Miseries Suffered,Unvoiced, Unknown? Communication of Suicidal Intent by Men in “Rural” Queensland,Australia

It has long been argued that suicide prevention efforts in rural locations face not only structural barriers, such as a lack of accessible health care and specialized mental health services, but also a range of cultural barriers. A commonly discussed cultural factor that may contribute to higher rural suicide rates is low levels of help‐seeking behavior, which in turn act as a barrier to accessing and receiving care. However, the assumption that suicide by rural men is more likely to be accompanied by low help‐seeking behavior, relative to urban men, has not been well tested. Using data from the Queensland Suicide Register, this study evaluates one form of help‐seeking behavior—communication of suicidal intent—among men who died by suicide. Contrary to the expectation that suicide in rural areas would be associated with lower levels of help‐seeking behavior than suicide in urban areas, it was found that communication of suicidal intent was broadly comparable across rural and urban settings. The implications for suicide prevention policies and service delivery strategies are discussed.     

Telling the Truth About Power

SUMMARY

In this culture, those in power do not usually talk about it and the rest of us tend not to recognize it either. A similar situation exists in therapy, where the therapist herself may not be aware of her own power-over tactics. This article suggests methods that may help therapists to acknowledge their power and also to change from power-over actions to mutually empowering relationships. From this line of thinking, there follows an exploration of altering the concept of boundaries in therapy into mutually constructed agreements between patient and therapist. This article was presented at the Summer Training Institute of the Jean Baker Miller Training Institute, June, 2003.     

The Validity of a Brief Risk Assessment Tool for Predicting Suicidal Behavior in Veterans Utilizing VHA Mental Health Care

Suicide risk among military veterans is an important and ongoing concern. The Veterans Administration (VA) mandates suicide risk screening of all veterans seen for mental health issues, but little is known about the effectiveness of this screening. A retrospective chart review to examine all suicide risk screens at VA San Diego between October and December 2012 (n = 3,365) was conducted to assess whether results were associated with suicidal behavior over the subsequent 12 months. Patients judged to be at increased risk for suicide were 3 to 16 times more likely to attempt suicide and 7 to 25 times more likely to engage in self‐directed violence over the next 12 months compared with others. The screening tool may be a useful addition to clinical practice.     

Experimental Test of Escape Theory: Accessibility to Implicit Suicidal Mind

This study tested the Escape Theory prediction that individuals blaming themselves for failure experience increased accessibility to implicit suicidal mind. One hundred and thirty‐eight undergraduate medical students were randomly assigned to three groups: failure‐related priming, success‐related priming, and control. Following experimental conditions, participants completed a death/suicide Implicit Association Test. Results revealed significant differences between groups in accessibility to implicit suicidal mind. Furthermore, priming manipulation interacted with individual differences in locus of control (LOC). Significant differences in accessibility to implicit suicidal mind were observed in individuals with internal LOC, while effects of priming manipulation were eliminated in individuals with external LOC.     

Risk Factors for Attempting Suicide in Heroin Addicts

In order to examine risk factors for attempting suicide in heroin dependent patients, a group of 527 abstinent opiate dependent patients had a psychiatric interview and completed the Childhood Trauma Questionnaire. Patients who had or had never attempted suicide were compared on putative suicide risk factors. It was found that 207 of the 527 heroin abusers (39.3%) had attempted suicide. Attempters were younger; more were female, reported childhood trauma, a family history of suicidal behavior, a history of aggression, treatment with antidepressant medication, and alcohol and cocaine dependence. Logistic regression revealed that a family history of suicidal behavior, alcohol dependence, cocaine dependence, and treatment with antidepressant medication were significant predictors of attempting suicide. These results suggest that attempting suicide is common among opiate dependent patients and that both distal and proximal risk factors may play a role.