This study investigated the knowledge level of secondary building-level administrators and secondary teachers regarding adolescent suicidal risk factors and warning signs. Additionally, this study contributed a social mediation component, to explore whether educators believe that they have the potential to be change agents for youth in their school communities. Three hundred forty-three participants (318 teachers, 18 assistant principals and 7 principals) from the middle and high schools in a local public school district in the Mid-Atlantic Region of the United States completed a survey pertaining to information on adolescent suicide. Data analyses were conducted through detailed cross-tabulations and analysis of variances to examine educator knowledge. Despite a wide variability in scores, findings suggest that the majority of educators acknowledge having moderate to low knowledge levels in most critical content domains of youth suicide. Additionally, educators believe that they have the ability to be social mediators of change for youth in the school setting.

Master of Science / Department of Mechanical and Nuclear Engineering / Akira Tokuhiro / One of the most deadly tactics used by today’s terrorists is suicide bombing. Sensors have been developed and are being used in different situations to detect weapons and the people initiating suicide bombing attacks. The ideal detection technology would be fast, accurate, effective from long distances, and safe for the both detector and the object being detected. One detector that has shown potential as a tool for detecting hidden weapons is an infrared detector. Infrared detectors are passive sensors that create infrared, or thermal, images without having to expose the subject to any radiation. These images show the heat signature that is given off by objects of interest. Previous studies using infrared detectors for concealed weapon detection have tried to observe the image of the weapon. These have been largely unsuccessful, however, because infrared waves will not readily penetrate clothing. The research presented here determines the feasibility of modeling the heat signature produced by a suicide bomber using thermal models that predict the temperature of the exterior layers of clothing worn. The goal is to be able to compare the images acquired of the suspected bomber to the expected temperatures from the thermal models. If the presence of a hidden weapon affects the emitted heat signature to a point in which the clothing temperatures are not responding as predicted by a model, it is possible a detection system may be created using these models as a comparator and signal for detection. This research also determines a temperature range for which an operator viewing infrared images for suicide bomb detection may be relatively certain of the presence of a foreign object. Testing was also completed to determine those variables that affect an infrared image in ways that help or hinder the use of the thermal models in predicting the temperatures that appear in the infrared images.

Cotton has over the past years become a less profitable crop to grow. This has affected millions of people cultivating it. In India the struggles of cotton farmers become clear when looking at the high suicide rates amongst them with economic reasons being the most common cause. In this thesis the aim is to investigate the situation of small cotton farmers in India and define the important factors in deciding their profitability. To be able to achieve this, a qualitative multiple case study in Maharashtra district, India was conducted with farmer interviews as the backbone of the study. Our contribution through this thesis is to provide an improved understanding of the cotton farmers’ situation and the factors that affect their yield. We found that for the farmers in this study insufficient access to water was the most pressing issue. Water is an important factor in deciding the yield of cotton and thus important for the farmers’ economy. This finding may not be representative for other cotton growing areas as the issues can vary greatly geographically.

M.MSc. (Med.), Faculty of Health Sciences, University of the Witwatersrand, 2009 / Violence is a hidden problem in most communities, yet it is among the leading causes of death and non-fatal injury worldwide. It is an essential public health issue for every country and needs to be addressed as a matter of priority. While rural areas of South Africa are believed to be safer than urban areas, they are not necessarily safe per se. The main objective of this study is to examine the burden of fatal violent injuries on a rural South African community. The violent deaths data used in this report were collected through a verbal autopsy (VA) process during the period 1992 to 2000 in Agincourt, Bushbuckridge, a rural area in the north-eastern part of South Africa with a population of about 69 000 people. Person-years data for the same period, obtained from the Agincourt Health and Demographic Surveillance System (AHDSS), were used for the denominator in the computation of rates. Violence accounted for 5.9% (170/2 859) of deaths from all causes in the Agincourt area between 1992 and 2000. Of the 170 violent deaths, 68.2% were due to assault while the remaining 31.8% were suicides. The proportion of violent deaths, as proportion of deaths from all causes, is highest in the 15–19 year age group (20.9%, compared to 1.0% amongst those under the age of 15 years and 2.0% among those 60 years and older). The small number of victims in each age group results in wide confidence intervals. The violent deaths proportion, as a proportion of deaths from all causes, is higher in males (9%) than in females (2.3%). Violence levels appear to be higher among South Africans than among self-settled former Mozambicans, though the observed difference between these two populations is not statistically significant. However, a statistically significant difference is found between levels of death due to assault among migrants and permanent residents. To address this situation, violence prevention strategies and programmes need to be put in place to reduce violence. However, more research is required in order to identify more risk factors associated with violent behaviour, to study the identified risk factors, and to inform the development of these programmes.

