Abstract Seasonal variations of events are apparently playing an important part in various psychiatric conditions. To study the seasonal variation of a condition appears to be one useful approach to clarify the aetiology of a mental disorder and phenomena to which mental disorders are associated. In the present study the seasonal variations of suicides during the period of 1980-95 (n=21279) and homicides during the years 1957-95 (n=4553) in Finland were analysed. In addition, the use of statistical techniques for seasonality and some important characteristics of study samples were evaluated from 44 original suicide seasonality studies published between 1970-97. Special attention was paid to statistical methods for seasonality and these were reviewed in the summary part of this dissertation. A statistically significant spring peak of suicides was found in both genders, in all age groups (aged 39 years or below, 40-64 years, and 65 years or more) and in violent (hanging, drowning, shooting, wrist-cutting, jumping from a height) and non-violent suicides (poisoning, gas, other methods). A secondary autumn peak of suicides was present in females and also associated with non-violent methods. The rate of violent suicides had increased significantly during 1980-90 and decreased thereafter, while the non-violent suicides had kept steadily increasing over the whole 16-year study period. The seasonal variation of violent suicides had remained stable and statistically significant over the whole study period, but the seasonality in non-violent suicides has diminished over time. The seasonal pattern of homicides showed a statistically significant peak in summer and a trough in winter. The observed rate of homicides was about 6% higher in summer and 6% lower in winter than expected under the null hypothesis of a uniform distribution. Both the crude numbers of homicide and the rate of homicides per 100 000 population increased significantly over the 39-year study period. The increasing rate of homicides in Finland was accompanied by decreasing homicide seasonality. The seasonal trends in homicides correlated significantly (positive correlation) with the seasonal trends in the violent suicides over the period of 1980-95. The use of particular statistical techniques was specified in the majority of the 44 reviewed suicide seasonality articles. This was considered as satisfactory, although in subgroup analyses and in comparisons of the seasonal pattern of suicides with phenomena other than suicides, researchers tended to interpret their study findings without a statistical significance test. In those 37 articles, which had actually examined the seasonal pattern of suicides with a statistical test, statistical methods varied from simple standard tests like the chi-square test (14 articles, 38%) to sophisticated time series analyses such as a spectral analysis (4 articles, 11%). The calendar effect (i.e. effect due to the unequal lengths of months and leap years) was reported to have been taken into account in only 10 out of 44 (22%) reviewed studies. The lack of reporting the size of a sample (12 articles, 27%) or monthly values of suicides (17 articles, 54%) was found to be a major deficit in the reviewed studies. On the basis of these findings it is recommended to carry out further surveys, which evaluate statistical content and use of statistical methods in published medical articles. These kinds of surveys remind researchers to consider more thoroughly methodological and statistical issues in their investigations.

Appendices A-D were not provided by the author. The goal of the study was to explore the perceptions of the station commissioners of Waterberg District regarding the Suicide Prevention Workshops targeted at police officers. The study was conducted with the station commissioners of Waterberg District in Limpopo. The population in this study was composed of 15 station commissioners who were regarded as the sample due to the fact that the population is small. The research approach used in the applied study was a qualitative approach. A semi-structured interview schedule was used to collect data from the station commissioners in order to uncover their perceptions regarding the Suicide Prevention Workshops. A theoretical background about suicide in general and police suicide was provided through a literature study. In the literature study the background information about factors contributing towards police suicide were indicated, together with methods used to commit suicide. Causes of suicide in general as compared to those of police members, were also clarified. The focus in the literature was also on gender whereby an indication was mentioned about who exactly are at risk of committing suicide. The attitude of police officers and the society’s expectations and perceptions regarding police members has been discussed. The empirical study focused on the perceptions of station commissioners of Waterberg District in Limpopo regarding the Suicide Prevention Workshops targeted at police officers. A semi-structured one-on-one interview was held with each station commissioner on individual basis where by questions were asked about his or her perception of the Suicide Prevention Workshops. The findings of the study revealed that station commanders appreciate the role played by social workers, chaplains and psychological services in presenting suicide prevention programmes to police officers. They indicated that at some point they fail to nominate police officers to attend the workshops because some of the subordinates are not cooperative and they might even submit sick notes in order to be excused from attending. It was also reported that if there is a shortage of personnel due to other core business of SAPS, police officers might not be nominated. Based on the findings of the study, conclusions and recommendations were made with regard to how the suicide prevention program and workshops can be improved in SAPS. Copyright / Dissertation (MSW)--University of Pretoria, 2013. / Social Work and Criminology / unrestricted

