I vården av suicidala patienter ställs sjuksköterskan inför många utmaningar samtidigt som den suicidala patienten är i behov av ett omsorgsfullt bemötande som skapar trygghet och känslor av acceptans. De attityder som sjuksköterskan har mot patienterna är därför av stor betydelse. Syftet med denna studie var att undersöka vilka attityder till suicidala patienter som förekommer hos sjuksköterskor samt att utforska om det finns faktorer som har betydelse för sjuksköterskans attityder. Metoden var en litteraturstudie där resultatet från tolv vetenskapliga studier har analyserats och sammanställts i olika teman. Resultatet visar att sjuksköterskor utifrån kognition, affekt och beteende, uppvisade både positiva och negativa attityder mot suicidala patienter. Faktorer som till exempel sjuksköterskornas utbildning, kunskap, förståelse och upplevelse av svårigheter och otillräcklighet visade sig ha betydelse för sjuksköterskans attityd. Slutsats: Sjuksköterskan uppvisar attityder mot suicidala patienter som är både positiva och negativa. Negativa attityder som ilska och avståndstagande försvårar vården för patienten medan positiva attityder som empati och stöd skapar en trygg situation för patienten. Betydelsen av sjuksköterskans utbildning kan inte förbises utan är viktig för att få förståelse för patienten och att kunna hantera de svårigheter som uppstår i vården / In the care of suicidal patients the nurse is confronted by many challenges. At the same time the suicidal patient is in need of a caring attitude that creates safety and feelings of acceptance. Therefore the nurse´s attitudes towards the patients are of great importance. The aim of this study was to explore which attitudes nurses hold against suicidal patients and also to explore whether there are factors that are important for nurses´ attitudes. The method was a literature study where the results from twelve scientific articles was analyzed and compiled in different themes. The results showed that nurses, both cognitively, affectively and behavioral, held positive and negative attitudes towards suicidal patients. Factors such as education, knowledge, understanding, and nurses´ experiences of difficulties and shortcomings were found to have an impact on nurses´ attitude. Conclusion: The nurses hold both positive and negative attitudes towards suicidal patients. Negative attitudes such as anger and rejection complicate the nursing care while positive attitudes like empathy and support create a safe environment for the patient. The importance of the nurse´s education cannot be overlooked as it is important for gaining understanding and handling the difficulties that emerge in the care of the suicidal patient.

Study One of this research aimed to assess interpersonal problem-solving ability in individuals who evidenced suicidal behaviour. Suicide attempters were compared with mixed psychiatric outpatients and normal controls on a measure of means-ends problem-solving. The results of Study One suggested that suicidal individuals produced significantly fewer relevant means, story directed responses and sufficient narratives compared to both normal and psychiatric subjects. On qualitative indices of introspection, emotional relevant means and on time and obstacle recognition suicidals were significantly more deficient than control groups. Amongst suicidal subjects greater social dysfunction, stress and affective disturbance was associated with poorer interpersonal problem-solving. A model for the development of suicidal behaviour which suggested possible points of entry for intervention was proposed. In Study Two three treatment strategies for suicidal behaviour - Cognitive Therapy, Problem-solving Training and Psychiatric After Care were compared. In general the results suggested that all treatments were having some positive effects. The most significant changes in problem-solving skills occurred in the group receiving such training but improvement in this area was also noted in the Cognitive Therapy Group. It was proposed that aspects of Cognitive Therapy may have direct influence on problem-solving behaviour. Affective change seen at the end of eight weeks of treatment followed a different time course compared to cognitive change and the maintenance of such change to follow-up was shown to be dependent upon skills learnt during Cognitive Therapy and Problem-solving Training. Problem-solving Training had the most significant impact in improving social dysfunction and all treatments were shown to reduce suicidal ideation but at differing rates. One episode of suicide attempt occurred in the Psychiatric After Care Group representing a 6.25 percent rate of reoccurrence. It was concluded that the acquisition of interpersonal and cognitive skills held implications for the prophylaxis of suicidal behaviour. Suggestions for early primary intervention within the family and education systems were proposed.

