Resources for Suicide Prevention E-Book

• Herausgeber: Hogrefe Publishing
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 286

Veröffentlichungsjahr: 2018

Beschreibung

Keep up-to-date with recent research and practice in suicide. This book is based on the TRIPLE i in Suicidology international conferences, which are organised annually by the Slovene Centre for Suicide Research in memory of the late Prof. Andrej Marušič with the aim of promoting intuition, imagination, and innovation in the research and prevention of suicide and suicidal behaviour. The carefully selected chapters provide food for thought to practitioners, researchers, students, and all those who come into contact with the tragedy of suicide, with the hope of stimulating new ideas and interventions in the difficult fight against suicidal behaviours. In four parts, the internationally renowned team of authors summarise the achievements of suicidology so far (both in quantitative and qualitative research), present effective interventions in suicide prevention (including for youths and older people) and knowledge gained in bereavement and postvention studies (such as in different cultures and those bereaved by suicide), and highlight future directions for suicide research and prevention. The volume is thus a useful resource for all those interested in keeping up-to-date with recent research and practice in suicide.

Leseprobe

Resources for Suicide Prevention

Bridging Research and Practice

Edited by

Diego De Leo

Vita Poštuvan

About the Editors

Diego De Leo, Doctor of Science and Emeritus Professor of Psychiatry, Griffith University, Australia, is the Head of the Slovene Centre for Suicide Research (UP IAM). He has been a world-leading researcher in suicide research and prevention over several decades. He has designed and advised suicide prevention activities, projects, and programs around the world, including his contribution to the World Health Organization.

Vita Poštuvan, Doctor of Psychology and Assistant Professor of Psychology, is the Deputy Head of the Slovene Centre for Suicide Research (UP IAM). She is involved in research, therapeutic and public-health work related to suicidal behaviour, bereavement, and crisis interventions. She is active in international cooperations promoting mental health.

Library of Congress Cataloging in Publication information for the print version of this book is available via the Library of Congress Marc Database under the Library of Congress Control Number 2016954776

Library and Archives Canada Cataloguing in Publication Data

Resources for suicide prevention : bridging research and practice / edited by Diego De Leo, Vita Poštuvan.

Includes bibliographical references.

Issued in print and electronic formats.

ISBN 978-0-88937-454-6 (paperback).--ISBN 978-1-61334-454-5 (epub).--ISBN 978-1-61676-454-8 (pdf)

1. Suicide. 2. Suicidal behavior. 3. Suicide--Prevention. 4. Suicide--Sociological aspects. I. De Leo, Diego, 1951-, editor II. Poštuvan, Vita, editor

HV6545.R47 2017

362.28

C2016-906429-8

C2016-906430-1

The authors and publisher have made every effort to ensure that the information contained in this text is in accord with the current state of scientific knowledge, recommendations, and practice at the time of publication. In spite of this diligence, errors cannot be completely excluded. Also, due to changing regulations and continuing research, information may become outdated at any point. The authors and publisher disclaim any responsibility for any consequences which may follow from the use of information presented in this book.

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Contents

Foreword

Preface

Acknowledgments

Part I What Have We Achieved So Far?

Chapter 1 Translating Research Into Practice: The Quantitative Perspective

Introduction

Concepts of Suicidal Behaviour

Models of Suicidal Behaviour

Preventing Suicide

Research Experience Preventing Suicide

Some Results From the Research

Collaboration

Conclusion

References

Chapter 2 Translating Research Into Practice: The Qualitative Perspective

Introduction

Outline of Chapter

A Critical Look at Quantitative Research

Philosophy of Science

How Qualitative Studies Can Bring the Field of Suicidology Forward

Common Objections to Qualitative Research

Examples From Qualitative Research

Qualitative Psychological Autopsy Studies

Other Types of Qualitative Studies

References

Part II Interventions

Chapter 3 Exploring the Phenomenology of Suicide

The Influence of Past Centuries

Suicide: Symptom or Syndrome?