Research suggests that reporting suicide has the potential to influence vulnerable individuals to emulate suicide behaviour. Media guidelines for the responsible reporting of suicide have been developed and disseminated worldwide, but with mixed success. One factor that may influence guideline uptake is the degree to which health professionals have collaborated with the media professionals in guideline development, dissemination and implementation. The study used semi-structured interviews with media professionals to understand attitudes towards the guidelines, to explore the ways in the media were engaged in communication regarding the guidelines, and to identify whether this engagement bears upon media attitudes toward the guidelines. Findings indicate that media professionals view the guidelines as useful information within the bounds of normal reporting, but find them difficult to implement. Excellence theory indicates that the predominantly one-way and asymmetrical strategies used to engage the media in communication around the guidelines may play a role in these attitudes. The study echoes literature suggesting that collaborative guideline development and implementation is essential to meaningfully change suicide reporting practices.

Les conduites suicidaires (CS) sont considérées comme des entités pathologiques à part entière avec une neurobiologie propre, abordées selon un modèle stress-vulnérabilité et pouvant bénéficier de la recherche de biomarqueurs. Nous proposons l'ébauche d'un modèle clinico-biologique de la vulnérabilité aux CS en considérant la douleur au coeur du processus suicidaire. Les stress psychosociaux sont sources de douleur psychologique. Leur maintien ou leur émergence perpétuerait ou majorerait la douleur psychologique via un dysfonctionnement du système vasopressinergique et des régions cérébrales impliqués dans les cognitions sociales. Nos données suggèrent une modification du seuil douloureux chez les sujets vulnérables pour le suicide qui percevraient une douleur psychologique accrue, associée aux idées suicidaires. Aussi les difficultés interpersonnelles sont associées une altération de prise de décision sous tendue par un dysfonctionnement du cortex préfrontal, associé à la vulnérabilité suicidaire. Ceci entrainerait le sujet à favoriser un choix (suicide) associé à une récompense immédiate (sédation de la douleur), même s'il est associé à les conséquences délétères (mort). Ainsi la douleur psychologique serait centrale dans les CS en tant que conséquence immédiate des stress psychosociaux, et en influençant les facteurs de vulnérabilité, qui favorisent sa perception et augmentent la sensibilité à certains événements sociaux via des processus neuroanatomiques et biochimiques. Nos travaux ouvrent de nouvelles voies de compréhension physiopathologiques et permettent d'envisager la douleur psychologique comme une potentielle cible thérapeutique de prévention suicidaire. / Current knowledge suggests that suicidal behavior: 1) are pathological entities per se, with a specific neurobiology, 2) may be studied according to a stress-diathesis model, 3) may be better characterized by identifying biomarkers. Emphasizing that pain is the core of the suicidal process, we propose an outline of a model of suicide based on clinical neuropsychological and neuroimaging data. Psychosocial stressors cause psychological pain. Through dysfunctional vasopressinergic system and cerebral regions involved in social cognitions, psychosocial stress would be maintained or give rise to new stresses, perpetuating or increasing psychache. We suggest a modification of pain thresholds in vulnerable subjects for suicide leading to an increased perception of psychache, which is associated with suicidal ideation. Then, interpersonal difficulties are associated with impaired decision-making underpinned by prefrontal dysfunction that has been associated with suicidal vulnerability. This would cause the subject to promote a choice (suicide) associated with immediate reward (pain relief), although it is associated with deleterious consequences (death). Thus, psychological pain is central to suicidal behavior as an immediate consequence of psychosocial stressors, and influencing the suicidal vulnerability favoring pain perception and increasing susceptibility to social events, based on neuroanatomical and biochemical bases. Finally the hypothesis that a change of pain perception is involved in the suicidal process would open new avenues for understanding suicidal pathophysiology. It allows considering the psychological pain as a potential therapeutic target to prevent suicide

