Environmental factors in suicide in long-term care facilities.

One major purpose of this study was to identify environmental factors related to suicide in long-term care facilities. Questionnaires were mailed to a random sample of administrators at 1,080 facilities. Information was collected on facility characteristics, overt suicide, and intentional life-threatening behavior. Chi-square analyses revealed 4 environmental characteristics related to suicidal behavior and deaths from suicide: staff turnover, size, auspices, and per diem cost. More suicides occurred in larger facilities and facilities with higher staff turnover. Religious or "other" facilities experienced more suicidal deaths than public or private facilities; facilities charging less experienced more deaths.     

Suicidal behavior in hospitalized schizophrenics

A group of 131 hospitalized schizophrenics who had attempted suicide within the past year was compared with another group of 70 hospitalized schizophrenics who had not attempted suicide, using the Present State Examination (PSE) depressive symptoms. The former had a significantly higher number of symptoms indicative of a depressive disorder.     

Suicidal behavior in chemically dependent adolescents

Among 250 adolescents in a short-term residential treatment program for chemical dependency, 20% had attempted suicide in the two years prior to admission. Females, however, were found to have a higher attempt rate than did males. Suicide attempters were compared with a group of 50 nonsuicidal adolescents from the same treatment program and 50 non-chemically dependent, nonsuicidal high school students. Each adolescent was administered the Symptom Checklist 90-Revised (SCL-90-R), and a biographical history was obtained. The suicidal group was found to be more psychologically distressed than were the other two groups. Post hoc analysis revealed that there were significant differences between the chemically dependent groups (suicidal, nonsuicidal) on the Global Severity Index of the SCL-90-R, as well as the following subscales: Somatization, Depression, Anxiety, and Phobic Anxiety. It was also found that the majority of suicidal gestures or attempts had gone untreated beyond medical management. It was found that only 28% of the suicide attempters had received crisis intervention or emergency room treatment, and only 27% had received some type of follow-up treatment or counseling. These results are discussed, particularly in regard to the issue of "covert suicide."     

Command use and compliance in staff communication with elderly residents of long-term care facilities

Verbal communication between nursing assistants and individuals with dementia can be challenging, particularly during hands-on caregiving tasks. Although there are many aspects of verbal communication that can affect the quality of an interaction, one potentially important communication variable is the types of commands issued by nursing assistants when they need a resident to complete a task. The purpose of this study was to examine the kinds of commands used by nursing care staff when they interact with patients with dementia during activities of daily living. Commands were categorized according to their feasibility/specificity as well as form. An additional goal of this study was to measure compliance and noncompliance rates associated with the various categories of commands. Results indicate that alpha commands (clear, concise, and feasible) account for higher compliance and less noncompliance compared with beta commands (ambiguous, interrupted, and not feasible). In addition, commands that are stated directly, that clarify a previous command, and that are repeated exactly produce better compliance. It is concluded that training nursing staff to change the types of commands they provide during caregiving tasks may reduce distress experienced by both staff and residents.     

Suicidal behavior in adolescent and young adult gay men

The relationship of homosexuality to suicidal behavior was explored by questionnaire responses from 52 men in gay-and-lesbian college organizations and 56 men in gay rap groups. A family background of alcoholism and physical abuse, social supports perceived as rejecting of homosexuality, and no religious affiliation were associated with a history of suicidal ideation, reported by 55% of the participants. Racial/ethnic minorities tended to be overrepresented among suicidal as compared to nonsuicidal gay men. Suicide attempts, reported by 20% of the sample, were most often associated with intrapersonal distress, and occurred most often while individuals were "closeted" and/or in the context of recent rejection for being homosexual. Nearly all attempters were aware of their homosexual feelings, but had not yet established a "positive gay identity" at the time of their first suicide attempt. Suicidal behavior in gay youths may be the product both of familial factors that predispose youths to suicidal behavior, and for social and intrapersonal stressors involved in coming to terms with an emerging homosexual identity.     

Suicidal behavior in childhood and early puberty--syndromatic nosologic aspects

The author points out the necessity to separate suicidal behaviour in childhood and early puberty on the one hand and of adults on the other hand. Suicidal acts (attempted suicides) of 100 suicidants at the age until sixteen are analyzed on syndromatic-nosologic aspects. Preventive-prophylactic measures are shortly mentioned.     

Philosophy in religious health care facilities

Why formulate a philosophy statement? How may this statement influence organizational life? Answers to these questions affirm the practical utility of a philosophy within a health care facility. In addressing the first question, consideration is given to the philosophical questions by whom, to whom, and for what purpose is the organization sent. Also considered are its purpose in relating to and mode of relating to its patients. The practical place of a philosophy is illustrated through the difference between for-profit and non-profit corporations. A close analysis of organizational structure, systems, and strategies details this difference.     

