A Cross‐National Study of the Relationship Between Elderly Suicide Rates and Urbaninzation

There is mixed evidence of a relationship between suicide rates in the general population and urbanization, and a paucity of studies examining this relationship in the elderly. A cross‐national study with curve estimation regression model analysis, was undertaken to examine the a priori hypothesis that the relationship between elderly suicide rates and urbanization would be curvilinear and follow an inverted U‐shaped curve. There was a curvilinear relationship between male suicide rates in both the elderly age‐bands and the percentage of the population living in urban areas, but this was not observed in females. A three‐stage sequential model was developed to explain the observed relationship between suicide rates in elderly males and urbanization. The relationship between suicide rates in elderly females and urbanization.     

Evidence-based medicine,psychoanalysis and psychotherapy

SUMMARY

The scientific status of psychoanalysis is a matter of importance to both theorists and clinicians in psychiatry. The empirical evidence for both the theory and the practice of psychodynamic practice is much greater than is generally recognised. There is strong evidence for the effectiveness of psychoanalysis and psychoanalytically oriented therapy. the future of psychoanalysis depends on this evidence. We will discuss both the evidence and reasons why it is overlooked in certain quarters, and review the developing neuro-cognitive understanding of the mechanisms that underlie psychoanalytical processes.     

Combined therapy with borderline and narcissistic inpatients at the cassel hospital

An account is given here of a rather unorthodox approach to psychodynamic therapy with Borderline patients in part of the therapeutic community at the Cassel Hospital. ‘Combined therapy’ here refers to the setting in which one therapist sees patients in groups and individual sessions concurrently. The paper demonstrates the manner in which this approach brings to the fore the massive destructiveness and rage which so often lies at the core of these patients' difficulties. This is done by describing the development of the group over its first nine months. The therapist comes to be split in the patient's perception, the group sessions representing separation in all its most hated aspects rather than as a prerequisite for differentiation and growth. The resultant rage and destructiveness threaten to render the group unworkable and dangerous. The individual sessions, by contrast, represent a fantasy of being regressed and at one with the ideal mother. It is my belief that these difficulties can be contained only within a therapeutic community. The strength of this approach lies in the vivid reconstruction of a central conflict for these patients and corresponding potential for working through difficulties in the area of separation and individuation. It is also particularly effective in bringing the therapeutic community alive within the therapy. The discussion attempts to address some of the complex theoretical issues raised by the transformation of the transference in both settings which occurs when they are used together and with the same therapist.     

Evaluating the performance of departments of psychotherapy

Conceptual and practical issues which surround attempts at assessing the efficiency of psychotherapy departments are surveyed and the advantages and disadvantages associated with performance indicators reviewed. The issues of assessing efficiency in general and the selection of appropriate indicators at both national and local levels are discussed. It is concluded that it is possible to find indicators which reflect the value of a psychotherapeutic service to the community within which it is based, and that the identification of a generally agreed set of such parameters is a matter of priority.     

Female Suicide Rates in Ghizer,Pakistan

Suicide is an understudied subject in Pakistan. There are many social, legal, and religious sanctions against it. National rates of suicides are not known. We calculated suicide rates of women in the Ghizer District of the remote Northern Areas of Pakistan. During years 2000 to 2004, 49 women committed suicide. Taking average mean population for women for 5 years as 65,783, we calculated annual crude suicide rates for women as 14.89/100,000/year. For women over the age of 15 years, rates were 33.22/100,000/year; age‐specific rates for 15–24 years were 61.07/100,000 per year. These figures are considerably higher than suicide rates in other parts of Pakistan and may be related to high psychiatric morbidity in Pakistani women. This study underscores the need for a standardized system of registration of suicides in Pakistan. There is also urgent need to address high psychological distress in women in Pakistan.     

Training in group-analytic psychotherapy in Europe

Group-analytic psychotherapy focuses on the making and maintaining of close, emotionally fulfilling relationships. Its practitioners attempt to fuse an individual and a whole-group perspective, and seek to provide the enabling conditions for freer communication between group members. The group-analytic approach is widely used in the United Kingdom, and many experiential groups on psychotherapy training courses are conducted on group-analytic lines. The Institute of Group Psychotherapy in London recognizes eight one-year courses in England and Scotland specifically oriented to group-analytic theory and methods. These courses provide an introduction to group psychotherapy to over 300 professionals of varied backgrounds every year. There are also two courses in the United Kingdom that provide a full training in group-analysis and group-analytic psychotherapy, and 11 courses on the continent of Europe. The number of courses is growing and there is now a European Group-Analytic Training Network providing formal links between them. Results of a postal survey indicate that few (10%) attenders at a one-year course have a negative response and that many (85%) recommend the course to colleagues. The efficiency and therefore reduced cost of group teaching and the incorporation of a group experience may be contributing factors to the increasing demand for this type of training.This paper is based on a presentation at an Open Session on Training in Group Psychotherapy: The Quest for a Viable Model at the American Group Psychotherapy Association Annual Meeting, Boston, February 1990. This paper represents the author's own views and is not an official statement of the Institute of Group Analysis [London]. However, members and staff of the Institute have made helpful contributions to the author in preparing it. He is especially grateful for the assistance of Mrs. Liesel Hearst (Chairperson, Overseas Training Sub-Committee, Institute of Group Analysis, London), Dr. Keith Hyde (Convenor, Manchester Course in Group Psychotherapy), Fr. Jim Christie (Convenor, Glasgow Course in Group Psychotherapy), and Dr. Vivienne Cohen (Chairperson, Training Committee, Institute of Group Analysis, London, in preparing this paper. The questionnaire study was conducted with the assistance of the Training Section of the North-Western Regional Health Authority.     

Suicide Clusters: A Review of Risk Factors and Mechanisms

Suicide clusters, although uncommon, cause great concern in the communities in which they occur. We searched the world literature on suicide clusters and describe the risk factors and proposed psychological mechanisms underlying the spatio‐temporal clustering of suicides (point clusters). Potential risk factors include male gender, being an adolescent or young adult, drug or alcohol abuse, and past history of self‐harm. However, the majority of studies lack methodological rigor. Many different psychological mechanisms are described, including contagion, imitation, suggestion, learning, and assortative relating, but supporting empirical evidence is generally lacking. More scientifically rigorous studies are needed to improve understanding of suicide clusters.     

The Definition and Epidemiology of Clusters of Suicidal Behavior: A Systematic Review

Suicide clusters are a rare and underresearched phenomenon which attract wide media attention and result in heightened concern in the communities where they occur. We conducted a systematic literature review covering the definition and epidemiology of the time–space clustering of suicidal behavior. Of the 890 articles identified by electronic searching, 82 were selected for inclusion and the extracted data were analyzed by narrative synthesis. Less than a third of studies included a definition of a suicide cluster, and definitions varied considerably. Clusters occurred in various settings, including psychiatric hospitals, schools, prisons, indigenous communities, and among the general population. Most clusters involved young people. The proportion of all episodes that occurred in clusters varied considerably between studies and partly depended on study methodology (e.g., a larger proportion was found in studies of specific clusters compared with general population studies). Future studies should aim to combine the statistical analysis of time–space clustering with a case study of events, which examines potential links between individuals and the wider environmental context.