Etude 1- Objectif: Explorer les contributions relatives des facteurs socioculturels et psychopathologiques aux idéations suicidaires dans un échantillon d’adolescents issus de l’immigration (N=292). Bien que les événements de vie négatifs, les symptômes dépressifs, et l'individualisme sont des facteurs de risque, et l'attachement aux parents un facteur de protection chez les garçons et les filles, des différences de genre sont observées. Les traits limites (facteur de risque), l'assimilation et la marginalisation (les deux facteurs de protection) étaient des prédicteurs significatifs de l’idéation suicidaire chez les filles uniquement.Etude 2- Objectif: Explorer les différences ethniques (717 Français vs. 251 issus de l’immigration) concernant les facteurs de risques et de protection associés à l’idéation suicidaire dans une population d’adolescents. Les garçons issus de l’immigration rapportaient une sévérité d’idéation suicidaire plus importante que les garçons Français alors que les filles issues de l’immigration rapportaient une moyenne plus élevée à l’échelle de l’idéation suicidaire que leurs pairs Françaises. Des différences ethniques sont apparus significatives pour l’âge chez les garçons et pour les cognitions délinquantogènes, les traits limites et l’anxiété sociale chez les filles. Etude 3- Objectif : Explorer l’idéation suicidaire et les symptômes dépressifs en France par des analyses centrées sur les variables et sur les personnes dans un échantillon d’adolescents issus de l’immigration. La marginalisation prédisait significativement les idéations suicidaires alors que la discrimination perçue prédisait les symptômes dépressifs. Quatre classes latentes ont émergés de l’analyse : « Séparés-Intégrés », « Intégrés », « Indifférenciés » et « Individualisés ». Des différences significatives sont apparues entre les quatre profils culturels pour l’identité ethnique, la discrimination perçue et le stress acculturatif. En revanche, bien que la prévalence de l’idéation suicidaire et des symptômes dépressifs était élevée dans l’échantillon total et dans les profils culturels, aucune différence significative n’est apparue. Etude 4- Objectif : Identifier les aspects cognitifs et comportementaux qui sous-tendent les conduites suicidaires de 15 jeunes issus de l’immigration. Le suicide représente « un moyen de se libérer de la contrainte à simuler une identité » et « une reprise du contrôle ». Les dissonances culturelles, les distorsions cognitives, les cognitions identitaires favorisent l’émergence de comportements autodestructeurs et de stratégies de coping. Les aspects cognitifs et comportementaux, sous-tendus par des éléments culturels contradictoires, amènent ces adolescents à anticiper un possible rejet, qui susciterait une angoisse d’abandon. / Study 1- Aim: Explore the contributions of sociocultural and psychopathological factors to suicidal ideation among of 292 adolescents with an immigrant background. Although stressful life events, depressive symptoms, and individualism were risk factors, and attachment to parents a protective factor for both boys and girls, some gender differences emerged. Borderline traits (risk factor), assimilation and marginalization (both protective factors) were significant predictors only among girls.Study 2- Aim: Explore ethnic differences (717 French vs. 251 with an immigrant background) regarding risk and protective factors associated to suicidal ideation among adolescents. The frequency of serious suicidal ideation was higher among the ethnic minority males group compared to the French males group. The mean of suicidal ideation however was higher among the ethnic minority group of females. Ethnic differences were observed regarding the age among males in the prediction of suicidal ideation and self-serving cognitive distortions, borderline traits, and social anxiety among females. Study 3- Aim: Examine suicidal ideation and depressive symptoms in France, both across variables and across persons in a non-clinical sample of adolescents with an immigrant background. Marginalization significantly predicted suicidal ideation whereas perceived discrimination significantly predicted depressive symptoms. Four latent classes emerged from analysis—“Separated-Integrated”, “Integrated”, “Undifferentiated” (characterized by adolescents who were not associated with any of the acculturation categories), and the “Individualized-Assimilated”. Significant differences appeared between the four classes for the indices of ethnic identity, perceived discrimination, and acculturative stress. Prevalence and mean score of suicidal ideation and depressive symptoms were high among both the sample and the four acculturative profiles; however no differences between the four classes emerged.Study 4- Aim: Identify cognitive and behavioral aspects which underline suicidal ideation and attempts of 15 adolescents with an immigrant background. Suicide represents “a way to release itself from the constraint to feign an identity”, and to “regain control”. Cultural dissonance, cognitive distortions, identity cognitions emphasize the emergence of self-destructive behaviors and coping strategies. These cognitive and behavioral aspects, underlined by contradictory cultural elements, lead these adolescents to anticipate a possible rejection, which may cause a fear of abandonment.

