El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Antepartum suicidal behaviors are a leading cause of maternal injury and death. Previous research has not investigated associations between antepartum suicidal ideation and perinatal complications. Our study objective was to evaluate the relationship of antepartum suicidal ideation with low infant birthweight, small for gestational age, and preterm birth. A cohort study was conducted among 1,108 women receiving prenatal care in Peru. Suicidal ideation was measured using the Patient Health Questionnaire-9 during pregnancy. Birth outcomes were extracted from medical records. Linear regressions and multivariable logistic regressions were used to estimate were used to investigate associations between suicidal ideation and pregnancy outcomes. The prevalence of suicidal ideation was 8.7%, preterm delivery was 5.7%, low birthweight was 4.4%, and small for gestational age was 3.4%. In an adjusted model, infant birthweight was 94.2 grams lower for mothers with antepartum suicidal ideation (95% CI: −183.0, −5.5, p = 0.037) compared with those without suicidal ideation. After adjusting for confounders including depression, participants with suicidal ideation had a nearly four-fold increased odds of delivering a small for gestational age infant (OR: 3.73; 95% CI: 1.59–8.74). These findings suggest suicidal ideation during pregnancy is associated with adverse perinatal outcomes, especially low infant birthweight. / Revisión por pares

The term “moral injury” has recently been introduced to describe psychopathology resulting from perpetrating or bearing witness to an event that transgresses deeply held moral beliefs, typically in relation to military service. Two studies examined relations between potentially morally injurious events (PMIEs) during military service, self-conscious emotions, and negative mental health outcomes. The potential moderating contributions of social support and psychopathic personality traits on these relations were also assessed. A subset of 40 of the 501 veterans who completed a detailed on-line survey was also interviewed to gain a more thorough understanding of individual experiences. Veterans who had experienced higher numbers of PMIEs were significantly more likely to experience depression symptoms and suicidal ideation, as well as guilt and shame related to their military service, but high levels of social support decreased the likelihood of negative mental health outcomes and subsequent guilt and shame; psychopathic personality traits did not moderate these relations. Qualitative analysis of the interviews confirmed that social support plays a key role in the prevention of moral injury-related symptoms. Social support was crucial to reintegration after deployment for many veterans. Results indicate that adequate social support following PMIEs may reduce the likelihood of psychopathology. Implications of this study and future directions are discussed.

Magister Artium - MA / This mini-thesis aims to gauge the extent of occurrences of suicidal ideations among a sample of first-year students at the University of the Western Cape. The study investigates whether differences among those with suicidal ideations exist with respect to gender, race, religious affiliation and faculty for which students are registered. The sample of the current study consisted of 161 students from two first year Psychology classes at the University of the Western Cape. Non-probability convenience sampling was used whereby only those students who attended the two lectures were asked to participate in the current study. Students self-completed a questionnaire which included a brief demographic section and a section with the Beck Scale for Suicide Ideation (BSS). The overall occurrence of suicidal ideations in the chosen sample was 26%. No significant differences among those with suicidal ideations in terms of gender, race, religion or faculty were observed. The results of this study highlight the importance of establishing prevention and intervention programmes on university campuses to create more awareness about suicide and offer more education to students on this topic in general, as well as to specifically offer counselling and support to students suffering from suicidal ideations.

Suicidal behaviour is a phenomenon encountered the world over. Recognising and adequately dealing with such behaviours, in a professional setting, is a role expected of a psychologist. Working with suicidal behaviour is influenced by a variety of factors on the part of the psychologist. These may include, inter alia, experiences they may have had with suicidal behaviour, the training they have received in order to deal with such behaviours and their subjective experience of self-efficacy in dealing with such behaviours. The current qualitative study sought to explore and describe the experiences of recently qualified South African psychologists in dealing with suicidal behaviour through semi-structured interviews. The focus was on newly qualified clinical psychologists who received their masters training at a university in the Eastern Cape Province of South Africa. The study aimed to understand how confident, equipped, and ready newly qualified psychologists perceived themselves in dealing with suicidal behaviour. Three major themes emerged from the data. The first describes the strategies psychologists used in order to recognise potential suicidal behaviour, the second was how newly qualified psychologists managed suicidal behaviour, and the final theme described how psychologists could be prepared for their role to deal effectively with these behaviours. Investigating their experiences enabled the participants to contribute towards creating knowledge in this crucial area of psychological practice and allowed for the discovery of invaluable insights which could benefit the future training of psychologists.