Thesis advisor: Karen Rosen / Thesis advisor: Daniel Bowles / Transgender individuals in the twenty-first century face stigmatization across the globe. Discrimination contributes to the development of early life stress (ELS), and this may lead to depression, anxiety, and social and developmental problems as individuals enter adulthood. Suicide rates in transgender populations in Western countries peak above 41%, compared to 4.6% in the general population (Haas, Rodgers, & Herman, 2014). Though medical and social efforts to treat suicide in the community are being developed, existing measures have been unable to effect significant change regarding these disproportionately-high suicide rates. Some parts of the world are drawing ahead of others in this respect. As one of the most gay-friendly countries in the world (Rand, 2013), for example, Germany is making progress medically and legally, including recently having introduced a third gender option into legal documents and opened new discussions on depathologizing transgender identity in medical care. Germany has been able to build on its early history as the first country to publicly tolerate and provide healthcare to transgender individuals. This has fostered transgender activism from the postwar period to today and may contribute to lowered suicide rates among transgender Germans. This thesis aims to use Germany’s early history of transgender rights to contextualize the state of the transgender population there today. Using an analysis of existing literature, it looks at the effects of stigmatization on suicide rates in the transgender population. Positive and negative aspects of Germany’s LGBTQ+ and transgender culture are evaluated for their impact on neurological development and the perpetuation of suicidal behavior. The thesis concludes with proposals for improved social, legal, and medical practices regarding transgender health in Germany, with a particular focus on the development of cultural understanding of transgender identity. / Thesis (BA) — Boston College, 2018. / Thesis (BA) — Boston College, 2018. / Submitted to: Boston College. College of Arts and Sciences. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Psychology. / Discipline: German Studies.

Background: Self-injury is a serious behaviour undertaken by those in distress. Attitudes to self-injury both with and without intent to end life is often studied in terms of professionals working in Accident and Emergency (A&E), with little attention paid to other professionals or non-professionals. There are several potential aspects to one's stigmatising attitudes, such as willingness to help individuals, perceived causes for behaviour, optimism for prognosis and general empathy experienced. Moreover, some research suggests stigmatising attitudes may be different depending on the severity of the self-injury, including the presence or absence of suicidal intent. The aim of this study was to investigate the impact on these factors of the form of self-injury and professional background. Methods: Using an online survey methodology 436 respondents completed the survey. The attitudes of Mental Health Professionals, Primary Care Professionals and those not working in either of these settings ('Non-Professionals') were compared to explore their attitudes towards self-injury. Participants were randomly shown a vignette depicting either self-injury with or without intent to end life and reported their overall empathy, willingness to help, attributions for the behaviour and optimism for prognosis. Results: On all measures Non-Professionals reported more negative attitudes than either healthcare professional group, who had similar attitudes towards self-injury. Both professional groups differed in their attitudes towards self-injury with and without suicidal intent on all measures expect for optimism for prognosis. Across all professional groups a difference was seen between the optimism for personal and others' intervention. Conclusions: The study outlined the current attitudes of different healthcare professionals and the general public towards self-injury both with and without intent to end life. Differences in attitudes were seen, showing the potential to improve the stigmatising attitudes experienced by those who self-injure; methods were suggested by which to do this. Further research is needed in order to assess the clinical effectiveness of attempts to improve stigmatising attitudes.

