Near-Death Experiences and Attempted Suicide

ABSTRACT: Attempted suicide is correlated with an increase subsequent risk of committed suicide. However, preliminary data and psychodynamic hypotheses suggest that serious suicide attempts followed by transcendental near-death experiences (NDEs) may decrease rather than increase subsequent overt suicide risk, despite the NDEs’ apparent “romanticization” of death. Studies of NDEs and of their influence on suicidal ideation are proposed which may yield greater understanding of self-destructive urges and new strategies of suicide prevention.     

Temperamental Vulnerability and Suicide Risk After Attempted Suicide

The aim was to extend recent findings of suggested temperamental features in attempted suicide and to explore possible domains of vulnerability to suicide risk after attempted suicide. Fifty-four psychiatric inpatients hospitalized after a suicide attempt underwent lumbar puncture for analysis of CSF 5-HIAA concentration and also completed the Karolinska Scales of Personality (KSP) before discharge from the hospital. Suicide attempters scored high on Somatic Anxiety, Psychic Anxiety, and Muscular Tension, and low on Socialization, findings that support recent findings in suicide attempters followed up after an emergency room visit. Five patients committed early suicide, i.e., within 3 years, and the overall long-term suicide mortality after attempted suicide was 13%. There were significant correlations between survival time among early suicides and CSF 5-HIAA (r = .87;p = .054), and the following KSP scale t scores: Somatic Anxiety (r = ?.96;p < .05), Impulsivity (r = ?.88; p < .05), and Socialization (r = .90; p < .05). KSP Socialization showed correlations with CSF 5-HIAA (r = .89; p = .046) among the early suicides. Features of temperamental vulnerability to suicide risk after attempted suicide might involve anxiety proneness, impulsivity, low socialization, and low CSF 5-HIAA.     

Suicide among Attempted Suicides

ABSTRACT: A 10-year follow-up is presented of 484 patients who made serious suicide attempts. Of this group 23% had died, 9% from natural causes, 3% from accidents or from uncertain causes, and 11% from suicide. Suicide frequency is highest in the period immediately after the suicide attempt. Especially interesting is the distribution according to sex. During the first 5 years there is a preponderance of male suicides (which is in agreement with the findings of other investigators), but after 10 years this difference in sex disappears. Suicides are found especially among men from 50 to 60 years of age, disabled pensioners, and persons who have attempted suicide several times, and to a lesser degree among persons living alone and criminals.     

CSF 5-HIAA Predicts Suicide Risk After Attempted Suicide

Suicide risk after attempted suicide, as predicted by cerebrospinal fluid (CSF) monoamine metabolite concentrations, was studied in a sample of 92 psychiatric mood disorder inpatients admitted shortly after attempting suicide. The potential of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in the CSF to predict suicide risk within the first year after attempted suicide was studied by means of survival analysis after median split sub-grouping. Eleven patients (12%) committed suicide within 1 year after attempted suicide. Eight of these belonged to the below-the-median (< 87 nM) CSF 5-HIAA subgroup, that is, the suicide risk was 17% as compared with 7% among those with above-the-median CSF 5-HIAA. The cumulative number of survived patient-months during the first year after attempted suicide was significantly lower in the low CSF 5-HIAA subgroup. It was concluded that low CSF 5-HIAA predicts short-range suicide risk after attempted suicide in mood disorder psychiatric inpatients. These findings lend further support to the serotonin hypothesis of suicide risk.     

Attempted Suicide: An Ethological Perspective

ABSTRACT: Attempted suicides are complex phenomena. Examination of the observed and described behavior permits an analogy to be drawn between them and the biological concept of “conservation withdrawal.” This takes cognizance of innate responses, individual differences and changing socio-cultural standards. Such a formulation more readily allows a non-judgmental approach to the patient, with acceptance of both the appeal and wish to die components. In addition, it offers a different view of the nosological debate, rendering the differences more apparent than real.     

The Family Therapy of Attempted Suicide

Suicidal behavior is a multidetermined act based upon a variety of factors among which family tensions and patterns of interaction predominate. Family therapy, nevertheless, is underutilized for suicidal situations because too few practitioners possess the requisite skills in both suicidology and family treatment. This paper attempts to integrate the two fields, describes some assessment procedures, and presents an account of the method of family therapy utilized by the author with suicidal persons. The basic goals of therapy are to help initiate and to catalyze a healing process that will enable the participants to accept changes in both individual and family existence; to decrease the amount of destructive family interaction; to deal with the inevitable anxiety that accompanies growth and development; to make contact with and among the family members; and to provide hope.     

