Impact of Death by Suicide of Patients on Thai Psychiatrists

The objective of this study was to identify the impact of a patient's suicide on psychiatrists in Thailand. A confidential coded postal questionnaire survey was sent to 320 eligible psychiatrists; with a response rate of 52.18%). The results showed that 94 (56.28%) of responding psychiatrists had a patient die by suicide, consistent with high rates found in similar large‐scale studies in the United States and United Kingdom. Less than half (41.5%) of patients had been diagnosed with schizophrenia, 33% had a depressive disorder, and the others had a wide array of diagnoses. More than 50% of psychiatrists reported personally experiencing sadness, depression, hopelessness, and guilt; 74.5% reported professional reactions, most frequently a review of their practice (93.4% reported being more aggressive in assessment of suicidality). Respondents were diverse in their postvention; 90% of Thai psychiatrists reported that working through with colleagues was most helpful. Family and friends helped. A majority (72.4%) of psychiatrists prayed or did “merit” for the dead patient; 86.8% found it helpful. This finding suggests that cultural sensitivity may be needed to understand the impact of suicide on psychiatrists but also to its response.     

Behavioral Risk Assessment of the Guarded Suicidal Patient

Psychiatrists and other mental health professionals are trained to assess patients by direct observation and examination. Short inpatient length of stay, brief outpatient visits, emergency room evaluations, and other time‐limited clinical settings require rapid assessment of suicide risk. Recognition of behavioral suicide risk factors can assist in the early identification of the guarded suicidal patient, thus avoiding total reliance on the patient's reporting.     

Risk Factors for Attempting Suicide in Prisoners

We wished to examine determinants of suicidal behavior in prisoners. 903 male prisoners had a psychiatric interview which included various psychometric tests. Suicide attempters were compared with prisoners who had never attempted suicide. Significantly more of the attempters had a history of psychiatric disorder, substance abuse, a family history of suicidal behavior, convictions for violent crime, had exhibited aggressive behavior in jail, and had higher BGLHA aggression scores. A similar pattern of risk factors was found for prisoners with suicidal ideation. A lifetime history of attempting suicide, or of having suicidal ideation, is frequent in prisoners. Risk factors include family, developmental, aggression, personality, psychiatric, and substance abuse factors.     

Enrichment and Stress in Families Caring for a Child with a Serious Emotional Disorder

We examined enrichment and stress in 214 families who had children with severe emotional disorders. Caregivers' ratings of enrichment and stress were obtained through a newly developed instrument, the Effects of the Situation Questionnaire, which used parallel items covering 17 life areas. While ratings of stress were generally higher than enrichment, caregivers reported some enrichment in areas encompassing self concept and family relationships, Bivariate and multivariate analyses using various child, family, and service-system variables revealed that stress was notably associated with severity of the child's disorder, low empowerment, and a lack of coordination among service providers. Enrichment was unrelated to severity but associated with high empowerment and spiritual support. Our findings suggest that families' experiences of caregiving can have both positive and negative aspects and that a comprehensive approach to serving and studying families should take both into account.     

Comparison of the Effects of Telephone Suicide Prevention Help by Volunteers and Professional Paid Staff: Results from Studies in the USA and Quebec,Canada

Research since the 1960s has consistently found that lay volunteers are better at helping suicidal callers than professionals. Yet, professional degrees are increasingly becoming requirements for helpline workers. In our first study, we conducted post hoc comparisons of U.S. helplines with all professional paid staff, all lay volunteers, and a mix of both, using silent monitoring and standardized assessments of 1,431 calls. The volunteer centers more often conducted risk assessments, had more empathy, were more respectful of callers, and had significantly better call outcome ratings. A second study of five Quebec suicide prevention centers used silent monitoring to compare telephone help in 1,206 calls answered by 90 volunteers and 39 paid staff. Results indicate no significant differences between the volunteers and paid employees on outcome variables. However, volunteers and paid staff with over 140 hours of call experience had significantly better outcomes. Unlike the United States, Quebec paid employees were not required to have advanced professional degrees. We conclude from these results and previous research that there is no justification for requiring that suicide prevention helpline workers be mental health professionals. In fact, the evidence to date indicates that professionals may be less effective in providing telephone help to suicidal individuals when compared to trained lay volunteers.     

A dyadic assessment of forgiveness in intimate relationships

This study investigated forgiveness by examining couples’ recollections and perceptions of specific incidents of transgressions in their relationships. The results replicated previous research but also produced some novel findings. Results showed that more positive attributions and relationship quality independently predicted higher internal forgiveness, whereas expressed forgiveness was related only to relationship quality. Overall, the sample was negatively biased in their perceptions of their partner's forgiveness, but those participants who tended toward a positive bias were happier with their relationships as were their partners. Results are discussed in terms of prior research and theories of forgiveness and related social judgments in intimate relationships.