Background: Suicide is a common cause of death and mental illness is the main reason why someone decides to end their life. Many family members are left in sorrow after these dramatic changes. Research shows that people who have lost a relative in suicide are more likely to become depressed. Objective: The purpose of this study was to describe how relatives experience losing a relative to suicide. Method: A literature-based study was used to investigate how relatives experience losing a relative to suicide. The results were analyzed by using a qualitative content analysis comprising five steps. The analysis resulted in three themes and eight subthemes. Results: The result showed that the initial response to the suicide is shock and confusion. They experienced a hard time understanding what have happened and needed support to cope. Society's stigmatization made it hard to move on. Finally they have to accept the unacceptable in order to continue their lives. Conclusion: The relatives got into a traumatic crisis when they first heard of the suicide. They experienced problems with their mental- and psychical health. They need a lot of support to find strategies for managing their grief. Nurses play a major role in helping them in their grief, giving them comfort and finding professional support. / Suicid är en vanlig dödsorsak i Sverige. Beskedet om att någon valt att ta sitt liv kommer ofta plötsligt och utan förvarning. Här lämnas en stor andel närstående såsom familj, vänner och kollegor som ofta är oförstående för vad som inträffat och oförmögna att hantera beskedet. Examensarbetet fokuserar på vad som händer med de som lämnas kvar efter att någon de älskat valt att ta sitt liv. Vid ett vanligt dödsfall så sker det ofta mer odramatisk och det kanske är förväntat att personen ska dö. När en anhörig begår en suicidhandling blir den drabbade närstående kvar med ilska, skuld och frågor som inte kan bevaras. Självmordet kan ske på dramatiska sätt som innebär en svårare sorgehantering för de som efterlämnas. Risken för att drabbas av psykisk ohälsa är större för de som upplevt ett trauma och för att förebygga ett lidande hos de närstående behöver sjukvården fånga upp dem och ge dem de verktyg de behöver för att bearbeta sin sorg. Examensarbetet baseras på 10 kvalitativa vetenskapliga artiklar, där författarna till studien plockat ut fynd i resultatet för att belysa studiens syfte som är att beskriva närståendes upplevelser av att förlorat en anhörig i suicid.  I resultatet framkommer det att de närstående går igenom en traumatisk kris, upplever stigmatisering från samhället och att det har ett stort behov av support. Genom denna studie kan sjuksköterskor få en större insikt för hur närstående upplever förlusten av en anhörig genom suicid och med hjälp av det lära sig mer om krishanteringen för att kunna bemöta den patientgruppen genom att ge tröst och lindra lidanden.

Purpose: Assessment and management of suicidal risk often relies on the client’s willingness to disclose suicidal thoughts or behaviors. Understanding why clients make the decision to conceal these symptoms is key to improving techniques of assessment. This study directly queried suicide concealers to learn how psychotherapists can better elicit honest disclosure of suicidal material. Method: A sample of 107 suicide concealers provided both short essay responses and multiple choice responses explaining why they concealed suicidal thoughts from their therapist. In addition, a sub-sample of 64 suicide concealers provided short essay responses describing what they thought their therapist could do differently to help them disclose, and answered multiple-choice questions explaining how they felt about concealment, and whether concealment impacted their therapy. Content analysis was used to identify motives and themes in short essay responses. Results: Nearly three-fourths of suicide concealers cited fear of practical consequences as the reason they did not disclose. Chief among these fears was involuntary hospitalization, which respondents viewed as the likely outcome of telling a therapist about their suicidal thoughts. Less concrete motives for concealment, such as shame or embarrassment, were significant but secondary concerns. Nearly half of suicide-concealing clients said they would be more honest only if the threat of hospitalization was somehow reduced or controlled. Many asked for some form of assurance or explanations about the chances of being hospitalized as a result of their disclosure. Concealers most commonly felt conflicted about their decision to conceal, with significant numbers feeling frustrated or guilty as well as safe or in control. While a quarter of concealers believed concealment hurt their progress in therapy, the majority reported no effect. Limitations: While responses suggest a range of symptom severity, the sample includes an unknown proportion of mild versus severe suicide risk, reducing generalizability to the general or clinical population. Male and minority clients are under-represented in the sample. Conclusions: The concerns expressed by the suicide concealers in this sample suggest that improving techniques of suicide risk assessment may require renewed attention to providing transparent, complete, and easy-to-understand psychoeducation about the triggers for hospitalization and other possible outcomes of disclosure. Clients ultimately control their level of disclosure, and the results of this study suggest they desire sufficient knowledge to make an informed decision.

