The aim of this research was to test a series of theoretical models based on Beck (1967) cognitive diathesis-stress and Kwon and Oei (1994) linear mediational models as well as earlier research findings to determine the best-fitting model to explain the aetiological processes of suicide attempts in Taiwanese people. The participants were patients diagnosed with Major Depressive Disorders (MDD) recruited from three hospitals in Taiwan. They were used for data analyses in both cross-sectional (main) study and longitudinal (follow-up) study. In addition, a sample of students recruited from three universities in Taiwan was used for data analyses in the generalized study to examine the generalization of the results from clinical depressed patients to nonclinical university students. In the main study, by the application of structural equation modeling (SEM) techniques, four initial models were compared using the MDD patients (N = 162). The SEM analyses showed that two interactional models failed to provide an adequate fit to the given data, suggesting that the hypothesis of interaction between dysfunctional attitudes and negative life events in predicting the psychopathology of Taiwanese MDD patients was not supported. The SEM analyses supported two mediational models in terms of goodness-of-fit. Because the two mediational models were very similar, they were combined to form a combined mediational model. The SEM analyses indicated that the combined model provided an adequate fit to the given data. After modifying the model to improve its goodness-of-fit, the final modified combined mediational model was selected as the most appropriate in representing the data of Taiwanese MDD patients. The final model revealed that dysfunctional attitudes mediated the relationship between negative life events and depressive hopelessness, which in turn increased depression, which then precipitated suicidal ideation, which finally resulted in suicide attempts. In addition, it was found that negative life events exerted direct influences on depressive hopelessness and suicide attempts; sex and age exerted direct influences on negative life events. However, social support buffered the impact of negative life stress on dysfunctional attitudes and compliance with medications prevented the development of depression. In the follow-up study, the final modified combined mediational model was validated and reexamined with two-wave panel data gathered from the same population of Taiwanese MDD patients who participated in assessments twice, separated by a six-month interval (N = 142). The SEM analyses showed that the model provided an adequate fit to the two-wave panel data, suggesting that the model can be applied for predicting suicide attempts over six months in Taiwanese MDD patients. In the generalized study, the findings obtained from the MDD patients were replicated in a sample of Taiwanese university students (N = 324). Results revealed that the final modified combined mediational model failed to fit the given data. The result suggests that the most appropriate model for Taiwanese MDD patients can not be generalized to Taiwanese students. Some cautions and limitations should be noted. First, the models obtained from clinical and nonclinical people in Taiwan should not be directly generalized to people outside Taiwan. Further research using clinical and nonclinical samples from other countries to cross-validate the models was suggested. In addition, the researcher’s interventions during the follow-up period may disturb the relationship between predictor variables and subsequent suicide attempts. However, the problems appear to be unavoidable because of the research ethics of protecting participants from suicidal risk. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1339675 / Thesis (Ph.D.) - University of Adelaide, School of Psychology, 2008

The presented graduation thesis is entitled {\clqq}Health and Social Services For Suicidal Patients``. Lot of learned papers were written on the suicide theme by researches who are trying to find out specific causes, motives, symptoms and interventions related to suicidal behavior. The professional care includes both medical and non-medical support. In case of an individual who attempted to take his/her life, the help starts after the intervention of the lifesaving service or other factors, mostly in the anaesthesiological-resuscitation wards and intensive care units. As soon as the patient is outside danger to life, he is subjected to a psychological and psychiatric examination. After repeated suicidal tendencies are excluded by the psychiatrist, the care of the client is handed over to outpatient psychiatric clinic. An option of psychotherapy is also considered. His/her integration into normal life may be supported by healh and social services that are the subject of this thesis. This thesis is divided into a theoretical part and a research part. The theoretical part deals with definitions of terms related to the theme of the graduation thesis {--} suicide, affecting factors, types of suicidal behavior, health and social services for suicidal individuals. The aim of the thesis is to map out the situation in the health and social services rendered to suicidal clients in the Region of Jihlava and to establish the knowledgeability about these services among the population or clients´ satisfaction with these services, as exemplified by several case studies. The case studies also describe the treatment of patients after the suicidal attempt, how the life of suicide attempters has changed since the attempt, how do they perceive their suicide attempt retrospectively and also what should be done so that their troubles do not occur again. The existing thesis may give an insight into the health and social services situation in the region of Jihlava, into availability or non-availability of the services in the region, and may give an idea for broadening health and social services for suicidal individuals.

