In developed countries, suicidal behaviour is recognised as a significant public health problem among young people, but there are few studies from developing countries on this subject. The present thesis aims at estimating the extent of the problem and at exploring factors related to suicidal behaviour among young people in a developing country, Nicaragua, using a combined quantitative and qualitative approach. Three studies were conducted between 1999 and 2006. In the first study, all hospital admitted suicide attempt cases in the area of León were assessed over a three year period. Secondly, a qualitative study using individual in-depth interviews was conducted with eight girls aged between 12 and 19 admitted to hospital after attempting suicide. Thirdly, a study using the Attitudes Towards Suicides (ATTS) questionnaire was conducted in a community based sample of 278 young people aged 15-24 years to assess own suicidal behaviours, attitudes towards suicide as well as exposure to suicidal behaviour among significant others. The hospital surveillance showed that suicide attempt rates were highest among females in the age group 15-19 years with a female rate three times that of males (302.9 versus 98.9 per 100,000 inhabits per year). Drug intoxication and pesticides were the most commonly used methods for the attempts. A consistent seasonal variation with peaks in May-June and September-October was found in each of the three years, possibly related to exam periods in schools. Findings in the qualitative approach led to a tentative model for pathways to suicidal behaviour based on four main categories: Structuring conditions, triggering events, emotions and action taken. Dysfunctional families, lack of confidential and trustworthy contacts and interpersonal conflicts followed by emotions of shame and anger were some important components in the model. The community studies showed that suicidal expressions (life-weariness, death wishes, suicidal ideation, suicide plans and suicide attempts) were common among young people where more than 44.8% of males and 47.4% of females reported some kind of suicidal expression. Gender differences were small. Exposure to suicidal behaviour among others was associated with higher levels of self-reported suicidal behaviour. The attitude study showed that boys had less pro-preventive attitudes than girls, possibly indicating their higher risk for completed suicide. Exposure to suicidal behaviour and own suicidal behaviour showed an association with specific patterns of attitudes. The findings should be taken into consideration when planning for prevention of suicidal behaviour among young people in a developing country like Nicaragua.

Bakgrund: Ungefär en miljon människor mister sitt liv av suicid årligen i hela världen. Det finns psykosociala, kliniska och biologiska faktorer bakom suicidala handlingar. Huruvida suicid utvecklas belyses i en suicidal process. Vården efter ett misslyckat suicidförsök upplevs oftast obehagligt och känsloladdat för suicidnära individen. Målen med vården är bland annat att främja patientsäkerheten. För att individen skall känna tillit för vården och vårdgivaren bör en trygg och förtroendefull vårdrelation skapas. Syfte: Syftet var att beskriva sjuksköterskors upplevelser av att vårda suicidnära individer.   Metod: Författaren har arbetat fram en litteraturstudie i enlighet med Friberg (2006). Studien baseras på tio vetenskapliga artiklar ifrån databaserna CINAHL with full text, MEDLINE with full text och PubMed. Särskilda inklusions- och exklusionskriterier följdes. En innehållsanalys och kvalitetsgranskning gjordes på valda artiklar. Resultat: Resultaten från vetenskapliga artiklar sammanställdes i litteraturstudien i fem olika kategorier. Dessa kategorier lyder så här: Känna ansvar, Känsla av upptagenhet och tidsbrist, Känsla av bristande kompetens, Känsla av osäkerhet i kommunikationen med suicidnära individer och Förhållningsätt till suicidnära individer.  Diskussion: Författaren har dragit slutsatsen att sjuksköterskor upplever att det finns faktorer som hindrar möjligheten till god interaktion mellan de och suicidnära individer. Dessa faktorer indelas sammanfattningsvis som brist på olika resurser och kompetens inklusive kommunikation. Det framkallar i sin tur känslor av frustration i samband med att inte kunna vara till hjälp tillräckligt för dessa individer. / Background: About one million people lose their lives by suicide each year worldwide. There are psychosocial, clinical and biological factors in suicidal acts. Whether suicide developed illustrated in a suicidal process. Care after a failed suicide attempt is experienced mostly uncomfortable and emotional of suicide close to the individual. The goal of treatment is to promote patient safety. For individuals have to feel confidence in the care and caregiver should be a safe and trustful care relationship is created. Aim: The aim was to describe nurses' experiences of caring for suicidal individuals. Methods: The author has worked out a study of literature in accordance with Friberg (2006). The study is based on ten scientific articles from databases CINAHL with Full Text, MEDLINE with Full Text and PubMed. Specific inclusion- and exclusion criteria were followed. A content analysis and quality assessment was done on selected articles. Results: The results of scientific articles compiled in the study of literature in five different categories. These categories are as follows: Feeling of responsibility, Feeling of occupied and lack of time, Feeling of lack of competence, Feeling of insecurity in communication with suicidal individuals and Approach to suicidal individuals. Discussions: The author concludes that nurses feel that there are factors that prevent the possibility of good interaction between the suicide and suicidal individuals. These factors are divided summarized as deficient of resources and attainment including communication. It induces in turn feelings of frustration associated with not being able to be helpful enough for these individuals.

