abstract: Suicidality, understood as the risk of suicide with intent or the idea of suicide, has been increasingly prevalent in our country, yet the topic of suicidality is one that is often spoken in hushed tones and behind closed doors (Pam, 2013). While suicide statistics trend upwards, there is a growing need to understand representations of suicidality, particularly within media (Centers for Disease Control, 2017). This thesis looks to explore the representations of suicidality in media, specifically Netflix’s original series, Thirteen Reasons Why. Data collection for this thesis will be collected from online social media forums dedicated to the show in the form of episode discussions reflecting on each episode in the season. Through an emergent, grounded analysis, this paper will address current representations of suicidality within Thirteen Reasons Why as well as identify common themes found in online social media forums. This research established common themes of resilience-enhancing, community building, and individuals feeling at-risk or triggered by representations of suicidality in Thirteen Reasons Why as found throughout the online social media forums. / Dissertation/Thesis / Masters Thesis Communication Studies 2020

Befindet sich eine Person in Haft, unterliegt diese der staatlichen Obhut. Inwiefern der Bedarf einer medizinischen Behandlung der Inhaftierten besteht, ist jedoch bei Haftbeginn oftmals unklar. In der vorliegenden Untersuchung wurden im Zeitraum Februar 2012 - März 2013 randomisiert Inhaftierte aus sechs verschiedenen sächsischen Justizvollzugsanstalten hinsichtlich Suizidalität und psychischer Erkrankungen befragt. Die Suizidalität wurde mittels Selbstangaben der Inhaftierten zur aktuellen Suizidalität, zur lifetime Suizidalität und zu lifetime Suizidversuchen sowie verschiedener Fragebögen erfasst. Die für die vorliegende Untersuchung relevanten psychischen Erkrankungen, genauer Persönlichkeitsstörungen bzw. Persönlichkeitsauffälligkeiten, wurden mittels des Assessment of DSM-IV Personality Disorders (ADP-IV) und des Persönlichkeits-Stil-und-Störungs-Inventares (PSSI) ermittelt. Für Inhaftierte mit Hinweisen auf Persönlichkeitsstörungen bzw. Persönlichkeitsauffälligkeiten konnte eine signifikant höhere Suizidalität im Vergleich zu Inhaftierten ohne derartige Hinweise oder Persönlichkeitsauffälligkeiten festgestellt werden. Ein signifikanter Zusammenhang zwischen der bereits abgeleisteten Haftdauer oder der Gesamthaftdauer (Strafmaß) und der Suizidalität aller Inhaftierten konnte nicht ermittelt werden. Die verbleibende Haftzeit (Resthaftdauer) zeigte keinen signifikanten Einfluss auf die Suizidalität der Inhaftierten. Zwischen der Suizidalität von Untersuchungs- und Strafgefangenen konnte kein signifikanter Unterschied nachgewiesen werden. Außerdem konnte für die Selbstangabe der aktuellen Suizidalität kein signifikanter Zusammenhang zu den Suizidalitätsangaben in den verwendeten Fragebögen gefunden werden.:1. Einleitung 5 1.1. Suizidalität 5 1.1.1. Begriffsbestimmung Suizidalität 5 1.1.2. Individuelle Entwicklung von Suizidalität 7 1.1.3. Epidemiologie Suizid 10 1.2. Risikofaktoren für Suizidalität 14 1.2.1. Lebensereignisse 14 1.2.2. Affektive Erkrankungen 15 1.2.3. Sucht 17 1.2.4. Persönlichkeit 19 1.2.5. Haft 22 2. Ziel der Arbeit, Fragestellung und Hypothesen 28 3. Material und Methoden 30 3.1. Studiendesign und –durchführung 30 3.2. Probanden 32 3.3. Einschlusskriterien 32 3.4. Datenerhebung und verwendete Instrumente 32 3.4.1. Soziodemografische und haftspezifische Daten 32 3.4.2. Interview 33 3.4.3. Fragebögen zur Suizidalität 33 3.4.4. Fragebögen zur Persönlichkeit 35 3.5. Datenauswertung 36 4. Ergebnisse 37 4.1. Vorstellung der Probanden 37 4.2. Beurteilung der Suizidalität 38 4.3. Übereinstimmung der Selbstangabe zur Suizidalität, VISCI und FBS 42 4.4. Suizidalität und Haftdauer 44 4.4.1. Gesamthaftdauer und Suizidalität 45 4.4.2. Bisherige Haftdauer und