Psychological Autopsy Studies

Toward a Phenomenology of Suicide

Conclusions

References

Chapter 4 Assessing the Effectiveness of Suicide Prevention Programmes: Integrating Outcome and Process Evaluation

Introduction

Effectiveness of Restricting Access to Means

Interventions for Self-Harm Patients

Pharmacotherapy

Screening for Self-Harm and Suicide Risk

Awareness Campaigns

Awareness and Skills Training

Media Guidelines

References

Chapter 5 The European Alliance Against Depression: Optimised Care of Depressed Patients and Prevention of Suicidal Behaviour via Community-Based Four-Level Interventions

Introduction

From the Model Project Nuremberg Alliance Against Depression to the European Alliance Against Depression

What Is the Evidence for the Efficiency of This 4-Level Intervention Concept of the Alliances Against Depression Concerning the Prevention of Suicidal Acts?

Summary

References

Chapter 6 Suicide Prevention in Youths

Understanding Suicidal Behaviours

Multidimensional Approach to Suicide Prevention

Suicide Prevention Strategies

The Seyle Project

References

Chapter 7 Suicide in Old Age

Epidemiological Considerations

Misconceptions of Suicide in Old Age

Cross-Cultural Aspects

Suicidality in Old Age: A Few Peculiarities

Help-Seeking Behaviour

A Few Recommendations for Future Research Directions

References

Chapter 8 Suicide Prevention and Older People: Clinical Management

Have Suicide Rates Changed?

Psychopathology and Suicidal Behaviour in Old Age

Suicidality in Old Age: Clinical Assessment and Interventions

Objective Assessment Measurements for Suicidality in Older People

Clinical Management of Suicidal Patients

References

Part III Postvention

Chapter 9 Suicide Survivors Across Cultures

Introduction

Bereavement After Suicide

Different Kinds of Help for Suicide Survivors

Suicide Survivors Across Cultures

Loss and Gain

References

Chapter 10 Bereaved by Suicide – Evidence-Based Findings

Introduction

Register-Based Studies on Bereaved By Suicide

Children Bereaved by Suicide

Parents Bereaved by Suicide

Partners Bereaved by Suicide

Future Directions

Conclusion

References

Chapter 11 Suicide Survivors’ Reintegration: The Growing Flower Model

Introduction

Current Understanding of Death and Grief

Qualitative Study of Bereaved After Suicide

Growing Flower Model of Suicide Survivors’ Reintegration

Conclusion

Acknowledgements

References

Part IV Future

Chapter 12 Future Directions in Suicide Research and Prevention

What Has Been Achieved So Far in Suicide Prevention?

Research Achievements

Policy Achievements

Practice Achievements

What We Should Aim to Achieve in the Foreseeable Future

Research

Surveillance

Aetiological Research

Evaluation Research

Policy

Practice

Acknowledgements

References

Contributors

|vii|Foreword

Suicide is one of those existential topics that touches every one of us. As human beings, we all have something to say about it, because we have opinions about life and death. It is, therefore, challenging to study suicide in a scientific manner. It seems that the science around it is less exact than that of mathematics. Suicidologists need to be aware of and reflect on their cultural background, professional training, and many personal experiences that influence them and thus can also influence their scientific thinking.

Such reflecting is always easier with others around. Colleagues from the Slovene Centre for Suicide Research (established at our university) have invited established scientists in the field of suicidology to reflect on the TRIPLE i in Suicidology conferences, and in this book, on the past, present, and future knowledge that suicidology has acquired.

This volume, Resources for Suicide Prevention: Bridging Research and Practice, gathers the thoughts of distinguished researchers. The chapters focus on the topics of qualitative and quantitative research approaches, means to assess and implement suicide prevention programmes, and understanding those bereaved by suicide.

For many of the authors, knowing the late Prof. Andrej Marušič was an important personal experience. He initiated many Slovene and international projects that shaped public mental health programmes attempting to prevent suicide and promote mental health. Once he related a story about a patient with schizophrenia who could be cured of his hallucinations. As his psychiatrist, he told the patient that whenever the hallucinations occurred, he should use his mobile phone to “talk” to them. Andrej told me how the patient used this technique while he was on a bus in Ljubljana. When a hallucination “rang,” he took his mobile and said, “What do you want? My psychiatrist told me you don’t exist, so there is no point in you calling me, so please stop….”

Today, the work of the Slovene Centre for Suicide Research continues the ideas Andrej initiated. The centre plays an important role in the promotion of mental health and in prevention, postvention, and interventions related to suicide. Being at one of the newest universities in Slovenia, we encourage these activities and consider the continuation of them as an important public responsibility. We hope that this book will give further motivation for that.

