Predicting Suicide Intent: The Roles of Experiencing or Committing Violent Acts

According to the interpersonal theory of suicide (Joiner, 2005), repeated exposure to painful or provocative experiences is associated with lethal or nearly lethal suicide attempts. However, suicide research often focuses on suicide ideation or attempts, rather than intent. Using data from the Collaborative Psychiatric Epidemiological Surveys, we examined traumatic experiences, with a focus on repeated exposure to traumas, in individuals who described their suicide attempts as a strong intent to die versus a cry for help. Only repeated acts of committing violence were associated with high suicide intent, suggesting that individuals who engage in violence are at heightened risk for suicide.     

Acting on persecutory delusions: the importance of safety seeking

OBJECTIVE: Acting on delusions is a significant clinical issue. The concept of safety behaviours--actions carried out with the intention of reducing perceived threat--provides a new way of understanding acting on delusions. A study was conducted with the aim of examining the prevalence and correlates of safety behaviours related to persecutory delusions. METHOD: One hundred patients with persecutory delusions were assessed for safety behaviours, acting on delusions, anxiety, depression, and psychotic symptoms. Case note data were collected on instances of serious violence or suicide attempts. RESULTS: Ninety-six patients had used safety behaviours in the last month. Greater use of safety behaviours was associated with higher levels of distress. A history of violence or suicide attempts was associated with greater use of safety behaviours. Safety behaviours were significantly associated with acting on delusions, but not with the negative symptoms of psychosis. CONCLUSION: Safety behaviours are a common form of acting on persecutory delusions. These behaviours have the consequence that they are likely to prevent the processing of disconfirmatory evidence and will therefore contribute to delusion persistence.     

Delusional disorder and delusions: is there a risk of violence in social interactions about the core symptom?

Delusional disorders are rare, but psychoses with prominent and persistent delusions are less so. A small but significant association between psychosis and violence is often mediated by delusions in such illnesses. Traditionally, delusions have been viewed as “incorrigible”, but there is evidence that they change over time. During development of a scale for measuring delusions, it was found that people who acted violently on their “most important” delusion were more likely to have modified that belief after a mild form of challenge to it. When cognitive–behaviour therapy (CBT) is used for schizophrenia, attempts to modify psychotic symptoms are generally included. Could studies of CBT provide further information about possible risks of social interactions about delusions? In the UK, 2000 people with schizophrenia have been in randomized controlled trials of CBT with a goal of symptom modification. These studies were examined for evidence of violence during the treatment. There was none. Given the period prevalence of violence among people with psychosis, this is surprising. In these studies, however, both challenge to delusions and change in them was minimal and in the context of a safe clinical relationship. Challenge to delusions may, however, occur in a variety of social situations. There are no systematic data on lay challenge to them, but it seems likely that some in the sufferer's social circle will do so vigorously. Relatives, friends, and acquaintances are the people most vulnerable to the most serious violence by someone with psychosis. Study of how people interact in these circumstances and whether their interactions are relevant to modification of delusions would be worthwhile. Could those close to a sufferer learn skills for responding to such pathological beliefs that could be protective against violence, perhaps derived from the principles of CBT?. Copyright © 2006 John Wiley & Sons, Ltd.     