(1) Background. Defeat and entrapment have been highlighted as major risk factors of suicidal ideation and behavior. Nevertheless, little is known about their short-term variability and their longitudinal association in real-time. Therefore, this study aims to investigate whether defeat and entrapment change over time and whether defeat predicts entrapment as stated by the integrated motivational–volitional model of suicidal behavior. (2) Methods. Healthy participants (n = 61) underwent a 7-day smartphone-based ecological momentary assessment (EMA) on suicidal ideation/behavior and relevant risk factors, including defeat and entrapment and a comprehensive baseline (T0) and post (T2) assessment. (3) Results. Mean squared successive differences (MSSD) and intraclass correlations (ICC) support the temporal instability as well as within-person variability of defeat and entrapment. Multilevel analyses revealed that during EMA, defeat was positively associated with entrapment at the same measurement. However, defeat could not predict entrapment to the next measurement (approximately two hours later). (4) Conclusion. This study provides evidence on the short-term variability of defeat and entrapment highlighting that repeated measurement of defeat and entrapment—preferably in real time—is necessary in order to adequately capture the actual empirical relations of these variables and not to overlook significant within-person variability. Further research—especially within clinical samples—seems warranted.

Inledning: Psykisk ohälsa och missbruksproblem utgör betydande riskfaktorer för suicid i vårt samhälle. Psykoterapeuters erfarenheter och upplevelser kring att bedöma suicidrisk hos patienter är ett viktigt bidrag för överlevnad och till vidare forskning för att minska antalet självmord. Syftet var att få ta del av ett antal psykoterapeuters upplevelser kring att bedöma suicidrisk hos patienter. Frågeställningarna fokuserade på terapeuternas upplevelser av att i mötet med patienter bedöma risken för suicid och vilka faktorer som enligt deras erfarenheter påverkat deras upplevelser. Metod: Datainsamling gjordes genom intervjuer med sex psykoterapeuter. Studien hade en induktiv kvalitativ forskningsansats och tillämpade en tematisk analysmetod. Resultat: Studien visar att själva samtalet och etablerandet av allians med patienten är avgörande för bedömningsarbetet. Patientens upplevelser av meningslöshet och tomhet ses som främsta riskfaktorer, liksom missbruk. Gränsen mellan psykoterapi och psykiatri upplevs ibland som otydlig, vilket kan påverka de terapeutiska ramarna. Familj och närstående beskrivs som en alltför outnyttjad resurs. Oro för att göra en felaktig bedömning, tvivel på den egna kompetensen, oro att bli ifrågasatt och granskad är personliga upplevelser som terapeuterna beskriver. Handledning och kollegialt erfarenhetsutbyte upplevs som främsta stödet i arbetet. Diskussion: Resultatet visar att terapeuterna upplever suicidriskbedömning som en viktig del i patientarbetet. Möjligt att bedöma är graden av suicidalitet hos patienten. Att kunna förutsäga ett faktiskt självmord är omöjligt. / Mental health problems and addiction problems are the two main risk factors for suicide in our society. The experiences psychotherapists have made in assessing the risk of patients committing suicide are important to further research in order to decrease the suicide numbers. The purpose of this study was to look into the experiences psychotherapists have made in assessing the risk of suicide in patients. The questions focused on the experiences of assessing the risk of suicide and which factors that might have had an influence on these experiences. Data was collected by interview with six psychotherapists. The study had an inductive qualitative approach and thematic analysis was used as method for analysis of data. Results show that the conversation and establishing of an alliance with the patient is decisive for the assessment. Feelings of meaninglessness and emptiness in the patient are seen as the main risk factors along with addiction. The sometimes indistinct borderline between psychotherapy and psychiatry may affect the therapeutic framework. Family and relatives are described as an unutilized resource. The risk of making a false assessment can at times create worries in the therapists and doubts about their own ability. Supervision and exchanging experiences with colleagues are mentioned as the main support in the work. Discussion: The results show that the therapists sees assessment of suicidal risk in the patient as an important part of the work. It is possible to assess the suicidality in the patient. It is impossible to predict an actual suicide. Further research is required to increase knowledge in the subject.

