published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Considering the escalating rate of suicidal behaviour in adolescents, not much is known about the risk and protective factors that mediate non-fatal suicidal behaviour among this group. This study has focused on exploring the subjective worlds of Indian adolescents who have engaged in non-fatal suicidal behaviour in order to identify such factors, which are crucial in the designing of effective intervention programmes. The sample consisted of 10 adolescent patients who were admitted to R.K. Khan Hospital in Chatsworth, Durban after non-fatal suicide attempts. The emergent risk and protective factors were conceptualised according to Bronfenbrenner’s (1979) Social Ecology Theory, which facilitated an understanding of the multiple levels of risk and protective factors that mediate NFSB in adolescents. The results of this study highlight the collective influences of individual, familial, cultural and societal factors on adolescents’ decisions to engage in non-fatal suicidal behaviour. A number of clear priorities for prevention programmes emerged from the results of this study. As such, recommendations were made to facilitate prevention and intervention programmes at a site, familial, peer and community level. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2008.

The main purpose of this study was to develop a more complete understanding of the deeply situated, ethical and political character of suicide prevention program planning practice through the analysis of everyday narratives or "practice stories." By offering an in-depth view of program planning practice - based on the retrospective analysis of a national conference planning process - this study provides an ideal opportunity for learning about "what matters most" when multiple interest groups come together to plan new programs. Three broad research questions provide the focus for this study: What are the diverse personal and professional understandings that stakeholders bring to the work of suicide prevention? How do these various identities and roles get enacted through language? What are the implications that these various understandings and multiple discourses have for shaping subsequent program planning experiences, decisions and actions? Using an open-ended interview structure, nine conference planning committee members were invited to reflect on their own experiences at the planning table. My own storied account of our planning experience is presented alongside the observations and stories of my planning colleagues. Thus, the varied perspectives of different planning partners and stakeholders are represented in their own words and are woven into an unfolding and textured narrative about planning practice in the mental health field. Several important findings emerged which have relevance for the future study and practice of program planning. First, there was a clear privileging of professional knowledge and interests at our planning table. Second, the tasks of problem framing and discourse shaping are key functions that planners need to bring conscientious attention to in order to advance the overall planning agenda. Finally, critical listening, emotion, empathy, and care are important elements of communication and meaning making and I have argued that these relational attributes should be explicitly cultivated and nurtured at the planning table.

This study is an analysis of adolescent risk behaviors contributing to an increased rate of suicidal ideation for 12 to 18 year olds. The Youth Risk Behavior Surveillance System Survey (YRBSS) is an epidemiologic survey designed to monitor the prevalence of risky behaviors of adolescents in middle and high school1. The YRBSS is a complex sample survey with a three-stage cluster design. Multiple logistic regression is used to analyze the data, including methods of analysis to address issues in complex survey design. Results of this study indicate several different risk factors that influence the rate of suicidal ideation among adolescents, including alcohol and drug use, sexual risky behaviors, unhealthy weight loss methods, depressed mood, sex and race/ethnicity. The conclusions of this study indicate that many risk factors associated with suicidal ideation are behaviors that could be addressed with early intervention strategies to reduce the risk of suicidal ideation.

År 2011 uppgick antalet personer som suiciderat i Sverige till 1387. Studier visar att den suicidbenägna patientens första kontakt med sjukvården är avgörande för hur det kommande vårdförloppet kommer att utvecklas. Ambulanspersonal är en av många yrkesgrupper som möter suicidbenägna patienter. Studier visar även på att om patienten möts av dåliga attityder så kan det medföra negativa konsekvenser för patienten. Syftet med studien var att översätta, re översätta och validera en engelsk enkät: the Suicide Behavior Attitude Questionnaire (SBAQ): för användning i den svenska ambulanssjukvården. Metoden i att översätta, re översätta och validera SBAQ följde de tio stegen som tagits fram av the translation and cultural adaptation group. Elva ambulanssjuksköterskor medverkade i valideringen av den svenska SBAQ. Resultatet åskådliggör att det är möjligt att översätta och validera den engelska enkäten SBAQ till svenska. Studien kan därför ligga till grund för en mer omfattande studie inom ambulanssjukvården med den svenska SBAQ som instrument. Det här kan bidra till ökad uppmärksamhet och vid behov förbättringar avseende ambulanspersonalens bemötande i framtida situationer med suicidbenägna patienter. / In 2011, the number of persons who committed suicides in Sweden amount to 1387. Studies show that the suicide-prone patient's first contact with health services is crucial for how the future care process develops. Ambulance personnel is one of many professional groups that meet suicide prone patients and studies make clear that if the patient is met with bad attitudes it can result in negative consequences for the patient. The aim of the study was to translate, retranslate and validate an English questionnaire: the Suicide Behavior Attitude Questionnaire (SBAQ) for use in the Swedish ambulance service. The method to translate, retranslate and validate SBAQ followed the ten steps developed by the translation and cultural adaptation group. Eleven ambulance nurses participated in in the validation of the Swedish translated SBAQ. The results illustrate that it is possible to translate and validate the English SBAQ survey to Swedish. The study can therefore be the basis for a more comprehensive study within the ambulance service with the Swedish SBAQ as tool. This may help increase attention and, if necessary, improvements by ambulance personnel treatment in future situations with suicidal patients.

