Panic disorder and suicide attempt in the National Comorbidity Survey

Clinical and some epidemiological data conflict concerning the likelihood of suicide attempt in individuals with panic disorder (PD). The purpose of this study was to illuminate the panic disorder-suicide attempt association in the National Comorbidity Survey (NCS; R. C. Kessler et al., 1994). Specifically, suicide attempt histories of those 5,872 respondents answering "yes" or "no" to the suicide attempt question were regressed against lifetime diagnostic histories. Lifetime PD history, in the presence of other disorders, was unrelated to elevated risk of suicide attempt and did not account for additional variance. PD respondents who had made a suicide attempt were characterized by Comorbidity. Epidemiological respondents with lifetime histories of PD alone are not at heightened risk for self-reported suicide attempt.     

Investigating Correlates of Suicide Among Male Youth: Questioning the Close Affinity Between Suicide Attempts and Deaths

This study was based on a sample of male high school students who completed National Longitudinal Adolescent Health Surveys in 1994, 1995, and 2001. We studied these students prospectively, comparing those who later died by suicide (n = 21) with those who were still living (n = 10,101). We employed chi‐square and analysis of variance tests for statistical significance between suicide decedents and living respondents. Results showed suicide decedents were more likely to have experienced the suicide loss of another family member, to have been expelled from school, to have engaged in more delinquent actions including fighting, and to have greater involvement with the criminal justice system. Although one might have expected suicide casualties to have exhibited a greater amount of suicidal thoughts, attempts, and higher incidences of suicidality among their friends, our analyses did not find that these factors were associated with actual suicides. Should these findings be replicated, this would point to a need to refine youth suicide risk assessments. Collecting life histories, as well as identifying patterns of delinquency and fighting, may serve as more potentially fruitful means for assessing genuine suicide risk than some traditional risk assessment methods.z     

Impact upon therapy and the therapist when working with suicidal patients: some transference and countertransference aspects

The suicide, or attempted suicide, of a client/patient is something that a substantial number of counsellors and psychotherapists have encountered during their career. The literature indicates that this can be a cause of anxiety for many. In this paper the experience of psychotherapists working with suicidal patients is explored. One hundred psychotherapists were surveyed, by means of a postal questionnaire. Five follow-up interviews were conducted. The findings indicate that suicidal patients can evoke intense feelings within the therapist, and the meanings of this are discussed. The links with the concept of projective identification are particularly considered. It is noted how such feelings, experienced within the transference relationship and the therapist's own countertransference, can reflect the inner world of the patient concerned. The psychotherapists described how they felt themselves to have been affected by the work, both personally and professionally. Commonly mentioned responses included feelings of hopelessness and helplessness and a sense of failure. Finally, the respondents outlined measures that they believed to be vital for their own support. The importance of firm boundaries and staying in the therapeutic role is discussed.     

Interpersonal reactions to suicide attempt: the role of respondent causal attributions

Interpersonal responses to a depressed person with or without a suicide attempt were examined. It was hypothesized that the depressed person who attempted suicide would receive higher negative attributions and interpersonal rejection, and that attributions would mediate the relationship between exposure to a depressed person and rejection. Contrary to hypotheses, respondents were more willing to interact with, held higher esteem for, and endorsed lower negative attributions for the depressed person who attempted suicide. Mediation hypotheses were supported. Findings suggest that a suicide attempt may promote less negative attributions toward depressed individuals, which in turn dampen negative interpersonal reactions.     

Factors Associated with Achieving Complete Mental Health among Individuals with Lifetime Suicidal Ideation

The objective of this study was to identify factors associated with complete mental health among Canadians who had ever seriously considered suicide. Data for this study were obtained from Statistics Canada's 2012 Canadian Community Health Survey–Mental Health (N = 2,844). The outcome variable examined in this study was complete mental health and was analyzed using binary logistic regression. Of the 2,844 respondents with lifetime suicidal ideation, 1,088 (38.2%) had complete mental health (i.e., had flourishing mental health, no mental illness, and no suicidal ideation in the past 12 months). Those who had a confidant were seven times more likely to have complete mental health. Other factors associated with achieving complete mental health among formerly suicidal respondents include being older, being a woman, having higher income, use of religious coping, and never previously having a mental illness. Considering the importance of these protective factors in formulating public health policies will allow for a more wide‐reaching approach to suicide prevention.     