Some Psychological Reflections on the Death of Malcolm Melville*

ABSTRACT: Malcolm Melville died on September 12, 1867, at age 18 from—to quote his death certificate—a “pistol shot wound in [his] right temporal region.” Contemporary designations of the mode of his death changed within hours from suicide, to accident, to death while of unsound mind. Historically, the mode of his death has remained equivocal. In order to approach this enigma a “psychological autopsy” of an equivocal death case as identical to Malcolm Melville's as was possible was conducted as though it were a genuine current “open” case at the Los Angeles Suicide Prevention Center in 1973. That procedure resulted in a near-unanimous judgment by the center staff that the most accurate certification of the death as described was “probable suicide,” which would then be certified as “suicide.” In this paper the assertion is made that Herman Melville himself had been a psychologically “battered child” and, in a way typical for battered children, psychologically battered his own children when it came his turn to be a parent. The further assertion is made that, for Malcolm, his father was suicidogenic; and established this penchant in Malcolm (through his neglect, active rejection, fearsomeness, and his fixed attention to his own writing—Redburn, White Jacke, and Moby Dick) within the first 2 years of Malcolm's life. For Malcolm, the psychological basis of his suicidal state was isolated desperation—a ubiquitous characteristic of most suicides. Malcolm had a deep unconscious feeling of not being wanted by his father; that it would be better if he were out of the way, dead. On the morning of his death, the choice for Malcolm was between the memory of his mother's kiss a few hours before and the terror of (and the need to protect himself against) his father's rage to come.     

The Predictors of Suicidality in Previous Suicide Attempters following Case Management Services

Suicide attempts constitute a serious clinical problem. People who have attempted suicide are at an elevated risk for additional suicide attempts, but there is limited evidence regarding the predictors of suicidality of suicide attempters following case management services. In the present study the indicators of suicidality after case management were examined. A total of 1,056 subjects who had recently attempted suicide were recruited from January 1, 2011, to June 30, 2011. The suicide prevention center of Kaohsiung City in Taiwan provided case management services and followed up on suicide attempt cases for 6 months. The salient factors for repeat suicide attempts were estimated using a logistic regression analysis. The results showed that multiple factors, including a “willingness to receive mental health services during a crisis,” “social support,” “a history of mental disorders,” and “a history of suicide,” could predict repeat suicide attempts with hazard ratios (0.58, 0.54, 3.84, 1.51) and 95% confidence interval (0.39–0.86, 0.36–0.83, 2.41–6.10, 1.03–2.21). The four factors mentioned above were the most accurate predictors of subsequent suicidality when case management services were utilized after 6 months of follow‐up. The findings of our study could help clarify future strategies for suicide prevention.     

Suicidal ideation among adolescents in relation to recalled exposure to violence

The relationship between exposure to violence and vulnerability to suicide among adolescents was examined. The topic was initiated by the rapid increase in adolescent's exposure to violence and the sparse systematic research available on its relationship to attitudes about life and death. The study's main hypothesis is that high levels of exposure to violence are associated with high suicide risk according to two conceptual paradigms-Fear of Death and Attraction and Repulsion to Life. Eighty-five adolescents were administered three self report questionnaires. The questionnaires assessed levels of exposure to violence, fear of death, and attitudes towards life and death. Those who had been exposed to a high level of violence reported attitudes synonymous with the profile of an individual at risk for suicide (low fear of death, low repulsion to death, and low attraction to life; high repulsion to life and high attraction to death).     

Suicidal ideation among adolescents in relation to recalled exposure to violence

The relationship between exposure to violence and vulnerability to suicide among adolescents was examined. The topic was initiated by the rapid increase in adolescent's exposure to violence and the sparse systematic research available on its relationship to attitudes about life and death. The study's main hypothesis is that high levels of exposure to violence are associated with high suicide risk according to two conceptual paradigms-Fear of Death and Attraction and Repulsion to Life. Eighty-five adolescents were administered three self report questionnaires. The questionnaires assessed levels of exposure to violence, fear of death, and attitudes towards life and death. Those who had been exposed to a high level of violence reported attitudes synonymous with the profile of an individual at risk for suicide (low fear of death, low repulsion to death, and low attraction to life; high repulsion to life and high attraction to death).     

