Thèse d'exercice : Médecine. Médecine générale : Nantes : 2007. / Bibliogr.

M.A. dissertation, University of Hong Kong, 1974. / Typescript.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Death certification of ‘‘suicide by cop’’ is controversial among some medical examiners and coroners. We present five such deaths that were certified as suicides and discuss the medico-legal issues involved with these certifications. To certify such a death as a suicide, certain criteria should be met. Suicide by cop is a circumstance that involves competing intentional acts that may result in dichotomous determinations of the manner of death. Despite the absence of direct self-infliction, there is overwhelming evidence that these five individuals intended to end their own lives. Their use of an unusual method to accomplish this goal may inappropriately result in a reflexive certification of homicide. All of the decedents possessed weapons or a facsimile of a weapon. We present five instances of suicide by cop and contend that these types of deaths are best certified as suicides. KEYWORDS: forensic science, forensic pathology, suicide, police, gunshot wounds, manner of death

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Despite the wealth of information on suicide prevention issues and the widespread implementation of suicide prevention strategies, program evaluation efforts have been limited. Lack of sound program evaluation remains one of the most significant barriers to identification and implementation of effective intervention and prevention strategies. The purpose of this study was two-fold: to conduct a summative evaluation of the gatekeeper suicide prevention program implemented at the Toronto Transit Commission, and to concomitantly, appraise the efficacy and effectiveness of the Kirkpatrick evaluation model as an analytical framework to guide suicide prevention program evaluations. The study used a two-phase, sequential mixed-method approach of converging quantitative and qualitative methodologies. The quantitative study employed a repeated measures design and examined the immediate and long-term effects of the gatekeeper program on attitudes, knowledge, intervention abilities. The qualitative study consisted of semi-structured interviews and explored participants’ effective and utility reactions to the gatekeeper training program. The results of this study indicated safeTALK and suicideAWARE training programs increased participants’ knowledge of suicide and suicidal behaviour, enhanced positive attitudes toward the suicidal individual, suicide intervention, and improved intervention skills. The empirical findings from this study support the premise that the Kirkpatrick evaluation model could be adapted for use in gatekeeper program evaluations. The model provides a highly relevant, well-rounded, rigorous approach to suicide prevention program evaluations.

Two studies were undertaken to examine the relationship between suicidality and three key psychological predictors of suicide risk, namely, depression, hopelessness, and psychache. Study 1 determined the degree to which these suicide risk predictors are distinct using a sample of undergraduate students (N = 587). Because typical measures of depression, hopelessness, and psychache differ in terms of their scale format, results were compared using original items, dichotomized items, parcels of original items, and parcels of dichotomized items. Exploratory and confirmatory factor analyses indicated that depression, hopelessness, and psychache comprise three separate, but correlated factors. Psychache accounted for a greater proportion of variance in depression and hopelessness than vice versa, and psychache was also more strongly associated with a wider range of suicide criteria than depression and hopelessness, though all three predictors made unique contributions to suicidality. In order to ascertain whether suicide risk predictors interact with stress to predict suicidality, study 2 compared diathesis-stress models of depression, hopelessness, and psychache in a 4-month longitudinal study using an independent sample of university undergraduates (N = 301). When initial levels of all variables were controlled, hopelessness and psychache, but not depression, were significantly associated with suicide risk. Furthermore, negative cognitions about oneself, the world, and the future served as a common diathesis that interacted with major negative life events to precipitate increases in both hopelessness and psychache. Simple slopes analyses further indicated that among individuals with a low level of cognitive diathesis, the frequency of major life stressors was positively associated with both hopelessness and psychache. However, among individuals with a high level of cognitive diathesis, the frequency of major life stressors was negatively associated with hopelessness and unrelated to psychache. Together, the results of the research presented in this dissertation have important implications for understanding the unique roles of depression, hopelessness, and psychache in the prediction of suicide risk. / Thesis (Ph.D, Psychology) -- Queen's University, 2007-12-14 17:09:43.918 / Social Sciences and Humanities Research Council