A multinomial logit analysis of methods used by persons who completed suicide

This paper presents a multinomial logit analysis of the methods used by Taiwanese individuals who completed suicide between 1991 and 1993. We investigated the influence of age, gender, urban or rural residence, seasons, and occupations on the six "choices" of suicide methods. The findings suggest that a systematic pattern exists between the choice of method and demographic characteristics of persons who have completed suicide. Most of the different patterns of suicide by sex, age, occupation, or residence can be understood by the different availability and accessibility to the means of suicide faced by the individuals. Our findings support Becker's (1962, 1974, 1993) contention that all kinds of human behavior or choices are shaped by the constraints imposed on the individuals. The findings also have important policy implications for suicide prevention in that they support Lester's advocacy to prevent or reduce suicide incidents by limiting availability, blocking accessibility, or "inconveniencing" the suicidal individuals.     

What Right to Die?

This letter first discusses two meanings of a "right to die." In the popular sense, the term refers to a right to refuse life-sustaining treatment. In the strict sense, the term signifies an affirmative right to obtain death--a right to suicide. The letter then explores the legal implications of a suicide right. This right would extend to competent adults, mature minors, and probably also incompetent persons. Counselors would have to inform clients of the suicide option. Intervention to prevent suicide could trigger civil liability. Suicidal intentions would not justify involuntary commitment. Consent would become a defense to homicide.     

Self-Prophecy Effects and Voter Turnout: An Experimental Replication

Psychological research has found that being asked to predict one's future actions can bring about subsequent behavior consistent with the prediction but different from what would have occurred had no prediction been made. In a 1987 study, Greenwald, Carnot, Beach, and Young induced an increase in voting behavior by means of such a "self-prophecy" effect: Undergraduates who were asked to predict whether they would vote in an upcoming election were substantially more likely to go to the polls than those who had not been asked for a prediction. This paper reports on a replication of the Greenwald study conducted among a larger group of respondents more representative of the American electorate. No evidence was found that self-prophecy effects increase voter turnout.     

Expectations and preferences regarding confidentiality in the psychologist-client relationship

Two hundred and fifty-six members of the Australian public were surveyed regarding situations in which a psychologist might breach confidentiality and third parties to whom information might be disclosed. There was strong agreement between respondents' expectations about the way in which psychologists would act, and their preferences regarding how psychologists should act. While respondents supported confidentiality within the psychotherapeutic relationship, they clearly distinguished situations in which, and third parties to whom, disclosure could appropriately occur. Disclosure was expected and preferred when a client revealed a murder (planned or confessed), suicide plans, child abuse, or treason, and where the recipients of the information were colleagues of the psychologist or parents of a client younger than 13 years. Compared to nonparents, parents more strongly supported disclosure regarding illegal drug use and child abuse, and believed that parents should have access to a child's records. In general, respondents' view of the way in which psychologists should treat confidentiality issues were consistent with the guidelines prescribed by the Australian Psychological Society in the Code of Professional Conduct (1986).     

An integrated approach to estimating suicide risk

It is ironic that if we had a perfect predictive instrument we would not be able to recognize it because it could never be validated by its critical outcome criterion. Though some exceptions could occur, we would be obliged to take all available measures to prevent a suicidal outcome in cases where suicide was predicted. After the crisis we could have no way of knowing with certainty whether the person would have suicided or not. Even if we accepted the reality that people are not either 0% or 100% likely to suicide, and developed a perfect scale to estimate degree of risk, we would still be unable to validate it in individual cases. If it indicated "moderate" risk of 2.5-5.0%, for example, and no intervention were offered, we would have to observe one suicide in every 20-40 persons assessed at this level of risk to demonstrate its validity. The key to assessment is obtaining information, primarily regarding present or anticipated pain and the threshold of pain tolerance in the individual involved. Since different persons communicate in a variety of ways--verbal, nonverbal, symbolic, metaphoric, etc., eclecticism in approach is essential. For some clinicians communication will be facilitated most by one style; for others, a different method would be most effective. Thus, the "best" approach is the one that works best given the unique characteristics of the persons involved and under the conditions existing at the time. My own bias is that every assessment, whatever the approach, must include some form of direct inquiry regarding suicidal intent, and that the final decision in this regard must be a subjective and intuitive judgment. Contrary to possible assumptions in the legal world, accurate assessment does not necessarily mean safety. It can serve as a guide to the degree of risk that may be involved in a treatment program, but even low risk management measures may have an adverse outcome without implications of negligence or carelessness. There has been no mention here of biological markers of suicide, which are of much current interest but still in an investigational stage. Similarly, rational suicide has not been mentioned, though our aging population and the status of AIDS are making this issue progressively more important. The principles involved in assessment of risk are the same as with other forms of suicide, however. Finally, we can only presume that more precise assessment will operate to reduce suicidal deaths.(ABSTRACT TRUNCATED AT 400 WORDS)     

