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abstract: While the suicide rate in Mexico is relatively low when compared to countries throughout the world, it is increasing at an alarming pace. Unfortunately, the amount of suicide research focused on Mexican populations is relatively scarce. Using a sample of high school students living in Guanajuato, Mexico, this study explored the relationship between recent suicidal ideation and three factors that previous research in other countries has connected to suicide: Migration aspirations, religiosity, and sexual behavior. Using multiple and logistic regression, the results indicated the following: 1) Recent suicidal ideation predicted increased migration aspirations, 2) higher levels of external religiosity predicted lower odds of recent suicidal ideation, and 3) stronger parent-child relationships predicted lower odds of recent suicidal ideation. The findings are discussed in light of the Bronfenbrenner's ecological systems theory, Bogenschneider's risk/protection model, and Stark's religious commitment theory. / Dissertation/Thesis / Ph.D. Social Work 2011

The purpose of this study is to analyze the interaction of (1) the secondary school teacher's knowledge concerning both the problem of adolescent suicide and the potential for teacher intervention and (2) selected demographic variables on the dependent variables of the teacher's attitudes concerning both the problem of adolescent suicide and the potential for teacher intervention in order to develop a data base upon which to examine the prospects for realizing the intervention potential of secondary school teachers in the area of adolescent suicide. Findings indicate that there are significant differences in knowledge concerning the problem of adolescent suicide and the potential for teacher intervention as a function of particular demographics. Similarly, there are significant differences in attitude toward the problem of adolescent suicide and the potential for teacher intervention as a function of particular demographics. Findings further reveal that level of knowledge appears to be a significant contributing factor in the secondary school teacher's attitude as a function of selected demographics. Secondary school teachers appear to possess a low level of knowledge concerning both the problem of adolescent suicide and the potential for teacher intervention, and they exhibit a range of predominantly negative attitudes toward the problem of adolescent suicide. However, the teachers appear to possess a tenuously positive attitude toward the potential for teacher intervention.

The operators working the emergency line 112 receive, evaluate and handle information about the type of incidence while performing their job. They also receive situations where they handle emergency calls dealing with suicides. Talking to a person with suicidal intent is an extremely stressful and mentally challenging situation. Operators are well aware when handling a suicide call a human life hangs in the balance. They are the ones which can discourage the intention of suicide or lose the caller. Due to the seriousness of the matter it is really essential that the operators are professionally prepared to handle such calls and successfully deal with this challenging situation. The thesis deals with the handling of suicide calls on the single European emergency line 112 in the South Bohemia and Plzen regions. I established two goals for the diploma thesis. The first objective is to compare the professional preparation of the emergency line 112 operators for handling suicide calls in the South Bohemia and Plzen regions. The second is to create a proposal for increasing the training preparedness of the emergency line 112 operators for dealing with suicide calls. The thesis is divided into a theoretical and practical part. The theoretic part covers the basic concepts of the topic of suicide. In general the reader becomes familiar with the basic concepts, such as forms, motives, causes, developmental stages, methods or risk factors for suicidal tendencies, past and present social attitudes and other facts are described. Further the issue of crisis intervention is clarified from the point of view of the emergency call 112 centers and their operators. The theoretical part of the thesis relies on the knowledge based on the analysis, synthesis and research from available sources dealing with this issue. Printed books, magazines, journals, laws, statutory regulations and methodology of the Czech Republic Fire and Rescue Service, Fighting rule of Fire protection units, Catalog File of Type Activities and electronic sources were used as references. To achieve the purpose and obtain answers to the research question, the qualitative methodology of research was used in the thesis. In both regions, on the basis of a questionnaire survey, readiness of the emergency number 112 operators to handle calls from individuals contemplating suicide was evaluated and the research question answered. Response to the research question proved that professional preparedness of the operators of emergency number 112 for handling calls related to suicide requires the operators possess additional professional knowledge and skills. Based on the data from the questionnaire survey and a study of the professional literature, design methodology is developed to enhance professional preparation service emergency number 112 suicide calls. The results from the questionnaire survey indicated that not all the operators demonstrated the same knowledge level and skills and that regularly all of them do not go through the same training on the theme of suicide. Therefore in design methodology, training divided by each category is incorporated. For each category, a schedule, structure and content of the training is elaborated and a suitable trainer is recommended. In the discussion and conclusion of this thesis there are further useful recommendations listed which relate to the research topic, however they are not part of the above mentioned methodology.