Suizidalität 47 4.4.3. Resthaftdauer und Suizidalität 50 4.5. Auftreten von Persönlichkeitsstörungen und Persönlichkeitsauffälligkeiten 52 4.6. Persönlichkeitsstörungen/ Persönlichkeitsauffälligkeiten und Suizidalität 55 4.6.1. PKS allgemein (vorhanden/ nicht vorhanden) 55 4.6.2. PKS spezifisch (Clustereinteilung) 57 4.6.3. Persönlichkeitsauffälligkeiten (allgemein) und Suizidalität 60 4.6.4. Persönlichkeitsauffälligkeiten (Entsprechungen der Cluster) und Suizidalität 62 5. Diskussion 67 5.1. Methodendiskussion und Limitationen 67 5.1.1. Auswahl der Inhaftierten 67 5.1.2. Erfassung von Suizidalität 67 5.1.3. Erfassung von Persönlichkeitsstörungen und Persönlichkeitsauffälligkeiten 70 5.2. Ergebnisdiskussion 72 5.2.1. Fragestellung 1 - Beeinflussen Persönlichkeitsauffälligkeiten/ Persönlichkeitsstörungen die Suizidalität in Haft? 72 5.2.2. Fragestellung 2 - Gibt es einen Zusammenhang zwischen der bisherigen Haftdauer und der Suizidalität? 76 5.2.3. Fragestellung 3 - Gibt es einen Zusammenhang zwischen der Gesamthaftdauer (Strafmaß) und der Suizidalität? 79 5.2.4. Fragestellung 4 - Beeinflusst die noch verbleibende Haftzeit die Suizidalität? 80 5.3. Ausblick 82 6. Zusammenfassung 84 7. Anhang I 8. Abkürzungsverzeichnis VIII 9. Danksagung IX 10. Literaturverzeichnis X / By law it is the responsibility of the government to secure the well-being of all imprisoned persons. In this study inmates of six prisons in Saxony were interviewed about suicidality and mental illnesses from February 2012 till March 2013. The interviews included questions about self reported suicidal tendencies at the present and the past of the inmates, self reported suicide attempts and some other questionnaires. Personality disorders were recorded by the Assessment of DSM-IV Personality Disorders (ADP-IV). Additionally, specific characteristics of the inmates' personalities were recorded by a special questionnaire (PSSI - Persönlichkeits-Stil-und-Störungs-Inventar). In comparison to inmates without personality disorders or without specific characteristics of their personality inmates with personality disorders or specific characteristics of their personality showed a significant relation to suicidality. A significant correlation between the time spent already in prison and the suicidality could not be found, neither was there a significant difference between the suicidality of prisoners, who are in a pre-trial custody and other prisoners. Furthermore there was no significant link between self reported suicidality and suicidality that was ascertained by the questionnaires.:1. Einleitung 5 1.1. Suizidalität 5 1.1.1. Begriffsbestimmung Suizidalität 5 1.1.2. Individuelle Entwicklung von Suizidalität 7 1.1.3. Epidemiologie Suizid 10 1.2. Risikofaktoren für Suizidalität 14 1.2.1. Lebensereignisse 14 1.2.2. Affektive Erkrankungen 15 1.2.3. Sucht 17 1.2.4. Persönlichkeit 19 1.2.5. Haft 22 2. Ziel der Arbeit, Fragestellung und Hypothesen 28 3. Material und Methoden 30 3.1. Studiendesign und –durchführung 30 3.2. Probanden 32 3.3. Einschlusskriterien 32 3.4. Datenerhebung und verwendete Instrumente 32 3.4.1. Soziodemografische und haftspezifische Daten 32 3.4.2. Interview 33 3.4.3. Fragebögen zur Suizidalität 33 3.4.4. Fragebögen zur Persönlichkeit 35 3.5. Datenauswertung 36 4. Ergebnisse 37 4.1. Vorstellung der Probanden 37 4.2. Beurteilung der Suizidalität 38 4.3. Übereinstimmung der Selbstangabe zur Suizidalität, VISCI und FBS 42 4.4. Suizidalität und Haftdauer 44 4.4.1. Gesamthaftdauer und Suizidalität 45 4.4.2. Bisherige Haftdauer und Suizidalität 47 4.4.3. Resthaftdauer und Suizidalität 50 4.5. Auftreten von Persönlichkeitsstörungen und Persönlichkeitsauffälligkeiten 52 4.6. Persönlichkeitsstörungen/ Persönlichkeitsauffälligkeiten und Suizidalität 55 4.6.1. PKS allgemein (vorhanden/ nicht vorhanden) 55 4.6.2. PKS spezifisch (Clustereinteilung) 57 4.6.3. Persönlichkeitsauffälligkeiten (allgemein) und Suizidalität 60 4.6.4. Persönlichkeitsauffälligkeiten (Entsprechungen der Cluster) und Suizidalität 62 5. Diskussion 67 5.1. Methodendiskussion und Limitationen 67 5.1.1. Auswahl der Inhaftierten 67 5.1.2. Erfassung von Suizidalität 67 5.1.3. Erfassung von Persönlichkeitsstörungen und Persönlichkeitsauffälligkeiten 70 5.2. Ergebnisdiskussion 72 5.2.1. Fragestellung 1 - Beeinflussen Persönlichkeitsauffälligkeiten/ Persönlichkeitsstörungen die Suizidalität in Haft? 72 5.2.2. Fragestellung 2 - Gibt es einen Zusammenhang zwischen der bisherigen Haftdauer und der Suizidalität? 