Last but not least, I would like the readers to take the opportunity to reflect on their attitudes while reading the book. Perhaps this will stir some new ideas that can help us to better understand the phenomenon of suicide.

Dragan Marušič

Rector

University of Primorska, Slovenia

|ix|Preface

Imagine that you are invited to consider innovative and intuitive ideas for preventing suicide. How would you respond?

Perhaps your ideas would go back into history, and you would search for the best practices and summarise all of the achievements that science has accomplished so far. Then you might collect all of the best current practices and see how new experiences are bridging the gaps – targeting youths and older persons, and creating large public health initiatives. Or perhaps you would attempt to understand the most vulnerable people or those bereaved by suicide. Maybe, you would just peer into the future and leave it to your intuition, imagination, and sense of innovation.

Resources for Suicide Prevention: Bridging Research and Practice is based on the TRIPLE i in Suicidology international conference (devoted to intuition, imagination, and innovation), which is organised annually by the Slovene Centre for Suicide Research (Andrej Marušič Institute, University of Primorska, Slovenia) in memory of the late Prof. Andrej Marušič, with the aim of promoting intuition, imagination, and innovation in the research and prevention of suicide and suicidal behaviour. The authors of this book’s chapters presented their ideas during those conferences.

The first TRIPLE i in Suicidology conference was held in May 2009 around the time of Andrej Marusic’s birthday. In recent years, the conference has connected many people in the field of suicide research and prevention. The conference has developed into a platform for productive discussion among distinguished experts, interacting with young and future suicidologists or other enthusiastic professionals in the field. TRIPLE i in Suicidology has become an opportunity to express and practice intuition, imagination, and innovative ideas.

The intention of this volume is to provide food for thought to lay people, practitioners, researchers, and all others that come in contact with the tragedy of suicide. Our aim is to stimulate new ideas and interventions that can help in the difficult fight against suicidal behaviours, a fight that requires the active participation of everyone.

Diego De Leo and Vita Poštuvan

Slovene Centre for Suicide Research

Andrej Marušič Institute

University of Primorska, Slovenia

|x|Acknowledgments

The work of the Slovene Centre of Suicide Research (UP IAM) and our TRIPLE i in Suicidology conferences have always had strong support at the University of Primorska. We wish to acknowledge this and thank Prof. Dragan Marušič (Rector of the University of Primorska), Associate Prof. Klavdija Kutnar (Dean of UP FAMNIT), and Assistant Prof. Vito Vitrih (Director of UP IAM).

We also wish to thank the incredible colleagues working with us at UP IAM: Ursa Mars, Tina Podlogar, Nuša Zadravec Šedivy, and Janina Žiberna, as well as Alenka Tančič Grum, Dejan Kozel, Ana Petrović, and Saška Roškar. We appreciate all of your dedication to our projects, ideas, and innovations.

We also wish to thank Maja Rahne for her contributions in preparing this volume, Terry Troy Jackson who proof-read the text, and several students who helped us during the past few years.

This book is partly supported by the Slovene Centre for Suicide Research with the cooperation of the Slovenian Research Agency (research program P3-0384 and projects J3–4046 and Z5–7492).

|1|Part IWhat Have We Achieved So Far?

|3|Chapter 1Translating Research Into Practice

The Quantitative Perspective

Enrique Baca-García1,2,3,4 and Victoria de Leon-Martínez1

1IIS Fundacion Jimenez Diaz, Madrid, Spain

2New York State Psychiatric Institute, New York, NY, USA

3Columbia University, New York, NY, USA

4CIBERSAM, Madrid, Spain

Why are some people healthy and others not? This seems to be a simple question. The answer, however, is complex and has to do not only with disease and illness, but also with who we are, where we live and work, and the social and economic policies of our government, all of which play a role in determining our health. (Institute of Medicine, 2003)

Introduction

Suicide prevention is a global healthcare priority (Hunt et al., 2006). In 2002, it was estimated that one person committed suicide every 40 s (World Health Organization [WHO], 2002). In recent years, the number of suicides has increased, making suicide the third leading cause of death worldwide in people 15–44 years old (Holmes, Crane, Fennell, & Williams, 2007). In addition to the human cost, suicidal behaviour (suicide attempts and suicide completion) creates a considerable economic burden. The annual cost of suicidal behaviour has been estimated to be US $33 billion in the United States alone (Coreil, Bryant, & Henderson, 2001). Despite these |4|negative figures, the research effort for understanding, treating, and preventing this type of behaviour is far from proportionate.

