Gender and the Primary Prevention of Suicide Mortality

Primary prevention aims at reducing the incidence of a disorder. The first step in primary prevention involves documenting the magnitude of the problem and identifying risk factors. Consistent with primary prevention practices, we review the national and international epidemiological data on suicide mortality and then discuss the implications these data hold for primary prevention. Our approach is novel because we systematically examine the suicide epidemiology data by gender and culture. Suicide mortality appears to be highest among individuals (e.g., young adult married females in some Papua New Guinea regions; older adult, isolated, White males in the United States) for whom such behavior is culturally sanctioned. Thus, an important target for primary prevention may be local cultures of gender and suicide.     

关怀哲学视阈下的自杀防控探究

自杀问题是当下社会中存在的精神卫生症候之一,从关怀哲学的视角探究自杀防控理念的历史源流、现实境遇、临床困境与价值诉求,经由医患关怀的和谐转化,医务人员可以在防控自杀病人的进程中达到“关怀”与“防控”的知行统一,一方面为自杀病人提供文化关怀的防控脉相,另一方面为医护人员在自杀防控的实践运用层面提供参考.     

An Integrative Suicide Prevention Program for Visitor Charcoal Burning Suicide and Suicide Pact

An integrative suicide prevention program was implemented to tackle an outbreak of visitor charcoal burning suicides in Cheung Chau, an island in Hong Kong, in 2002. This study evaluated the effectiveness of the program. The numbers of visitor suicides reduced from 37 deaths in the 51 months prior to program implementation to 6 deaths in the 42 months post‐implementation period. The number of visitor suicide pacts decreased from 7 pacts (15 individuals) to 1 pact (2 individuals). No statistically significant differences in the numbers of visitor suicide attempts and resident suicides were observed in the two time periods. No statistically significant changes in visitor suicides during the study period were observed on the comparison islands. The consistency and timing of reduction in visitor suicides correlated with the development and delivery of the integrative program on the intervention island, suggesting a causal association between program delivery and reduction of visitor suicides. The possibility of displacement seems small because there was no increase in visitor suicides on the comparison islands during the study period. This integrative approach in preventing target‐specific suicides may serve as an example for other communities to develop suicide prevention programs that make use of the existing local resources.     

Mobilizing Schools for Suicide Prevention

ABSTRACT: Experience in providing consultation and survivor counseling to school personnel following student suicides led to the development of a program of prevention through training school personnel. The goal of the program was to increase the ability of resource persons available to adolescents—teachers, counselors and school nurses—to recognize signs of suicidal depression and to respond effectively to suicidal students. This report describes that program, the reaction of the participants and the observations of the project staff, and comments on the feasibility of this approach as a means of helping to prevent suicide among adolescents.     

Primary Care for the Elderly Bereaved: Recommendations for Medical Education

The aim of this study was to explore the current practices of primary care physicians (PCPs) in providing bereavement care to elderly patients, with implications for medical education. A total of 63 PCPs answered a brief online survey about their typical practices, barriers, comfort level with bereavement, and confidence in their ability to diagnose prolonged grief disorder (PGD). They were recruited through an online newsletter and contacts of one of the authors. The results found that two-thirds of the PCPs do not routinely screen their elderly patients for recent losses, nor do they refer to mental health clinicians when loss is identified. Barriers included not learning of the deaths in patients’ lives and lack of time during clinic visits. Those PCPs who had experienced their own losses were significantly more comfortable in speaking to patients about recent losses and more confident in their ability to diagnose PGD. We recommend bereavement education be incorporated into the medical school curriculum from the outset, utilizing the psychological principle of graded exposure to bereaved individuals.     

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.     

New Directions for Suicide Prevention Centers*

ABSTRACT: This paper considers a number of questions regarding the epidemiology of suicidal phenomena and discusses some of the efforts of the Cornell Program in Social Psychiatry to study these questions and to explore new directions for suicide prevention work. Particular attention is paid to high suicide risk groups that are outside the network of existing medical services. Strategies for extending the clinical picture differentiating between syndromes assessing individual risk, clarifying etiological factors, and improving the working of the health services are considered.     

Interprofessional Education: Preparing Psychologists for Success in Integrated Primary Care

Rapidly occurring changes in the healthcare arena mean time is of the essence for psychology to formalize a strategic plan for training in primary care settings. The current article articulates factors affecting models of integrated care in Academic Health Centers (AHCs) and describes ways to identify and utilize resources at AHCs to develop interprofessional educational and clinical integrated care opportunities. The paper asserts that interprofessional educational experiences between psychology and other healthcare providers are vital to insure professionals value one another’s disciplines in health care reform endeavors, most notably the patient-centered initiatives. The paper highlights ways to create shared values and common goals between primary care providers and psychologists, which are needed for trainee internalization of integrated care precepts. A developmental perspective to training from pre-doctoral, internship and postdoctoral levels for psychologists in integrated care is described. Lastly, a call to action is given for the field to develop more opportunities for psychology trainees to receive education and training within practica, internships and postdoctoral fellowships in primary care settings to address the reality that most patients seek their mental health treatment in primary care settings.     