76 5.2.3. Fragestellung 3 - Gibt es einen Zusammenhang zwischen der Gesamthaftdauer (Strafmaß) und der Suizidalität? 79 5.2.4. Fragestellung 4 - Beeinflusst die noch verbleibende Haftzeit die Suizidalität? 80 5.3. Ausblick 82 6. Zusammenfassung 84 7. Anhang I 8. Abkürzungsverzeichnis VIII 9. Danksagung IX 10. Literaturverzeichnis X

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Abstract: The purpose of this study was to determine if a correlation exists between suicide and CAG repeat length in Huntington’s disease. Methodology: A case-control study using the COHORT Study de-identified database was conducted. Responses were collected from 163 participants. Depression, substance abuse history and use of benzodiazepines were covariates. Responses to the UHDRS behavioral section pertaining to the frequency and severity of suicidal ideation (“feels life is not worth living”, “has suicidal thoughts”) were analyzed. Results: Despite taking depression, benzodiazepine use, and history of substance abuse into account, there was a predictive relationship between CAG repeat length and frequency of suicidal ideation (p = .010). When the effect of depression was taken into account, there was no significant relationship between CAG repeat length and the severity of suicidal ideation. Recommendations: The findings from this quantitative analysis supported using CAG length in a clinician’s risk factor assessment to determine the frequency of suicidality.

BACKGROUND: Suicide is a leading but preventable cause of death and is preceded by domains of thoughts, plans, and attempts. We assessed the prevalence of suicidality domains and determined the association of suicidality domains with sexual identity, mental health disorder symptoms, and sociodemographic characteristics. METHODS: We used the 2019 National Survey on Drug Use and Health (NSDUH) data to perform weighted multivariable logistic regression and margins analyses to examine between and within-group differences in suicidality by sexual identity among adults aged ≥ 18 years. RESULTS: About 4.89%, 1.37%, and 0.56% of the population experienced suicidal thoughts, plans, and attempts, respectively. Those aged 18-25 years old had a higher odds of suicidality compared to those aged 26 years or older. Compared to those who reported having no alcohol use dependence, illicit drug use dependence, and major depressive episodes (MDEs), those who reported alcohol use dependence, illicit drug use dependence, and MDE had higher odds of suicidal thoughts, plans, and attempts. Between all sexual identity groups, bisexuals who experienced MDEs had the highest probability of having suicidal thoughts while lesbians and gays who experienced MDE showed a higher probability of suicidal plans and attempts compared to heterosexuals. Within each sexual identity group, the probability of having suicidal thoughts, suicidal plans, and suicidal attempts was higher for those who had experienced MDEs compared to those who had not experienced MDEs. CONCLUSION: Substance use disorder and MDE symptoms were associated with increased suicidality, especially among young adults and sexual minority people. This disparity underscores the need for tailored interventions and policies to enhance the provision of prompt mental health screening, diagnosis, and linkage to care for mental health services, particularly among the most vulnerable in the population.