Of the 800,000 suicides recorded globally every year, over a third are due to pesticide ingestion, the majority of which occur in rural Asia with organophosphorus (OP) compounds. These anticholinesterase pesticides cause an acute cholinergic syndrome characterised by decreased consciousness, excessive airway secretions and respiratory failure. A combination of these clinical features is the most common cause of death. Up to 30% of OP pesticide poisoned patients are admitted to the Intensive Care Unit (ICU) for tracheal intubation and lung ventilation, but up to half die. It is not understood why the case fatality for intubated poisoned patients is so high, but one hypothesis is that the patients, when unconscious, aspirate their stomach contents (including the OP and the solvent present in its agricultural formulation) causing a toxic lung injury which contributes to the observed high mortality. In this PhD, I aimed to characterise the lung injury caused by OP pesticide self-poisoning through both indirect (ingestion) and direct (aspiration) means. To achieve this, I analysed data from previous toxicological minipig work and designed and conducted a specific minipig pulmonary aspiration study which was complemented by an experimental OP poisoning ex vivo lung perfusion model and human data from pesticide poisoned patients in Sri Lanka. I first investigated the pulmonary pathophysiology resulting from orogastric administration of OP pesticide without aspiration. Analysis of my group’s Gottingen minipig in vivo work demonstrated that orogastric placement of agricultural OP (dimethoate EC40) produced lung injury via exposure to blood-borne pesticide. Pathological lung changes consisted of alveolar and interstitial oedema, pulmonary haemorrhage and modest neutrophilia with increased concentrations of protein, IL-6 and IL-8 when compared with controls, but with low concentrations of TNF-α and IL-10 in bronchoalveolar lavage fluid (BALF). In a second study, OP poisoned minipigs had increased concentrations of BALF protein, neutrophils, IL-8 and CRP six hours after orogastric poisoning when compared with their baseline values. Electron microscopy images of both studies demonstrated damage to the alveolar capillary membrane secondary to systemic OP poisoning. Prior to conducting the main pulmonary aspiration study in minipigs, there was considerable refinement of the processes involved through use of: (i) pilot aspiration and dose ranging studies; (ii) the development of a specific pulmonary histopathological scoring system; and (iii) employment of modern human anaesthetic equipment and intensive care patient management protocols. After this period of model development, an in vivo 48 hour study using Gottingen minipigs (n=26) was conducted to investigate the pulmonary pathophysiology in animals given either sham bronchoscopy (sham control) or 0.5 mL/kg of: saline (saline control), porcine gastric juice [GJ], OP (dimethoate EC40) + GJ [OP+GJ], or solvent (cyclohexanone) + GJ [Solv+GJ] into the right lung under bronchoscopic guidance. The results showed that in a minipig model OP and GJ placed into one lung created a direct (right) and indirect (left) lung injury significantly different to controls, and in some respects worse than GJ alone 48 hours after poisoning. The direct lung injury caused by OP+GJ was characterised by significantly worse pathology (p=0.0003) in terms of: pulmonary neutrophilia, alveolar haemorrhage, necrosis, oedema and fibrin deposition, when compared with sham controls at 48 hours. Lungs injured directly with OP+GJ also had significantly higher concentrations of BALF neutrophils (p≤0.01), protein (p≤0.05), IL-6 (p≤0.01), IL-8 (p≤0.01) and CRP (p≤0.05) at 24 hours, and BALF protein (p≤ 0.01), and CRP (p≤ 0.05) when compared with sham controls at 48 hours. The BALF from OP+GJ minipigs at 48 