<p>I Sverige begår ca 1500 personer suicid per år, och 90 % av dessa har visat tecken på psykisk sjukdom. Av de som har gjort suicidförsök kommer ungefär hälften i kontakt med vården. Psykiatrisk omvårdnad syftar till att främja hälsa och lindra lidande och det behövs många olika färdigheter i arbetet med den suicidnära patienten, för att genom den terapeutiska relationen kunna ge en empatisk, säker och professionell omvårdnad. Syftet med litteraturstudien var att beskriva vilka faktorer som var viktiga i omvårdnadsarbetet med suicidnära patienter, ur ett patientperspektiv. Metoden som användes var en litteraturstudie. Den bestod av 13 vetenskapliga artiklar, 12 kvalitativa och en både kvalitativ och kvantitativ, publicerade mellan 1999-2008, som granskats, analyserats och bearbetats enligt Polit och Becks arbetsmodell. Resultatet visade på tre huvudkategorier och åtta subkategorier. Huvudkategorin <em>Relation </em>bestod i subkategorierna <em>bemötande, bekräftelse </em>och<em> kommunikation</em>. Huvudkategorin <em>Aktivitet </em>bestod i subkategorierna <em>avledande sysselsättning </em>och <em>sömn/vila</em>. Huvudkategorin <em>Säkerhet</em> bestod i subkategorierna <em>personligt övervak, fysisk miljö </em>och <em>visitation</em>. Dessa kategorier visade vilka faktorer som suicidnära patienter upplevde som värdefulla för att minska deras suicidala tankar/handlingar och hur de önskade bli omhändertagna av omvårdnadspersonal.</p>

I Sverige begår ca 1500 personer suicid per år, och 90 % av dessa har visat tecken på psykisk sjukdom. Av de som har gjort suicidförsök kommer ungefär hälften i kontakt med vården. Psykiatrisk omvårdnad syftar till att främja hälsa och lindra lidande och det behövs många olika färdigheter i arbetet med den suicidnära patienten, för att genom den terapeutiska relationen kunna ge en empatisk, säker och professionell omvårdnad. Syftet med litteraturstudien var att beskriva vilka faktorer som var viktiga i omvårdnadsarbetet med suicidnära patienter, ur ett patientperspektiv. Metoden som användes var en litteraturstudie. Den bestod av 13 vetenskapliga artiklar, 12 kvalitativa och en både kvalitativ och kvantitativ, publicerade mellan 1999-2008, som granskats, analyserats och bearbetats enligt Polit och Becks arbetsmodell. Resultatet visade på tre huvudkategorier och åtta subkategorier. Huvudkategorin Relation bestod i subkategorierna bemötande, bekräftelse och kommunikation. Huvudkategorin Aktivitet bestod i subkategorierna avledande sysselsättning och sömn/vila. Huvudkategorin Säkerhet bestod i subkategorierna personligt övervak, fysisk miljö och visitation. Dessa kategorier visade vilka faktorer som suicidnära patienter upplevde som värdefulla för att minska deras suicidala tankar/handlingar och hur de önskade bli omhändertagna av omvårdnadspersonal.