It is common for people to search for health information on the internet, share their health issues through social media, and ask for advice from people in online communities. Some people reported feeling more comfortable sharing their psychological stress online and anonymously asking for advice from people. As such, people disclose not only their suicide risk but also their suicidal risk-associated drivers (e.g., suicide ideation, relational stress, financial crisis). This study aims to identify suicidal drivers from narratives extracted from social media, synthesize findings and suicide theories, and provide insights into future suicide prevention policies and practices. This research gathered and analyzed 128,587 posts written by 76,547 people worldwide. The posts were written in English from January 2021 to December 2022 on the r/SuicideWatch of Reddit. Natural Language Processing and topic modeling, specifically Latent Dirichlet Allocation (LDA), were used to identify clusters of posts based on similarities and differences between posts. Thematic analysis was used to identify suicidal drivers across clusters of posts. The web crawler developed by Brandwatch was used in data collection, and Python was used for all analyses.  Six theme clusters of posts were identified. The first theme was Disclosure of Repetitive Suicide Ideation (i.e., “I want to die. I want to die, I want to die…(repeated)”), and 36.4% of posts had this theme. The second theme was Disclosure of Relational Stress (i.e., “I don’t have any friends”), and 31.9% of posts had this theme. The third theme was Disclosure of Suicide Attempts and Negative Healthcare Experiences (i.e., “I’ve had a suicide attempt before”, “The nurses ignored me”), and 9.9% of posts had this theme. The fourth theme was Disclosure of Abuse (i.e., “He would beat me black and blue”), and 8.8% of posts had this theme. The fifth theme was Disclosure of Contextual Stress, including finance and legal matters (i.e., “every moment was a living fear of the debt collector knocking on the door”), and 7.2% of posts had this theme. The last theme was Philosophical and Informative Discussions around suicide (i.e., “After death, the physical begins to deteriorate and life/energy is simply moved to another being”), and 5.8% of posts had this theme. Understanding different suicidal drivers is an essential component in designing individualized intervention plans for people at suicide risk. The current research identified the idiosyncrasies in the suicide drivers people talked about when disclosing their suicidality. Furthermore, the findings from this study’s data-inspired and exploratory approach provided additional evidence supporting existing suicide theories and frameworks. This research has the potential to lay the groundwork for designing suicide intervention strategies that target individuals’ self-disclosures of their struggles online.

BACKGROUND: Both mood and anxiety disorders are more prevalent in women than men with the onset typically occurring during adolescence or early childbearing years. These disorders are particularly prevalent during pregnancy and the postpartum period. While depression during the perinatal period has received significant attention recently, anxiety has not received the same amount of attention. METHODS: The current study was a secondary analysis of a prospective cohort study that followed 91 women with mood disorders through pregnancy and the postpartum period. Our objective was to determine if a correlation existed between anxiety and suicidality. We hypothesized that pregnant women with a history of a mood disorder and comorbid anxiety are more likely to be suicidal than those without comorbid anxiety. The presence of anxiety was determined using the anxiety subscale of the Edinburgh Postnatal Depression Scale, EPDS; a cut off score of six or greater was used to indicate significant anxiety. Suicidality was determined using three separate measures: question ten on the EPDS, question eighteen on the Inventory of Depressive Symptomatology, and question ten on the Montgomery-Asberg Depression Rating Scale. ANALYSIS: Chi square tests were used to compare the demographics of the anxious and non-anxious women based on both diagnosis of anxiety disorders and symptoms of anxiety. Z proportion tests were then used to compare the proportion women with anxiety versus those without anxiety who were suicidal. Lastly, binary logistic regression was used to determine if patients with anxiety were more likely to be suicidal. RESULTS: Among the women in this study, 62 (68.1%) had a diagnosis of major depressive disorder and 29 (31.9%) had a diagnosis of bipolar disorder based on DSM-IV-TR diagnostic criteria. In addition, 45 (49.5%) had a lifetime history of an anxiety disorder. The prevalence of significant anxiety symptoms, as determined by the anxiety subscale on the EPDS, ranged from 9.1-37.5% depending on the time point. Suicidality prevalence also varied depending on both the time point and the scale used: 0-17.5% using the MADRS, 6.7-24.7% using the EPDS, and 2.4-14.7% using the IDS. Using a binary logistic regression, we determined that anxiety was a risk factor for suicidality at time T3 (OR 2.106; 95% CI 1.274-3.481) and M1 (OR 2.057; 95% CI 1.179-3.586) on the MADRS and at T3 (OR1.758; 95% CI 1.219-2.535) on the EPDS.

