Factors mediating suicidal behaviour: Their utility in primary and secondary prevention

Case-control study of risk factors for suicide attempts in Isfahan, Iran

BACKGROUND

Suicide is an important, preventable, public health problem worldwide, caused by the interaction of numerous environmental, biological and psychosocial factors.

AIMS

This study aimed to identify the factors associated with suicidal attempts in Isfahan, Iran, in 2015.

METHODS

In this case-control study, 175 cases who committed suicide and were admitted to emergency services were compared with 175 controls selected among outpatients from the same hospital without any history of suicide attempt. Demographic, psychosocial, personality traits, religiosity, coping skills, stressful life events, socioeconomic status and psychiatric distress were compared between groups. Multivariable logistic regression was used to identify independent risk factors for suicide.

RESULTS

Marital status, education, socioeconomic status, psychological distress, perceived social support, stress coping strategies, personality, religious beliefs, stress life events and general health condition were significantly different between groups. The regression analysis revealed that perceived social support (odds ratio (OR) = 0.962, 95% confidence interval (CI): 0.94-0.984), religious beliefs (OR = 0.923, 95% CI: 0.867-0.984) and stressful life event (OR = 1.524, 95% CI: 1.251-1.856) were significantly associated with suicide attempts.

CONCLUSION

Our finding showed that religious beliefs, perceived social support and stressful life events are the main factors associated with suicide attempts. So, positive strategies such as improvements in life skills to control stressful life events, religiosity and perceived social support can be used to control suicide attempts.

Understanding suicide risk: identification of high-risk groups during high-risk times

BACKGROUND

The assessment of suicide risk is a complex task for mental health professionals. Certain demographic groups are associated with completed suicide including males, divorced adults, and Caucasians. However, demographic variables alone provide a crude assessment of suicide risk. Psychiatric diagnosis and recent life events might improve the identification of high-risk individuals.

METHOD

The current study evaluated 148 individuals who died by suicide compared with 257 adults who died suddenly from accidents or medical problems. Psychological autopsy was used to assess Axis I psychiatric diagnosis and recent stressful life events.

RESULTS

Suicide completers were significantly more likely than comparison subjects to have a depressive disorder, a substance abuse disorder, and to have experienced interpersonal conflict in the months leading up to their death. A discriminant function analysis revealed that the combination of demographic variables, recent stressful life events, and psychiatric diagnoses best discriminated between suicide completers and comparison subjects.

CONCLUSIONS

Proper assessment of suicide risk should include a comprehensive evaluation of demographic characteristics, recent life stressors, and psychiatric diagnosis.

An Emic Perspective on the Dynamics of Non-Fatal Suicidal Behaviour in a Sample of South African Indian Women

We aimed to obtain an emic perspective on the dynamics of non-fatal suicidal behaviour in a high risk population group in South African, viz. adolescent females of Indian origin. Interviews were conducted with 10 respondents admitted to a state hospital in the greater Durban area, following their intentional overdose of prescription medication. Interviews were tape recorded, transcribed, and thematically analysed in an attempt to identify influences on suicidal behaviour. Intrapersonal influences on suicidal behaviour included poor communication and problem-solving skills. Interpersonal influences included family conflict, rigid and inflexible parental attitudes, a family history of attempted or completed suicide and high parental expectations. Socio-cultural influences related largely to conflicting social roles and values in the context of contemporary acculturation pressures. The study findings are discussed in terms of their implications for prevention and future research.

When the solution is part of the problem: problem solving in elderly suicide attempters

OBJECTIVES

Depression, loss, and physical illness are associated with suicide in the elderly. However, the nature of individual vulnerability remains poorly understood. Poor problem solving has been suggested as a risk factor for suicide in younger adults. Unresolved problems may create an accumulation of stressors. Thus, those with perceived deficits in problem-solving ability may be predisposed to suicidal behavior. To test this hypothesis, we investigated whether elderly suicide attempters perceived their problem solving as deficient.

