published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

The main purpose of this study was to develop a more complete understanding of the deeply situated, ethical and political character of suicide prevention program planning practice through the analysis of everyday narratives or "practice stories." By offering an in-depth view of program planning practice - based on the retrospective analysis of a national conference planning process - this study provides an ideal opportunity for learning about "what matters most" when multiple interest groups come together to plan new programs. Three broad research questions provide the focus for this study: What are the diverse personal and professional understandings that stakeholders bring to the work of suicide prevention? How do these various identities and roles get enacted through language? What are the implications that these various understandings and multiple discourses have for shaping subsequent program planning experiences, decisions and actions? Using an open-ended interview structure, nine conference planning committee members were invited to reflect on their own experiences at the planning table. My own storied account of our planning experience is presented alongside the observations and stories of my planning colleagues. Thus, the varied perspectives of different planning partners and stakeholders are represented in their own words and are woven into an unfolding and textured narrative about planning practice in the mental health field. Several important findings emerged which have relevance for the future study and practice of program planning. First, there was a clear privileging of professional knowledge and interests at our planning table. Second, the tasks of problem framing and discourse shaping are key functions that planners need to bring conscientious attention to in order to advance the overall planning agenda. Finally, critical listening, emotion, empathy, and care are important elements of communication and meaning making and I have argued that these relational attributes should be explicitly cultivated and nurtured at the planning table.

M.Ed. / The increase in suicides and suicide attempts by adolescents makes it essential that the subject be looked into intensively as to why these increases occur and how the problem can be identified and prevented. The suicide problem can be traced back to the disintegration of inter-personal communication, either in the family, peergroup or society. In consequence it is apparent that parents, teachers and the community should listen more intensively, actively and with empathy to the problem. The problem is that the "distress call" is sometimes ignored. On account of these different "calls for help" not being heard, it is clear why the futile "why" questions are asked afterwards by the people left behind' after a suicide has been committed, and when it is too late to prevent. Since the problem of suicide and suicide attempts affect our society in so many sectors, the data regarding this phenomenon has been obtained from several sources. The method used in obtaining the necessary information is binary of nature. On the one hand it consists of an intensive literature study of the subject and on the other hand an empirical investigation through questioning as technique. As per De Groot (1961: 29) the present investigation may be described as explorative research, but in terms of Helmstadter's theory (1970: 31-32), as implemented, it is library-scouting and field research. The literature study covers the occurrence of suicide and suicide attempts within the society with special emphasis on the adolescent. The study also covers the causes thereof and how suicide and suicide attempts are embedded in society, taking into account the adolescent's relationship with parents, siblings (family), schools, the peergroup, the community and the society at large. This report is an attempt to view the problem of suicide and suicide attempts of adolescents from a sociopedagogical perspective. The empirical component of the research includes, firstly interviews with concerned parties of actual suicide cases and secondly the studying of police and hospital documents and files of actual suicide cases and suicide attempts. As a result of this research the following emerged: in the case of the majority of adolescents who commit suicide three dominating feelings are present, namely uselessness, despair and depression. Linked with these three dominating feelings the lack of communication is a major problem that faces the suicidal adolescent. Persons with suicidal tendencies are of a negative nature towards themselves and others and non-committal to life in general, resulting in disturbed relations with fellow man. It is necessary that pedagogical assistance and guidance must be intensive, active and empathetic : "Suicide prevention in adolescence is probably best served by general care, tenderness, understanding and support for all unhappy adolescents, rather than searching for suicide specific predictor traits All unhappy adolescents should arise within us the fear of possible self initiated death". (Davis, 1983: 55.)