Researchers have investigated the role of hope as a protective factor against suicide. Of the 3 factors posited by Joiner's interpersonal theory of suicide (IPTS) to be necessary before suicide can occur, increased hope has been shown to reduce 2 (thwarted belongingness and perceived burdensomeness), but, counterintuitively, to increase the 3rd (acquired capability for suicide). A fuller understanding of this phenomenon may lie with Bernardo's locus-of-hope construct-pursuant to which hope may lie not only in one's own plans and capabilities (internal locus-of-hope) but in those of others (external locus-of-hope) but to date no study has researched the relationship between external locus-of-hope and acquired capability for suicide. The purpose of this quantitative study was to contribute to the understanding of hope and suicidality by examining the following research question: Is there a relationship between external locus-of-hope and acquired capability for suicide? The study used existing objective instruments to measure levels of hope and acquired capability for suicide. Data from a sample recruited online (N = 193) was analyzed using a 3-step hierarchical regression procedure designed to isolate the effects of external locus-of-hope on acquired capability for suicide. Results confirmed that internal locus-of-hope raises acquired capability for suicide and demonstrated that external locus-of-hope has the opposite effect: it is associated with lowered acquired capability for suicide. It follows that interventions designed to raise one's level of externally located hope have the potential to deter suicidal individuals from actualizing their plans. This study thus has implications for positive social change by contributing to the saving of lives.

We examined prospectively whether mania and hypomania are associated with an elevated risk for suicidality in a community sample of adolescents and young adults. Baseline and four-year follow-up data were used from the Early-Developmental- Stages-of-Psychopathology (EDSP) Study, a prospective longitudinal study of adolescents and young adults in Munich. Suicidal tendencies (ideation/attempts), mania, and hypomania were assessed using the standardized Munich-Composite-International- Diagnostic-Interview. At baseline, mania/hypomania was associated to a different degree with suicidality (Odds ratios [OR] range from 1.9 to 13.7). In the prospective analyses, the risk for subsequent incident suicidal ideation was increased in the presence of prior mania (38.0% vs. 14.1%; OR = 4:4; 95% CI = 1.4–13.5). No associations could be found between prior mania/hypo-mania and incident suicide attempts. The prospective analyses revealed a remarkable relationship between preexisting mania and increased risk for subsequent suicidal ideation.

During 2010, 1446 people committed suicide in Sweden. Research shows that groups that are less favored in society have an increased risk of suicide. Social services often encounter groups of people that have a high risk of suicide, for instance welfare recipients or substance abusers. The purpose of this study was to shed light on how social workers talk about suicide and how this might affect interactions with suicidal clients. The study is based on qualitative interviews with five social workers in Stockholm. The results were analyzed using the theory of professional discretion and the perspective of existentialism. The most important results were that social workers do not think that they can help suicidal clients on their own, instead they need psychiatric help. Meeting with suicidal clients raises a lot of feelings and one way to cope with this is by distancing oneself from the client. The study also showed that suicide is a complex issue and it can be hard to find a position between the human right of autonomy and the will to help people. Continuity was viewed as an important factor, but due to the work load it can be hard to follow up these clients.