Suicidal behavior among youth with severe emotional disturbance

The purpose of this study was to replicate an investigation of risk behaviors associated with suicidal behavior in public high school students, in a population of high school age youth with severe emotional disturbance (SED). Subjects for the study were clients of the South Carolina Continuum of Care (COC) (N=83). Information on suicidal thoughts and acts, aggressive behaviors, substance use and physical recklessness was gathered using a modified version of the self-report National Youth Risk Behavior Survey. Four percent of the youth reported seriously considering suicide, 8% reported planning how they would attempt suicide, 10% reported actually attempting suicide at least once, and 6% reported attempts requiring medical treatment Of the 13 youth who reported attempting suicide, four (31%) did not report planning an attempt. All suicidal behaviors except thoughts occurred more in girls than boys with SED. Alcohol and illicit drug use were associated with suicidal behavior, with larger odds ratios for attempts than for thoughts/plans. Youth with SED who use alcohol and illicit substances are particularly at risk of suicidal behavior. A high index of suspicion is appropriate when evaluating suicidal risk in girls with SED, especially in the presence of known alcohol or substance use.Continuum of Care for Emotionally Disturbed Children Division, S. C. Office of the Governor.     

Suicidal behavior among "normal" high school students

The findings of a pilot study, focusing on suicidal behaviors among 313 high school students in the Midwest, are discussed. Of all the students who participated in the study, 62.6% reported some degree of suicidal ideation or action, including 8.4% who had actually made a suicide attempt. The current study provides a linchpin between the studies of adolescent suicide attempt rates and the studies reporting on percentages of adolescents who made suicide attempts. When the percentage of attempters who made attempts but did not seek medical help is taken under consideration, these two groups of studies become equivalent. Apparently, suicide is a personal concern for most high school students--a problem that warrants immediate attention.     

Terrorism-related risk management for health care facilities

Clinicians should have a basic understanding of the physical and financial risk to mental health facilities related to external threat, such as (but not necessarily limited to) terrorism. Patient care and accessibility to mental health services rest not only on clinical skills, but on a place to practice them and an organized system supported by staff, physical facilities and funding. Clinicians who have some familiarity with the non-clinical requirements for care are in a position to support non-clinical staff in preventing care from being interrupted by external threats or events such as terrorist activity, and/or serving at the interface of facility operations and direct clinical care. Readers should note that this article is an introduction to the topic and cannot address all local, state, and national standards for hospital safety, or insurance providers' individual facility requirements.     

Acceptability of interventions for aggressive behavior in long-term care settings: comparing ratings and hierarchical selection

Fifty-six active treatment team members in long-term nursing care facilities completed an online survey assessing treatment acceptability of modern behavioral, pharmacological, and sensory interventions. A traditional treatment acceptability rating scale was compared to treatment selections in a paired-options format. Unlike earlier research, there were no significant differences in acceptability between the 3 interventions on the traditional rating scale. However, ratings and selections were significantly correlated for behavioral and pharmacological interventions. The clinical significance of such relations and the implications for the use of treatment ratings is discussed.     

Suicidal behavior inLatinas: explanatory cultural factors and implications for intervention

We posit that the high rates of suicidal behavior by teenage Hispanic females reported in large-scale surveys can be understood as a cultural phenomenon, a product of specific elements of the history, tradition, ideology, or social norms of a particular society, and that treatment interventions must take family and cultural factors into consideration. For over a decade, surveys have reported that among ethnic and racial minority youth in the United States, Latinas have the highest rates of suicidal behavior compared to African American and non-Hispanic White adolescent females. However, other research shows that the psychological profiles of suicidal Latina adolescent girls and the risk factors for Latina suicidal behavior may not be that different from non-Hispanic suicidal adolescent females. The unique situation of adolescent Latinas involves the convergence of cultural and familial factors (i.e., familism, acculturation, relatedness, autonomy, etc.) with the developmental, social, and individual factors frequently associated with suicidal behaviors. Based on this background, family-oriented interventions appear to be the most appropriate approach to the prevention and treatment of Hispanic suicidal girls. Factors implicated in Latina suicidal behavior and community-based interventions that include the adolescent and her family are suggested.     

Provider management of child stress behavior in family day care facilities: scaffolding for learning and development by developmentally appropriate practice

Six children (5 boys, 1 girl; aged 36-60 months) participated in this qualitative study. Each child was enrolled in a different family child care facility. The authors rated the child care providers in 3 of the facilities as using developmentally appropriate practices (DAP) most of the time and rated the providers in the 3 other facilities as rarely or never using DAP. They also examined provider management of children's stress behaviors. The authors observed less active and passive stress behaviors in the high-DAP facilities than in the low-DAP facilities. The authors discuss the results with regard to the distinctively different day care culture found in high-DAP facilities versus low-DAP facilities and the implications for practice.