Concepts of Suicidal Behaviour

Suicide is apermanent solutionto atemporary problem.

Edwin Schneidman, MD (Founder of Suicidology)

As set forth by Robins and Guze (1970), suicidal behaviour meets the criteria for diagnostic validity. Suicidal behaviour is (1) clinically well-described (Mann et al., 2005), (2) research has identified post mortem and in vivo laboratory markers (Robins & Guze, 1970), (3) it can be subjected to a strict differential diagnosis (Posner, Oquendo, Gould, Stanley, & Davies, 2007), (4) follow-up studies confirm its presence at higher rates in those with a previous diagnosis (Oquendo, Currier, & Mann, 2006), and (5) it is familial (Brent et al., 2002).

This behaviour is enormously complex. Rates of suicide differ across regions worldwide (see Figure 1.1) due to geographic/climate differences, sociocultural, and economic differences and differences in the availability of lethal methods. In addition, differences may be produced by differing accuracies of registries (Rihmer, Belsö, & Kiss, 2002).

Figure 1.1.  World map of age-standardised suicide rates for 2012. (Reprinted by permission from WHO, 2014)

Interestingly, the scientific data on suicide are not focused on areas of high suicidal prevalence. Most of the scientific and clinical research generated focuses on |5|the populations of Western countries. Unfortunately, the highest rates of suicide are not found in these areas but in Baltic countries as well as in Russia. Furthermore, high rates of suicide in females correspond to Eastern countries, such as India and China. Despite this trend in the non-Western world, this phenomenon is not solely exclusive to Eastern countries. Within the United States, the highest rates of suicide are found in the western states while academic and scientific research institutions are concentrated on the two coasts.

Models of Suicidal Behaviour

There are several conceptual models of suicide. Perhaps the most complete model with clinical and preventive value is the stress-diathesis model of suicide (Figure 1.2).

Figure 1.2.  Stress-diathesis model of suicide. Select biological vulnerabilities or risk factors integrate with life stressors resulting in an individual’s predisposition to suicidal behaviors. These factors coupled with increasing stress can lead to the crossing of a threshold resulting in a progression of suicidal behaviors escalating to a suicide attempt or completed suicide.

Preventing Suicide

To combat the issue of suicide, several countries have adopted national prevention strategies. For example, the National Suicide Prevention Strategy for Eng|6|land, 2002, endeavoured to reduce the rate of suicide nationwide by 20%. This programme used the following methods to meet this goal: reducing the availability and lethality of suicide methods, reducing risks in key high-risk groups, promoting mental well-being in the wider population, improving reporting of suicidal behaviour in the media, promoting research on suicide and suicide prevention, and improving monitoring of progress toward the Saving Lives: Our Healthier Nation target to reduce suicide. Following 10 years of application, the programme successfully achieved its objective of decreasing suicide rates by 20% in England.

In contrast, fluctuations in suicidal behaviour have been identified in the United States, which are reflective of oscillating suicide rates between 10.0 per 100,000 to 19.0 per 100,000 over the past 100 years. The natural fluctuation of suicide rates has been estimated to be 50%.

In contrast to national strategies, regional and local strategies have also been applied. Local alternatives with specific catchment areas (Hampton, 2010) have had better results in comparison with their national counterparts. These strategies at the local and community levels focus on improving the treatment of mood disorders; redesigning depression care delivery based on safety; focusing on patient preference, need, and value; reducing waiting times and delays; avoiding money wasting; and providing equal care to all patients.

Research Experience Preventing Suicide

In recent years, the authors of this chapter have progressively been involved in several research areas on suicidal behaviour, which cover a wide range of focuses: from epidemiology to genetics as well as psychopathological and clinical topics. In fact, the exploration of the genetic underpinnings of psychiatric disorders has been one of the endeavours of the authors since the very beginning. Over the past 12 years, several association studies of functional polymorphisms have been carried out. Currently, the capacity for greater patient recruitment in our gene bank has been developed, thus enabling the obtaining of samples from more than 4,000 patients. The authors are projecting network studies to replicate their results.