La recherche sur l'association entre l'expérience traumatique et la suicidalité est un domaine en pleine expansion dans la littérature depuis vingt ans. Cette thèse avait originalement pour but d’identifier les conditions suffisantes ou nécessaires de différents types de suicidalité chez les personnes traumatisées. Une procédure d'extraction de règles d'association a été mise en œuvre sur une base de données issue d'une enquête nationale française. Considérant le manque de conditions suffisantes ou nécessaires de suicidalité, deux autres questions liées à la suicidalité ont été envisagées. La première étude porte sur l'ordonnancement empirique des profils de suicidalité et la détection des symptômes qui modèrent les niveaux de risque. En utilisant la tentative de suicide dans le mois passé comme critère prédictif, trois niveaux de risque ont été établis. Tous les niveaux de suicidalité sont systématiquement modérés par le symptôme d'anxiété chronique. La deuxième étude visait à tester la robustesse de l'association entre les niveaux de traumatisme et la fréquence de la tentative de suicide dans le mois passé par l'identification des symptômes modérateurs de l'incidence de tentative de suicide dans chaque niveau de trauma. Sept symptômes concernant l'envie de mourir, l’intention d’automutilation, l’idéation suicidaire, la tentative de suicide au cours de la vie, l'humeur dépressive, la perte d'intérêt, et l'expérience de l'attaque de panique ont démontré un effet «d’éventail». Un examen détaillé de la littérature a révélé la difficulté d'obtenir une vue d'ensemble des types de suicidalité et leurs facteurs de risque dans le contexte «traumatisme-suicidalité». La troisième étude met en avant l’idée d’une plate-forme graphique visant à récapituler les connaissances empiriques obtenues par 26 études portant sur 20 facteurs de risque de six types de suicidalité dans différents échantillons de personnes traumatisées. Les principaux facteurs de risque sont la dépression majeure et le trouble de stress post-traumatique. Cette étude souligne l'importance d'un cadre descriptif commun et de la disponibilité des bases de données recueillies dans les études précédentes. / Research on the association between the experience of trauma and suicidality has been a growing field in the literature since two decades. The current dissertation was originally aimed at identifying sufficient or necessary conditions of suicidality outcomes among individuals exposed to trauma. A procedure of association rule extraction was implemented on a database from of a French national survey. Considering lack of sufficient or necessary conditions of suicidality outcomes, two other suicidality related issues were addressed. The first study focuses on the evidence-based ordering of the suicidality profiles and the detection of symptoms that moderate suicidality levels. Using ‘past month suicide attempt’ as the criterion, three suicidality levels were established. All suicidality levels were systematically moderated by the chronic anxiety symptom. The second study aimed at testing the robustness of the association between the trauma levels and the frequency of past month suicide attempt by identification of the symptoms moderating the incidence of outcome in every trauma level. Seven symptoms regarding desire for death, self-harm intention, suicidal ideation, lifetime suicide attempt, depressed mood, loss of interest, and panic attack exhibited a moderating effect with the fan-shaped pattern. A comprehensive review of the literature revealed the difficulty to obtain an overall picture of the investigated outcomes and their risk factors in the trauma-suicidality background. The third study puts forward a graphical platform aimed at recapitulating the evidence found by 26 studies concerning 20 risk factors of six suicidality outcomes among traumatized individuals. The main risk factors are major depression, and post-traumatic stress disorder. This review highlighted the importance of a common descriptive framework and the availability of the databases collected in previous studies.

