This study gathers the literature on suicidal children and creates guidelines designed to assist professionals with assessing the suicidality of a child. Analysis of the literature reveals that there are varying ages of children used in the research, a lack of standardization for the definition of suicide, and resistance towards a collective research approach to understanding suicidal behaviour. The literature also identifies the important risk factors, which are incorporated into guidelines for determing this sucidality of a child: family discord and violence, depression, significant loss, poor and/or dysfunctional parent/child communication and bonding, aggressive behaviour, stress, physical abuse, parental separation/divorce, hopelessness, academic difficulties, prior suicide attempts, and viewing death as a temporary state of being. / viii, 104 leaves ; 29 cm.

Background Suicidal behaviour among young people is one of the major public health problems in low-income countries; it is estimated that every year 70,000 young people take their lives and maybe 40 times as many attempt suicide. Nicaragua has the highest suicide rate among young people of all Latin and Central American countries. This thesis aims at examining: (1) suicidal expressions and their determinants among school adolescents in Nicaragua, (2) cross-cultural aspects on suicidal expressions comparing Nicaragua and Cambodia, (3) pathways to suicide attempts among young men, and (4) primary health care professionals’ perceptions of suicidal behaviour and mental health problems among young people. Method Paper I is a cross-sectional study of 368 school adolescents in Nicaragua using self-report instruments (Youth Self Report and Attitudes Towards Suicide). Paper II compares data from Paper I with corresponding data from a study of 316 adolescents in Cambodia using the same methodology. Paper III is a qualitative study based on interviews with 12 young men who have recently attempted suicide. Paper IV is a qualitative study with 12 primary health care professionals. Results Paper I: Among adolescents, suicide ideation during recent year was reported by 22.6%, suicide plans 10.3%, and suicide attempts 6.5%. Girls were significantly more likely to report suicidal ideation. Multivariate analyses showed that anxious/depressed syndrome (YSR), somatic complaints syndrome (YSR) and exposure to attempted or completed suicide in significant others were significantly associated with their own serious suicidal expressions. Paper II: There was no significant difference in serious suicidal expressions (plans and attempts) between countries, but milder suicidal expressions during past year were more common among Nicaraguan young people. Overall, mental health problems were more commonly reported in Cambodia, where adolescents scored significantly higher on almost all YSR-syndromes as compared to Nicaraguan adolescents, except for withdrawn/depressed syndrome among boys. The pattern of association between mental health problems and suicide plans/attempts differed between countries. In Nicaragua, all eight YSR-syndromes were significantly associated with serious suicidal expressions for both genders compared to only one syndrome among girls and two syndromes among boys in Cambodia. Paper III: A model of the pathways leading to suicide attempts among young men was constructed based on the informants’ experiences. Structural conditions such as poverty or single-headed families, along with normative expectations within a framework of hegemonic masculinity, were all involved to create a sense of failure and an inability to cope. Subsequent increased drinking and drug abuse as well as exposure to attempted and completed suicide among friends and family acted as triggers to their own suicide attempt. Paper IV: Primary health care professionals felt themselves that they lacked knowledge and competence when approached by young people with mental health problems. Misconceptions were common. They felt frustrated which made them either ignore signs of mental health problems or reject help-seeking young people. In practice, a common response from health care professionals was to refer the patient over to someone else, the “hot potato” strategy. Conclusions The prevalence of serious suicidal expressions among young people in Nicaragua is within the range reported from Western high-income countries. Health care professionals need to be aware that somatic complaints as such are related to an increased risk of serious suicidal behaviour among young people, and that those who have been exposed to the attempted or completed suicide of someone close are at increased risk of serious suicidal expressions also when there are no warning signs in terms of mental distress. The cross-cultural comparison lends support to the notion that both cultural specificity and universality characterize serious suicidal expressions, as suggested by several researchers. Whereas prevalence shows less variation between cultures, associated factors might behave differently as shown in the present study, calling for different preventive approaches. The interviews with young men who had attempted suicide tell us that not only difficult socio-economic conditions but also the normative expectations on young men need to be addressed to decrease their risk of suicide. Health care professionals need to be alerted that sometimes serious mental health problems are hidden behind help-seeking for more trivial reasons. There is a necessity of a more integral approach towards mental health problems in PHC, including integral training of staff. The continued involvement of the community, family and other institutions would be essential to develop the care further.