Perturbation and Lethality as Precursors of Suicide in a Gifted Group

ABSTRACT: Thirty cases, for whom longitudinal personality data were available from 1921 to 1960, were analyzed. All the cases were Caucasian males with high I.Q.'s. Five individuals had committed suicide (all by gunshot), 10 (matched) individuals had died natural deaths from cancer or heart disease, and 15 were still living. A blind clinical analysis was conducted primarily in terms of two guiding concepts, perturbation and lethality, by means of a Meyerian “life chart” and a “psychological autopsy,” respectively. The results indicated that four of the five cases deemed to be most suicidal had, in fact, committed suicide—a chance probability of 1 out of 1,131. The prodromal clues—instability, trauma, and personality controls—are discussed. The role of the “significant other” and the “burning-out” of affect seem to be paramount. Suicide is seen as a discernible part of a life style and as a predictable outcome, in a person of 50, by the time that individual is 30 years old.     

Suicide and the Generation Gap*

ABSTRACT: To explore psychological parameters of suicide as perceived by young adults, the middle-aged, and old people, an area sample of 317 Detroit subjects, whose ages placed them in one of these three generations, was administered a questionnaire concerning their beliefs about the generations and suicide and their self-reported relationship to suicide. A 3-way fixed-effects analysis of variance (generation × sex × socioeconomic status) indicated that all generations believed that the old (a) have the greatest desire to die, (b) know the least about suicide, (c) make the fewest attempts, (d) are the least frequently successful, and (e) are the least socially condemned for committing suicide. Self-appraisals indicated that (a) lower socioeconomic status is associated with a greater “death wish,” (b) young adults and males claim a greater knowledge about suicide, and (c) the generations do not differ in desire to die, considerations of suicide, and suicide attempts.     

The Effects of the Family Bereavement Program to Reduce Suicide Ideation and/or Attempts of Parentally Bereaved Children Six and Fifteen Years Later

Findings concerning the long‐term effects of the Family Bereavement Program (FBP) to reduce suicide ideation and/or attempts of parentally bereaved children and adolescents are presented. Parental death is a significant risk factor for suicide among offspring (Guldin et al., 2015). This study is a long‐term follow‐up of 244 children and adolescents who had participated in a randomized trial of the FBP, examining the intervention effects on suicide ideation and/or attempts as assessed through multiple sources. Results indicate a significant effect of the FBP to reduce suicide ideation and/or attempts at the 6‐ and 15‐year follow‐up evaluation. The findings support the potential benefits of further research on “upstream” suicide prevention.     

A Systematic Review of Mass Media Campaigns for Suicide Prevention: Understanding Their Efficacy and the Mechanisms Needed for Successful Behavioral and Literacy Change

Mass media campaigns are increasingly seen as an important part of suicide prevention; however, despite their popularity, their efficacy is not well understood. The current review aimed to address key knowledge gaps regarding how mass media campaigns can be optimized to prevent suicide, by looking at their global efficacy, and mechanisms related to successful outcomes. A systematic review of the international literature examined studies which evaluated mass media campaigns targeted at suicide prevention, where suicide behaviors (mortality, attempts) or suicide literacy (knowledge, attitudes, help‐seeking) was identified as a primary outcome. Thirteen articles describing 12 unique campaigns met eligibility criteria. For behavioral outcomes, mass media campaigns appear to be most effective when delivered as part of a multicomponent suicide prevention strategy, while “standalone campaigns” were modestly useful for increasing suicide literacy. Level of exposure, repeat exposure, and community engagement appeared to be fundamental to the success of these campaigns; however, these constructs were poorly adhered to in the development and implementation of campaigns. Overall, the mixed quality of the included studies highlights a need for increased quantity, consistency, and quality of evaluations to advance the evidence base.     

No Matter How Hard You Try,Your Feet Still Get Wet: Insider and Outsider Perspectives on Bridging Diversity

Mental health practitioners have offered relatively little in response to the pervasive community violence faced by many children living in impoverished neighborhoods. The “neighborhood club” is a school‐based, short‐term, support group designed to assist children with the psychological impact of exposure to community violence. Ten “neighborhood clubs” were conducted in two public elementary schools in Detroit, Michigan. This paper reviews the implementation of a bilingual “neighborhood club,” undertaken to better serve the Spanish‐speaking Latino students in a school community. We discuss many of the rewards and challenges of conducting a bilingual, multicultural support group for children and conclude that a bilingual support group provides all children with a model that validates ethnic and cultural diversity while also building empathic bonds based on mutually‐reinforcing, common experiences.     

