Thesis (Ph. D.)--University of South Florida, 2003. / Includes vita. Title from PDF of title page. Document formatted into pages; contains 126 pages. Includes bibliographical references.

Background: Substantial attention has been given to studying suicides among those who had been in contact with healthcare providers. However, effective suicide prevention must target both users (contact) and non-users of healthcare services (non-contact). The non-contact group has been under-researched and prevention programs are often designed based on studies that over-rely on samples of the contact group. Using both quantitative and qualitative methods, this thesis aims to retrospectively explore and explain the profiles and service-use patterns of the non-contact group alongside service utilization models. The quantitative studies, which aimed to identify factors associated with the non-contact groups, were conducted based on the samples drawn from the psychological autopsy study of suicides (aged 15-59) in Hong Kong (2003-2005). Study 1: Portfolio analysis of the non-contact group with psychiatric illnesses Considering psychiatric illness as the basic “evaluated need” for psychiatric service-use, it was controlled for in the comparison between the contact (n=52; 43.7%) and non-contact group (n=67; 56.3%). The non-contact group was associated with having relatively stable employment, a higher level of problem solving ability, unmanageable debts, and non-psychotic disorders. They were evidently different from the contact group, while accounting for a larger proportion of the suicide population. Study 2: Study of suicides without psychiatric illnesses Twenty-nine suicide cases without any psychiatric diagnoses were compared to live controls without diagnoses (n=135), and live controls (n=15) and deceased (n=86) with non-psychotic diagnoses. They were not significantly different to the groups with psychiatric illness on the level of impact from various life events, either acute or chronic, including relationship, family, legal, physical, and job insecurity. However, with fewer signs of detectable abnormalities such as previous suicide attempts, they were not given timely attention from healthcare or psychosocial services. Alternative preventive measures are suggested to address the service needs arising from their negative life events. Study 3: Study of suicides with distress from job insecurity Suicides who were employed at time of death tended to make no contact with healthcare services. They were single, lived alone, earned less income, and suffered from depression. Chronic job insecurity, which was partially mediated by psychiatric illness, was found to influence their non-contact pattern. This could be due to fear of job loss or being stigmatized at work if they decided to receive treatment. Strengthening mental health programs and financial management in workplaces is suggested. Study 4: Study of perceptions towards pathway to care among patients survived from near-lethal suicide attempts The personal accounts of patients that survived from near-lethal suicide attempts revealed that the higher their suicide intent, the lower their perceived needs and the greater their resistance to receiving healthcare services. Themes associated with their non-contact pattern were irrelevancy, non-usefulness and self-reliance. Their views were detouring or against the pathway to care. Conclusion: The non-contact pattern of suicides cannot be explained by conventional service-use models. They showed a distinctive profile from the contact group, and it is suggested that they be helped through proactive prevention programs and / or population-based preventive measures, e.g. restriction of suicide means. / published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

published_or_final_version / Sociology / Master / Master of Social Sciences

Thesis (Ph.D.)--University of Wyoming, 2007. / Title from PDF title page (viewed on June 15, 2009). Includes bibliographical references (p. 49-65).

Thesis (M.S.)--Florida State University, 2006. / Advisor: Thomas E. Joiner, Jr., Florida State University, College of Arts and Sciences, Dept. of Psychology. Title and description from dissertation home page (viewed June 7, 2006). Document formatted into pages; contains v, 26 pages. Includes bibliographical references.

This study aimed at investigating the relationship between adolescent parasuicide, depressive illness and associated risk factors. Reports worldwide indicate that suicidal behaviour in this age group has risen 150% over the past 20 years, whilst the rate for suicide in adults and the elderly has remained the same (Deykin et al, 1985; Neiger & Hopkins, 1988; Sudak, Ford & Rushforth, 1984a). In South Africa statistics confirm similar trends with regard to attempted and completed suicide. Statistics reveal that a high local incidence of adolescent suicide attempters are seen at psychiatric units. One pilot study recorded 187 adolescent suicide attempters during a three month period. This study was based on the hypothesis that the incidence of depressive illness in adolescent suicide attempters is higher than is generally accepted and that this condition often goes unrecognised and is misdiagnosed because it manifests differently with acting out behaviour and "masked" symptomatology. A random sample of suicide attempters between the ages of 13 - 25 who presented at C23 (psychiatric emergencies) Groote Schuur Hospital following a suicide attempt were assessed. 100 subjects were seen over a period of three months. The research procedure comprised a comprehensive assessment incorporating a semi-structured interview, self-report and objective rating scales for depression as well as instruments designed to assess the general health of each subject and their level of suicide intent. The depressive inventories used have been validated for use in this age group and were designed to elicit the associated features of adolescent depression. If warranted, a clinical diagnoses was given based on DSM 1V criteria. This diagnosis was substantiated by information from the research instruments which formed part of the assessment process. A high incidence of clinical disorders was diagnosed in the sample (86%). Depressive illness was found to be a significant risk factor for suicidal behaviour with 68% of the subjects suffering from an affective disorder and 21% reporting depressive symptoms. This study shows that the correlation between parasuicide and depressive illness is high enough to suggest that all suicidal behaviour in this age group should be taken seriously as parasuicide in itself is often a reliable indicator of an underlying depressive condition. Additional risk factors for adolescent parasuicide identified in this study correlated well with the findings of similar research studies. Psychiatric co-morbidity, especially substance use (42%) and cluster B personality factors (54%), were high and served to increase an individual's vulnerability to suicide risk. Psychosocial factors such as sexual abuse (28%) and physical abuse (37%) were also identified as high risk factors for adolescent suicidal behaviour. Individuals at risk for depression and suicidal behaviour typically came from broken homes which were disrupted and unsupportive. Family members were frequently abusing alcohol and 67% of the subjects reported the presence of psychiatric illness in the family. The preferred method of suicide attempt was an overdose (90%). These attempts were generally unplanned and impulsive with no disclosure prior to the event. Intent was usually high at the time of the act. It is only through identifying the risk factors specific to the developmental concerns of this age group and acknowledging the role of depressive illness in adolescent suicidal behaviour that effective preventative measures can be devised.

This research utilized data concerning adolescents at imminent risk for harm confined to the Edmonton and Lethbridge secure treatment centres in Alberta. Once screened for inclusion criteria in a single stage, non-random convenience sampling protocol, 210 files were included in the study. From these files, the adolescents' psychopathological diagnoses, Suicide Probability Scale (SPS) scores as well as other demographic data (including age, gender, ethnicity and previous suicide attempts) were recorded. This research was designed to delineate the characteristics of adolescents admitted to secure treatment, examine the overall suicide risk in this sample, investigate the relationship between study variables via crosstabulation and chi-square analysis, and to determine which independent variable/s best predicted suicide risk via ANOVA and multiple lineear regression analysis. Analysis results indicated that the sample was predominantly comprised of female adolescents, Caucasian ethnicity and was aged between 13 and 15 years. The majority of adolescents with suicide history information available in their file had previously attempted suicide. Youth demonstrated an average of 2.7 psychopathological diagnoses, the most frequent of which were conduct disorder, substance abuse, depression, adjustment disorder and parent child relational disorder. The majority of youth were in the moderate suicide risk category from SPS scores. Multiple linear regression analysis determined that the diagnoses of adjustment disorder and depression were found to be predictive of increased suicide risk scores, as was gender (females had higher risk scores), age (younger adolescents had higher risk scores) and previous suicide attempts. Those in the "other" ethnicity category demonstrated lower suicide risk scores. / xi, 193 leaves ; 29 cm.

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / abstract / Social Work and Social Administration / Doctoral / Doctor of Philosophy