Suicide embodies a considerable but often preventable loss of life. As the second leading cause of death for young people in Canada between the ages of 15 and 24, nearly one-quarter of all annual deaths for this age group are accounted for by those who have died by suicide. Greater still is the prevalence of suicidal behaviour. Annually, suicide and suicidal behaviours across the age span are estimated to cost the Canadian economy $2.2 billion. Given the high personal costs to victims, survivors, and taxpayers, it seems crucial that prevention strategies be implemented to reduce the high rate of suicide and suicidal behaviours, as well as to promote mental health, particularly in youth. The promotion of positive mental health and well-being is especially relevant for youth living in rural areas. Fewer mental health resources are available in rural communities than in urban centres. Moreover, youth living in rural, low population density areas often do not believe that their anonymity and right to privacy would be protected if they were to seek mental health services. The present research was carried out to provide a potential foundation for stimulating mental health promotion and suicide prevention approaches, differing by rural and urban community and by gender, before such concerns emerge. Through a survey of 813 (459 rural youth; 354 urban youth) secondary school youth in Eastern Ontario, we examined the inverse association between suicidal ideation and engagement in extracurricular activities, such as sports, music, drama, or community groups. Who is at greatest risk: It was found that rural youth reported significantly more suicidal thoughts than did urban youth (p < .01). Perceived social support accounted for rural and urban differences, while difficulties coping with daily stressors accounted for gender differences, in self-reported suicidal ideation. Thus, “red flags” for communities at risk could include perceived deficits in social support within a given community, as well as having a number of young females who indicate poor coping with daily stressors. What factors to target: Depressive symptoms, risk behaviours, self-esteem, and social support differed in importance in the prediction of suicidal ideation based on rural-urban setting and gender. Results reflecting differences underscore the importance of examining such factors in mental health research. A “one size fits all” approach to youth mental health promotion and suicide prevention does not appear to be a prudent strategy. How to intervene: Youth engagement was explored as one possible means of intervention. In rural youth, personally meaningful engagement and engagement in a number of activities was directly inversely related to suicidal ideation. Regression analyses involving interaction analyses were carried out with youth engagement as a moderator for mental health indicators such as depressive symptoms, risk behaviours, self-esteem, and social support in the prediction of suicidal ideation. Through simple slope analyses, it was found that youth engagement significantly reduces the relationships between suicidal ideation and mental health indicators, particularly for males (p < .001). Therefore, youth engagement appears to be more universally beneficial for rural youth, given that rural dwelling appears to be a risk factor for suicidal ideation. Moreover, for male youth at risk for suicidal ideation, given depressive symptoms, risk behaviours, low self-esteem, and low perceived social support, youth engagement may be of particular benefit. With knowledge of who is at greatest risk for suicidal ideation, what factors to target, and a possible intervention road map, we can reach youth and foster resiliency before suicidal thoughts emerge.

Bakgrund: Fler än 800. 000 personer i världen dör av suicid varje år. Psykisk ohälsa var den vanligaste riskfaktorn. Suicidala patienter kunde hos sjuksköterskor väcka varierade känslor och utmana deras existentiella frågor. Syfte: Syftet med litteraturöversikten var att belysa sjuksköterskors attityder till suicidala patienter inom sjukvården. Metod: Litteratursökningen genomfördes på Cinahl och PsychINFO med lämpliga sökord. 28 artiklars kvalitet granskades, 12 valdes ut att ingå i litteraturöversikten. Analysen genomfördes förutsättningslöst för att finna likheter och skillnader. Slutligen framkom två teman. Resultat: Patienterna väckte olika attityder hos sjuksköterskor, däribland ogynnsamma och tillmötesgående. Ålder, erfarenhet, utbildning och religion påverkade attityder och det uttryckdes även ett behov av utbildning för att förbättra dessa. Diskussion: Det var betydelsefullt att sjuksköterskor tror på patienten för att en människa till människa relation skulle kunna skapas. Kultur och samhälle upplevdes influera sjuksköterskors attityder. Attityder kunde påverkas av erfarenhet, ålder, utbildning och andra livshändelser. Sjuksköterskor borde hålla tillbaka sina egna värderingar och tro då det är patienten som skall stå i centrum. Slutsats: Sjuksköterskor behövde mer utbildning kring suicidala patienter för att förbättra sina attityder och sin kommunikationsförmåga.

Thesis (M. Phil.)--University of Hong Kong, 2008. / Also available in print.

Thesis (Ph.D.) -- University of Western Sydney, 2004. / "A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy, School of Applied and Human Sciences, University of Western Sydney" Includes bibliography.

Dissertation (Ph.D.)--Auburn University, 2006. / Abstract. Vita. Includes bibliographic references (p.99-112).

Thesis (Ph. D.)--University of Rhode Island, 2004. / Typescript. Includes bibliographical references (leaves 172-186).

Thesis (M.A.)--York University, 2007. Graduate Programme in Communication and Culture. / Typescript. Includes bibliographical references (leaves 148-154). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:MR32022

Thesis (Ph. D.)--West Virginia University, 2010. / Title from document title page. Document formatted into pages; contains vii, 72 p. : ill. Includes abstract. Includes bibliographical references (p. 35-41).