The main purpose of this study was to develop a more complete understanding of the deeply situated, ethical and political character of suicide prevention program planning practice through the analysis of everyday narratives or "practice stories." By offering an in-depth view of program planning practice - based on the retrospective analysis of a national conference planning process - this study provides an ideal opportunity for learning about "what matters most" when multiple interest groups come together to plan new programs. Three broad research questions provide the focus for this study: What are the diverse personal and professional understandings that stakeholders bring to the work of suicide prevention? How do these various identities and roles get enacted through language? What are the implications that these various understandings and multiple discourses have for shaping subsequent program planning experiences, decisions and actions? Using an open-ended interview structure, nine conference planning committee members were invited to reflect on their own experiences at the planning table. My own storied account of our planning experience is presented alongside the observations and stories of my planning colleagues. Thus, the varied perspectives of different planning partners and stakeholders are represented in their own words and are woven into an unfolding and textured narrative about planning practice in the mental health field. Several important findings emerged which have relevance for the future study and practice of program planning. First, there was a clear privileging of professional knowledge and interests at our planning table. Second, the tasks of problem framing and discourse shaping are key functions that planners need to bring conscientious attention to in order to advance the overall planning agenda. Finally, critical listening, emotion, empathy, and care are important elements of communication and meaning making and I have argued that these relational attributes should be explicitly cultivated and nurtured at the planning table. / Education, Faculty of / Educational Studies (EDST), Department of / Graduate

Suicidal thoughts and behaviors (STBs) are a problem among young adults. Problem solving deficits have been implicated in suicide outcomes and may be especially relevant to young adults given the developmental demands and increased risk for STBs during this life stage. Emerging research suggests that problem solving and related cognitive processes (e.g., episodic memory) can be modified through a brief cognitive training session, hereafter referred to as the specificity induction. However, it is unknown whether benefits of this specificity induction extend to suicidal populations. The present study tested a web-based version of the specificity induction intended to improve problem solving skills, episodic memory and divergent thinking among suicidal young adults. We recruited and consented a sample of 105 young adults with past year STBs and randomly assigned them to receive either the specificity induction or a control condition (i.e., general impressions induction). Regarding feasibility of conducting an online study with this population 81.90% (n=86) of those who provided informed consent completed the study protocol. Regarding clinical acceptability of the web-based specificity induction, the majority of participants which received this cognitive training rated that they would be unlikely to “use again”, while endorsing that it was “easy to use” across several items of a user experience self-report questionnaire. Contrary to hypotheses,young adults assigned to complete the specificity induction did not show improvement in their performance on measures of problem solving and related cognitive processes compared to those assigned to the control condition. Through post-hoc analyses we investigated candidate sources of systematic variability in task performance (e.g., attention, mood, task order effects), but none were found to account for participants’ demonstrated problem solving performance. In sum, we conclude that testing this brief cognitive training through an online experimental study was feasible, the cognitive training was modestly acceptable in its online format, and it does not immediately improve suicidal young adults’ problem solving or related cognitive processes. By demonstrating what does not necessarily work with suicidal young adults, there remains room for future research to pursue alternative design or modes of single session interventions.

The present study compares two types of treatments designed to reduce suicidal ideations: social problem-solving therapy and supportive therapy. Social problem-solving therapy is based on research indicating that suicidal individuals have deficits in problem-solving skills in general and in interpersonal problem-solving skills, in particular. Supportive therapy was chosen as a comparative treatment to control for nonspecific effects of problem-solving therapy and to provide an ethical alternative treatment. The results indicated that problem-solving therapy was more effective than supportive therapy for reducing depression and for improving interpersonal problem-solving self-efficacy at posttest. At 3 month follow-up there continued to be differences between the groups in depression, but not in problem-solving self-efficacy. In addition, at follow-up problem-solving therapy was more effective than supportive therapy for reducing hopelessness and loneliness. Although there were no differences between the groups on severity of suicidal ideations, within group analyses revealed that problem-solving therapy significantly reduced severity of ideations over time. The findings suggest that social problem-solving therapy is a more effective treatment than supportive therapy for reducing depression, hopelessness, and loneliness of suicidal individuals. This may be due to social problem-solving deficits being a key problem for suicidal individuals. Although there are several limitations to the study, such as small sample sizes, it provides an example of treatment research with suicidal individuals. Similar studies would be useful to further evaluate empirically-based treatments for suicidal individuals. / Ph. D.