Suicidal behaviour is a serious public health problem. Globally and in South Africa prevalence rates are increasing particularly amongst young adults, highlighting a need for preventative measures. One way to assist with these efforts is to enhance our understanding of suicide by investigating young adult’s views towards suicidal behaviour. To date, limited research exists in the South African context on views towards suicide. The purpose of this study was to explore young adult’s views about suicidal behaviour within the context of culture and religion. A qualitative research design was adopted using semi-structured individual interviews. The participants were ten students from the University of the Witwatersrand between the ages of twenty and twenty-five. The results were analysed using thematic content analysis. The results revealed that participants predominantly identified psychological, social and cultural risk factors for suicidal behaviour, ignoring the influence of psychopathology. The participants also highlighted the influence of the social and cultural context on shaping not only their own views, but those of their family, culture and community. The results indicated that unlike their families, religions and communities, the participants did not hold negative views towards suicide. Instead they appeared to have a great deal of sympathy towards those who had attempted or committed suicide and seemed to denounce the negative views of those around them. Lastly, the results illustrated that role of gender was central to explanations gender differences in suicidal behaviour. Implications of the findings for future research and prevention are discussed.

ABSTRACT The increasing prevalence of suicidal behaviour especially among adolescents is an important public health problem. With the increasing adverse global economic conditions and HIV/AIDS prevalence, especially in developing world, the problem of suicidal behaviours is expected to get worse, and the impact on the healthcare systems will increase. Objective: This study was done to evaluate the socio-demographic and clinical profile of the patients who were admitted into Leratong Hospital for suicidal behaviours, and the factors associated with these suicidal behaviours. In the context of worsening social and economic problems, and the increasing HIV/AIDS epidemic, it is hoped that the results of this study will help in quantifying needs, defining appropriate management protocols and referral systems, and informing capacity building processes. Methods: This was a descriptive cross-sectional study. All patients admitted to the medical wards for parasuicides and attempted suicide from November 2007 to February 2008 (n=162) were interviewed during the course of their admission. Data on their socio-demographic characteristics, history of previous suicide ideations and attempts, methods of and reasons for the present suicidal behaviours, and past personal and family histories of the patients were extracted and analyzed. Results: Patients admitted for suicidal behaviours constituted about 5% of all medical patients. More than 67% of the patients were younger than 30 years, and more than 60% were females. Only about 16% of the patients were married, and about 45% were unemployed, and among those employed about 40% were unskilled, though more than 60% were living in either formal or RDP houses. Majority of the patients (60%) completed only grade 11 or less. Majority of the patients attempted suicide by ingesting overdose of medications (43%) and organophosphates (32%). The commonest reason given by patients for attempting suicide was domestic or relationship conflicts (75%). About 21% and 14% of the patients had histories of previous suicide ideation and attempt respectively. Common adverse events in the background histories of the patients were stress from their families (56%), unemployment (38%), alcohol abuse (32%), and abandoned by spouse (25%). Common adverse events in the family histories of these patients include at least one death in family in the last two years (70%), alcohol abuse (60%), family member in prison (46%), family member was a victim of crime (46%), and family member had a severe disease (42%). Risk factors found to be significantly associated with suicidal behaviours and the different methods of suicidal attempt include race, sex, younger age group, type of house, and family history of severe illness, death, divorce and substance abuse. The study has demonstrated the socio-demographic profile of these patients, the burden posed by suicidal behaviours on our health systems, and the risk factors associated with such behaviours. Based on these results, it is therefore recommended that health workers should look out for, and assess all patients for, risk factors associated with suicidal behaviours, and patients admitted for suicidal behaviours should be evaluated and managed properly, with appropriate referrals, before they are discharged.

published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

This thesis is about attempted suicides and is based on open and in-depth interviews of 31 individuals who have attempted suicide once or several times. The phenomenon is presented through the concept of "career" and from the subject's point of view. Its first objective is to reconstruct the sequence of events that marks the experience of individuals who had decided to commit suicide but have failed in their project. / This sequence starts with the decision to commit suicide, the choice of method, followed by the act itself; it is characterized by an interruption that triggers different forms of intervention: physical treatment in a hospital and psychiatric evaluation; it continues with the return of the individual to his/her familiar circle, facing the life conditions he/she had wanted to leave. / Reconstructing this experience emphasizes the solitary, the physical and the uncertain nature of the suicidal act. It also shows how individuals who do not complete their suicide will be caught in disconcerting and compromising situations, and that their act will force them to justify themselves to different audiences and will taint their relationships with others. Finally, the analysis indicates that the terms in which individuals envisage suicide are transformed in the course of their experience.

Thesis (Ph. D.)--Drexel University, 2004. / Includes abstract and vita. Includes bibliographical references (leaves 121-127).