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.

A growing body of research has indicated that the levels of suicidal behaviour are particularly heightened among individuals with Posttraumatic Stress Disorder (PTSD). Two theoretical models of suicide, the Cry of Pain Model of suicide (CoP; Williams, 1997) and the Schematic Appraisals Model of Suicide (SAMS; Johnson, Gooding & Tarrier, 2008) have proposed that perceptions of defeat and entrapment are key components of the psychological mechanisms which drive suicidal behaviour. The SAMS has also emphasized the importance of psychological resilience factors for preventing suicide risk. Resilience to suicide has been recently defined as a set of appraisals which buffer the impact of risk factors on suicidal behaviour. The first aim of this thesis was to investigate the role of perceptions of defeat and entrapment in suicidal behaviour in those with full or subthreshold PTSD. The second aim of this thesis was to obtain empirical evidence for the presence of resilience factors to suicidal behaviour in PTSD. Initially, a comprehensive narrative review and a meta-analysis were conducted to examine the magnitude of the association between various forms of suicidal behaviour and a PTSD diagnosis and the role of comorbid depression in this association. Both, the narrative review and the meta-analysis demonstrated a strong positive association between suicidal behaviour and PTSD, and supported the mediating impact of comorbid depression in this association. A re-analysis of a previous dataset of individuals with PTSD was also pursued to establish the relevance of negative perceptions/appraisals to suicidal behaviour in those with PTSD. Next, three empirical studies were designed to investigate the utility of perceptions of defeat and entrapment in explaining suicidal behaviour in those with full or subthreshold PTSD. The outcomes across the three studies supported the hypothesis that defeat and entrapment represent the proximal psychological drivers of suicidal behaviour in PTSD and fully account for the suicidogenic effects of negative self-appraisals and PTSD symptoms. Two additional empirical studies were conducted to examine resilience factors to suicidal behaviour among individuals with full or subthreshold PTSD. The first of these studies provided evidence that high levels of perceived social support buffered the impact of PTSD symptoms on suicidal behaviour. The last study supported the efficacy of a resilience-boosting technique, the Broad-Minded Affective Coping procedure (BMAC), to enhance the experience of positive emotions and improve mood amongst individuals diagnosed with PTSD. Together, the current results support the SAMS' postulation concerning the role of perceptions of defeat and entrapment in the emergence of suicidal behaviour in PTSD and highlight the importance of boosting resilience as a means of targeting suicidal behaviour in those with PTSD. Clinical implications of these findings are outlined throughout the thesis.

Youths who attempt suicide may have many negative feelings about themselves which are manifested in a low level of self-acceptance. This factor is often overlooked in specific assessment and intervention measures while socio-economic and situational variables are treated. Nurses, because of their location in schools, are in a unique position to recognize and intervene with the potentially suicidal youth. Nurses however may have difficulty in recognizing the youth with poor self-acceptance. This exploratory study was undertaken in order to answer the question: 'is a low level of self-acceptance in youths age sixteen to twenty-five correlated with suicide attempts?' The answer was sought from information obtained from youths' self-reports on the Berger Scale of Self-Acceptance and the California Psychological Inventory. These tests were administered to thirty youths divided into three groups. Group A were suicide attempters seen in the emergency ward of a large general hospital, group B were non-suicide attempters seen in the emergency ward and group C were chosen from the community. An analysis of variance was carried out to discover if there was a significant difference in self-acceptance among the three groups. The findings supported the overall conclusion: youths between ages sixteen and twenty-five who attempted suicide had a significantly lower self-acceptance than control group youths. The variable of hospitalization did not effect self-acceptance. / Applied Science, Faculty of / Nursing, School of / Graduate