The relationships among clinical depression, suicide, and other actions that may hasten death

Clinical depression and other psychological disorders have been associated with suicidal ideation, attempts, and deaths. Because of the link between suicide and mental illness, whenever discussion of "assisted suicide" arises, the possibility that major depression is affecting the decision arises. This article examines the literature on clinical depression as it relates to suicide, "assisted suicide," and other decisions that will hasten death (i.e. withholding and withdrawing treatment, terminal sedation, and voluntarily stopping eating and drinking). Ethical and legal considerations when working with individuals who are considering taking an action that would hasten death are also briefly reviewed. The article ends with practice and policy recommendations.     

Suicide in pregnancy: the Hedda Gabler syndrome.

A review of forty-seven suicides in women of child-bearing age revealed that two women were pregnant, two were within the first year post-partum and two falsely believed themselves pregnant. The search revealed two additional pregnancy-associated suicides which had not been reported as suicide. Previous studies asserting that pregnancy protects against suicide would seem to be challenged by these data. Pregnancy-related suicides are similar to each other and to the literary suicide of Hedda Gabler and fit into a continuum of pregnancy-related disorders.     

The contemplation of suicide: Its relationship to irrational beliefs in a client sample and the implications for long range suicide prevention

This study investigated differences in irrational belief systems between clients in psychotherapy who reported they were contemplating suicide and those who reported they were not. The sample included over 95% of all persons aged 16 and over seen for psychotherapy over a six-year period (90 males and 117 females). Those contemplating suicide (N=85) were significantly more irrational on a number of basic dimensions. The general composite picture was that of an individual who sees him/herself as a helpless victim of past and present circumstances who must, nevertheless, perform well, be approved of, and never have anything go wrong; any kind of failure would be awful for it would prove one to be a worthless person. Findings are consistent with other cognitive-behavioral research on suicide. Other approaches to the explanation of suicide are reviewed and criticized, especially those that in Rational-Emotive Therapy terms have made an A-C error.Paul J. Woods, Ph.D., is a Professor of Psychology at Hollins College, an associate fellow and a certified supervisor of training of the Institute for Rational-Emotive Therapy in New York City, and is engaged in part-time private practice in Roanoke, VA.Geri E. Muller is a graduate student in the Master's program in psychology at Hollins College.     

Attitudes of Mothers of Children with Down Syndrome Towards Noninvasive Prenatal Testing

Noninvasive prenatal testing (NIPT) allows for highly sensitive detection of Down syndrome early in pregnancy with no risk of miscarriage, therefore potentially increasing the number of pregnancies identified with Down syndrome. This study assesses how mothers of children with Down syndrome perceive NIPT, especially the impact they think it will have on their families and other families with children who have Down syndrome. Seventy-three self-reported mothers of children with Down syndrome responded to an anonymous online survey emailed to, and posted on, message boards of various Down syndrome support groups and networks. Data analysis included chi-square tests and thematic analysis. Fifty-nine percent of respondents indicated they would use NIPT in the future; respondents who had not used prenatal testing in the past were significantly less likely to report interest in using NIPT in the future than those who had prenatal testing previously (p?MOST important factor. They also highlight the need to provide a diagnosis of Down syndrome in a balanced and objective manner.     

Reactions to the family of the suicide

The present study investigated reactions to the survivors of a family member's suicide. One hundred and twenty seven adults, members of a large urban Protestant church, responded to a newspaper account of a suicide in which the following factors were systematically varied: sex of the suicide, causal locus of the suicide, and whether the cause was prior or immediate to the suicide. The design was a 2 (sex of respondent) x 2 (sex of suicide) x 2 (locus of cause internal or external to the individual) x 2 (temporally remote cause or immediate cause). Results indicated a slight tendency for males to be somewhat more socially accepting of the surviving spouse of a suicide. There was also a significant interaction between sex of respondent x sex of the suicide, such that respondents indicated they would feel less tension in talking with the surviving family of a suicide of the same sex.     

