The Evolution of Epidemic Suicide on Guam: Context and Contagion

Thirty years of suicide rates for Guam were analyzed by age, sex, period, and cohort. Youth suicide increased rapidly in the 1990s; certain cohorts have higher rates. Four explanatory factors are discussed, including ecological factors and migration from the Federated States of Micronesia. Direct and indirect suicide contagion followed the death by suicide of a respected politician, strongly influencing period and cohort patterns. Suicide pacts inflated suicide among young people. These factors acted in combination to produce epidemic levels of suicide in the 1990s.     

Feasibility of a Web‐based Gatekeeper Training: Implications for Suicide Prevention

Web‐based training programs have advantages such as increased scheduling flexibility and decreased training costs. Yet the feasibility of applying them to injury prevention programs such as suicide prevention gatekeeper training has not been empirically verified. Two studies were conducted to assess the feasibility and effectiveness of a web‐based version of the Question, Persuade, and Refer (QPR) gatekeeper training program. Results of Study 1 revealed that participants in a web‐based training demonstrated significant gains in knowledge of suicide prevention, self‐efficacy for suicide prevention, and behavioral intentions to engage in suicide prevention, as compared to those in a control group. Results of Study 2 further showed that the web‐based training may be as effective as the face‐to‐face QPR training across pre‐ (T1) and post training (T2); however, knowledge, self‐efficacy, and behavioral intentions in both groups generally declined from T2 to 6‐months after the training. Overall, these results provide initial evidence to support the feasibility of adopting web‐based media to deliver gatekeeper training. Moreover, the present findings suggest the need to understand how to maintain gatekeepers’ knowledge, confidence, motivation, and skills after training.     

Power and Effectiveness: Envisioning an Alternate Paradigm

SUMMARY

Relational-Cultural Theory provides a straightforward and elegant definition of power; it is the capacity to produce change. The implication of this framework is that power is the energy of competence in everyday living. However, in a culture stratified along multiple dimensions-race, class, and sexual orientation to name a few–power is associated with hyper-competitiveness and deterministic control. The article begins by examining the “protective illusions” of the power-over paradigm, where humanity is rank ordered according to perceived cultural value and is stratified into groups of greater than and less than. In addition to exposing the false dichotomies of power-over arrangements, the article examines the destructive consequences of cultural disconnection, on both the putative winners and the losers. Examples from organizational practice, clinical relationships, and socio-political contexts are used to illustrate the Relational-Cultural Model in action. Specifically, scenarios are presented from the standpoint of the politically disempowered to demonstrate the relational competencies of empathic attunement, authenticity, and accountability that foster healing, resilience, and mutual empowerment. This article was originally presented at the 2002 Spring Training Institute sponsored by the Jean Baker Miller Training Institute at Wellesley College.     

Belongingness and Burdensomeness in Adolescents: Slovene Translation and Validation of the Interpersonal Needs Questionnaire

The Interpersonal Needs Questionnaire (INQ) for assessing thwarted belongingness (TB) and perceived burdensomeness (PB) has not been validated with community adolescents. We translated and administered the INQ to 307 Slovenian adolescents twice over 2–3 months and found that the 15‐item version (INQ‐15) did not fit without modification. TB and PB scales correlated with concurrent and later suicide ideation and lifetime suicide attempt history. The latent PB factor was associated with concurrent and later ideation controlling for TB, age, gender, depressive symptoms, binge drinking, and peer victimization. Suicide ideation and binge drinking were independently related to attempt history. Assessing and intervening on PB and binge drinking may be promising approaches to suicide prevention with community adolescents.     

Child/Adolescent Abuse and Suicidal Behavior: Are They Sex Related?

The association between childhood and adolescent abuse and suicidal behavior, and the possible contribution of abuse to sex differences in non lethal suicidal behavior, was investigated. Data were extracted from the Israel‐based component of the WHO World Mental Health Survey (Kessler & Utsun, 2008a). Increased risk for ideation, plan, and suicidal attempt were associated with childhood abuse, and increased risk for attempt was associated also with abuse at adolescence. No associations with sex or sex by abuse interactions were observed. The higher frequency of childhood abuse among women could account in part for their higher rates of suicidal attempts as compared to men.     

Effect of Socioeconomic Status on the Linkage Between Suicidal Ideation and Suicide Attempts

Previous suicide attempts are a leading risk factor for completed suicide. To identify specific characteristics of those at high risk for attempts, we investigated associations with socioeconomic status (SES). Data from the 2013 Korean Community Health Survey (KCHS) included adults who reported suicidal ideation (N = 220,245). Attempts in the past 12 months were assessed. Associations of demographic, socioeconomic, and suicide‐related behavioral factors were analyzed using multiple logistic regression. Among those with suicidal ideation, 862 (3.9%) had attempted suicide. After stratification by age and gender, results showed that low education and unemployed young adult men and women had significantly higher rates of attempts. The lowest income level was associated with significantly higher rates of attempts in only young adult women. Among those with the lowest and highest income, the association between ideation and attempts was attenuated, whereas it was enhanced among other income groups.     

Helping Callers to the National Suicide Prevention Lifeline Who Are at Imminent Risk of Suicide: Evaluation of Caller Risk Profiles and Interventions Implemented

Crisis lines are settings where identifying individuals at imminent risk of suicidal behavior and intervening to keep them safe are critical activities. We examined clinical characteristics of crisis callers assessed by telephone crisis helpers as being at imminent risk of suicide, and the interventions implemented with these callers. Data were derived from 491 call reports completed by 132 helpers at eight crisis centers in the National Suicide Prevention Lifeline network. Helpers actively engaged the callers in collaborating to keep themselves safe on 76.4% of calls and sent emergency services without the callers' collaboration on 24.6% of calls. Four different profiles of imminent risk calls emerged. Caller profiles and some helper characteristics were associated with intervention type. Our findings provide a first step toward an empirical formulation of imminent risk warning signs and recommended interventions.