This diploma thesis on the theme: The incidence of suicidal behaviour among drug addicts in the theoretical part deals with the development of the drug scene in the Czech Republic, the EU drugs policy in the Czech Republic, selected studies dealing with drug use, health and social consequences of drug use. Also deals with suicide behaviour, its forms, types, methods and causes of suicidal behaviour, motivation, development of data collection and the treatment of suicidal behaviour. The aim of this work was to find out the most common reasons and ways of suicidal behaviour in addicts individuals in the psychiatric hospital of the Cerveny Dvur (hereinafter referred to as PH CD ). Another objective was to determine whether the clients have undergone a treatment PH CD after the suicide attempt. On the basis of the objectives have been created three research questions. Due to the nature of the investigated problem was as a research method chosen semi- structured interview with clients. Before the research was carried out in PH CD questionnaire survey on suicidal behavior for a team project GA JU No. 103/2013/S "The effect of systematic psychotherapy tailored to the incidence of intentional self-injurious behaviour".. Based on the data from the questionnaire investigation were clients selected for this diploma thesis. Interviews were conducted with eight clients of PH CD.

Introdução: A automutilação é definida como qualquer comportamento intencional envolvendo agressão direta ao próprio corpo sem intenção consciente de suicídio. As formas mais frequentes de automutilação são cortar a própria pele, queimar-se, bater em si mesmo, morder-se e arranharse. Alguns pacientes apresentam rituais de automutilação e passam muito tempo pensando em como executá-la, lembrando sintomas compulsivos, porém com intenso componente de impulsividade. O DSM-IV classifica a automutilação como um dos critérios de diagnósticos para transtornos do controle dos impulsos não classificados em outro local ou Transtorno de Personalidade Borderline. O DSM-V propõe que a automutilação seja uma entidade diagnóstica à parte. A falta de homogeneidade na descrição da automutilação dificulta as pesquisas, tanto epidemiológicas como clínicas. A melhor caracterização clínica e psicopatológica da automutilação é fundamental para que intervenções terapêuticas mais efetivas possam ser desenvolvidas, incluindo novas abordagens psicofarmacológicas. Os objetivos deste estudo foram: fazer uma descrição clínica dos pacientes que procuram tratamento, tendo como principal queixa a automutilação e comparar estes com pacientes com Transtorno Obsessivo-Compulsivo (TOC) quanto a características compulsivas e impulsivas. Métodos: 70 pacientes foram avaliados, sendo 40 pacientes com automutilação e 30 pacientes com TOC. Todos estes pacientes foram avaliados de forma direta com os instrumentos: Entrevista Clínica Estruturada para Transtornos de Eixo I do DSM-IV, versão clínica (SCID-I); Entrevista Clínica Estruturada para Transtornos de Eixo I do DSM-IV, versão clínica, adaptada para Transtornos de Controle de Impulsos; Entrevista Clínica Estruturada para Transtornos de Eixo II, versão clínica (SCID-II); Escala de Sintomas Obsessivo-Compulsivos de Yale-Brown (Y-BOCS); Escala Dimensional para Avaliação de Presença e Gravidade de Sintomas Obsessivo-Compulsivos (DY-BOCS); Escala para Avaliação da Presença e Gravidade de Fenômenos Sensoriais da Universidade de São Paulo (USP-SPS); Questionários de História de Traumas; Escala de Comportamento de Automutilação (FASM); e Barrat Impulsivity Scale (BIS-11). Para comparação das variáveis categóricas, foi utilizado o teste qui-quadrado e para variáveis contínuas, o test-t. Para análise multivariada, foram utilizados os testes ANCOVA ou Regressão Logística Linear. Foi considerado, para todos os testes, o nível de significância 5%. Resultados: A média de idade dos pacientes avaliados foi de 29 anos. Quanto às características clínicas