M.Cur. (Psychiatric Nursing) / Suicide is the intentional, self-induced action leading to death - an action regarded by the World Health Organisation (WHO) as the third largest cause of death among people under the age of 20 years in the Western World. In South Africa the occurrence of suicide has risen from'0,73 percent of the population in 1987 to 1,12 percent. Suicide has both financial and emotional implications for the community, who pays for it, either directly or indirectly. Suicides and attempted suicides place a burden on the health system and the public by way of higher taxes, increased medical fund contributions and higher insurance premiums. Health and welfare costs escalate because disability pensions are paid of work functions have become impeded in cases where suicide attempts have failed and for the rehabilitation (physical and psychological) of the person whose suicide attempt has failed, as well as for the surviving members of a family where a suicide attempt was successful. Between seven ten people are affected by every person who commits suicide. Not only do they experience shock, denial and helplessness as in the case of a 'normal' death, but also feelings of anger guilt and emotional distress, together with the development of physical symptoms. They become anxious, weepy and are afraid to be alone. They tend to use more sedatives and, tragically, become higher suicide risks themselves than the average population. Therefore, suicide is not only the beginning of an unprepared, intense grief reaction, but also a psychiatric trauma which leaves people emotionally vulnerable and thereby negatively influences their quest for wholeness. People close to suicide victims require the mobilisation of resources to facilitate their quest for wholeness. This study is aimed at exploring the experiences of people close to suicide victims and to determine guidelines for supporting people close to suicide victims, to enable to nurse and mobilise the resources that will facilitate their quest for wholeness. The researcher used the Nursing for the Whole Person Theory as a point of departure. The research is of an exploratory and descriptive nature and contextually bond due to the fact that an effort was made to obtain new perceptions and understanding of the experiences of people close to suicide victims. A phenomenological method of naive sketches was used to obtain data. The random sample population consisted of ten participants obtained by way of purposive, convenient random test and which complied with specific selection criteria. Data was analysed by way of content analysis. The experiences of persons close to suicide victims are contained in experiences in the internal environment, the external environment and patterns of interaction according to the results of the research and a literary control. Certain themes are identified according to which guidelines can be set, namely: chaos immediately after being notified of the suicide, avoidance and denial as defence mechanisms, deranged perceptions concerning the suicide, mixed feelings, the development of empathy, a need for reason and meaning in the suicide, disturbed relationships, a need for ventilating and the occurrence of questions concerning the suicide. Guidelines for support are discussed in three phases of support. The first phase entails support immediately after being notified of the suicide, the second phase offers support by way of helping the persons close to the suicide victim to integrate the reality of the suicide, while the third phase of support addresses the lengthened grief process. General information, non-professional support and professional support are regarded as sources of support.

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bgelaye@hsph.harvard.edu / Article / Objective: To examine the independent and joint relationships of poor subjective sleep quality and antepartum depression with suicidal ideation among pregnant women. Methods: A cross-sectional study was conducted among 641 pregnant women attending prenatal care clinics in Lima, Peru. Antepartumdepression and suicidal ideationwere assessed using the Patient Health Questionnaire-9 scale. Antepartumsubjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Logistic regression procedures were performed to estimate odds ratios (aOR) and 95% confidence intervals (95% CI) adjusted for confounders. Results: Overall, the prevalence of suicidal ideation in this cohort was 16.8% and poor subjective sleep qualitywas more common among women endorsing suicidal ideation as compared to their counterpartswho did not (47.2% vs. 24.8%, Pb.001). After adjustment for confounders including maternal depression, poor subjective sleep quality (defined using the recommended criteria of PSQI global score of N5 vs. ≤5) was associated with a 1.7-fold increased odds of suicidal ideation (aOR=1.67; 95% CI 1.02–2.71). When assessed as a continuous variable, each 1-unit increase in the global PSQI score resulted in an 18% increase in odds for suicidal ideation, even after adjusting for depression (aOR=1.18; 95% CI 1.08–1.28). Women with both poor subjective sleep quality and depression had a 3.5-fold increased odds of suicidal ideation (aOR=3.48; 95% CI 1.96–6.18) as compared with those who had neither risk factor. Conclusion: Poor subjective sleep quality was associated with increased odds of suicidal ideation. Replication of these findings may promote investments in studies designed to examine the efficacy of sleep-focused interventions to treat pregnant women with sleep disorders and suicidal ideation. / This research was supported by an award fromtheNational Institutes of Health (NIH; R01-HD-059835, T37-MD000149 and K01MH100428). The NIH had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. The authors wish to thank the dedicated staff members of Asociacion Civil Proyectos en Salud (PROESA), Peru and Instituto Especializado Materno Perinatal, Peru, for their expert technical assistance with this research. / Revisión por pares

This study aims to describe the relationship of personality disorders to the repetition of parasuicide whilst taking cognizance of recent developments in the classification of and assessment for personality disorders. This study also aims to determine whether risk factors described by other authors for further suicidal behavior are characteristic of these patients locally. This study also aims to describe the contribution of newly described personality dimensions to repetition of parasuicide. This study also describes suicidal behavior in the follow-up period of a cohort of parasuicide patients who were seen in the emergency psychiatric service during follow-up. This study also examines the comorbidity between the personality disorders categories defined by the clinical criteria of the Tenth International Classification of Mental and Behavioral Disorders or ICD-10, (World Health organization, 1992). This study compares the co-occurence of these new personality disorder categories with the comorbidity which has been observed in older classification systems (American Psychiatric Association; 1980, 1987) in order to determine whether this new classification system has led to less comorbidity among the personality disorders. This study also examines aspects of the relationship between informant based diagnoses of personality disorder and personality dimensions described by Cloninger et al (1994).

Suicide is a leading cause of death in the United States, despite a wealth of research investigating suicide risk factors. Sleep disturbances are also rising, and continue to be an often undetected and untreated source of increased suicide risk. A growing body of literature has looked for connections between sleep disturbances and increased suicidality, but few studies have looked at differentiating between single and multiple suicide attempters. Further, when assessing nightmares, literature varies widely on defining and measuring symptoms of nightmares, and no known studies have compared frequency, distress/severity, and duration. Participants (n =225) were recruited via an online study conducted on Amazon Mechanical Turk who reported one or more prior suicide attempts. Results show that nightmare frequency independently predicted multiple suicide attempters when controlling for symptoms of depression, PTSD, insomnia, nightmare severity/distress, and nightmare duration. Clinical implications for findings include screening and treating nightmares as a potential suicide intervention.

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Bereavement is a challenging time for those experiencing a loss, and it poses a difficult clinical question: How do we help individuals who are grieving? The literature provides mixed evidence for variations in bereavement depending on the type of loss (e.g., suicide, expected natural, unexpected natural, accidental); however, there seems to be more overlap among grief processes than differences. Given that various religions tend to include tenets suggesting the sinfulness of death by suicide, the present study hypothesized that there would be greater levels of negative religious coping, less positive religious coping, less perceived religious support, and greater rates of lying about cause of death in response to suicide loss than natural or accidental deaths. Overall, our findings suggested little to no difference among positive religious coping or perceived religious support following suicide, accidental, or natural deaths. Various comparison methods yielded moderately consistent findings that individuals lied about cause of suicide death more often than natural or accidental deaths, consistent with extant research. Further, there was some evidence of greater levels of negative religious coping for accidental deaths than natural deaths. The current study contributes prevalence rates for exposure to and distress following suicide, natural, and accidental deaths, as well as suggesting that the role of religion in suicide bereavement need not be different from other types of death.

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