Physiological Reactions to a Suicide Film: Suicide Attempters,Suicide Ideators,and Nonsuicidal Patients

A film about two teenagers who commit suicide was shown to three groups of psychiatric inpatients: 17 who had attempted suicide, 20 who had expressed suicidal thoughts, and 10 who were not suicidal. Anxiety before and after the film was evaluated with psychometric (anxiety rating scale) and physiological tools (heart and respiration rate, blood pressure, electromyogram). Values noted before and after screening, and the degree of change in these values, were compared. In addition, psychomotor agitation was rated at several points during the film. Most results were negative. The suicide attempters had significantly lower postscreening heart rates and a significantly lesser change in heart and respiration rates than the other two groups. The suicide attempters revealed an increase in psychomotor agitation until the discovery of the suicide and a decrease thereafter, whereas the agitation of the nonsuicidal patients continued to increase from the start to the end of the film. The study suggests that on some parameters, suicide attempters reveal less anxiety than nonsuicidal psychiatric patients following exposure to a simulated suicide. The reaction of suicide ideators falls somewhere between the two groups.     

Temperament,Hopelessness, and Attempted Suicide: Direct and Indirect Effects

This study evaluated whether hopelessness mediated the relations between temperament and recent suicide attempter status in a psychiatric sample. Negative temperament and positive temperament (particularly the positive emotionality subscale) uniquely predicted levels of hopelessness. Although these temperament constructs also demonstrated significant indirect effects on recent suicide attempter status, the effects were partially (for the broad temperament scales) or fully (for the positive emotionality subscale) mediated by the levels of hopelessness. These findings indicate that a tendency to experience excessive negative emotions as well as a paucity of positive emotions may lead individuals to experience hopelessness. Although temperament may also indirectly influence suicide attempter status, hopelessness mediates these relations.     

中国自杀未遂的流行特征及影响因素研究

自杀是一个严重的社会问题和公共卫生问题。但目前尚未完全了解自杀的影响因素以及预防自杀的方法。流行病学研究表明自杀未遂是自杀的重要预测因素,了解自杀未遂的特征以及影响因素将有助于减少自杀行为的发生。本文对自杀未遂的流行特征以及影响因素进行了综述。     

Suicide Attempts in Preadolescent Child Psychiatry Inpatients

This paper describes a preliminary study examining the relative power of measures of perceived family support, hopelessness, and depression for the classification of suicide attempters and nonattempters in a series of 8- to 13-year-old psychiatric inpatients. Results of a stepwise discriminant-function analysis indicated that a measure of a child's perceived family support discriminated between suicide attempters and nonattempters with an 88% accuracy rate. The addition of measures of hopelessness and depression at later steps did not lead to improved classification. The results are interpreted as providing strong support for a link between suicide attempts in children and perceptions of low family support.     

Prevalence of Child and Adolescent Exposure to Community Violence

Emerging as one of the most significant health issues facing American youth today, child and adolescent exposure to community violence has generated much interest across multiple disciplines. Most research to date has focused on documenting the prevalence of community violence and the emotional and behavioral ramifications. This paper provides an overview of the current literature regarding prevalence of youth exposure to community violence, and identifies those areas where further research is warranted. In addition to examining overall rates of community violence exposure, this paper reviews the prevalence of different types of community violence, such as weapon use, physical aggression, and crime-related events. Predictors of community violence exposure, including gender, age, race, socioeconomic status, behavior patterns, and geography, are discussed.     

Dimensions of Perfectionism,Hopelessness, and Attempted Suicide in a Sample of Alcoholics

This study assessed whether specific dimensions of perfectionism and hopelessness were elevated in individuals who had made a serious suicide attempt in comparison to individuals with no history of suicide attempts. A sample of 39 inpatients with alcoholism who had made a serious suicide attempt and a matched sample of 39 inpatients with alcoholism but no history of suicide attempts completed the Multidimensional Perfectionism Scale, the Hopelessness Scale, ratings of achievement and social hopelessness, and the Beck Depression Inventory. The attempter group had higher scores on socially prescribed perfectionism, generalized hopelessness, achievement hopelessness, social hopelessness, and depression. A discriminant function analysis revealed that depression, social hopelessness, socially prescribed perfectionism, and other-oriented perfectionism were unique discriminators of the suicide groups. The results are discussed in terms of the importance of social personality variables in attempted suicide.     