METHODS

Sixty-four individuals aged 60 and older participated in the study including depressed suicide attempters, depressed non-attempters, and non-depressed controls. The social problem solving inventory-revised: short-version was used to measure participants' perceived social problem solving, assessing both adaptive problem-solving dimensions (positive problem orientation and rational problem solving) and dysfunctional dimensions (negative problem orientation, impulsivity/carelessness, and avoidance).

RESULTS

Depressed elderly who had attempted suicide perceived their overall problem solving as deficient, compared to non-suicidal depressed and non-depressed elderly. Suicide attempters perceived their problems more negatively and approached them in a more impulsive manner. On rational problem solving and avoidant style sub-scales, suicide attempters did not differ from non-suicidal depressed. However, both depressed groups reported lower rational problem solving and higher avoidance compared to non-depressed controls.

CONCLUSIONS

A perception of life problems as threatening and unsolvable and an impulsive approach to problem solving appear to predispose vulnerable elderly to suicide attempts.

Gender, suicide, and the sociocultural context of deliberate self-harm in an urban general hospital in Mumbai, India

Recognizing the complementary effects of social contexts and psychiatric disorders, this study clarifies the role of gender in suicidal behavior in urban Mumbai by considering psychiatric diagnoses and patient-identified sociocultural features. The cultural epidemiological approach suggests the critical impact of situational sociocultural factors that complement the customary psychopathological accounts for those who harm or kill themselves. The cultural epidemiology of deliberate self-harm (DSH), it is argued, is critical to planning for suicide prevention, community mental health and psychiatric practice. This study, based on a cultural epidemiological framework, compares male and female admissions for DSH, evaluating conditions with SCID-I and EMIC interviews. We assessed features and narratives of suicidal behavior, patient-identified underlying problems, their perceived causes and triggers. The study included 92 women and 104 men. A diagnosis of depressive disorder was made for 48.9 percent of women and 39.4 percent of men. Many patients (50.0 percent of women and 41.3 percent of men) did not fulfill the criteria for any diagnosis, or did so only for an adjustment disorder or a V-code. Men typically explained DSH with reference to work problems, financial problems and problem drinking. Women typically discussed domestic problems, in-law relations and victimization. Problem drinking affected women living with men who drank. Social and situational factors appear to play a relatively greater role than psychiatric illness in self-harm and suicide in Mumbai, as in other Asian studies, compared with Europe and North America.

The Strategy for Action on Farmers' Emotions (SAFE): working to address the mental health needs of the farming community

Within the United Kingdom farmers are considered to be the fourth highest occupation group at risk of committing suicide. However, the mental health needs of the farming community are currently poorly understood or addressed by mental health nurses and community mental health teams. This is unacceptable both in terms of the presented level of risk, and in the direction of the most recent mental health review, which suggests that mental health nurses have unique skills in identifying and responding to suicidal behaviour. By building upon the practice of the first author, this paper outlines the Strategy for Action on Farmers' Emotions (SAFE), which develops a comprehensive strategy to respond to the mental health needs of the farming community. Where it is applicable, it is vital that these needs are brought from the margins to the mainstream of policy and service provision. This paper suggests that this position will only be achieved once an increased understanding of farming life and culture is gained.

The specificity of autobiographical memory and imageability of the future

Three studies examined whether the specificity with which people retrieve episodes from their past determines the specificity with which they imagine the future. In the first study, suicidal patients and nondepressed controls generated autobiographical events and possible future events in response to cues. Suicidal subjects' memory and future responses were more generic, and specificity level for the past and the future was significantly correlated for both groups. In the second and third studies, the effect of experimental manipulation of retrieval style was examined by instructing subjects to retrieve specific events or summaries of events from their past (Experiment 2) or by giving high- or low-imageable words to cue memories (Experiment 3). Results showed that induction of a generic retrieval style reduced the specificity of images of the future. It is suggested that the association between memory retrieval and future imaging arises because the intermediate descriptions used in searching autobiographical memory are also used to generate images of possible events in the future.