High school adolescent's suicidal behaviour caused a concern to the Umzimkulu community and the multi - disciplinary team in the local Psychiatric institution during the years 1997 - 1999 . The purpose the study was to identify and describe the charactics of adolescents who committed suicide. Rutter's (1995) model of risk. resilience and recovery has been used as a theoretical frame work for the study. A descriptive, exploratory case study design is most suitable for the incidence of suicide at Umzimkulu District .The case study approach was best suited as it assists in an indepth study focussing on contemporary phenomena with sum real life contexts . The distinctive need for the case study design arises out the desire to understand complex psycho-social phenomena of adolescent suicide (Yin, 1989).Each adolescent who committed suicide over the last two years in Umzimkulu District will form a case . All data about the particular person will be the case description Adolescents who committed suicide were identified from the records at the police intelligence office of Umzimkulu Police Station. Parents, identified friends, teachers and health workers who had known the adolescents. Semi structured interviews with open ended questions were used. Interview schedules for teachers, parents and close friends differed slightly. A tape recorder for later transcription was utilised. To analyse the data, Ruttter's model was utilised to do cross case analysis. Results according to Rutter's model, were that, due to inconstant support received by the adolescents, high levels of stress in early child hood, had left them insuffiently resilient to with stand the problems they encountered during adolescence. / Thesis (M.Cur.)-University of Natal, Durban, 2001.

Cirka 800 000 människor världen över avslutade sina liv genom suicid 2014. En psykiatrisk diagnos är en vanligt förekommande bakomliggande orsak. De vanligaste diagnoserna är depression, bipolär sjukdom, post traumatiskt stressyndrom samt substansmissbruk. Tidigare suicidförsök är den enskilt största riskfaktorn för ett fullbordat suicid. Det är komplext att arbeta med suicidnära patienter i öppenvården och det ställs höga krav på specialistkompetens inom psykiatrisk omvårdnad och goda kunskaper kring det suicidpreventiva arbetet. Syftet med studien var att beskriva psykiatrisjuksköterskans erfarenhet av att bedöma suicidrisk på patienter på en vuxenpsykiatriskmottagning. En kvalitativ metod användes med induktiv ansats där fyra intervjuer med  psykiatrisjuksköterskor genomfördes. I resultatet framkom att psykiatrisjuksköterskan dagligen möter och behandlar suicidnära patienter på en öppenvårdsmottagning. Resultatet visade att psykiatrisjuksköterskan trots år av erfarenhet upplevde arbetet med suicidnära patienter som komplext och ansvarsfullt. Det framkom att psykiatrisjuksköterskan arbetade självständigt och stod ofta ensam med att bedöma suicidrisken och vidta åtgärder. Psykiatrisjuksköterskan har en viktig del i det suicidpreventiva arbetet och behöver känna sig trygga och säkra i omvårdnaden kring suicidnära patienter och i att bedöma suicidrisken. Vidare forskning skulle kunna ge fördjupad kunskap om psykiatrisjuksköterskan roll och behov för att ge omvårdnad till suicidnära patienter.