There are elevated rates of childhood maltreatment and posttraumatic stress disorder (PTSD) symptomatology in low-income, abused, suicidal African American women. This investigation aimed to: (1) identify the components of childhood maltreatment in this sample; (2) ascertain whether or not the constructs of childhood maltreatment and PTSD symptomatology were associated in this sample; and (3) examine if maladaptive coping mediated the childhood maltreatment-PTSD symptomatology link and if the magnitude of the mediated relationship was influenced by level of social support (i.e., moderated mediation). Specific types of childhood maltreatment generally loaded onto three components according to a principal components analysis (PCA) of the Childhood Trauma Questionnaire: physical-emotional abuse, sexual-emotional abuse, and neglect. Women who endorsed experiencing higher levels of two of the childhood maltreatment components (physical-emotional abuse and sexual-emotional abuse) reported higher levels of current PTSD symptomatology. However, contrary to the study hypotheses, current level of maladaptive coping did not mediate the relationship between child maltreatment and current PTSD symptomatology. Further, the addition of social support did not change this finding. Results are discussed, clinical implications are explored, and recommendations for future studies are offered.

In 2005, suicide was the third leading cause of death among youth 10-24 years of age in the U.S. —accounting for 4,482 deaths. Youth suicide is an important public health problem in the U.S. and research focusing specifically on gender differences is needed and warranted since recent research shows that rates of suicide attempts have increased specifically among young girls. Analyses of the recently released 2007 YRBS data (n=14,041; girls=7,036; boys=6,992) of high school students in 9-12th grades, show that 6.9% of adolescents attempted suicide (9.3% of girls versus 4.6% of boys) and 14.5% seriously considered a suicide attempt (18.7% of girls versus 10.3% of boys). Girls are 2.89 (95% CI: 2.31-3.61) times more likely than boys to report attempting suicide in the past 12 months. Moreover, girls who reported attempting suicide were significantly more likely to also report other risk factors such as depression (OR= 5.74), weapon carrying (OR= 1.48), experiencing intimate partner violence (OR=1.60), being forced to have sexual intercourse (1.72), huffing glue (OR=2.04), and being a minority (OR 1.65). However, boys who reported attempting suicide were significantly more likely to also report weapon carrying (OR=1.66), being forced to have sexual intercourse (OR=2.60), huffing glue (OR=1.63), participating in sports (OR=1.52), depression (OR=10.96), hard drug use (OR=2.18), and being a minority (OR=1.93). Furthermore, analyses of 1991 – 2007 YRBS data revealed that these gender specific risks have remained fairly constant over time. These findings will help guide prevention and intervention strategies to prevent suicide and suicidal behaviors among both girls and boys.