Background: Recent analyses have described metabolomic markers for depression and suicidal ideation in non-pregnant adults. We examined the metabolomic profile of antepartum depression and suicidal ideation during mid-pregnancy, a time of high susceptibility to mood disorders. Methods: We collected fasting blood from 100 pregnant Peruvian women and profiled 307 plasma metabolites using liquid chromatography-mass spectrometry. We used the Patient Health Questionnaire 9 to define antepartum depression (score ≥ 10) and suicidal ideation (having thoughts that you would be better off dead, or of hurting yourself). Logistic regression was used to calculate odds ratios (ORs). Results: Three triacylglycerol metabolites (C48:5 triacylglycerol [OR = =1.89; 95% confidence interval (CI): 1.14–3.14], C50:6 triacylglycerol [OR = =1.88; 95%CI: 1.13–3.14], C46:4 triacylglycerol [OR = =1.89; 95%CI: 1.11–3.21]) were associated with higher odds of antepartum depression and 4 metabolites (betaine [OR = =0.56; 95%CI:0.33–0.95], citrulline [OR = =0.58; 95%CI: 0.34–0.98], C5 carnitine [OR = =0.59; 95%CI: 0.36–0.99], C5:1 carnitine [OR = =0.59; 95%CI: 0.35–1.00]) with lower odds of antepartum depression. Twenty-six metabolites, including 5-hydroxytryptophan (OR = =0.52; 95%CI: 0.30–0.92), phenylalanine (OR = =0.41; 95%CI: 0.19–0.91), and betaine (OR = =0.53; 95%CI: 0.28–0.99) were associated with lower odds of suicidal ideation. Limitations: Our cross-sectional study could not determine whether metabolites prospectively predict outcomes. No metabolites remained significant after multiple testing correction; these novel findings should be replicated in a larger sample. Conclusions: Antepartum suicidal ideation metabolomic markers are similar to markers of depression among non-pregnant adults, and distinct from markers of antepartum depression. Findings suggest that mood disorder in pregnancy shares metabolomic similarities to mood disorder at other times and may further understanding of these conditions’ pathophysiology. / Revisión por pares

The purpose of the current study was to investigate the relative importance of diagnostic and psychosocial factors in the prediction of adolescent suicidal ideation. Previous research has shown both sets of variables to be significantly related to suicidality but has failed to compare their relative efficacy in explaining suicidal ideation. It was hypothesized that diagnostic variables would afford better prediction of suicidal ideation than psychosocial variables, diagnostic variables would predict suicidal ideation above and beyond psychosocial variables, and psychosocial variables would predict suicidality after controlling for the effects of diagnostic variables. This study included valid diagnostic and psychosocial variables, employed independent diagnoses as opposed to diagnostic groupings, and utilized continuous measures of psychiatric symptomatology, in series of regression analyses to test these hypotheses. Results revealed that diagnostic variables, in particular, severity of major depressive disorder symptomatology, afforded the strongest prediction of suicidal ideation, even after controlling for psychosocial variables. The comorbid combination of mood disorder and generalized anxiety disorder was found to be the most strongly linked to suicidal ideation of all diagnostic combinations. However, social support added to the prediction of suicidal ideation above and beyond that offered by all diagnostic variables. Moreover, the interaction of social support and family environment predicted suicidality above and beyond severity of major depressive disorder symptomatology. It was concluded that optimal prediction of suicidality is likely obtained through the utilization of continuous measures of psychiatric symptomatology in suicide research. Moreover, suicide research and clinical practice should include examinations of both diagnostic and psychosocial variables to increase prediction and understanding of suicidal ideation in adolescents. / Ph. D.

Indiana University-Purdue University Indianapolis (IUPUI) / Using data from the 2007-2017 cycles of the national Youth Risk Behavior Survey (YRBS), this researcher aimed to understand how weapons carrying mediates the association between bullying and mental health outcomes. I dichotomized four bullying outcomes to create one new carried a weapon after bullied (CWB) (no/yes; e.g. did not carry a weapon post-bullying vs. did carry a weapon post-bullying) for each bullying type. Mental health outcomes included (all dichotomized, past 2 weeks, no/yes): felt sad or hopeless, seriously considered suicide, had a plan for suicide and attempted suicide. I used descriptive statistics and binary logistic regression adjusted for YRBS sampling methods and weighting (Stata 15.0). Initial results showed that weapons carrying has a complex relationship with mental health after bullying. One notable finding is that individuals who had been in a physical fight were the most likely to carry a weapon (N = 268), followed by those who had been threatened at school (N = 233). Additionally, more students who had been bullied at school (N = 185) carried a weapon than those who were victims of cyberbullying (N = 166). Another interesting result found that across all bullying types, males were 2 to 3 times more likely to carrying a weapon as a result of being bullied. In terms of mental health, being threatened at school was the most significant bullying type in relation to suicidal ideation.