Family Loss and Hospital Suicide

In 19 consecutive cases of inpatient suicide occurring over many years, 18 out of the 19 cases (95 percent) were judged to have a significant “family” loss issue affecting the suicide. In five cases (26 percent), there seemed to be a powerful institutional attachment and loss threatened that attachment. In 13 cases (68 percent), a major family issue was involved which included events that estranged the patient from the family (real or imagined); divorce or separation issues; death or illness of a significant other; a family that insisted on continued treatment (and/or growth). In 13 cases (68 percent), significant communication from or about the “family” occurred which seemed to have an impact on the suicidal behavior often within days of the final event. In 10 cases (53 percent), an actual family visit had occurred within two weeks of the death. These issues are discussed and case examples presented.     

What Does Psychological Autopsy Study Tell Us About Charcoal Burning Suicide—A New and Contagious Method in Asia?

Charcoal burning suicides in Hong Kong between 2002–2004 in the 15 to 59‐year‐old age group were investigated using the psychological autopsy method. The psychopathological profiles of charcoal burning suicides (N = 53) were compared against “other suicides” (N = 97). The two groups did not differ significantly in the prevalence of DSM‐IV axis I diagnoses with the exception of schizophrenic spectrum disorder which was less frequently associated with charcoal burning suicides. Score on “neuroticism” in the NEO‐five Factor Inventory (NEO‐FFI) was significantly higher in victims of charcoal burning suicide. There was also a trend toward higher score on “conscientiousness” in the NEO‐FFI among charcoal burners than victims of other suicide.     

Interoceptive Deficits,Nonsuicidal Self‐Injury,and Suicide Attempts Among Women with Eating Disorders

People with eating disorders (ED s) have an elevated risk for both nonsuicidal self‐injury (NSSI ) and suicide compared to the general population. This study tests two theoretically derived models examining interoceptive deficits as a risk factor for NSSI , and examining interoceptive deficits, NSSI , fearlessness about death, and pain tolerance as risk factors for suicide. Ninety‐six adult, treatment‐seeking women with ED s completed self‐report questionnaires at a single time point. Interoceptive deficits were significantly associated with NSSI , and NSSI was in turn associated with both pain tolerance and fearlessness about death. Further, pain tolerance was in turn associated with past suicide attempts, although fearlessness about death was not associated with suicide attempts. Interoceptive deficits had a direct association with fearlessness about death but not pain tolerance. Results regarding the relation between interoceptive deficits and suicide attempts were mixed, yet overall suggest that interoceptive deficits are related to suicide attempts largely indirectly, through the effects of mediating variables such as NSSI , fearlessness about death, and pain tolerance. Results suggest that interoceptive deficits and pain tolerance merit further investigation as potential risk factors for fatal and nonfatal self‐harm among individuals with ED s.     

Where Are They Now? A Follow-up Study of Suicide Attempters from the Golden Gate Bridge

ABSTRACT: The Golden Gate Bridge is currently the number one suicide location in the world. From the opening day, May 18, 1937 to April 1, 1978, there have been 625 officially reported suicide deaths and perhaps more than 200 others which have gone unseen and unreported. Proposals for the construction of a hardware antisuicide barrier have been challenged with the untested contention that “they'll just go someplace else.” This research tests the contention by describing and evaluating the long-term mortality experience of the 515 persons who had attempted suicide from the Golden Gate Bridge but were restrained, from the opening day through the year 1971 plus a comparison group of 184 persons who made nonbridge suicide attempts during 1956–57 and were treated at the emergency room of a large metropolitan hospital and were also followed through the close of 1971. Results of the followup study are directed toward answering the important question: “Will a person who is prevented from suicide in one location inexorably tend to attempt and commit suicide elsewhere?”     