Research that explores the relationship between suicide and self-injury is limited, and the lack of clarity surrounding this topic can present challenges for professional counselors. Although persons who self-injure are at an increased risk for suicide (e.g., Toprak, Cetin, Guven, Can, & Demircan, 2011; Chapman & Dixon-Gordon, 2007), not all individuals who engage in self-injurious behaviors attempt or complete suicide (e.g., Hawton & Harriss, 2008; Howson, Yates, & Hatcher, 2008). Research on common and distinct risk factors for suicide and self-injury (e.g., Andover, Primack, Gibb, & Pepper, 2010; Brausch & Gutierrez, 2010; Greydanus & Apple, 2011; Hawton & James, 2005; Lloyd-Richardson, Perrine, Dierker, & Kelley, 2007; Toprak et al., 2011; Wichstrom, 2009), as well as emotional antecedents and consequences for suicide and self-injury (e.g., Chapman & Dixon-Gordon, 2007), has contributed to our understanding of this complex relationship. However, the specific nature of the relationship remains unclear. This study serves to help fill the gap in the literature by examining advanced professional counselors’, as measured by the Supervisee Levels Questionnaire-Revised, conceptualizations of the relationship between suicide and self-injury and by exploring how the presence of self-injury impacts clinical assessment and interventions. Data was collected by means of an online survey. Analysis was conducted by a research team using qualitative content analysis. Seven categories emerged, including: relationship between suicide and self-injury, functions of self-injury, associated risk, suicide risk assessment, treatment planning and goals, intervention, and identification of self-injury.

Alcohol and drug abuse are strong predictors of suicide. While screening methods have proven effective at identifying and treating substance abuse in non-treatment-seeking users (e.g., screening and brief intervention [SBI]), less attention has been given to the co-occurrence of suicidality among this population, including its correlates and etiology. The current study addresses this gap by presenting data from early adult emergency department (ED) patients (mean age = 27; N = 505), screened for substance abuse and suicidal ideation. Prevalence of past year ideation was high (15%). Results demonstrated a significant and positive indirect effect of cocaine use severity on likelihood of suicidal ideation, mediated through family support. The implications for SBI practices in the ED and suicide etiology among non-treatment-seeking substance abusers are discussed.

This study aimed to explore the relationship among self-esteem, problem solving ability, ways of coping, social support and suicidal ideation of patients with schizophrenia and the differences between these variables according to the existence of suicide attempt of the patients with schizophrenia. In order to analyse the relationship and find out the differences among patients who did and did not attempt suicide, Rosenberg&#039 / s Self Esteem Scale, Problem Solving Inventory, Turkish Ways of Coping Inventory, Multidimensional Scale of Perceived Social Support and Suicidal Ideation Scale were conducted to 90 patients with schizophrenia. The results of the study indicated that there was not a significant main effect for suicide attempt on self-esteem, problem solving,problem focused coping, emotion focused coping, indirect coping, social support and suicidal ideation of patients with schizophrenia. The only variable that significantly predict suicidal ideation found to be self-esteem. The results of the study evaluated and implications of the study were discussed. Finally, limitations of the study and recommendations for future research were explained.

Incidence of suicide has been shown to increase dramatically during adolescence. Despite an established pattern of depression and hopelessness leading to suicide in adults, no such pattern emerges in the adolescent literature. Recent investigations suggest that impulsivity may play a key role in adolescent suicide attempts. This study examined the role of impulsivity in adolescent suicidal gestures, as well as the relationships among demographic variables, anger expression, impulsivity, and suicidal behavior. A total of 100 participants (ages 11-17; 71 females and 29 males) were recruited from 2 inpatient crisis centers for children. The Children's Depression Inventory, Hopelessness Scale for Children, Adolescent Behavior Checklist, Pediatric Anger Expression Scale, and Suicide Intent Scale were administered to inpatients, and demographic information was obtained (age, gender, ethnicity, income, and structure of family). It was hypothesized that patterns of depression, anger, hopelessness, and impulsivity would vary by age, gender, ethnicity, and suicidality (e.g., suicidal gesture vs. no gesture). The large majority of hypotheses were not supported. Results are explained in terms of alternative theories for the role of impulsivity in adolescent suicidal gestures.