We have also pioneered the use of data mining in suicidology (Oquendo, Baca-Garcia et al., 2012; Baca-Garcia et al., 2006). Data mining is an eclectic discipline, also known as machine learning, that involves the process of extracting patterns from data. With this process, we are able to analyse massive amounts of information, especially problems with high multidimensionality (large amount of variables) and unknown probability distribution. Data mining is highly useful in situations with the following conditions: large quantities of data, noisy incomplete data, imprecise data, complex data structures, and when conventional statistical analyses are not possible. Several different types of techniques can be employed when |7|using data mining, such as Bayesian networks, regression analyses, neural networks, clustering, genetic algorithms, decision trees, and support vector machines. This computational approach enables an exploration of data to identify patterns and structures not suspected to be a priori and thus lead to the generation of new hypotheses. This is critical, especially in areas with huge datasets for which hypothesis testing and/or traditional analytic strategies have led to disappointing results, such as in genetics and brain imaging studies.

In Figure 1.3, the impact of data-mining methodologies in different medical specialties can be compared. At the moment, there are few studies using data mining in the field of psychiatry, while specialties that employ large and multidimensional datasets, such as genetics or biomedicine, are familiar with data mining and have experience using its methods.

Figure 1.3.  The impact of data-mining methodologies in different medical specialties. (Source: Oquendo et al., 2012)

Some Results From the Research

The association between impulsive personality traits, serotonergic hypofunction, and suicidal behaviour supports the idea that impulsivity is a main component of |8|suicidal behaviour. It is paradoxical that impulsivity may be a feature of less serious suicidal attempts, which may not be associated with changes in biological markers.

The authors’ studies have shown that the most impulsive attempts were also the most trivial, while the less impulsive attempts were the most severe. Overall, more than half of all suicide attempts are impulsive; therefore, impulsive suicide attempts tend to be less serious and lethal (Baca-Garcia et al., 2001).

A cross-cultural study on suicide attempters in New York City (USA) and Madrid (Spain) was also carried out, which suggested that the greater lethality of suicidal behaviour in New York City compared with Madrid was related to higher levels of aggression, although the study did exhibit limitations. Regardless, cross-cultural studies are needed to verify whether aggression and higher lethality suicide attempts share a common diathesis that would explain the higher suicide rates in New York City.

Suicide attempts are more frequent in fertile women during the follicular phase (Baca-García et al., 1998); however, hormone levels are not altered in attempters. Moreover, premenstrual syndrome is not related to suicide attempts (Baca-García, Diaz-Sastre, De Leon, & Saiz, 2000; Baca-García, Diaz-Sastre, et al., 2003). Each hormonal profile can be linked to a clinical profile: (1) follicular phase: history of psychopathology, high severity of suicidal behaviour, and high expectations regarding lethality of the attempt; (2) mid-cycle and luteal phase: less severe psychopathology, more instrumental behaviour; and (3) menopause: affective pathology and more serious suicide attempts. In addition, a protective effect of oestrogen on suicide has been demonstrated as well as a protective effect of the L allele of the serotonin transporter gene. However, when oestrogen levels are low, the L allele loses its protective effect and increases the lethality of suicide attempts (Baca-García et al., 2004; Baca-Garcia, Diaz-Sastre, et al., 2010).

The authors of this paper designed several studies to identify a model of single nucleotide polymorphisms (SNPs) that discriminated between suicide attempters and nonattempters using data-mining strategies. In a sample of approximately 300 male psychiatric patients a large number of functional SNPs involved in brain function and development genes were studied. A machine-learning classifier (known as a support vector machine) was used to correctly identify and rank the significant SNPs.