Introdução: Ideação suicida e tentativas de suicídio são geralmente complicações dos transtornos psiquiátricos. O estudo da freqüência e fatores associados podem contribuir para uma abordagem mais adequada por profissionais de saúde mental. Objetivos: Estimar a prevalência de tentativas e pensamentos suicidas, em pessoas com transtornos mentais graves (TMG) e as associações com características sócio-demograficas, diagnóstico, ajustamento social, sintomas psiquiátricos, uso de substâncias psicoativas, envolvimento familiar e tratamentos realizados. Método: Foram entrevistados e avaliados 192 pessoas que apresentavam TMG, com idade entre 18 e 65 anos e que tiveram contato com os serviços de saúde mental de três regiões definidas do município de São Paulo em período determinado. Utilizou-se anamneses estruturadas com questionários padronizados e escalas psicométricas. As entrevistas foram realizadas no domicílio do paciente. Realizou-se análise descritiva, análise univariada e análise multivariada. Resultados: Da amostra estudada predominaram as pessoas do sexo masculino (53,1%), solteiras (57,3%), com diagnóstico de esquizofrenia (58,3%). Poucas pessoas apresentavam abuso ou dependência de álcool (7,3%) e apenas três pessoas (1,6%) não utilizaram medicações psiquiátricas no período de um ano anterior à entrevista. Cento e nove (57,7%) entrevistados apresentaram pensamentos suicidas ao longo da vida e nos 12 meses anteriores a entrevista, trinta e oito (20,1%) tiveram tais pensamentos. Cinqüenta e nove (30,9%) pessoas já haviam tentado suicídio durante a vida e oito (4,2%) apresentaram tentativas nos 12 meses anteriores à entrevista. Para todas as variáveis de desfecho, apresentaram associação estatística, a presença de sentimentos de culpa e sintomas depressivos. Na análise multivariada, o uso de neurolépticos apresentou associação com pensamentos e tentativas de suicídio ao longo da vida. Conclusão: Ideação e tentativas de suicídio foram bastante prevalentes na população estudada devendo sempre ser investigadas pelos profissionais de saúde mental, para que se possa tomar as devidas condutas, como o manejo dos sentimentos de culpa e depressão, além do ajuste correto da medicação para o transtorno mental. / Introduction: Suicidal ideation and suicidal attempts are usually complications of psychiatric disorders. The study of the frequency and associated factors may contribute for the mental health professionals to have a more appropriate approach. Aims: Estimate the prevalence of attempts and suicidal thoughts, in people who have serious mental disorder (SMD) and the association with social-demographic characteristics, diagnosis, social adjustment, psychiatric symptoms, use of psychoactive substances, family involvement and treatments they have gone though. Method: One hundred ninety two subjects, age 18 - 65, showing SMD and having been in touch with mental health services in three defined zones in the city of Sao Paulo, in the determined period, were evaluated and interviewed. The researchers used structured anamnesis with standardized questionnaires and psychometric scales, the subjects were interviewed at home and a descriptive analysis, a univariate analysis and a multivariate analysis were used. Results: From the sample we studied we’ve found a predominance of men (53,1%), single people (57,3%), having a diagnose of schizophrenia (58,3%). Few people presented abuse or dependence of alcohol (7,3%) and only three people (1,6%) hadn’t used psychiatric medications within one year before the interview. One hundred nine (57,7%) people who where interviewed showed suicidal thoughts during their lives and during 12 months prior to the research, thirty eight (20,1%) had that kind of thoughts. Fifty nine (30,9%) people had tried to commit suicide during their lives and eight (4,2%) showed attempts to it within 12 months before the interview. The presence of guilt feelings and depressive symptoms showed statistics association to all dependant variables. The multivariate analyses showed statistics association to attempts and suicidal thoughts during the patients’ lives to the occasional use of neuroleptics. Conclusion: The presence of suicidal ideation and attempts to suicide were prevalent in the studied population and they should always be investigated by the health mental professionals in order for them manage the prosper procedures, such as the handling of guilt feelings and depression and be able to stablish the proper medication, for the mental disorder.

M.Ed. / The increase in suicides and suicide attempts by adolescents makes it essential that the subject be looked into intensively as to why these increases occur and how the problem can be identified and prevented. The suicide problem can be traced back to the disintegration of inter-personal communication, either in the family, peergroup or society. In consequence it is apparent that parents, teachers and the community should listen more intensively, actively and with empathy to the problem. The problem is that the "distress call" is sometimes ignored. On account of these different "calls for help" not being heard, it is clear why the futile "why" questions are asked afterwards by the people left behind' after a suicide has been committed, and when it is too late to prevent. Since the problem of suicide and suicide attempts affect our society in so many sectors, the data regarding this phenomenon has been obtained from several sources. The method used in obtaining the necessary information is binary of nature. On the one hand it consists of an intensive literature study of the subject and on the other hand an empirical investigation through questioning as technique. As per De Groot (1961: 29) the present investigation may be described as explorative research, but in terms of Helmstadter's theory (1970: 31-32), as implemented, it is library-scouting and field research. The literature study covers the occurrence of suicide and suicide attempts within the society with special emphasis on the adolescent. The study also covers the causes thereof and how suicide and suicide attempts are embedded in society, taking into account the adolescent's relationship with parents, siblings (family), schools, the peergroup, the community and the society at large. This report is an attempt to view the problem of suicide and suicide attempts of adolescents from a sociopedagogical perspective. The empirical component of the research includes, firstly interviews with concerned parties of actual suicide cases and secondly the studying of police and hospital documents and files of actual suicide cases and suicide attempts. As a result of this research the following emerged: in the case of the majority of adolescents who commit suicide three dominating feelings are present, namely uselessness, despair and depression. Linked with these three dominating feelings the lack of communication is a major problem that faces the suicidal adolescent. Persons with suicidal tendencies are of a negative nature towards themselves and others and non-committal to life in general, resulting in disturbed relations with fellow man. It is necessary that pedagogical assistance and guidance must be intensive, active and empathetic : "Suicide prevention in adolescence is probably best served by general care, tenderness, understanding and support for all unhappy adolescents, rather than searching for suicide specific predictor traits All unhappy adolescents should arise within us the fear of possible self initiated death". (Davis, 1983: 55.)

The present study attempted to identify demographic and psychological variables predictive of adolescent suicidal ideations and attempts. Data from 90 adolescents, who completed an intake form at a university community mental health clinic or were student volunteers, were utilized. Two judges tabulated information regarding age, gender, number of siblings, ethnicity, parental marital status, drug use, depression, suicidal ideation, and previous suicidal attempts. A multiple regression analysis was performed to identify which variables had predictive significance. Depression was the best predictor of both suicidal ideations and attempts. Ethnicity was also predictive; white adolescents were found to be at higher risk for suicide than individuals from other ethnic groups. It is suggested that additional studies be done exploring other predictors of suicide among adolescents.