Treating the Capability for Suicide: A Vital and Understudied Frontier in Suicide Prevention

Current efforts at suicide prevention center largely on reducing suicidal desire among individuals hospitalized for suicidality or being treated for related psychopathology. Such efforts have yielded evidence‐based treatments, and yet the national suicide rate has continued to climb. We propose that this disconnect is heavily influenced by an unmet need to consider population‐level interventions aimed at reducing the capability for suicide. Drawing on lessons learned from other public health phenomena that have seen drastic declines in frequency in recent decades (HIV, lung cancer, motor vehicle accidents), we propose that current suicidality treatment efforts trail current suicidality theories in their lack of focus on the extent to which individuals thinking about suicide are capable of transitioning from ideation to attempt. We summarize extant evidence for specific capability‐centered approaches (e.g., means safety) and propose other options for improving our ability to address this largely overlooked variable. We also note that population‐level approaches in this regard would represent an important opportunity to decrease risk in individuals who either lack access to evidence‐based care or underreport suicidal ideation, as a reduced capability for suicide would theoretically diminish the potency of suicidal desire and, in this sense, lower the odds of a transition from ideation to attempt.     

The Many Faces of Physician-Assisted Suicide

Physician-assisted suicide is a complex and controversial issue that touches on standards of medical practice, the balance between individual rights and the rights of the state, and our fears of death and pain. Supporters of assisted suicide propose it as an alternative to a lingering, highly technological death, and define it as the act of a physician who prescribes a lethal dose of a medication for a terminally ill patient, with the knowledge that the patient intends to commit suicide. The recent U.S. Supreme Court ruling upheld prohibitions against assisting in a suicide, but left open the possibility that in certain specific cases assisted suicide might be constitutionally protected. The Supreme Court's refusal to extend constitutional protection to assisted suicide was done in part to insure that public debate and legislative fact-finding would continue. As stated in Justice Rehnquist's majority opinion, ...Americans are engaged in an earnest and profound debate about the morality, legality and practicality of physician-assisted suicide (Washington v. Glucksberg, 96-110—Opinion, 1997, p. 26). As researchers, policy makers, and health care providers, we have an obligation to insure that political debate and empirical research are continuing and productive, and that this issue becomes more than just an occasion to play out ideological or personal differences.     

Suicide ideation: its relation to depression, suicide and suicide attempt

A random sample of 3,935 adults from a general population were interviewed and asked to report how often they had thoughts of suicide as well as their opinion on the frequency of suicide ideation in others. Depression was found to be related to the respondent's reports of his/her own suicidal thoughts and to reports of frequent suicide ideation in others. A total of 5.4 percent of the respondents reported some degree of suicide ideation in the previous month and 9.1 percent reported that others think about suicide once a month or more. When the demographic characteristics of those who report suicide ideation in themselves or others were compared to those of suicide attempters and committers, some consistencies were found, suggesting that such questions may be useful in identifying those "at risk." Nevertheless, sufficient discrepancies were found which suggest that there may be a number of factors which increase or decrease the likelihood that someone with thoughts of suicide will attempt or commit suicide. Follow-up studies are necessary to uncover such factors and the degrees to which they influence the occurrence of suicide.     

Does Information That a Suicide Victim Was Psychiatrically Disturbed Reduce the Likelihood of Contagion?1

For example, psychological disturbance is stigmatizing, so knowledge that the suicide victim was psychiatrically disturbed may decrease the possibility that others will imitate the act. To assess this possibility, 306 undergraduate volunteers read a fictitious newspaper article about a 16-year-old high school sophomore, Pat, who committed suicide. There were 7 variations of the article, 4 containing negative circumstances (psychiatric disturbance, romantic relationship breakup, parents’ divorce, alcohol problems), and 2 containing positive circumstances (being a varsity athlete, being an honors student). A control group received no information about circumstances. Knowledge of Pat's life circumstances had no effect on respondents’ estimates of the possibility of the suicide being imitated, but did affect attitudes about the suicidal act itself and attitudes toward Pat's family. Apparently the circumstances surrounding the suicide have no affect on respondents’ estimates of themselves following suit, but do affect how they see the victim and bereaved family.