dos pacientes com automutilação, estes iniciaram o comportamento em média aos 17 anos de idade, e apresentavam cinco tipos diferentes de automutilação em média. Os comportamentos mais frequentes foram: cortar a pele (90%), cutucar ferimentos (75%), bater em si mesmo (67,5%). Os motivos mais frequentemente relacionados à automutilação foram para: parar sentimentos ruins (75%), aliviar sensação de vazio (70%), se castigar (70%), sentir algo, mesmo que fosse dor (47,5%) e sentir-se relaxado (40%). Na comparação entre os grupos com automutilação e TOC, quanto às comorbidades do Eixo I, o grupo com automutilação apresentou mais comorbidades com depressão (92,5%, p=0,03) e bulimia (25%, p<0,001). O grupo com TOC apresentou mais fobia social (40%, p<0,001). Os pacientes do grupo com TOC tiveram maior gravidade em todas as medidas do Y-BOCS (média: 26, p<0,001) e DY-BOCS (média 23,1, p=0,01). No grupo com automutilação, 60% dos pacientes referiram a automutilação associada a fenômenos sensoriais. Este grupo teve mais relato de fenômenos sensoriais referente à \"sensação de incompletude\" (45%, p=0,007) e \"sensação de energia interna\" (57,5%, p=0,001). O transtorno de personalidade mais prevalente em ambos os grupos foi Transtorno de Personalidade Obsessivo-Compulsiva. O grupo com automutilação apresentou maior prevalência de Transtorno de Personalidade Histriônica (22,5 %, p=0,02) e Transtorno de Personalidade Borderline (15%, p=0,04). A gravidade da impulsividade foi maior no grupo com automutilação segundo as medidas da BIS-11 para características motoras (média 26,6, p=0,002) e dificuldade para planejamento (média 31, p=0,014). Conclusão: A automutilação e o TOC são transtornos heterogêneos que compartilham características compulsivas e impulsivas. Na automutilação, o componente impulsivo é maior e no TOC, a compulsividade é maior quando comparamos estes dois grupos. Entretanto, a automutilação esteve associada à ocorrência de fenômenos sensoriais, apontando também para a presença de aspectos compulsivos nestes quadros. O Transtorno de Personalidade Borderline não é regra entre os pacientes com automutilação. Outros transtornos de personalidade, inclusive cluster C como o Transtorno de Personalidade Obsessivo-Compulsiva, também podem estar presentes entre pacientes com automutilação, assim como com TOC. Os pacientes adultos com automutilação apresentam este comportamento desde a adolescência e os tipos de automutilação apresentados por estes são de moderada a grave intensidade, além de associarem diferentes tipos de automutilação. Isto evidencia a necessidade de desenvolvimento de instrumentos diagnósticos mais precisos para identificação e tratamento precoce específico para estes quadros, evitando a cronicidade dos mesmos / Introduction: Non-suicidal self-injury (NSSI) is defined as a deliberate and voluntary physical self-injury without any conscious suicidal intent. Common forms of NSSI include cutting, burning, scratching, hitting, biting and interfering with wound healing. Some patients spend a lot of time thinking about how to perform their act doing it always the same way. They remember compulsive symptoms with intense component of impulsivity. The DSM-IV classifies NSSI as one diagnostic criteria for impulsive control disorders not elsewhere classified or as borderline personality disorder. The DSM-V proposes that the NSSI should be classified as a different disorder. The lack of a singular meaning for NSSI makes difficult the clinical and epidemiological researches about the subject. A better clinical and psychopathological definition for NSSI is crucial for the development of more effective therapeutic interventions, including new psychopharmacological treatment. The objective of this study is to describe the clinical features of patients seeking treatment for NSSI and compare their compulsive and impulsive features with patients with Obsessive Compulsive Disorder (OCD). Methods: 70 patients were