The mental health consequences of dealing with self-inflicted death in custody

The impact of dealing with a death in custody was explored in 49 prison officers who had dealt with such an event in the period 3–7 months prior to the study. A 36.7% incidence rate of post-traumatic stress disorder (PTSD) was identified. Optimism, avoidance problem solving style, prior experience of suicide and level of involvement in the incident were direct mediators of the impact of the event for the total sample, while perceived control, emotional support and other aspect of problem-solving style had an indirect effect. Separate analysis of the PTSD and non-PTSD groups showed that the only mediator for the PTSD group was prior experience. For the non-PTSD group a range of variables mediated the impact. It is argued that this provides a case for preventive rather than treatment interventions.     

Quality of Social Support Predicts Hopelessness and Depression Post Spinal Cord Injury

Research has documented elevated levels of depression and suicide in the spinal cord injured (SCI) population, with the majority of suicide attempts occurring within 12 months of injury onset. Social support has been linked with depression and suicidal intent, and this study aimed to determine the impact of the quality and quantity of social support on levels of depression and hopelessness, an indirect indicator of suicide risk in the SCI population. Fifty-three individuals with traumatic SCI at Week 6 of their rehabilitation, and 42 at Week 18, with an approximate male to female ratio of 4:1, completed the Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), and Social Support Questionnaire. Stepwise multiple regression analyses revealed that high quality of social support was associated with low hopelessness and depression scores, being more pronounced at Week 18 postinjury. The impact of social support on psychological well-being demonstrates the importance of fostering and integrating social support in rehabilitation following spinal cord injury.     

Depression in the Context of Disability and the “Right to Die”

Arguments in favor of legalized assisted suicide often center on issues of personal privacy and freedom of choice over one's body. Many disability advocates assert, however, that autonomy arguments neglect the complex sociopolitical determinants of despair for people with disabilities. Specifically, they argue that social approval of suicide for individuals with irreversible conditions is discriminatory and that relaxing restrictions on assisted suicide would jeopardize, not advance, the freedom of persons with disabilities to direct the lives they choose. This paper examines the idea promoted by some proponents of assisted suicide that it is reasonable to be depressed about one's diminished quality of life in cases of irreversible illness or disability and, therefore, such depression should not call into question the individual's competence to request assistance in dying. The concept of rational depression is defined and examined in the context of: four real-life cases involving individuals with disabilities who requested assistance in dying; a set of criteria commonly applied to decision-making to determine rationality; and research bearing on the emotional status of people with disabilities. It is concluded that although disability is associated with particular socially mediated stressors, there is no theoretical or empirical evidence to indicate that depression and its role in the right to die is dynamically different, more natural, or more reasonable for disabled people than for non-disabled people.     

Questions of culture,age and gender in the epidemiology of suicide

Cultural values were examined as predictors of suicide incidence rates compiled for men and women in six age groups for 33 nations for the years 1965, 1970, 1975, 1980, and 1985. Hofstede's cultural values of Power-Distance, Uncertainty Avoidance, and Masculinity (i.e., social indifference) were negative correlates of reported suicide, and Individualism was a strong positive correlate. The proportion of variance in suicide reports generally related to these four cultural values was R2 = 0.25. Suicide by women and by middle-aged people was most related to cultural values, even though international variance in suicide is greater for men and for the elderly. Suicide incidence for girls and young women showed unique negative correlations with Individualism. For all age groups, Individualism predicted a greater preponderance of male suicides, and Power-Distance predicted more similar male and female suicide rates. Social alienation and Gilligan's feminist theory of moral judgment were hypothesized to explain some gender differences.     

Complex and underreported? A study into the prevalence of suicide by motor vehicle in the state of Queensland

While suicide is recognised as one of the leading causes of death in Australia, it is often presumed that fatal road crashes are primarily accidental in nature. However, international research has indicated that deliberate attempts at self-harm while driving may account for between 1.1% and 7.4% of road crashes. Despite the personal and financial costs associated with such events, few studies have examined the extent of motor vehicle suicides (MVS) or the circumstances surrounding such incidents in Australia. Given this, the current study reviewed coronial, police and toxicology findings of 762 motor vehicle fatalities in Queensland (Australia) during the period 2011 to 2015 to determine the frequency of confirmed cases and explore the prevalence (and characteristics) of possible MVS that remain undetected. In total, 22 confirmed cases were identified, and such events shared significant similarities with 14 possible events, including evidence of recent emotional upset, adversity and mental health diagnoses. In contrast, differences between the groups were limited to confirmed cases being more likely to involve males and contain a suicide note or evidence of past suicidality, while possible cases were more likely to involve a multiple vehicle impact with a truck. Importantly, crucial information regarding the deceased’s psychological state and life circumstances (e.g., psychological autopsy) was not reported in many cases. Corresponding qualitative analysis of the coroners final determination (between the two groups) revealed the occurrence of the word suicide to occur seven times (31.8%) among confirmed cases and five times (35.7%) for possible casers. Furthermore, the coroners final determination of intent to suicide was open or undetermined in six of the possible cases (43%), which further suggests a reluctance (or procedural uncertainty) to categorically identify MVS. The paper further reviews the main findings, illuminates core challenges associated with identifying MVS and proposes a need for future investigations to incorporate a more standardised and evidence-based approach in order to effectively identify such events.     

