Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 6 uppsatser.

Mental health risks within the adult male homosexual population have been researched; however no comprehensive synthesis of research findings was identified. The purpose of this research was to synthesize current research findings of mental health risks among the male homosexual population. This was limited to international studies conducted between 2003-2008 focusing on suicide, Eating Disorders, and Depression. These findings may serve as an educational resource for nurses and healthcare providers. Findings indicated that homosexual men are at an increased risk for suicide, Eating Disorders, and Depression. Several possible causes were identified, such as internalized homophobia, minority stress, social isolation, gender role orientation, community pressure, and comorbidity with mental health disorders. Limitations included small sample sizes, with limited age and ethnic diversity. Non probability sampling and lack of consistency in measurement of research variables limited the generalizability of the findings. Nursing education and practice should emphasize culturally-competent care and specific healthcare needs of this population. A focus on assessment and awareness of healthcare risks may be beneficial. Recommendations for future research include large, probability samples, and possibly population-based surveys. Research should focus on stressors and protective factors to formulate culturally sensitive interventions. Clinical trials of interventions are needed to form evidence-based practice guidelines.

Suicide in India is a complex social issue and a neglected area by the state. Research has focused on risk factors and the epidemiology of suicide; studies concerning the intersection of culture with attempted suicide are limited. The aim of this study is to explore cultural implications of attempted suicide and its prevention in Southern India by means of comparing and contrasting the accounts of survivors of attempted suicide, mental health professionals and traditional healers engaged in treating people with suicidal behaviour. Methodology: A qualitative design is used drawing on constant comparison method and thematic analysis. The analysis of the data is underpinned by the theoretical concepts of Bourdieu’s work. In-depth interviews were conducted with fifteen survivors of attempted suicide, eight mental health professionals and eight healers from Southern India. Results: Application of Bourdieu’s theory of symbolic power and violence, cultural capital and habitus to the analysis of data revealed the process of constant interaction among visible and invisible fields such as faith, power, control, family, religion and social systems which impact survivors’ disposition to situations. Disparities in gender and role structures within families, financial challenges, health concerns, abuse, and violence were commonly cited factors by all three groups of participants. A few survivors and healers attributed misfortunes and distress to magic, spells and ‘bad times’. Healers and professionals were particularly of the opinion that cultural transition has added to stress among people. Survivors considered religious and traditional methods of support as socially accepted norms. Medical assistance was sought only during apparent ill health. Psychosocial support was very rarely accessed and availed. A lack of awareness among family members and friends to identify mental health concerns and a wide gap between identification of severe stressors and treatment increased the risk of suicide and limited timely intervention. Conclusion: This study identified a set of cultural mechanisms that produced negative impact and led to attempted suicide. The role of culture in causing suicide and attempted suicide is explained by unraveling the dynamics of cultural mechanisms and support processes that survivors experienced and as reported by professionals and healers. This research evidence presents pathways into attempted suicide and a life away from suicide.

Background: It is unclear whether antidepressants can prevent suicides or suicide attempts, particularly during longterm use. Methods: We carried out a comprehensive review of long-term studies of antidepressants (relapse prevention). Sources were obtained from 5 review articles and by searches of MEDLINE, PubMed Central and a hand search of bibliographies. We meta-analyzed placebo-controlled antidepressant RCTs of at least 3 months’ duration and calculated suicide and suicide attempt incidence rates, incidence rate ratios and Peto odds ratios (ORs). Results: Out of 807 studies screened 29 were included, covering 6,934 patients (5,529 patient-years). In total, 1.45 suicides and 2.76 suicide attempts per 1,000 patient-years were reported. Seven out of 8 suicides and 13 out of 14 suicide attempts occurred in antidepressant arms, resulting in incidence rate ratios of 5.03 (0.78–114.1; p = 0.102) for suicides and of 9.02 (1.58–193.6; p = 0.007) for suicide attempts. Peto ORs were 2.6 (0.6–11.2; nonsignificant) and 3.4 (1.1–11.0; p = 0.04), respectively. Dropouts due to unknown reasons were similar in the antidepressant and placebo arms (9.6 vs. 9.9%). The majority of suicides and suicide attempts originated from 1 study, accounting for a fifth of all patient-years in this meta-analysis. Leaving out this study resulted in a nonsignificant incidence rate ratio for suicide attempts of 3.83 (0.53–91.01). Conclusions: Therapists should be aware of the lack of proof from RCTs that antidepressants prevent suicides and suicide attempts. We cannot conclude with certainty whether antidepressants increase the risk for suicide or suicide attempts. Researchers must report all suicides and suicide attempts in RCTs.

Suizidale Handlungen, also Suizide und Suizidversuche, sind mit großem Schmerz, großer Trauer und auch großem Schamgefühl verbunden. Dies betrifft nicht nur die Suizidenten selbst, sondern auch Angehörige und Freunde. Weltweit sterben etwa eine Million Menschen jährlich durch Suizid und in Deutschland steht der Suizid auf Platz sieben der häufigsten Todesursachen. Schätzungen zu Folge ist die Anzahl der Suizidversuche pro Jahr, im Vergleich zu den Suiziden, bis zu 30-fach höher. Dies zeigt, dass suizidale Handlungen zusätzlich eine hohe Relevanz für das Gesundheitssystem darstellen. Diese Arbeit entstand im Zuge des OSPI-Projektes in Leipzig. Einem europäischen Projekt zur Einführung eines Präventionsprogramms gegen suizidale Handlungen. Es wurden alle Suizidenten, die innerhalb eines Zeitraums von drei Jahren im Universitätsklinikum Leipzig behandelt wurden, erfasst. Die elektronischen Patientenakten wurden dafür, unter Verwendung der entsprechenden ICD-Kodierungen für Selbstverletzungen bzw. Selbstvergiftungen, durchsucht. Ziel war es, neben der lückenlosen Erfassung und epidemiologischen Auswertung aller Fälle, Aussagen über die Art der Behandlung von Suizidenten und den damit verbundenen direkten und indirekten Kosten zu machen. Es zeigten sich, im Vergleich zu bereits bestehenden Studien aus anderen Ländern, keine signifikante epidemiologischen Unterschiede, während deutlich mehr Patienten intensivmedizinisch versorgt und psychiatrisch untersucht wurden, als dies in anderen Ländern der Fall war. Im Hinblick auf die Gesamtkosten, in Höhe von rund 3,9 Millionen Euro, konnte diese Arbeit, abgesehen vom menschlichen Aspekt, die ebenfalls wichtige gesundheits-ökonomische Bedeutung solcher Fälle aufzeigen.

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From a practical point of view, the well-proven antisuicidal and anti-aggressive effects of lithium are of utmost importance for a rational, safe and economical treatment of patients with affective disorders. Regular lithium long-term treatment reduces the otherwise 2- to 3-fold increased mortality of untreated patients with severe affective disorders down to the level of the general population. This is mainly due to the reduced suicide risk. Many international studies have confirmed this fascinating property of lithium which so far has not been demonstrated with comparable evidence for any other psychotropic compound. The antisuicidal effects of lithium might possibly be related to its anti-aggressive effects which have been shown in various species, populations and settings, such as animals, inhabitants of nursing homes for the elderly, mentally handicapped subjects, children and adolescents with hyperactive, hostile and aggressive behavior, and particularly in hyperaggressive inmates of correction units and prisons. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.