hours also had higher numbers of aerobic bacteria than other groups, suggesting the development of pneumonia could be a source of additional lung injury. Lung damage might also have resulted from a reduction in the surfactant component responsible for the lowering of alveolar surface tension. Direct lung injury with OP+GJ caused a proportional reduction of beneficial pulmonary surfactant phosphatidylcholine (PC) species 16:0/16:0 [29(±4) % vs. 38(±4) %] when compared with sham controls at 48 hours. Unlike the other groups, OP+GJ (direct and indirectly-injured) lungs had type 2 alveolar cell ultrastructural morphological differences in the lamellar bodies that stored the surfactant. The lamellar bodies were more numerous and more dense in the OP+GJ lungs compared with other groups and could signify a failure of surfactant release or some other pathology pertinent to OP aspiration lung injury. Computed tomography analysis showed that direct lung injury with OP+GJ caused significantly more lung tissue to be poorly or non-aerated [77 (±13) % ; p≤0.0001 when compared with sham] as opposed to 62 (±27) % in GJ, 53(±13)% in sham and 47(±0.2)% in saline control animals by 47.5 hours and was mainly due to pulmonary haemorrhage and oedema fluid. The key differences between aspiration of OP+GJ versus GJ alone was that the majority of inflammatory markers (e.g. BALF protein, IL-6 and CRP) appeared to increase from 24-48 hours in OP+GJ treated animals, but decreased in GJ pigs, possibly signifying resolution. Treatment with GJ alone produced less severe histopathological damage, bacterial BALF numbers and percentage of poorly and non-aerated lung tissue. Importantly, there was less evidence of indirect lung injury within the GJ pigs when compared with animals treated with OP+GJ. Solvent placed into the lung seemed to offer some form of protection from the effects of GJ aspiration. This was dramatically demonstrated by the histopathology scores, proportional percentage of beneficial phosphatidylcholine (PC) species 16:0/16:0 and the percentage of poorly and non-aerated lung tissue all approaching control animal levels by 48 hours in minipigs that had Solv+GJ placed in the directly-injured (right) lung. Further evidence of benefit was provided by statistically significant reductions (p≤ 0.05) in BALF concentrations of IL-8, IL-6 and CRP in minipigs which had aspirated Solv+GJ when compared with OP+GJ and/or GJ minipig groups at 24 hours. The pathophysiology of aspirated OP+GJ was also investigated in a pilot ovine ex vivo lung perfusion (EVLP) model (n=4). Lungs directly-injured with OP+GJ had higher concentrations of total protein (4300 mg/L vs. 350 mg/L) with a proportional reduction of beneficial pulmonary surfactant phosphatidylcholine species 16:0/16:0 (27% vs.34%) when compared with control lungs. Analysis of toll-like receptor (TLR) lung tissue expression in the OP+GJ directly and indirectly-injured lungs indicated that inflammatory mechanisms might also involve upregulation of TLR 3 and 5, unlike other lung injuries e.g. those induced with lipopolysaccharide, which typically upregulates TLR 2 and 4. To compare OP-induced lung injury in humans and the minipigs, a small feasibility study was conducted in the ICUs of the University of Peradeniya hospital, Sri Lanka. Unfortunately, ethics review and recruitment proved more difficult than expected and we failed to recruit to target. We did however find raised BALF concentrations of IL-6, IL-8 and CRP and low concentrations of TNF, IL-1β, IL-10 in intubated OP poisoned patients at 24 hours when compared with controls. We also found that two plasma micro-RNA biomarkers thought to be involved in inflammation and lung injury, MiR-21 and MiR-146a, had significantly reduced expression in OP-poisoned patients with aspiration compared to non-intubated control patients from the UK (p=0.008 and p=0.0083 respectively). The work from this thesis has allowed the characterisation of both indirect and direct lung injuries caused by OP pesticide ingestion and aspiration. The minipig model showed that at 48 hours the lung injury created by aspiration of OP+GJ appeared more severe than GJ alone, but the addition of the solvent cyclohexanone seemed protective and even beneficial in the context of GJ aspiration. The cytokine expression profiles from both the human and minipig work, combined with the preliminary TLR lung tissue analysis from the EVLP model, suggest that OP+GJ aspiration is unlike normal GJ aspiration and classic ARDS. / Increased concentrations of aerobic bacteria in the minipig OP+GJ lungs at 48 hours and evidence of suppression of plasma miR-21 and miR-146a in OP poisoned patients could be linked, and may involve cholinergic immune system modulation. These molecular mechanisms need to be investigated further in both in vitro and in vivo models. These discoveries indicate the complex nature of the pulmonary injury that occurs after OP pesticide poisoning, and suggests that damage is not caused by gastric contents alone. Preliminary findings indicate that aspiration of OP+GJ could create favourable conditions for the development of aspiration or ventilator-associated pneumonia but this would need confirmation in larger clinical studies. The potential roles of micro RNA as a biomarker of OP poisoning and lung injury, and solvent as a therapy for aspiration should be explored in further pre-clinical studies.

Esta dissertação busca interrogar a relação entre o obsceno e o suicídio, levando em conta a teoria psicanalítica. Inicia-se falando sobre a leitura de Durkheim sobre o suicídio e diferentes abordagens psicanalíticas sobre o tema. Opta-se por seguir a leitura de Jinkis e Pipink, que entendem que o suicídio pode ser lido como ato, ato falho, passagem ao ato ou acting out. Então, uma breve apresentação sobre cada um desses conceitos é feita, seguida pela análise de como um suicídio pode ser lido em cada uma dessas situações. Logo, parte-se para uma reflexão acerca do obsceno, que é entendido como o que não pode ser colocado em cena. Relaciona-se o obsceno com a morte, que é mostrada em sua vertente repugnante, que está relacionada com o impensável de nossa desaparição. Uma vez que o obsceno comporta a dialética mostrar-ocultar, ele coloca em jogo a pulsão escópica e, por conseguinte, a questão do olhar em psicanálise é abordada. O olhar é entendido como uma das vertentes do objeto a e se relaciona com o desejo de ver, desejo de saber. Por fim, aborda-se a relação entre o obsceno e o suicídio, sustentando-se a ideia de que o suicídio pode ter um lugar obsceno. / This dissertation seeks to interrogate the relationship between suicide and the obscene considering the psychoanalytic theory. Starts talking about Durkheim’s reading on suicide and different psychoanalytic approaches to the topic. Is chosen to follow the reading of Jinkis and Pipink who understand that suicide can be read as an act, Freudian slip, passage to the act or acting in out. Then, a brief presentation on each of these concepts is made, followed by how a suicide can be read in each of these situations. So, we go to a reflection about the obscene, which is understood as what can not be put into play. Relates obscene with death that is shown in its disgusting aspect, which is related to the unthinkable of our disappearance. Once obscene involves the dialectical show and hide, it brings into play the scopic drive, therefore the question the gaze in psychoanalysis is discussed. The gaze is understood as one aspect of the object a and it relates to the desire to see, desire to know. Finally, it handles the relationship between the obscene and suicide, where it supports the idea that suicide may have a obscene place.