Rural‐Urban Differences in Suicide Rates for Current Patients of a Public Mental Health Service in Australia

Rural versus urban rates of suicide in current patients of a large area mental health service in Australia were compared. Suicide deaths were identified from compulsory root cause analyses of deaths, 2003–2007. Age‐standardized rates of suicide were calculated for rural versus urban mental health service and compared using variance of age‐standardized rates with 95% confidence intervals. There were 44 suicides and the majority (62%) were rural. Only urban patients used jumping from heights as a method of suicide (4/17; p = 0.02). Rural patients had 2.7 times higher rates of suicide, similar to findings for rural versus urban community suicides and may reflect the underlying community rates, differences in mental health service delivery, or socioeconomic disadvantage.     

Changing Rates of Suicide Ideation and Attempts Among Inuit Youth: A Gender‐Based Analysis of Risk and Protective Factors

Inuit in Canada currently suffer from one of the highest rates of suicide in the world. The objective of this study was to explore the prevalence of suicide ideations and attempts among 15–24 year olds living in Nunavik, Québec, and to explore risk and protective factors of suicide attempts as a function of gender. A cross‐sectional survey was conducted in 2004 across Nunavik. Univariate and multivariate logistic regressions were conducted. A total of 22% of young males and 39% of females adults reported past suicidal attempts. Gender differences were observed in relation to associated risk and protective factors as well as degree of exposure to risk factors. Suicide prevention must include alcohol and drug prevention programs and rehabilitation services, interventions to reduce physical and sexual violence and their long‐term impacts on Inuit youth, as well as exposure to culturally meaningful activities.     

Are Reports of Life Event Stress among Suicidal Youth Subject to Cognitive Bias?

Severity of depressive symptoms, hopelessness, and suicidal ideation were examined to determine whether they were significantly associated with the accuracy of suicidal adolescents' ratings of stressful life events. The sample included 130 inpatient adolescents who endorsed suicide‐related behaviors. Stress interviews were administered, and the severity of stressful events was rated separately by adolescents and an independent team. A residualized cognitive bias score was created by regressing adolescents' severity ratings to the independent team's severity ratings of the same events. Depressive symptoms, but not hopelessness or suicidal ideation, were significantly associated with cognitive bias scores. A negative cognitive bias in adolescents' reports of life stress may be present at higher levels of depression relative to minimal levels of depression. Further research on the relations between stress and suicide‐related behaviors is encouraged to include independent ratings of stress severity.     

The WHO/START Study: Promoting Suicide Prevention for a Diverse Range of Cultural Contexts

The WHO/Start Study is introduced and described in its four main components. The study originated as a response to growing concerns about trends of suicide, the prevalence of which in the Western Pacific Region of the World Health Organization is the highest among the six regions of the WHO. So far, nineteen centers have joined the study. This ambitious project is expected to provide important transcultural perspectives on both fatal and nonfatal suicidal behaviors, together with increased awareness for these phenomena and the growth of culture‐sensitive prevention programs.     

Prior Health Care Utilization Patterns and Suicide Among U.S. Army Soldiers

Suicides among U.S. Army soldiers are increasing and, in January 2009, outpaced deaths due to combat. For this study, 1,873 army suicides identified through death, inpatient, and emergency room records were matched with 5,619 controls. In multivariate models, older, male, White, single, and enlisted soldiers with a prior injury (OR = 2.04, 95% CI = 1.64‐2.54), alcohol (OR = 3.41, 95% CI = 2.32‐4.99), or mental health hospitalization (OR = 6.62, 95% CI = 4.77‐9.20) were at increased risk for suicide. Risk was greatest immediately following diagnoses, but remained elevated even after 5 or more years of follow‐up. Most injury hospitalizations were unintentional but, nonetheless, significantly associated with suicide. Interactions indicate soldiers with both mental health and injury history are particularly vulnerable.     

The Predictors of Suicidality in Previous Suicide Attempters following Case Management Services

Suicide attempts constitute a serious clinical problem. People who have attempted suicide are at an elevated risk for additional suicide attempts, but there is limited evidence regarding the predictors of suicidality of suicide attempters following case management services. In the present study the indicators of suicidality after case management were examined. A total of 1,056 subjects who had recently attempted suicide were recruited from January 1, 2011, to June 30, 2011. The suicide prevention center of Kaohsiung City in Taiwan provided case management services and followed up on suicide attempt cases for 6 months. The salient factors for repeat suicide attempts were estimated using a logistic regression analysis. The results showed that multiple factors, including a “willingness to receive mental health services during a crisis,” “social support,” “a history of mental disorders,” and “a history of suicide,” could predict repeat suicide attempts with hazard ratios (0.58, 0.54, 3.84, 1.51) and 95% confidence interval (0.39–0.86, 0.36–0.83, 2.41–6.10, 1.03–2.21). The four factors mentioned above were the most accurate predictors of subsequent suicidality when case management services were utilized after 6 months of follow‐up. The findings of our study could help clarify future strategies for suicide prevention.     

How Change Happens: Controlling Images,Mutuality, and Power

SUMMARY

Change is inevitable but it can go in a positive direction toward growth or in a negative direction. Extending Patricia Hill Collins' concept of controlling images (2000), we can see how these images interact with relational images and strategies of disconnection to obstruct growth on both the societal and the personal level. In therapy, change is defined as movement-in-relationship toward better connection; and increased connection leads to growth. Several aspects of therapy that lead to deeper and wider connection are explored, especially increasing the patient's power. Prior versions of parts of this article were presented at the Jean Baker Miller Summer Training Institutes in 2001 and 2002 and at the 2002 Learning from Women Conference sponsored by the Jean Baker Miller Training Institute and the Harvard Medical School/Cambridge Hospital in Boston, Massachusetts.

As therapists, we're “in the business” of change–change for the better. That's our goal. Another word for change for the better is growth. Change is the essence of life. It is most obvious in children but it is a necessity through all of life. Change will occur inevitably but it can go in a positive or a negative direction. Further, I believe change toward growth creates pleasure. We feel most alive and zestful when we are engaged in this expanding activity.     

关于建国以来群众运动不断生成的另一种解读

群众运动是1949—1978年中华人民共和国历史上一个非常重要而独特的政治现象。然而一直以来,学术界大多强调群众运动是高度集中的政治经济体制和毛泽东个人因素的结果。文章从政治社会学的角度对群众运动进行解读,认为建国以来群众运动的不断生成,既具有一种路径依赖的性质,也是危机状态下的功能需求和基于体制内资源匮乏的一种无奈选择。     

A Virtual Hope Box Smartphone App as an Accessory to Therapy: Proof‐of‐Concept in a Clinical Sample of Veterans

A “Hope Box” is a therapeutic tool employed by clinicians with patients who are having difficulty coping with negative thoughts and stress, including patients who may be at risk of suicide or nonsuicidal self‐harm. We conducted a proof‐of‐concept test of a “Virtual” Hope Box (VHB)—a smartphone app that delivers patient‐tailored coping tools. Compared with a conventional hope box integrated into VA behavioral health treatment, high‐risk patients and their clinicians used the VHB more regularly and found the VHB beneficial, useful, easy to set up, and said they were likely to use the VHB in the future and recommend the VHB to peers.