interviewed, 40 patients who specifically sought treatment for NSSI and 30 patients who sought treatment for OCD. Standardized instruments were used: Structured Clinical Interview for Diagnosis of Axis I, according to DSM-IV and for impulse-control disorders, Structured Clinical Interview for Axis II Disorders (Clinical Version (SCID-II)), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS); Dimensional Yale- Brown Obsessive-Compulsive Scale (DY-BOCS), University of São Paulo Sensory Phenomena Scale (USP-SPS); Trauma History Questionnaire; Functional Assessment of Self-Mutilation (FASM) and Barratt Impulsivity Scale, version-11 (BIS -11). To compare categorical variables the chi-square test was applied. For continuous variables, t-test was applied. For multivariate analysis, the ANCOVA test or Logistic Regression were applied when required. A significance level of 5% was applied for all statistical tests. Results: The mean age of patients was 29 years. The NSSI began at 17 years old, and had 5 different types of NSSI on average. The more common behaviors were: cutting the skin (90%), pick at a wound (75%), beat himself (67.5%). The most often reasons for NSSI were to: stop bad feelings (75%), relieve feeling numb or empty (70%), punish himself (70%), feel something, even if it was pain (47.5%) and feel relaxed (40%). In the comparison between NSSI and OCD groups, the NSSI group presented more axis I comorbidities with depression (92.5%, p = 0.03) and bulimia (25%, p <0.001). The OCD group showed more social phobia (40%, p <0.001). The OCD group had higher severity in all measures of the Y-BOCS (mean: 26, p <0.001) and DY-BOCS (mean 23.1, p = 0.01). In the NSSI group, 60% of the patients reported NSSI associated with sensory phenomena. This group had more reports of sensory phenomena related to the \"incompleteness\" (45%, p = 0.007) and \"internal energy\" (57.5%, p = 0.001). The most prevalent personality disorder in both groups was Obsessive-Compulsive Personality Disorder. The NSSI group had higher prevalence of Histrionic Personality Disorder (22.5%, p = 0.02) and Borderline Personality Disorder (15%, p = 0.04). The severity of impulsivity was higher in the NSSI group according to the measures of the BIS-11 for motor impulsivity (mean 26.6, p = 0.002) and non-planning impulsivity (mean 31, p= 0.014). Conclusion: NSSI and OCD are heterogeneous disorders that share compulsive and impulsive features. In NSSI, the impulsive component is stronger and in OCD the compulsive is stronger when comparing both groups. However, NSSI was associated with the occurrence of sensory phenomena which evidence the presence of compulsive aspects. The borderline personality disorder is not a rule among patients with NSSI. Other personality disorders, including cluster C personality disorders, may also be present among patients with NSSI and OCD, as well. Adult patients with NSSI started this behavior during adolescence. The NSSI symptoms presented were moderate to severe, different types of NSSI were also involved. These results highlights the needs for development of more accurate diagnostic tools for early identification and specific treatment of the NSSI, avoiding chronicity

Suicide is an issue that plagues adolescents in the United States. Suicide crosses socioeconomic, racial, and gender divides and is difficult to predict and prevent. Primary care providers (PCPs) are in a position to detect suicidality in adolescents; however, PCPs lack the knowledge and confidence necessary to accurately identify suicidal adolescents. The author conducted an extensive review of current literature (meta-analyses, systematic reviews, literature reviews, case reports, and existing clinical practice guidelines) on identification of adolescent suicidality in pediatric primary care settings. This paper provides a set of recommendations for primary care providers on how to properly identify adolescents with suicidal ideation and behavior.

