Autobiographical Memory and Suicide Attempts in Schizophrenia

According to the cry of pain model of suicidal behavior, an over‐general autobiographical memory function is often found in suicide attempters. The model has received empirical support in several studies, mainly of depressed patients. The present study investigated whether deficits in autobiographical memory may be associated with an increased frequency of suicide attempts in patients with schizophrenia. We found support for our hypothesis that patients with schizophrenia and previous suicide attempts have an over‐generalized autobiographical memory compared to patients with schizophrenia without previous suicide attempts. Adjustment for sociodemographic and clinical variables did not change the results.     

Is There a Relationship between Suicidal Intent and Lethality in Deliberate Self‐Poisoning?

The relationship between suicidal intent and lethality of deliberate self‐poisoning (DSP) episodes and their associations with suicide have yielded contradictory findings. The aims of this study were to investigate the association between patients’ suicidal intent and independently rated lethality of DSP episodes, and whether the association changes over time. Eighty‐nine DSP patients were investigated longitudinally. Self‐reported suicidal intent, including perceived likelihood of dying, wish to die, and whether or not the DSP was considered a suicide attempt, was measured at the time of the index episode (t1), 3 months (t2), and 12 months (t3) later. Lethality was assessed independently by three clinical toxicologists. Lethality was significantly associated with patients’ reported wish to die (p = .01) and perceived likelihood of dying (p = .04) at t1, but not at t2 and t3. No association was found between whether the episode was considered a suicide attempt or not and lethality at t1, t2, or t3. Lethality and suicidal intent should be considered as largely separate dimensions of self‐harm. Clinicians should bear this in mind during clinical assessment, especially regarding historical information.     

Self‐Harm in Young Offenders

The prevalence and correlates of self‐harm and suicidal behavior in 515 young offenders (mean age 17.3 years, SD = 1.7) serving community‐based orders (CBOs; n = 242) or custodial sentences (n = 273) in Victoria, Australia, are described. Results from structured interviews showed that 83 (16.1%) participants reported self‐harming in the previous 6 months, and this was more common among those serving custodial sentences than those serving CBOs (19.4% vs. 12.4%; OR 3.10, 95% CI: 1.74–5.55). Multiple incidents were more common in females and 24% (95% CI: 19–39) of participants who had self‐harmed reported having done so with suicidal intent. Self‐harm was associated with recent bullying victimization, expulsion from school, past year violent victimization, cannabis dependence, and risk‐taking behavior in the preceding year. The epidemiological profile of self‐harm in this population appears to be distinct from that seen in the general population. Young offenders who self‐harm are a vulnerable group with high rates of psychiatric morbidity, substance misuse problems, and social risk factors. They may benefit from targeted psychological interventions designed specifically to address impulsivity, delivered both within–and during the transition from–the youth justice system.     

Investigating the Co‐Occurrence of Self‐Mutilation and Suicide Attempts among Opioid‐Dependent Individuals

The prevalence and risk factors associated with self‐mutilation among opioid dependent cases and controls were determined, and the co‐occurrence of self‐mutilation and attempted suicide was examined. The prevalence of self‐mutilation among cases and controls did not differ significantly (25% vs. 23%, respectively), with gender differences identified among cases only. A number of risk factors were found to be associated with self‐mutilation, including borderline personality disorder, alcohol dependence, childhood sexual abuse, and multiple suicide attempts. Not only is self‐mutilation a clinically significant problem, but when combined with a history of attempted suicide, the psychological dysfunction observed is markedly high.     

The Effect of Cancer on Suicide among Elderly Holocaust Survivors

Jewish‐Israelis of European origin with cancer have higher suicide rates relative to their counterparts in the general population. We investigated whether this effect results from the high proportion of Holocaust survivors among them, due to vulnerabilities arising from the earlier traumas they sustained. The study was based on all Jewish‐European persons with cancer, 60 years and over, diagnosed in Israel between 1999 and 2007. The standardized incidence ratios were not significantly different between the exposed and nonexposed groups (men: 0.90, 95% CI 0.60–1.19; women: 0.95, 95% CI 0.55–1.37). Past exposure to maximum adversity did not increase the suicide risk among persons with cancer.     

Creative Moments in Relational-Cultural Therapy

SUMMARY

Creative moments in therapy are those occasions when something new and growth-fostering occurs. This article offers three illustrations and a discussion of these characteristics. It is based on a panel discussion held at the Stone Center-Harvard Medical School/Cambridge Hospital “Learning from Women Conference” in April, 2000.