To further discriminate between suicide attempters and nonattempters, the authors searched for the most relevant SNPs by genotyping 800 SNPs in a training sample of 222 psychiatric patients. Data-mining techniques were used to build a classifier using this training sample. A classifier is an algorithm generated by data-mining techniques using a training sample to learn the best way to differentiate individuals (in this case, suicidal and nonsuicidal patients) according to nonfixed criteria (in this case, SNPs that had previously been selected as relevant). In this study, the algorithm included three SNPs. The results indicated that the odds ratios, sensitivity, and specificity of the relevant SNPs were greater for combined SNPs than for separate SNPs (Table 1.1). A limitation of our study was that the classifier |9|used was a black box; therefore, we cannot know what relationship among these SNPs caused an increase in the risk of suicide attempt. Finally, this algorithm was tested in a new sample (55 subjects) with results similar to those obtained in the training sample (Baca-Garcia, Vaquero-Lorenzo, et al., 2010).

Collaboration

It is critical that health practitioners and scientists in other disciplines recognise the importance of replication of such findings before they can serve as valid indicators of disease risk or have utility for translation into clinical and public health. (Risch, 2009, p. 2470)

Risk assessment is normally targeted for individuals after a suicide attempt; however, these types of evaluations can be inaccurate because the risk factors for suicide show weak predictive values. In addition, there is a paucity of studies that measure the predictive accuracy of suicidal behaviour risk factors. This leads to imprecise predictive models and the impossibility of developing specific guidelines for the prevention of future suicide attempts.

Problems in assessment are common to other branches of psychiatric research. The problems of follow-up studies are related to the relatively low frequency of completed suicide after a suicide attempt. It is well-known that 10% of suicide attempters will commit suicide in 10 years, and more than 80% of suicide victims |10|have attempted suicide before. These rates mean that it takes a great effort to obtain a sample with enough power to test hypotheses about risk factors and to test the validity of diagnostic methods in suicide research.

We propose a collaborative effort for the following reasons: to generate a global model that will integrate genetic, clinical, and environmental factors implicated in the full suicide spectrum; to cover the full suicide spectrum to discover interactions between SNPs; to generate a bank of candidate genes associated with suicide to apply novel approaches to gene–environment interactions in suicidal behaviours; and to generate a specimen bank to explore metabolic factors.

We believe that complex behaviours are the results of multiple biological, genetic, and clinical factors. These factors are combined in different ways to produce the same observable behaviours. This means that different combinations of different factors may produce the same output. Moreover, the effect of each single factor can be very small. Therefore, we propose the use of combined strategies to fully analyse this type of behaviour. By combining biological, genetic, environmental, and clinical markers, as well as combining multisite collaborative efforts and analysis methodologies, we hope to establish effective preventive measures and eliminate risk factors.

Conclusion

Suicide is a major public health problem that needs primary and secondary prevention programmes. Programmes based on mental disease are effective in clinical populations. Current limitations in suicide research can be addressed with international collaborative programmes.

References

Baca-Garcia, E., Diaz-Satre, C., Basurte, E., Prieto, R., Ceverino, A., Saiz-Ruiz, J., & de Leon, J. (2001). A prospective study of the paradoxical relationship between impulsivity and lethality of suicide attempts. Journal of Clinical Psychiatry, 62,560–564. Crossref

Baca-García, E., Diaz-Sastre, C., Ceverino, A., García-Resa, E., Oquendo, M., Saiz-Ruiz, J., & De Leon, J. (2004). Premenstrual symptoms and luteal suicide attempts. European Archives of Psychiatry and Clinical Neurosciences,254(5),326–329.

Baca-Garcia, E., Diaz-Sastre, C., Ceverino, A., Perez-Rodriguez, M. M., Navarro-Jimenez, R., Lopez-Castroman, J., . . . Oquendo, M. A. (2010). Suicide attempts among women during low estradiol/low progesterone states. Journal of Psychiatric Research,44(4),209–214.

|11|Baca-García, E., Diaz-Sastre, C., Ceverino, A., Saiz-Ruiz, J., Diaz, F. J., & De Leon, J. (2003). Association between the menses and suicide attempts: A replication study. Psychosomatic Medicine,65(2),237–244.

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|13|Chapter 2Translating Research Into Practice

The Qualitative Perspective

Heidi Hjelmeland

Norwegian University of Science and Technology, Department of Social Work and Health Science,Trondheim, Norway

Introduction

The title of this chapter is “Translating Research Into Practice: The Qualitative Perspective.” The qualitative perspective and my response to the question of what we have achieved so far, would have to be not that much, yet – if we were to base our answer on what is found in the main suicidological journals.

Hjelmeland and Knizek (2011a