Orientador: Neury José Botega / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-17T15:41:56Z (GMT). No. of bitstreams: 1 Cais_CarlosFilintodaSilva_D.pdf: 5508164 bytes, checksum: c31e9a8839229803d4d10cae8544dd64 (MD5) Previous issue date: 2011 / Resumo: Este projeto implementou localizadamente duas estratégias selecionadas de prevenção de suicídio sintonizadas com as recomendações da Organização Mundial da Saúde: capacitação de equipes de saúde e estímulo aos indivíduos que tentaram o suicídio para que conseguissem e se mantivessem em tratamento. Para avaliar a eficácia da capacitação, o projeto mensurou o impacto da mesma em termos de mudança de conhecimento, habilidades clínicas e atitudes das equipes de saúde em relação ao comportamento suicida. Já em relação ao monitoramento avaliaram-se qualitativamente alguns casos monitorados visando à obtenção de informações que pudessem aperfeiçoar os serviços de saúde. A capacitação foi eficaz em promover mudanças desejadas nos profissionais de saúde, tanto do ponto de vista de mudanças de atitudes, quanto de aprimoramento nos conhecimentos/habilidades clínicas em prevenção do suicídio. Estas mudanças se deram do inicio do curso para o final do mesmo e mantiveramsediferentes de antes do curso em uma reavaliação após nove meses. Em relação ao conhecimento/habilidades clínicas, auferido através do respectivo questionário o mesmo subiu de 9,4 em 21 pontos possíveis para 13,7 em 21 (p < 0,001 com nível de significância de 95%) e após nove meses se manteve diferente do início do curso: 11,5 em 21 pontos possíveis (p < 0,001). Foram criados constructos agrupando itens correlacionados do Questionário de Atitudes Frente ao Comportamento Suicida: Sentimentos negativos diante do paciente; Percepção de capacidade profissional e Direito ao Suicídio, os três constructos mostraram mudanças favoráveis do início do curso para o final do mesmo (p= 0,04; p<0,01 e p=0,02 respectivamente) e os dois primeiros mantiveram-se diferentes do início do curso em uma reavaliação após nove meses do final do curso (p= 0,04; p<0,01 e p=0,07 respectivamente). Em relação ao monitoramento, nenhum dos 67 indivíduos monitorados faleceu por suicídio durante o seguimento de seis meses e quatro fizeram nova tentativa de suicídio neste período. Através da avaliação qualitativa de seis casos monitorados, notaram-se benefícios a adesão dos mesmos ao tratamento em saúde mental, e também pontos de possível aprimoramento no fluxo e acolhimento dos pacientes que tentaram o suicídio / Abstract: Two strategies in tune with the recommendations of the World Health Organization for suicide prevention were implemented: training of healthcare teams in suicide prevention and systematically monitoring individuals who attempted suicide by phone calls or home visits in order to help them to seek and keep treatment. A 18 hours-duration suicide prevention training designed to improve health professional?s knowledge and attitudes in suicide prevention was provided to 270 health professionals who were in contact with patients at high risk for suicide in their routine practice. Questionnaires were used to assess changes in professional?s attitudes and knowledge. The score in the questionnaire for the assessment of suicide prevention knowledge, which had 21 as maximum score, increased from 8.9 to 13 (p <0.001, significance level of 95%) and when professional?s knowledge was assessed nine months later it remained significantly higher than at first assessment: 11.5 (p <0.001). The Suicide Behavior Attitude Questionnaire had 25 items assessing professional?s attitudes, 18 of them showed significant changes after the training. The questionnaire was divided in sub-scales: "right to suicide"; "negative feelings towards the patient with suicidal behavior" and perceived professional ability to deal with patients with suicidal behavior". The three constructs showed favorable changes right after the training (p = 0.04, p <0.01 and p = 0.02) and the first two remained different nine months later (p = 0.04, p <0.01 and p = 0.07 respectively). The suicide prevention training adopted has enhanced knowledge and attitudes toward suicide prevention in healthcare workers Regarding the monitoring of patients, none of the 67 monitored individuals died by suicide during the following six months and only four attempted suicide again during the follow-up. Qualitative evaluation of six cases allowed for the identification of aspects of health care delivery to patients who attempted suicide that might need to be improved / Doutorado / Saude Mental / Doutor em Ciências Médicas

The diploma thesis "Autobiographical Memory in Suicide Attempters" deals with recall of specific autobiographical memories in suicide attempters. The theoretical part of the thesis defines basic concepts associated with autobiographical memory, presents its structure, role throughout the life-span, and describes relation of autobiographical memory to emotions, depression and self. The second part of the thesis presents basic concepts of suicidal behaviour, describes selected theoretical approaches and models of development of suicidal behaviour, methods and consequences, assessment and prevention of suicidal behaviour, and presents most common myths about suicide. The empirical part verifies ability to recall specific autobiographical memory, latency in recall of autobiographical memories, and tendency for overgeneral autobiographical memories. The empirical part employs Autobiographical Memory Test (AMT), Beck Depression Inventory (BDI - II), Suicide Behavior Questionnaire - Revised (SBQ-R) and The Stress Coping Style Questionnaire (SVF 78). The research sample consists of 40 participants (20 suicide attempters, 20 non-suicidal persons). The results indicate that suicide attempters show higher latency in producing specific autobiographical memories, produce fewer specific memories, and show lower...