Thesis (MSc) -- Stellenbosch University, 2013. / ENGLISH ABSTRACT: Suicidal behaviour is a serious public health problem. Globally and in South Africa a gendered pattern of suicide rates has been observed, with males being more likely to kill themselves than females. To date little quantitative and qualitative research is available on young male suicidal behaviour in South Africa. This study investigated the attitudes, beliefs and myths young male students hold about suicidal behaviour. Thirteen male university students (ages 20 to 25 years; with and without a history of suicidal behaviour), who volunteered to take part in the present study in response to an email invitation, were interviewed. The attitudes, beliefs and myths identified from the qualitative data are grouped into four themes: 'Moral acceptability of suicidal behaviour', 'Perceived causes and risk factors of suicidal behaviour', 'Perceived motives of suicidal behaviour', and 'Perceived prevention and protective factors of suicidal behaviour'. Besides these four themes, two underlying narratives are identified and discussed: (1) 'Apart or a part: Belonging and suicidal behaviour' is centred on the idea that perceiving oneself to be an integral part of a social system is protective against suicidal behaviour, while a thwarted sense of belonging increases vulnerability to suicidal behaviour. (2) 'Dying to be a man: (Re) negotiating masculinity and suicidal behaviour' is concerned with participants' views that men's relational position to hegemonic (socially most dominant) forms of masculinity is a factor in male suicidal behaviour. Participants regard hegemonic forms of masculinity to be both a part of the problem of suicidal behaviour and a potential solution to suicidal behaviour. These findings are interpreted through a social constructionist lens of gender as performance. Finally, implications of findings for future research, prevention and treatment are discussed. / AFRIKAANSE OPSOMMING: Selfmoordgedrag is 'n ernstige openbare gesondheidsprobleem. Wêreldwyd en in Suid-Afrika is mans meer geneig as vrouens om selfmoord te pleeg. Tot op hede is daar min kwantitatiewe en kwalitatiewe navorsing beskikbaar van jong manlike selfmoordgedrag in Suid-Afrika. Hierdie studie ondersoek die houdings, oortuiging en mites oor selfmoordgedrag van jong manlike studente. Dertien manlike universiteitstudente (ouderdomme 20 tot 25 jaar, met en sonder 'n geskiedenis van selfmoordgedrag) het vrywillig aan die huidige studie deel geneem in reaksie op 'n e-pos uitnodiging. Die houdings, oortuiging en mites wat vanaf die kwalitatiewe data geïdentifiseer is, is in vier temas gegroepeer: 'Morele aanvaarbaarheid van selfmoordgedrag', 'Siening van die oorsake en risiko faktore van selfmoordgedrag', 'Waargenome motiewe van selfmoordgedrag', en 'Waargenome voorkoming en beskermende faktore van selfmoordgedrag'. Naas hierdie vier temas, is twee onderliggende temas geïdentifiseer en bespreeek: (1) 'Samehorigheid en selfmoordgedrag' is gemoeid met die idee dat om 'n integrale deel van 'n sosiale sisteem te wees is beskermend teen selfmoordgedrag, terwyl 'n persepsie van isolasie tot selfmoordgedrag kan lei. (2) 'Onderhandeling van manlikheid en selfmoordgedrag' is gemoeid met die deelnemers se sienings dat mans se verhouding tot hegemoniese vorme (sosiaal mees dominante vorme) van manlikheid 'n faktor in manlike selfmoordgedrag is. Deelneemers beskou hegemoniese vorme van manlikheid as beide 'n deel van die probleem en 'n moontlike oplossing vir selfmoordgedrag. Hierdie bevindinge is geïnterpreteer deur middel van 'n sosiale konstruksionistiese lens van geslag as prestasie. Die implikasies van die bevindings vir toekomstige navorsing, voorkoming en behandeling word ten slotte bespreek.