Primary Prevention Through a Campus Alcohol Education Project

A comprehensive primary prevention model for campus alchohol education is described. Preliminary results are presented for policy implementation and a fraternity alcohol education intervention.     

Myths and Facts about Suicide from Individuals Involved in Suicide Prevention

Myth‐busting, in which a so‐called myth is presented and dispelled by facts, is used in suicide prevention gatekeeper trainings such as QPR. Evidence from other areas of public health shows this technique leads to memory for myths and not facts. An internet survey was used to determine if the “myths” and “facts” presented in QPR are endorsed as such by the suicidology community and to determine if demographics influenced statement identification. Overall, statements did reflect the opinions of the suicidology community and any type of training increased correct identification. Future research should focus on whether myth‐busting is an appropriate strategy for suicidology.     

Resolving Ethical Dilemmas in Suicide Prevention: The Case of Telephone Helpline Rescue Policies

The ethical basis of suicide prevention is illustrated by contrasting helpline emergency rescue policies of the Samaritans and the AAS and the U.S. National Suicide Prevention Lifeline network. We contrast moralist, relativist, and libertarian ethical premises and question whether suicide can be rational. Samaritans respect a caller's right to decide to die by suicide; U.S. helplines oblige emergency intervention during an attempt even against the caller's will. We analyze the effect of emergency rescue when there is high suicide risk but an attempt has not been initiated. We examine links between values and actions, needs for empirical evidence to guide practice, and propose vigorous dialogue about values in the gray zone of moral practice.     

Risk Factors of a Suicide Reattempt by Seasonality and the Method of a Previous Suicide Attempt: A Cohort Study in a Japanese Primary Care Hospital

Suicide has a great impact on the individual whose life is lost and the bereaved family members. The risk of a suicide reattempt is particularly high during the first 12 months after a suicide attempt. In this cohort study, risk factors for a suicide reattempt were explored among 291 patients at suicide risk. Clinical and demographic data were collected from a Japanese primary care hospital. Past psychiatric history and multiple diagnoses were associated with suicide reattempts in both genders. Drug overdose, past psychiatric history, and the summer season were linked to suicide reattempts among males. Past psychiatric history and multiple diagnoses were linked to suicide reattempts among females. Appropriate assessment of past psychiatric history, season and method of suicide attempt, gender, and diagnosis may play a role in preventing suicide.     

自杀高危人群的识别及预防研究

自杀是由严重心理危机导致的行为.通过描述自杀高危人群存在的时代状况,从社会学与心理-精神病学的维度分析了高危人群的自杀成因,进而对其自杀前的异常言行表现、自杀的方式及当前各种预防措施进行讨论.同时,对中国文化语境下的自杀及其预防展开了反思与展望.     

Ethical Criticism of the Bible: The Case of Divinely Mandated Genocide

Taking as a test case biblical texts in which the God of Israel commands the destruction other nations, the present paper defends the legitimacy and the necessity of ethical criticism of the Bible. It takes issue with the suggestions of several contemporary Christian philosophers who have recently defended the view that (in Israel’s early history) God had good and morally sufficient reasons for commanding genocide.     

Impact of Applied Suicide Intervention Skills Training on the National Suicide Prevention Lifeline

We examined the impact of the implementation of Applied Suicide Intervention Skills Training (ASIST) across the National Suicide Prevention Lifeline's national network of crisis hotlines. Data were derived from 1,507 monitored calls from 1,410 suicidal individuals to 17 Lifeline centers in 2008–2009. Callers were significantly more likely to feel less depressed, less suicidal, less overwhelmed, and more hopeful by the end of calls handled by ASIST‐trained counselors. Few significant changes in ASIST‐trained counselors' interventions emerged; however, improvements in callers' outcomes were linked to ASIST‐related counselor interventions, including exploring reasons for living and informal support contacts. ASIST training did not yield more comprehensive suicide risk assessments.     

Assisted Suicide,Euthanasia, and Suicide Prevention: The Implications of the Dutch Experience

What impact would legalization of assisted suicide and euthanasia have on our ability to treat suicidal patients and to prevent suicide? Information from a study of the Dutch experience illustrates how legal sanction promotes a culture that transforms suicide into assisted suicide and euthanasia and encourages patients and doctors to see choosing death as a preferred way of dealing with serious or terminal illness. The extension of the right to euthanasia to those who are not physically ill further complicates the problem. So too does the tendency of doctors in such a culture to begin to feel that they can make decisions about ending the life of competent terminally ill patients without consulting the patient. “Normalizing” suicide as a medical option lays the groundwork for a society that turns euthanasia into a “cure” for suicidal depression.