Suicide in India is a complex social issue and a neglected area by the state. Research has focused on risk factors and the epidemiology of suicide; studies concerning the intersection of culture with attempted suicide are limited. The aim of this study is to explore cultural implications of attempted suicide and its prevention in Southern India by means of comparing and contrasting the accounts of survivors of attempted suicide, mental health professionals and traditional healers engaged in treating people with suicidal behaviour. Methodology: A qualitative design is used drawing on constant comparison method and thematic analysis. The analysis of the data is underpinned by the theoretical concepts of Bourdieu’s work. In-depth interviews were conducted with fifteen survivors of attempted suicide, eight mental health professionals and eight healers from Southern India. Results: Application of Bourdieu’s theory of symbolic power and violence, cultural capital and habitus to the analysis of data revealed the process of constant interaction among visible and invisible fields such as faith, power, control, family, religion and social systems which impact survivors’ disposition to situations. Disparities in gender and role structures within families, financial challenges, health concerns, abuse, and violence were commonly cited factors by all three groups of participants. A few survivors and healers attributed misfortunes and distress to magic, spells and ‘bad times’. Healers and professionals were particularly of the opinion that cultural transition has added to stress among people. Survivors considered religious and traditional methods of support as socially accepted norms. Medical assistance was sought only during apparent ill health. Psychosocial support was very rarely accessed and availed. A lack of awareness among family members and friends to identify mental health concerns and a wide gap between identification of severe stressors and treatment increased the risk of suicide and limited timely intervention. Conclusion: This study identified a set of cultural mechanisms that produced negative impact and led to attempted suicide. The role of culture in causing suicide and attempted suicide is explained by unraveling the dynamics of cultural mechanisms and support processes that survivors experienced and as reported by professionals and healers. This research evidence presents pathways into attempted suicide and a life away from suicide.

Bakgrund Suicid är ett folkhälsoproblem. Varje år tar mer än 700 000 personer sitt liv i världen. Under 2020 vårdades 6 666 personer i Sverige på sjukhus till följd av ett suicidförsök. Stigmatisering av suicidala personer förekommer både i samhället och inom hälso- och sjukvården. Patienter med suicidalt beteende söker vård inom alla delar av hälso- och sjukvården och vårdpersonal uppger ofta att de har en bristande kunskap om suicidalitet och vad som krävs för ett gott omhändertagande av dessa patienter. Det finns därför ett behov av att sammanställa aktuell forskning för att öka vårdpersonalens kunskap och förståelse för suicidalt beteende och mötet med dessa patienter. Syfte Syftet var att belysa hur patienter med suicidalt beteende upplever mötet med hälso- och sjukvården. Metod En icke-systematisk litteraturöversikt som baserades på 15 vetenskapliga originalartiklar med kvalitativ ansats. Artiklarna inhämtades från databaserna PubMed och CINAHL med hjälp av sökord i olika kombinationer. Artiklarna har genomgått kvalitetsgranskning utifrån Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet. Resultatet sammanställdes och analyserades med en integrerad dataanalys. Resultat I sammanställningen av resultatet identifierades fyra huvudkategorier: Upplevelser av värdighet, Upplevelser av engagemang och partnerskap, Upplevelser av stigma samt Upplevelser av en trygg och säker vårdmiljö. Resultatet visade att upplevelsen av trygghet i mötet var den mest centrala aspekten för att forma ett partnerskap och för att uppnå en öppenhet kring det suicidala beteendet. Personcentrerad vård och ett ömsesidigt engagemang framkom vara av betydelse för att upprätthålla värdighet och lindra lidande. Slutsats Denna litteraturöversikt visade värdefulla möjligheter i ett partnerskap och ömsesidigt engagemang mellan patienter med suicidalt beteende och hälso- och sjukvården. Studien identifierade upplevelsen av trygghet och personcentrerad vård som centrala premisser i mötet för att suicidala patienter ska känna förtroende för vården. Med ökad kunskap och förståelse kan hälso- och sjukvården förbättra omhändertagandet av suicidala patienter och förhindra fler suicid. / Background  Suicide is a public health problem. Globally, every year more than 700 000 people commit suicide. In 2020, 6 666 people in Sweden were hospitalized as a result of a suicide attempt. Stigmatization of suicidal patients are prevalent both in society and in healthcare. Patients with suicidal behaviour seek care in all areas of healthcare. Healthcare personnel often state that they have a lack of knowledge about suicidality and what is required for good care of suicidal patients. For that reason, there is a need to compile latest research to increase healthcare personnels’ knowledge and understanding of suicidal behaviour and the encounter with these patients. Aim  The aim of this study was to illuminate how patients with suicidal behaviour experience the encounter with healthcare. Method  Non-systematic literature review based on 15 scientific articles with a qualitative approach. The articles were retrieved from the databases PubMed and CINAHL using keywords in various combinations. The articles have undergone a quality review based on Sophiahemmet University assessment basis for scientific classification and quality. The results were compiled and analyzed with an integrated data analysis. Results  In the compilation of the results, four main categories were identified: Experiences of dignity, Experiences of commitment and partnership, Experiences of stigma, and Experiences of a safe and secure care environment. The results showed that the experience of trust in the encounter was the most central aspect in order to form a partnership and for achieving openness about suicidal behaviour. Person-centered care and mutual commitment emerged to be significant for maintaining dignity. Conclusions  This literature review showed valuable opportunities in a partnership and mutual commitment between suicidal patients and healthcare. The study identified experiences of trust and person-centered care as central premises in the encounter, for suicidal patients to have confidence about the care. With increased knowledge and understanding, healthcare can improve the care of suicidal patients and prevent more suicide.