Introduction Suicidality and excessive alcohol use are both important public health issues. Various risk factors including alcoholism have been studied and identified to be associated with suicidality. Increasing evidence has shown that excessive alcohol use is associated with a wide range of physical and mental health issues. There is a lack of local study to study the association between alcohol consumption and suicidality in details including the association of different patterns of alcohol use with suicidal thoughts and behaviors. The aim of this study is to study the association between alcohol use and suicidality, taking into account of possible differences between different pattern of alcohol use and various possible confounding factors. Methods This study was based on analysis of data collected in Population Health Survey (PHS) conducted in 2003/04, which was conducted by the Department of Health (HKSAR) and the Department of Community Medicine (HKU). A total of 5600 respondents between the age of 18 to 64 were included in this study. The primary outcome was current suicidal ideation. Association between history of suicidal attempt with the other variables was also studied. The primary predictors variables included alcohol-related variables (presence of drinking, age of first drink, type of drink, amount of drinking, presence of binge drinking), history of mental illness (self-reported known history of depression, anxiety disorder and schizophrenia), level of depression and anxiety (STAI and CES-D scores), quality of life (WHOQOL-BREF score), exercises, stress management and various demographic variables including age, sex, place of birth, marital status, education level and income level. Logistic regression was used to analyze the association between suicidality and alcohol use. Results The prevalence of lifetime history of suicidal attempts is 5.1% in this population. 17.3% has lifetime history of suicidal ideations, 1.3% has a suicidal attempt in the past 1 year and 11.9% have suicidal ideations in the past one week. Being divorced or separated, being female, being a smoker, considering themselves having need for emotional support, having more severe depressive symptoms, having chronic diseases, depression and anxiety disorder were associated with presence of a history of suicidal attempt. The presence of current suicidal ideations was found to be associated with more severe depressive symptoms, poorer quality of life as reflected by a lower physical domain score of WHOQOL-BREF, being single, having history of binge drinking, having recent suicidal thoughts and lifetime history f suicidal thought. The presence of alcohol drinking and larger amount of alcohol intake were not shown to be significantly associated with presence of suicidal ideations and behaviors in the binary logistic regression models. Only the association between presence of current suicidal ideation and binge drinking was shown to be statistically significant. Conclusion This study did not find a strong association between alcohol consumption and suicidality. Among the alcohol-related variables, only binge drinking was found to be statistically significantly associated with current suicidal ideations. Further study to further explore association between alcohol and suicidality should be considered. / published_or_final_version / Public Health / Master / Master of Public Health

In 2005, suicide was the third leading cause of death among youth 10-24 years of age in the U.S. —accounting for 4,482 deaths. Youth suicide is an important public health problem in the U.S. and research focusing specifically on gender differences is needed and warranted since recent research shows that rates of suicide attempts have increased specifically among young girls. Analyses of the recently released 2007 YRBS data (n=14,041; girls=7,036; boys=6,992) of high school students in 9-12th grades, show that 6.9% of adolescents attempted suicide (9.3% of girls versus 4.6% of boys) and 14.5% seriously considered a suicide attempt (18.7% of girls versus 10.3% of boys). Girls are 2.89 (95% CI: 2.31-3.61) times more likely than boys to report attempting suicide in the past 12 months. Moreover, girls who reported attempting suicide were significantly more likely to also report other risk factors such as depression (OR= 5.74), weapon carrying (OR= 1.48), experiencing intimate partner violence (OR=1.60), being forced to have sexual intercourse (1.72), huffing glue (OR=2.04), and being a minority (OR 1.65). However, boys who reported attempting suicide were significantly more likely to also report weapon carrying (OR=1.66), being forced to have sexual intercourse (OR=2.60), huffing glue (OR=1.63), participating in sports (OR=1.52), depression (OR=10.96), hard drug use (OR=2.18), and being a minority (OR=1.93). Furthermore, analyses of 1991 – 2007 YRBS data revealed that these gender specific risks have remained fairly constant over time. These findings will help guide prevention and intervention strategies to prevent suicide and suicidal behaviors among both girls and boys.