Non-suicidal self-injury (NSSI) is the intentional destruction of bodily tissue in the absence of suicidal motives. NSSI is strongly associated with self-criticism (Gilbert et al., 2010) and individuals who self-injure often report doing so to punish themselves. Conversely, self-compassion, or the tendency to be caring with oneself, is associated with psychological well-being (Neff et al., 2007). The aim of the present study was to determine whether experimentally inducing self-criticism or self-compassion would lead to changes in implicit identification with NSSI. The Self-Injury Implicit Association Test (SI-IAT; Nock & Banaji, 2007) is an assessment of the strength of the automatic associations that a person holds between themselves and NSSI. Participants were randomly assigned to a self-criticism induction, a self-compassion induction, or a neutral condition and completed the SI-IAT before and after the induction. Results showed that participants in the self-criticism induction experienced an increase in their implicit associations with NSSI while implicit associations in the self-compassion and control conditions generally did not change. Results were not significantly different for those with or without a history of NSSI and highlight the importance of self-criticism in NSSI. Future research should examine increases in self-criticism as a potential precursor of NSSI in longitudinal samples.

La sécrétion de vasopressine (AVP) et de corticolibérine (CRH) déclenchent la sécrétion d'ACTH via leurs récepteurs V1B et CRF1, puis celle des catécholamines et des corticostéroïdes, résultant dans les effets physiologiques induits par le stress. Trois mutations résultant de variants non-synonymes affectant le récepteur V1B (K65N, R364H et G191R) ont été associées chez l'homme à des troubles psychiatriques tels que la phobie, l'hyperactivité et le comportement suicidaire. Nous avons étudiés les propriétés pharmacologiques de ces variants V1B qui pourraient être la cause de ces pathologies. Après construction de chacun des plasmides codant pour chaque variant, nous les avons exprimés dans des cellules HEK293 et avons établi les caractéristiques de chaque récepteur telles que son affinité de liaison, ses couplages à la PLC, à la MAP kinase et la mobilisation du Ca2+. Nous avons observé que le variant R191 avait un couplage à la PLC et à la MAP kinases fortement augmenté (+50%), alors que les autres variants montraient un baisse de ces couplages. Les différences n'étant pas dûes à des constantes d'activation (Kact) pour l'AVP différents. L'association avec les β-arrestines n'est pas équivalente pour tous les variants, le R191 montrant une forte association aux β-arrestines 1 et 2 alors que le variant N65 ne s'associe plus. Ces données indiquent que le déficit en ERK-phosphorylée peut être dû à la fois à une baisse de la production d'Inositol-P et de DAG via la voie Gq et à une baisse de signalisation directe via les β-arrestines. Nous avons également examiné les propriétés d'internalisation de ces variants en utilisant des lignées cellulaires stables exprimant chacun des récepteurs couplés à une EGFP. Nous avons observé, par microscopie confocale, que la cinétique et le taux d'internalisation étaient similaires pour tous les variants. Par contre, la voie du traffic intracellulaire est modifiée pour certains. Les variants possédant la mutation C terminale H364 (H364 et N65/H364) sont préférentiellement adressés à la voie de dégradation lysosomiale alors que les autres utilisent la voie classique de recyclage endosomial comme le récepteur sauvage, ainsi que le révèlent les marquages spécifiques de ces compartiments. En conclusion, les résultats obtenus durant cette thèse révèlent que les variants du récepteurs V1B trouvés chez des patients atteints de troubles affectifs ont des propriétés pharmacologiques de couplage et de trafic intracellulaire modifiées. Ces mutations pourraient participer à une plus grande vulnérabilité des patients au stress. Ainsi, elles pourraient être recherchées, à titre de marqueurs génétiques, chez des patients considérés comme à risque.Cette thèse translationnelle a été financée par un contrat doctoral CHRU/UM1. / The release of vasopressin (AVP) and corticoliberin (CRH) triggers the release of ACTH by the mean of V1B and CRF1 receptors, releasing catecholamines and corticosteroids and regulating stress. Genetic modifications of either element may produce severe consequences. Three non-synonymous variants of the V1B receptor gene were found in patients with phobia, hyperactivity or suicidal conducts (respectively K65N, R364H and G191R). To explore the pharmacological properties of these V1B variants, we generated and expressed in HEK293 cells cDNA constructs of each variant. We evaluated ligand affinity, PLC coupling, MAP kinase activation, Ca2+ mobilization. The capacity of R191 variant to accumulate inositol phosphates and to activate MAP kinase under AVP activation was higher as compared to N65 and H364 variants. However, all variants exhibited the same Kact for AVP. V1B variants were not similar in β-arrestin interaction either, with N65 variant impaired for this function, indicating that the deficit in ERK phosphorylation measured previously may result of 2 additional mechanisms, one due to a lower IP/DAG production with impaired coupling to Gq, and the other due to a decrease in β-arrestin interaction. Finally, we compared internalization properties using stable cell lines expressing EGFP–tagged V1B variants and confocal microscopy. First, we observed no difference neither in the internalization kinetics nor in amplitude (70% of total receptors internalized). However, H364 variant showed a different trafficking as compared to K65/G191/R364 (“wt”) and N65, with less cytoplasmic recycling endosomes and more lysosomial addressing as revealed by Lamp1 co-labelling.Altogether, these data reveal that V1B receptor variants in phobic and suicidal patients display modified coupling and/or desensitization processes. These mutations could participate to a predisposition to depression and could be used as diagnosis genetic markers in risky patients.M Manière's Ph.D Scholarship was granted on a translational CHRU/UM1.