A Transdiagnostic Multilevel Examination of Interoceptive Processing in Individuals With a Remote History of Suicidal Behavior

A developing area of research suggests that there may be a relationship between interoception and suicidal behavior. For example, it was recently reported that individuals who made a suicide attempt within the previous 5 years exhibit behavioral and neural abnormalities across multiple domains of interoception relative to nonattempters. This included increased tolerance for aversive sensations of pain and dyspnea, reduced heartbeat-perception accuracy, and blunted insula activity during attention to cardiac sensations. However, the degree to which interoceptive deficits persist following a suicidal attempt is unknown. In the current study, we examined differences between individuals with a remote history of suicide attempts (greater than 5 years ago; N = 56) versus those with no history of attempts (N = 240). We found that remote suicide attempters demonstrated greater pain tolerance and lower ratings of stress during a cold-pressor challenge and lower ratings of suffocation during a breath-hold challenge, as compared to nonattempters. In contrast, there were no group differences in breath-hold duration, interoceptive accuracy on a heartbeat-tapping task, or insula activation during cardiac attention. An exploratory resting-state functional connectivity analysis of individuals with suicide attempts in the past 5 years (N = 23), individuals with more remote histories of suicide attempts (N = 39), and nonattempters (N = 232) revealed preliminary and subtle evidence of differences in insula connectivity with areas of the temporal cortex in remote suicide attempters. Taken together, these findings suggest that blunted affective responses to aversive interoceptive sensations is an enduring characteristic of suicide attempters, even when assessed many years after a suicide attempt, whereas differences in the experience of nonaversive interoceptive sensations may be less persistent.     

Clarifying the Relationship of Dissociative Experiences to Suicide Ideation and Attempts: A Multimethod Examination in Two Samples

Fears of pain, injury, and death may represent key barriers to acting on suicidal thoughts. Dissociation, which involves a disconnection from one’s body, may reduce fears and sensations of pain associated with harming the body, in turn facilitating suicide attempts. This study examined whether dissociation differentiated individuals with a history of suicide attempts from those with a history of suicide ideation, and investigated whether other relevant constructs explain this relationship. Sample 1 included 754 undergraduates (M_age = 21, 79% female) who completed a battery of self-report measures. Sample 2 included 247 undergraduates (M_age = 19, 74% female) who completed a self-report measure of dissociation, a clinical interview regarding suicide history, and four counterbalanced behavioral pain tolerance tasks. In both samples, dissociation was elevated in lifetime attempters compared to ideators (d = 0.28; d = 0.46; ps = 0.01) and slightly elevated in lifetime ideators compared to nonsuicidal individuals (d = 0.19, p = .02; d = 0.24, p = .47), though this effect was non-significant in the latter sample. In Sample 1, dissociation no longer differentiated attempters from ideators after controlling for clinical covariates. In Sample 2, dissociation was unrelated to behavioral pain tolerance tasks, and these tasks did not account for the association between dissociation and attempts. Overall, dissociation differentiated individuals with a history of suicide attempts from those with ideation alone in both samples. Pain tolerance did not explain this association; instead, it is possible that the relationship of dissociation to suicide attempts is due to “third variables” associated with both phenomena, such as symptoms of borderline personality disorder or posttraumatic stress disorder.     

Interoception,Pain Tolerance,and Self-Injurious Behaviors: A Multidimensional Assessment

Impairments in interoception have been linked to self-injurious behaviors, and capability for suicide may account for this relationship. However, past studies have relied primarily on self-report and unidimensional measures. The present study aimed to replicate and extend previous findings by examining the relationship between interoceptive dysfunction, pain tolerance, and self-injurious behaviors using a multidimensional and multi-method approach. A sample of 245 undergraduate students (M_age = 19.27 years, SD = 2.81; 73.7% female, 72.% White/European American), who reported lifetime suicidal ideation on a screening survey completed a battery of self-report measures, four counterbalanced pain tolerance tasks, and a clinical interview assessing their self-injurious behaviors. A tendency to stay attuned to bodily sensations was significantly related to decreased pain tolerance. Only trust in one’s body was significantly related to decreased presence of lifetime suicide attempts. No other facets of interoception or pain tolerance were significantly associated with self-injurious behaviors. Overall, these findings contrast with previous findings that capability for suicide may account for relations between interoceptive dysfunction and self-injurious behaviors. Nonetheless, the results of this study provide important information on the factor structure of interoceptive dysfunction and pain tolerance, and highlight the importance of careful selection of measures and operationalization of key constructs, particularly interoceptive dysfunction and pain tolerance.     

Too much to swallow? Some reflections on adolescent overdose

Overdose, as a subcategory of self-harm, is under-represented in the psychoanalytic literature in terms of attempts to understand what may underpin it. Given the current prevalence of overdose amongst self-harming adolescents, it seems important to try to understand this from a psychoanalytic perspective. Drawing on clinical material from adolescent patients who overdosed, the author attempts to make sense of how overdose was used by these patients as a means of unconsciously communicating their difficulties. It is suggested that overdose might be understood in the following ways: as a physical enactment of the way in which the patient’s mind is overwhelmed by thoughts, feelings and experiences which it cannot digest or process; as a disguised wish beneath overt self-destructiveness to take in a ‘good feed’; as an enactment of past and present force-feeding, both literally and figuratively, by parents or carers; as an enactment of an internalised death wish from an object which has projected something poisonous into the patient.