Bakgrund: Suicid är ett globalt folkhälsoproblem. I Sverige vårdades 2021 cirka 11 000 patienter som försökt begå suicid. Intensivvårdssjuksköterskor har en betydelsefull roll i vården och mötet med patienten som utfört ett suicidförsök. Människor som försökt begå suicid har ett lidande och behöver bemötas utifrån en helhet av kropp, själ och ande. Syfte: Att beskriva intensivvårdssjuksköterskors erfarenheter av att på en intensivvårdsavdelning vårda patienter som försökt begå suicid. Metod: Kvalitativ innehållsanalys med induktiv ansats. Tio intensivvårdssjuksköterskor med erfarenhet av att vårda patient efter suicidförsök intervjuades. Resultat: Analysen resulterade i fyra kategorier, Väcker känslor, Vårda både kropp och själ, Att skapa en trygg miljö och Att bemöta anhöriga. De fyra kategorierna är sedan uppdelade i nio subkategorier. Konklusion: Studiens resultat visar att intensivvårdssjuksköterskor erfar att omvårdnaden av patienter som försökt begå suicid är komplex. Olika uppfattningar framkommer angående om det ingår i intensivvårdssjuksköterskans roll att prata med patienten om suicidförsöket. Att intensivvårdssjuksköterskor har olika syn på detta kan eventuellt leda till att patienter inte får jämlik vård. Vidare forskning av ämnet behövs för att skapa riktlinjer och tydliggöra om det är intensivvårdssjuksköterskans uppgift att initiera samtal om suicidförsöket. / Background: Suicide is a global public health problem. In Sweden, approximately 11,000 patients who attempted suicide were treated in 2021. Intensive care nurses have an important role in the care and meeting with the patient who has attempted suicide. People who have attempted to commit suicide are suffering and the whole person needs to be treated, body, soul and spirit. Aim: To describe intensive care nurses' experiences of caring for patients who have attempted suicide in an intensive care unit. Method: A qualitative content analyses with an inductive approach. Ten intensive care nurses with experience from caring for patients after suicide attempt, where interviewed. Result: The analysis resulted in four categories, Evokes emotions, Caring for both body and soul, Creating a safe environment and Dealing with relatives. Conclusion: Intensive care nurses experience that the care of patients who have attempted suicide is complex. Different opinions emerge regarding whether it is part of the intensive care nurse's role to talk to the patient about the suicide attempt. Different views on this could potentially lead to patients not receiving equal care. Further research on the subject is needed to create guidelines and clarify whether it is the intensive care nurse's task to initiate conversations about the suicide attempt.