Thesis (PhD)--AUT University, 2009. / Includes bibliographical references. Also held in print (184 leaves ; 30 cm.) in the Archive at the City Campus (T 362.28 ROS)

M.A. / According to Kleespies (2000), a client's behavioural crisis is a condition in which a client has reached a state of mind in which his or her usual coping mechanisms are inadequate to restore equilibrium or to allow him or her to go on functioning in an adaptive way. A crisis may be a turning point for better or worse, but it necessarily does not lead to danger of serious physical harm or life-threatening danger. A behavioural emergency will be taken to mean that a client has reached an acute mental state in which he or she is at imminent risk of behaving in a way that will result in serious harm or death of self unless there is some immediate intervention (Kleespies, 2000). Psychotherapists' work with suicidal clients seems to be placing huge demands on them, particularly on the emotional level, and there are anxieties which are felt when working with suicidal clients. The focus of this research study is on the exploration of the experiences of psychotherapists (qualified or trainees), in working with suicidal clients. Regarding work with suicidal clients, this research study is coming from a slightly different angle as it seeks to attend to therapists' feelings regarding working with clients with suicidal feelings and behaviour. For the purposes of exploration of this study, semi-structured interviews, with the assistance of a tape recorder, were conducted with respondents in order to gather information. These individual interviews were then transcribed, and the typed data was then analysed using the content analysis method of analysing data, according to Weber (1985). This also allowed for common themes, as identified in the interviews, to be obtained and they formed the results of this study. The results indicated a number of themes which emerged, and the researcher decided on selecting and discussing the major themes. There were a variety of themes found as the participants had described how they emotionally experienced working with suicidal clients, and on how they felt the emotional, personal and professional demands of the nature of this work.

This research was conducted in the hope of making some contribution to the emerging field of developmental psychopathology through an examination of the relations between progressive movement toward social-cognitive maturity and socioemotional adjustment in adolescence. The two developmental matters of particular concern were the contrastive ways in which suicidal and nonsuicidal adolescents undertake to secure a sense of their own personal continuity across time, and a sense of conviction in the face of growing skeptical doubts. Alternative accounts of suicidal behaviour generally fail to offer any explanatory framework with which to account for the sudden and dramatic increase in suicidal behaviour during the adolescent years. It is argued in this thesis that the self-destructive tendencies of suicidal youth may be better understood as behavioural manifestations of difficulties in dealing with the developmental matters of personal continuity and nascent skeptical doubt More specifically, the arguments presented in this thesis lead to the hypotheses that suicidal adolescents are less able than their nonsuicidal age-mates to 1) adequately warrant their own and others' persistent identity across time, and 2) make use of more mature strategies for dealing with issues of uncertainty and doubt. To test these predictions, 29 psychiatrically hospitalized suicidal adolescents, who were subsequently categorized in to either a high suicide risk group (n=13) or a low suicide risk group (n =16), and an age- and sex-matched group of 29 high school students were individually administered: (1) The Continuity Measure, comprised of 2 stories and a semi-structured interview procedure which inquires into how subjects warrant their own and others' personal continuity in the face of dramatic personal change; (2) The Nascent Skeptical Doubt Interview, also comprised of 2 stories and an associated semi-structured interview procedure aimed at determining subjects' characteristic strategies for dealing with uncertainty; and (3) The Nascent Skeptical Doubt Questionnaire, which permits the placement of respondents along an objectivist-relativist dimension. The results of this study indicate that, in comparison to their nonhospitalized age-mates, the psychiatrically hospitalized suicidal adolescents did evidence difficulties both in their abilities to understand how they and others could be said to remain continuous or self-same persons throughout time, and in their ability to cope with questions of uncertainty and doubt. In addition, adolescents at high risk for suicide were distinguished from other psychiatrically hospitalized individuals at low risk to suicide, and from their high school age-mates by: 1) their unique inability to find any workable means of justifying persistent identity across change; and 2) by their more extreme endorsement of absolutistic views in the face of uncertainty. These findings are seen to lend support to the general theoretical attempt of this thesis to interpret certain socioemotional difficulties experienced by adolescents as arising from a developmental asynchrony between progressive movement toward the more abstract, relativized, and self-reflective modes of thought associated with cognitive maturity, and the task of securing more mature strategies for dealing with the reconceptualizations of the problems of continuity and doubt which these cognitive advances necessitate. In addition, a number of theoretical, diagnostic, and treatment implications which are seen to follow from the results of this study are discussed. / Arts, Faculty of / Psychology, Department of / Graduate