published_or_final_version / Social Work / Master / Master of Social Sciences

Attitudes toward suicide have been linked to the way health professionals and lay people behave toward suicidal individuals. In some instances negative attitudes toward suicidal persons seem to have contributed to repeated attempts or to suicide completion. This study examines attitudes held by college students toward suicide, explores whether their attitudes are related to their skills at recognizing therapeutic verbal interventions, and seeks to identify personality variables that might predict attitudes toward suicide as well as skills at recognizing therapeutic interventions. Three instruments, the Suicide Opinion Questionnaire (SOQ), the Suicide Intervention Response Inventory (SIRI), and the California Psychological Inventory (CPI), were administered to 215 volunteer undergraduates (122 males and 93 females) from introductory psychology classes. Subjects' modal age range was 18 to 21 years. Forty-five attitudinal items from the SOQ yielded a total favorableness score for each subject; skills at recognizing suicide intervention responses to imaginary suicide callers was rated by a SIRI score from 0 to 25. The first hypothesis, that favorableness in attitudes toward suicide would correlate positively with skills at recognizing facilitative suicide intervention responses, was not supported by test data. The second hypothesis was accepted in that both, favorableness in attitudes toward suicide (SOQ scores) and recognition of faciliative intervention responses (SIRI scores), can be predicted from a personality test. SOQ scores were predicted positively by CPI scales Flexibility, and Achievement via independence, and negatively by Achievement via conformance. SIRI scores were predicted positively by Intellectual efficiency and Dominance, and negatively by Good Impression. The literature identifies flexibility as one of the behaviors of good crisis intervention workers. An implication from this study is that students showing more flexibility and autonomy are likely to show also more favorableness in attitudes toward suicide. Another implication is that students who are more intelligent and quick at making use of their intellectual abilities, who show initiative, and who have a moderate concern about their impression on others, are more likely to recognize intervention responses that may be helpful to suicidal persons.

No description available.

Ce travail s’articule autour du constat de l’hétérogénéité phénotypique des conduitessuicidaires conjointement à celui de l’existence de nombreux facteurs de validité nosologique.En suivant la méthode du symptôme candidat, nous avons pu montrer que la distribution del’âge à la première tentative de suicide (TS) était une mixture de deux distributionsgaussiennes. Ce symptôme candidat nous a permis de délimiter deux sous groupes distincts depatients en terme de caractéristiques cliniques. Parallèlement, l’exploration des dysfonctionscognitives de patients suicidants nous a permis de proposer un deuxième symptôme candidat :le déficit de l’inhibition cognitive. Enfin, grâce à l’analyse en composante principale d’uninstrument de mesure de la léthalité suicidaire, nous avons pu montrer que la sous dimensionde léthalité « implémentation du patient » constituait un symptôme candidat du fait de sesliens probables avec l’intentionnalité suicidaire, deux dimensions intriquées et déterminantesdans la genèse de conduites suicidaires. Notre contribution a la validation nosologique desconduites suicidaires concerne les résultats obtenus à partir de l’étude d’une population depatients bipolaires au sein de laquelle l’héritabilité des conduites suicidaires est apparuindépendante de celle du trouble bipolaire de l’humeur. Enfin, au sein d’une populationépidémiologique psychiatrique martiniquaise homogène sur le plan ethnique, 18% despatients avaient des antécédents de TS. Ce chiffre est inférieur à celui mesuré au sein d’étudesmenées en population cliniques majoritairement caucasiennes et conforte l’idée d’une « hyposuicidalité» dans les populations d’origine africaine. / This work starts with the report of the phenotypic heterogeneity of suicidal behavior jointly tothat of the existence of several nosological validity factors. While following the candidatesymptom approach, we could show that the distribution of the age at first suicide attempt(SA) was a mixture of two Gaussian distributions. This candidate symptom enabled us todelimit two distinct groups of patients in term of clinical characteristics. In parallel, theexploration of the cognitive dysfunctions among suicidal patients enabled us to propose asecond candidate symptom: the impaired cognitive inhibition. Lastly, by the study of asuicidal lethality scale, we could show that the “patient’s implementation” represented acandidate symptom because of its probable relationship with suicidal intent, two intricate anddetermining dimensions in the genesis of suicidal behavior. Our contribution to thenosological validation of suicidal behavior relates to the results obtained from the study of apopulation of bipolar patients within whom the heritability of suicidal behavior appearedindependent of that of the bipolar disorder. Lastly, among an Afro-Caribbeanepidemiological psychiatric sample, 18% of the patients had a history of SA. This rate islower than that measured within studies conducted among mainly Caucasian clinical samplesand strengthen the idea of a “hypo-suicidality” in the populations of African origin.