Background: Transitioning to college life in young adulthood can represent a challenging developmental period and college students are at heightened risk for engaging in suicidality. Aims: We aimed to investigate the roles dispositional optimism and coping strategies play in suicide risk (viz., suicidality) and suicide protection (viz., reasons for living) in college students. Method: A sample of 252 American college students were surveyed using anonymous questionnaires and hierarchical regression analyses were conducted to analyze the data. Results: Coping strategies, as a set, played an important role in both suicidality and reasons for living, after controlling for demographic factors (age and sex). When dispositional optimism was entered into the model, it was found to account for a significant amount of additional unique variance in both suicidality and reasons for living, even after accounting for coping. Limitations: It is unknown whether optimism remains meaningful in its association with suicide risk and protection beyond coping in other populations. Conclusion: Effective coping and optimism are associated with decreased suicide risk and increased suicide protection. Our findings point to the consistent role of dispositional optimism, over coping, in both suicide risk and protection.

Sleep problems are robust suicide risk correlates. According to the interpersonal theory of suicide, thwarted belongingness (TB) and perceived burdensomeness (PB) may explain the link between sleep problems and suicide risk. This study examined these relationships among 331 community-dwelling adults identifying as sexual and/or gender minorities. Self-report measures of sleep problems, TB, PB, suicide risk, and anxiety were completed. Bootstrap mediation analyses were conducted to test TB and PB as interacting, individual, and parallel explanatory factors linking sleep problems and suicide risk. Sleep problems were associated with greater TB, PB, and suicide risk. TB and PB, in parallel and individually, accounted for the relationship between sleep problems and suicide risk, beyond age and anxiety. In contrast to the interpersonal theory, the indirect effect of PB was stronger at lower levels of TB and the indirect effect of TB was stronger at lower levels of PB. Exploratory analyses indicated significant differences between sexual minorities, gender minorities, and individuals identifying as both sexual and gender minorities: the indirect effect of sleep problems on suicide risk through PB was descriptively strongest among sexual minorities, and the indirect effect through TB was descriptively stronger among gender minorities and individuals identifying with both minority groups. Findings suggest that intervening upon TB and PB may thwart the trajectory from sleep problems to suicide risk among sexual and gender minorities. Further work is needed to determine whether suicide risk pathways differ across minority groups.

Thesis advisor: Thanh V. Tran / Suicide is an escalating public health crisis for Black people in the United States, yet the majority of the suicide research in the United States is based on the European American population. The psychological impact of the centuries of persistent stress and pain Black Americans have endured in the U.S., fueled by racism since the tragic period of slavery, is well-documented. However, despite the unrelenting historical and contemporary manifestations of racism and other systems of oppression in U.S. society, Black Americans have chosen death by suicide at rates lower than White Americans. Previous research has established the complexity of suicide and revealed that there are multiple personal and societal stress factors that contribute to creating risk factors for Black suicide. Research has also established that Black Americans historically have cultivated a resistance to the desire to take their own lives, seemingly linked to religious/spiritual and cultural coping resources that have served as a protective factor against suicidal behavior. Yet, there is a lack of scholarship that explores the impact of these resources on suicide in this population. Suicidologists are calling for suicide to be examined within a multidimensional contextual framework and for there to be a shift from a deficit approach to a strengths-based approach. There is a need for greater research focus on the factors that influence suicidal behavior in Black Americans, as well as the factors that are associated with creating a shield of protection against this self-destructive behavior. Through a convergent mixed-method approach, and guided by a robust cluster of theories, with Critical Race Theory and the Afrocentric Worldview as the overarching theoretical and philosophical approaches, this dissertation aims to address the gaps in the literature by examining several research questions. The following questions are examined through quantitative research: (1) Do racial discrimination and personal stress influence suicide attempts among Black people in the U.S., and does religion/spirituality serve as a protective factor and moderate the relationship between attempted suicide and racial discrimination and personal stress?; (2) Do post-incarceration status and personal stress influence suicide attempts among Black people in the U.S., and does religion/spirituality serve as a protective factor and moderate the relationship between attempted suicide and post-incarceration and personal stress?; (3) Do veteran status and personal stress influence suicide attempts among Black people in the U.S., and does religion/spirituality serve as a protective factor and moderate the relationship between attempted suicide and veteran status and personal stress? The data for this study were drawn from the