Shneidman (1993) has theorized that psychache (i.e., intolerable psychological pain) is the key cause of suicide, and accounts for the effect of all other psychological factors. Two studies are presented that test Shneidman’s theory, and compare the influence of psychache on suicidality relative to that of hopelessness. In the first study, a causal hypothesis was examined using a longitudinal design. Undergraduate students (N = 588) completed measures of psychache, hopelessness, and suicide ideation at two time points four months apart. Results supported the hypothesis that psychache has a causal role in suicidality, as change in suicide ideation was predicted by change in psychache. However, the hypothesis that psychache would fully mediate the effect of hopelessness was not supported, as only a small and partial mediation effect was evidenced, and change in hopelessness also contributed unique variance to the prediction of suicide ideation. In a second study, the hypotheses that psychache is necessary and sufficient for suicide were examined. Undergraduate students (N = 1,333) were prescreened for high and low levels of psychache and hopelessness, and those who met cutoff criteria (N = 184) were selected to make up four groups with combinations of these constructs. Groups were compared with respect to various measures of suicide ideation, motivations, and behaviours using one-way multivariate analyses of variance. In general, dependent measures significantly differed by level of psychache, but not by level of hopelessness. This pattern of group differences supported the hypothesis that psychache is necessary for suicide. However, the claim that psychache is sufficient was not consistently supported, as some suicide criteria were significantly elevated only for groups exhibiting high levels of both psychache and hopelessness. Taken together, the results of this dissertation provide strong support for the key role of psychache in suicide and its parity with hopelessness as a statistical predictor of suicidality. These findings improve understanding of the suicidal state of mind, and have important implications for clinical practice. / Thesis (Ph.D, Psychology) -- Queen's University, 2009-11-30 13:33:54.267

This thesis is about attempted suicides and is based on open and in-depth interviews of 31 individuals who have attempted suicide once or several times. The phenomenon is presented through the concept of "career" and from the subject's point of view. Its first objective is to reconstruct the sequence of events that marks the experience of individuals who had decided to commit suicide but have failed in their project. / This sequence starts with the decision to commit suicide, the choice of method, followed by the act itself; it is characterized by an interruption that triggers different forms of intervention: physical treatment in a hospital and psychiatric evaluation; it continues with the return of the individual to his/her familiar circle, facing the life conditions he/she had wanted to leave. / Reconstructing this experience emphasizes the solitary, the physical and the uncertain nature of the suicidal act. It also shows how individuals who do not complete their suicide will be caught in disconcerting and compromising situations, and that their act will force them to justify themselves to different audiences and will taint their relationships with others. Finally, the analysis indicates that the terms in which individuals envisage suicide are transformed in the course of their experience.

Eating disorders are a significant health concern due to their high rates of comorbidity, mortality, and the physical and mental distress they cause. While many people are aware of the negative effects eating disorders have on physical and mental health, few realize that suicide is a potential outcome. Although the relationships between eating disorders and suicidality have been examined in clinical populations with anorexia nervosa and bulimia nervosa, these relationships have not been examined in the general population, nor with binge eating disorder. This study aimed to investigate these relationships in the Collaborative Psychiatric Epidemiologic Surveys (CPES, N=20,013), a large, nationally representative sample of adults in the United States. Logistic regression analyses revealed that individuals with a history of each eating disorder reported higher rates of suicide ideation and suicide attempts. Rates of suicide experiences among this population are similar to individuals with a history of major depression and a comorbid anxiety disorder. It is clear from this study that suicide remains a significant concern for individuals suffering from an eating disorder in the general population. It is essential that clinicians screen for suicide experiences in individuals suspected of suffering from an eating disorder.

Despite the wealth of information on suicide prevention issues and the widespread implementation of suicide prevention strategies, program evaluation efforts have been limited. Lack of sound program evaluation remains one of the most significant barriers to identification and implementation of effective intervention and prevention strategies. The purpose of this study was two-fold: to conduct a summative evaluation of the gatekeeper suicide prevention program implemented at the Toronto Transit Commission, and to concomitantly, appraise the efficacy and effectiveness of the Kirkpatrick evaluation model as an analytical framework to guide suicide prevention program evaluations. The study used a two-phase, sequential mixed-method approach of converging quantitative and qualitative methodologies. The quantitative study employed a repeated measures design and examined the immediate and long-term effects of the gatekeeper program on attitudes, knowledge, intervention abilities. The qualitative study consisted of semi-structured interviews and explored participants’ effective and utility reactions to the gatekeeper training program. The results of this study indicated safeTALK and suicideAWARE training programs increased participants’ knowledge of suicide and suicidal behaviour, enhanced positive attitudes toward the suicidal individual, suicide intervention, and improved intervention skills. The empirical findings from this study support the premise that the Kirkpatrick evaluation model could be adapted for use in gatekeeper program evaluations. The model provides a highly relevant, well-rounded, rigorous approach to suicide prevention program evaluations.