This thesis is an investigation of social problem-solving skills, psychological distress, and supportive relationships among three distinct samples. The research groups comprise a) 25 depressed inpatients and a matched comparison group; b) 50 hospital admissions following an act of suicidal behaviour; and c) 5 sub-groups of incarcerated young offenders (inmates on Strict Suicidal Supervision, inmates on protection, victims of bullying, identified bullies, comparison group) with 25 inmates in each group. Data was collected by structured interviews, standardised psychometric measures of mood states (e.g. Hospital Anxiety and Depression Scale, Beck Hopelessness Scale), problem-solving ability (e.g. Means-Ends Problem-Solving Procedure) and supportive relationships (e.g. Significant Others Scale). Data were analysed by means of parametric statistical techniques (e.g. analyses of variance and multiple regression analyses). Eight cross-sectional studies are reported. Depressed patients demonstrated problem-solving difficulties, which were related to the level of psychological distress experienced. Clinically depressed patients were also found to differ from a comparison group in their autobiographical memory recall and concentration ability - both of which were related to their impoverished problem-solving ability. Deficits in problem-solving ability in the depressed patients were not an artefact of their verbal IQ. Regression analyses of the data relating to suicidal community inpatients illustrated that social support variables were the prime predictors of suicidal intent, depression and hopelessness. Social problem-solving variables also emerged as significant predictors of psychological distress, albeit to a lesser extent. Social support and problem-solving variables were also important moderator variables in the relationship between stress and suicidality. The studies conducted with young offenders illustrated a hierarchy of problem-solving deficits and psychological distress among the inmate groups. Problem-solving ability was not an artefact of verbal IQ. The value of using problem-solving interventions with vulnerable offenders is discussed. The importance of prison relationships in the experience of stress by inmates was also highlighted. Similarly, parental relationships were related to the levels of distress experienced while incarcerated. The results of each study are discussed in relation to the relevant literature, practical implications for clinical interventions with each group, and suggestions for future research. The findings of the thesis are discussed in relationship to transactional, stress-hopelessness-distress models of psychological illness and distress.

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Gerontology / Master / Master of Social Sciences

This study examined the relationship between psychological birth order and substance abuse and suicide in adolescents. It was hypothesized that adolescents operating from a perceived inferior position as measured by the Psychological Birth Order Instrument would be more likely to abuse substances and/or engage in self-destructive behavior. Ninety-five adolescents from Southern Arizona volunteered to participate in this study. The forty-eight treatment subjects were current in-patients at a psychiatric hospital. The control group consisted of forty-seven high school students. The results indicated that there was a difference in perceptions between adolescents in treatment versus those not in treatment for substance abuse and/or suicide. There was a significant relationship at the.005 level and it was concluded that adolescents operating from a perceived inferior position are more likely to abuse substances and/or attempt suicide.

The aim of this study was to investigate how adults 25 years old and over describe the functions of their non-suicidal self-injury (NSSI) and to explore whether they report any changes in their experience with NSSI as they become older. Qualitative e-mail interviews were used in order to capture the participants’ experiences. The results of the study were analysed based on coping theory and previous research. The results indicate that, consistent with previous literature, adults self-injure for mostly the same reasons as adolescents – however, as the previous research shows adolescents are more likely to hurt themselves in order to communicate with others. The adults in the present sample report using problem-solving coping strategies to the same extent as emotion-focused strategies; a slight deviation from previous research which has suggested that people who self-injure are more likely to employ emotion-focused strategies. The participants of the study generally experience a feeling of increased control and deliberation of their self-injury as they have gotten older; hurting themselves has become a purposeful coping strategy. The results of this study might have implications for treatment of self-injury in adults; focusing the treatment on strengthening the adults’ autonomy and encouraging further problem-solving coping strategies might be beneficial.