Spiritual well-being is a well-established predictor of mental health, yet the potential mechanisms of this association are relatively unexplored. We examined the influence of spirituality, including religious and existential well-being, on depressive symptoms, and the potential mediating effect of optimism and pessimism, in a sample of 66 African American female suicide attempters. Participants were recruited from a large, urban hospital and completed the Spiritual Well-Being Scale, Life Orientation Test-Revised, and the Beck Depression Inventory-II. The association between spiritual well-being and depressive symptoms was mediated indirectly through both optimism and pessimism; greater religious and existential well-being was related to more optimism, and less pessimism and, in turn, to fewer depressive symptoms. Historically, spiritual well-being has been important to the African American community, and its beneficial effects on mental health might be explained, in part, by their effect on cognitive-emotional functioning.

This thesis investigated the experience of taking part in a psychosocial assessment following an episode of self-harm from the service user perspective. Psychosocial assessments are a key aspect of self-harm management in secondary care, designed to identify needs and risk and determine further care. This study utilised interpretative phenomenological analysis to privilege the voices of service users and produce in-depth, contextualised understandings of the experience of assessment and its impact on future help-seeking and engagement with services. Data collection consisted of semi-structured interviews with thirteen participants soon after their hospital attendance; follow-up semi-structured interviews were also completed with seven participants three months later, to explore patient-derived outcomes from assessment and hospital attendance. The lived experiences of participants were characterised by two main features: experiences of life as a struggle and of the self as “less than”. As a result of these struggles and experiences of powerlessness and devaluation, participants mostly saw self-harm and suicide as a natural progression in their narratives. Expressions of suicidal intent reflected a struggle between a desperate desire for change and hopelessness in the face of current circumstances. The key message gained from participants’ accounts of assessment was that the interaction with staff had the power to reinforce or challenge hopelessness and negative self-evaluations. In addition, the way an assessment was conducted had influence beyond the hospital: as an experience which created or reinforced expectations for future instances of help-seeking; as a deterrent or an encouragement to seek help; and as the first step along the path to change. Unfortunately, participants’ experiences of aftercare were dominated by a sense of stagnation due to the failure of services to follow through with promises of aftercare, which affected their attitudes towards future help-seeking and towards themselves. This thesis is the first study to utilise an in-depth idiographic methodology to explore and contextualise the service user experience of psychosocial assessment following self-harm within the wider circumstances of their lives. It demonstrates how patient-staff interactions within the hospital and after discharge can affect future help-seeking through reinforcing or challenging the hopelessness and self-negativity of patients.

Adolescent suicide and attempted suicide is an unhealthy practice that involves mental illness which led the suicidal behavior to be an important public health problem globally and in Africa. Suicide prevalence rates in young people in South Africa and in all major ethnic groups are a significant cause for concern. The adolescent mental illness causes sleepless nights on the education system. Though much research has been done on this problem it still remains one of the leading causes of death amongst adolescent learners locally and globally. As a parent and an educator reading news articles, attending memorial services and funerals of adolescent learners who took their own lives, gave me enough reason for actions to be taken in order to find out what is causing adolescents to commit suicide. During this emotional experience as the researcher, I have discovered that the adolescent stage is a very fragile stage. I also discovered that when life stresses strike, coping as an adolescent becomes difficult. This study focuses on an in-depth study of the causative factors of suicide and attempted suicide amongst the adolescent learners of Tshwane North (D3) area. The topic was investigated by means of a literature study and an empirical investigation using a qualitative approach. Data was collected by means of focus group discussion and one to one interview using a tape recorder and taking notes. Participant's answers were analysed individually and compared with all others. Findings shows that adolescent suicide and attempted suicide is a mental disorder that need to be addressed by including physicians and psychologists, upon realizing the warning signs of suicide in order to minimalize the practice. It is also clear that adolescence is a fragile stage of growth and adolescents struggle to cope with life challenges such as peer pressure, parent separations, socialization, pregnancy, chronic illness and academic pressure. It is recommended that NGOs in collaboration with the Health and Education Departments need to take action by organizing workshops to address causative factors of suicide and how to find help when realizing a suicidal adolescent learner. The department of education needs to ensure that adolescent suicide and attempted suicide preventative strategies should be taught from primary school level and be added to life skills subject in all grades. Life Orientation educator's to be trained about adolescent suicide to be well equipped to teach learners on how to recognize warning signs in their peers and friends. / Inclusive Education / M. Ed. (Inclusive Education)