自杀意念高中生的社会信息编码特征

采用两因素混合实验设计, 以日常用词为实验材料, 选取不同自杀意念得分的高中生为被试, 通过三个实验考察自杀意念高中生的社会信息编码特征。研究结果发现:(1)自杀意念高分组被试对出现在消极词位置的探测刺激的反应时显著短于出现在积极词位置的探测刺激的反应时; 自杀意念低分组被试对出现在积极词位置的探测刺激的反应时显著短于出现在消极词位置的探测刺激的反应时。(2)在知觉加工水平上, 自杀意念高分组被试对消极词、积极词及中性词的回忆量之间无显著差异; 自杀意念低分组被试对三类词的回忆量之间也不存在显著差异。(3)在语义加工水平上, 自杀意念高分组被试的消极词回忆量显著高于积极词回忆量; 自杀意念低分组被试的积极词回忆量显著高于消极词回忆量。研究结论如下：高自杀意念高中生存在对消极信息的注意偏向和语义加工偏向, 但不存在知觉加工偏向; 低自杀意念高中生存在对积极信息的注意偏向和语义加工偏向, 但不存在知觉加工偏向。     

Suicide Attempts and Suicide among Marines: A Decade of Follow‐up

Suicidal behavior among military personnel is of paramount public health importance because of the increased risk of death from suicide in this population. Pre‐ and post‐Marine recruit training risk factors for suicide attempts among current and former Marines were examined in 10 years following recruit training. The characteristics of the subsample of current and former Marines who died by suicide during this time are also described. Stressful and traumatic life events (e.g., childhood physical, sexual, and emotional abuse, sexual harassment during recruit training) and pre‐recruit training suicide attempts emerged as having strong associations with post‐recruit training attempts. Half of those who died by suicide in the 10 years following recruit training endorsed at least one significant life stressor prior to joining the Marines. This study highlights the importance of screening for stressful and potentially traumatic experiences occurring both before and during military service as part of a comprehensive suicide risk assessment in military samples.     

Exposure to community violence in adolescence: trauma symptoms

This research explored the relationship between exposure to violence and psychological stress among adolescents. It focused on the cumulative experience of recurring community violence during the high school years, differentiated victimization from witnessing violence, and examined four conceptually separate psychological symptoms of trauma (anger, anxiety, depression, and dissociation). Considerable exposure to recurring community violence, but also considerable variation in the amount of exposure, was found in the sample of 455 first-year students at an urban college. Exposure to recurring community violence was moderately correlated with the manifestation of psychological trauma symptoms. Further, being victimized and witnessing violence had independent (as well as overlapping) relationships with trauma symptoms. It was concluded that attempts to account for psychological stress among adolescents must include exposure to community violence.     

Differential Influence of Social Support in Emerging Adulthood Across Sources of Support and Profiles of Interpersonal and Non-Interpersonal Potentially Traumatic Experiences

Social support is protective against the negative effects of trauma, yet how these effects vary across sources of support and patterns of trauma exposure has not been examined. High co-occurrence exists among different types of trauma across domains and ages, yielding patterns of trauma exposure that may affect social support. This study identified profiles of potentially traumatic events (PTEs) experienced by 252 college students and examined the relationships between social support and mental health across these profiles. Five profiles emerged: “Non-Interpersonal Trauma Exposure,” “Adult Intimate Partner Violence,” “Poly-trauma Exposure,” “Low Trauma Exposure,” and “Childhood Family Violence.” The link between social support and adjustment differed across profiles. Family support was valuable for promoting resilience across patterns of PTEs. Friend and romantic partner support were related to lower mental health problems. Support from family and friends is particularly valuable in the context of adult intimate partner violence and childhood family violence.