Suicide and Drug Abuse in the Medical Community

ABSTRACT: In the United States each year the equivalent of an average-size medical school graduating class commits suicide, with the highest incidence occurring in the decade following the completion of training. Of these suicides, 20% to 30% are associated with drug abuse and 40% with alcoholism. Various problem areas are considered. Role strain, leading to excessive drug use in an attempt to increase work efficiency, is coupled with a denial of the physician's own dependency needs and gratification. The problem of identity occurs in relation to the exaggerated sense of duty and obligation the physician feels in attending to the demands of the patients and their families. Medicine as magical thinking is also discussed, revealing the physician's belief in his own immunity, which is strenuously tested when he actually sets up in practice. The community's high regard for the physician further complicates the situation. Too little has been done about working with emotional problems of medical students during their training and after they begin to practice. Unfortunately, physicians feel uncomfortable in turning to colleagues for help; rather, they tend to isolate themselves, resorting to alcohol and drugs. One should question the selection of medical students and their overall training, not only in terms of academic learning but also with more consideration for the stresses and strains of the future career.     

Spared at Random: Survivor Reactions in the Gay Community1

Many gay men who have tested negative for HIV were sexually active prior to a general awareness of how HIV is transmitted. Based on the work of Lifton (1980), such HIV-negative gay men may be considered “survivors” since they have witnessed the deaths of many members of their community and have been spared. Survivors may be expected to manifest one or more of three survivor reactions: guilt about surviving (HIV-related guilt), anxiety about dying (AIDS-related death anxiety), and blunted affect. The present study employed structural equation modeling in samples of HIV-negative (N= 129) and HIV-positive (N= 95) gay men to assess psychological and behavioral variables predictive of the presence of a survivor reaction. Survivor reactions were uniquely predicted among HIV-negative gay men. The larger the number of sexual partners HIV-negative gay men reported having had prior to 1984, the more likely they were to experience a survivor reaction. Greater satisfaction with social support from gay friends, and, indirectly, gay-related community group involvement, was associated with being less likely to experience a survivor reaction.     

Reactions to Interpersonal Evaluative Feedback1

Self-enhancement approaches to self-concept provide a perspective for identifying motivational factors likely to be affected by interpersonal evaluative feedback. The main hypothesies were that in contrast to positive feedback, negative feedback would lead to higher self-esteem, lower perceptions of task importance, and lower perceptions of control over an evaluator's reactions. Students received a lesson on solving analogies from a teacher (confederate), and then took a test on analogies. After reviewing the student's test, the teacher conveyed either positive feedback, negative feedback, or no feedback. Consistent with a self-enhancement perspective, recipients of negative feedback increased their global self-esteem, placed less importance on succeeding at the task, and felt less control over the teachers' reactions. Implications for understanding the role of interpersonal evaluative feedback in motivation and self-esteem, and self-enhancing responses to threats more generally are discussed.     

Emotional Reactions to News Events1

This study was designed to determine (a) what dimensions underlie emotional reactions to news events, (b) whether these dimensions are independent, (c) whether reactions to major news events are similar for different groups of people, and (d) whether a simple method could be developed for evaluating emotional reactions to news events. Subjects rated the similarity of their emotional reactions to 20 page-one newspaper stories in a paired-comparison task. The data were multidimensionally scaled using the KYST computer program. Two dimensions emerged that accounted for 89% of the judgment variance: pleasure/displeasure and degree of arousal. Interpretation of these dimensions was verified using a semantic differential task. The two dimensions were not independent. They were related by a U-shaped function: News events farther from evaluative neutrality were judged more arousing. A second study with 40 news events and a different subject population replicated these findings. Subjects' ratings of news events on three scales (happy, important, and exciting) were sufficient to recover the KYST dimensions. The theoretical and practical implications of these. results are discussed.