Bakgrund Psykisk ohälsa är ett ökande problem hos ungdomar. Suicidala tankar är ett försteg till suicid och olika faktorer kan öka risken för suicidala tankar. Världen över är suicid den tredje vanligaste dödsorsaken för ungdomar i åldern 15 – 19 år. Suicid räknas som en vårdskada om hälso- och sjukvården haft möjlighet att hindra individen att begå självmord via adekvata åtgärder. Därför ska hälso- och sjukvården arbeta förebyggande mot suicid. Försök till självmord redovisas i högre grad av ungdomar som är lesbiska, gay eller bisexuella (LGB). Ungdomarna upplevde att sjukvårdspersonal ibland kunde se homosexualitet som något avvikande. Syfte: Syftet var att beskriva förekomsten av suicidala tankar utifrån sexuell läggning hos ungdomar. Metod: Studiens design är en litteraturstudie. Totalt tio artiklar kvalitetsgranskades och analyserades. Artiklarnas likheter och skillnader beskrevs. Resultat: Sexuell läggning har en påverkan på suicidala tankar. Ungdomar som definierades som LGB, sexuell minoritet eller haft sexuell kontakt med någon av samma kön rapporterade suicidala tankar i högre grad än heterosexuella ungdomar. Tjejer rapporterade suicidala tankar i högre grad än killar, oberoende av sexuell läggning. Slutsats: Studier visar att det finns ett samband mellan sexuell läggning och suicidala tankar. Suicidala tankar är ett allvarligt problem som inte kan förbises, och därmed inte sambandet mellan sexuell läggning och suicidala tankar. Vidare forskning behövs både inom Sverige och internationellt. / Background: Mental illness is an increasing problem among adolescents. Suicidal ideation is an early stage of suicide and different risk factors can increase the risk of suicidal ideations. All over the world suicide is the third most common cause of death among adolescents aged 15 – 19 years. Suicide is a care-damage if the health service had the possibility to prevent a person to commit suicide with adequate interventions. Therefore, the health service is required to work preventive towards suicide. Suicide attempts is reported in higher rate among adolescents who are lesbian, gay or bisexual (LGB). Some patients perceived that health personnel sometimes saw homosexuality as something abnormal. Aim: The aim of the study was to describe the presence of suicidal ideations based on sexual orientation among adolescents. Method: The literature study includes ten articles. The quality of the articles was analyzed. Then the articles similarities and differences were described.    Results: Sexual orientation has an impact on suicidal ideations. Adolescents who were defined as LGB, sexual minority or had sexual contact with a person of the same gender reported suicidal ideation in a higher rate than heterosexual adolescents. Girls reported suicidal ideations in a higher rate than boys, regardless of sexual orientation. Conclusion: Studies shows that there is a correlation between sexual orientation and suicidal ideation. Suicidal ideation is a severe problem that can’t be disregard, and neither the correlation between sexual orientation and suicidal ideation. Therefore, research need to be done, both in Sweden and worldwide.