cross-sectional National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) III which covers April 2012-June 2013. Logistic regression was employed to analyze the data. The quantitative research explores the impact of personal and societal stressors on the mental health of Black people and the role of religion/spirituality in cultivating a healthy emotional and mental environment that insulates them from suicide. The qualitative data include interviews with three adult Black men from the researcher’s family across three generations. Through three generations of Black men from one family, this dissertation further aims to examine whether religion/spirituality is a protective factor insulating Black people in the U.S. from developing suicidal behavior as they navigate societal stress factors including racial discrimination, post-incarceration status, and veteran status and whether religion/spirituality as a protective factor is passed down intergenerationally. If so, it aims to explore whether there are any intergenerational patterns and/or differences in the utilization of religion/spirituality as a source of protection against developing suicidal behavior. Assessed together, the findings from the quantitative and the qualitative research underscore the potential impact of stress and societal stress factors on suicidal behavior among Black people. Specifically, the quantitative research shows an association between personal stress and societal stress factors including racial discrimination, post-incarceration status, veteran status, and suicide attempts. The quantitative research also underscores the complexity of the role of religion/spirituality as a protective factor, as the findings from the quantitative research show that religion/spirituality was not a buffer against suicide attempts for the participants in that study. The findings from the qualitative research reveal that religion/spirituality can serve as a buffer and illustrates religion/spirituality functioning as an extension of Afrocentric culture and serving as a protective shield enabling some Black people to resist the full psychological impact of personal and societal stressors. This dissertation provides the foundation for the broader work highlighted through this study encapsulated in the Ubuntu Relational Framework for the Study of Black Suicide, an Afrocentric framework I developed that emerged as a guide for exploring the risks and protective factors of Black suicide. The constructs of death consciousness and Divine consciousness emerged during the analysis of the qualitative research as a way of conceptualizing the influence of societal stressors and protective factors on suicidal behavior, and they are an expression of Afrocentric culture. This framework highlights the need to equally prioritize the concern of what animates Black people’s desire to live, which was illuminated through the qualitative research, along with the question of what factors make them at risk for cultivating a desire to die. It further attends to the need for social workers to address the conditions of the racist U.S. environment these factors are assessed within. This dissertation also includes my autoethnography which serves as an analytic review and critical analysis of key concepts related to the study of Black suicide. It is a resource for further grounding in the historical and contemporary context of the Black experience and the Afrocentric worldview incorporated in this work. Autoethnography is an epistemological site for exploring Divine consciousness and the role of religion/spirituality and culture passed down intergenerationally as a protective factor against suicidal behavior. It further outlines a methodology for employing spiritual and cultural resources and operationalizing spiritual resistance. Finally, this dissertation goes beyond identifying risk and protective factors for suicidal behavior in Black people. It outlines a structure for training social work clinicians and researchers in this Afrocentric framework that would expand social workers’ knowledge of African-centered social work, and a method appropriate for responding to this multidimensional mental health problem that requires a creative, culturally rich approach. The training includes a methodology for employing religious/spiritual and cultural resources that operationalizes spiritual resistance that will equip social workers for supporting Black people in developing a healthy holistic mental and social environment within an oppressive racist environment. / Thesis (PhD) — Boston College, 2021. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social work.

Thesis advisor: Sara Moorman / In this thesis, I investigate if there are regional differences in suicide acceptability attitudes in the United States and what might explain these differences, namely political views or religious beliefs. I examine four suicide attitudes from the 2018 General Social Survey: whether a person has the right to die by suicide due to an incurable disease; bankruptcy; dishonoring one’s family; or being tired of living and ready to die. I draw upon a number of theories that discuss how one’s environment can influence their attitudes and how individuals form their attitudes in general. An individual from New England was found to be more accepting of suicide than someone from another region, and individual-level political and religious views were somewhat able to explain one’s suicide acceptability attitudes. Overall, regional differences in suicide attitudes do exist, perhaps helpful for future research to better understand differences in suicide rates around the country. / Thesis (BA) — Boston College, 2022. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Departmental Honors. / Discipline: Sociology.