private and professional relationships seem to be crucial in stimulating the desire and hope to go on living. Conclusion: Becoming aware of the desire to live, being connected to others and experiencing someone who cares is necessary for life. Both private and professional networks seemed to be important resources that could remind the suicidal person of his or her own dignity as part of being human.
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Affiliation(s)
- May Vatne
- Oslo and Akershus University College of Applied Sciences, Norway
| | - Dagfinn Nåden
- Oslo and Akershus University College of Applied Sciences, Norway
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Howe E. Five ethical and clinical challenges psychiatrists may face when treating patients with borderline personality disorder who are or may become suicidal. INNOVATIONS IN CLINICAL NEUROSCIENCE 2013; 10:14-9. [PMID: 23440937 PMCID: PMC3579480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This article discusses five core ethical and clinical questions psychiatrists should consider when they treat patients with borderline personality disorder who are or may be suicidal. These questions include whether psychiatrists should tell patients their diagnosis, what they should tell them about their suicide risk, whether they should be "always" available by phone, when they should hospitalize these patients involuntarily, and how they should respond after these patients have attempted suicide and return for further care. This discussion highlights the ethical components of these questions. Optimal ethical and clinical interventions, in most cases, overlap. Psychiatrists may accomplish the most clinically by sharing with these patients some of the above conflicts that they face and/or the rationales for doing what they will do. These interventions may maximize the autonomy patients with borderline personality disorder and at the same time be clinically optimal, increasing a sense of self-efficacy and patient-psychiatrist trust in the patients.
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Affiliation(s)
- Edmund Howe
- Dr. Howe is Professor, Department of Psychiatry, Director, Programs in Medical Ethics, and Senior Scientist, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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