Department of Psychology, University of Newcastle. Bibliography: leaves 69-78.

Neuropsychological deficits may perpetuate the risk and chronicity of psychiatric disorder. Borderline Personality Disorder, characterized by significant suicide risk, intense affect and behavioural dysregulation, is frequently associated with the executive function (EF) deficits of decision making and inhibitory control. However, the role of inhibitory control on decision making remains poorly understood. This study examined the relationships among working memory, cognitive and motor inhibitory control, and IGT decision-making performance in 41 women with BPD and 41 healthy controls. Associations among EF and suicide risk were also explored. Experimental tasks included the Iowa Gambling Task, Digit Span, Stroop and Stop Tasks, and Raven’s Matrices. Only IGT decision-making deficits distinguished BPD subjects from healthy controls. Weaker yet normal range IQ and EFs in BPD women did not explain their disadvantageous IGT performance. Contrary to expectations, IGT deficits in BPD women did not predict any suicidal risk; however, intact interference control was as sensitive to suicidal risk as was depression. Normal interference control was associated with a reduction in suicide risk. While IGT decision making may be a marker for BPD, Stroop interference control is more sensitive to suicide risk and may represent a vulnerability for suicide that exists beyond psychiatric diagnosis.

Neuropsychological deficits may perpetuate the risk and chronicity of psychiatric disorder. Borderline Personality Disorder, characterized by significant suicide risk, intense affect and behavioural dysregulation, is frequently associated with the executive function (EF) deficits of decision making and inhibitory control. However, the role of inhibitory control on decision making remains poorly understood. This study examined the relationships among working memory, cognitive and motor inhibitory control, and IGT decision-making performance in 41 women with BPD and 41 healthy controls. Associations among EF and suicide risk were also explored. Experimental tasks included the Iowa Gambling Task, Digit Span, Stroop and Stop Tasks, and Raven’s Matrices. Only IGT decision-making deficits distinguished BPD subjects from healthy controls. Weaker yet normal range IQ and EFs in BPD women did not explain their disadvantageous IGT performance. Contrary to expectations, IGT deficits in BPD women did not predict any suicidal risk; however, intact interference control was as sensitive to suicidal risk as was depression. Normal interference control was associated with a reduction in suicide risk. While IGT decision making may be a marker for BPD, Stroop interference control is more sensitive to suicide risk and may represent a vulnerability for suicide that exists beyond psychiatric diagnosis.

Les adolescents sont de plus en plus nombreux à chercher des réponses à leurs questions en matière de santé par les technologies de l’information et de la communication (TIC), surtout en santé mentale. Ainsi, plus les adolescents ont un risque suicidaire élevé, moins ils cherchent de l’aide en personne et plus ils se tournent vers les TIC. À ce jour, aucune étude québécoise n’a exploré le processus de recherche d'aide par les TIC chez des adolescents ayant un risque suicidaire. Le but de la présente étude était donc de comprendre et générer une théorie sur le processus de recherche d'aide par les TIC chez des adolescents ayant un risque suicidaire. Les objectifs de recherche étaient : (1) de décrire l’utilisation des TIC par des adolescents à risque de suicide pour rechercher de l’aide et (2) de comprendre le processus de recherche d'aide des adolescents par les TIC pour trouver des ressources en lien avec le suicide. La méthode de la théorisation ancrée a été utilisée pour répondre à ces objectifs et modéliser le processus. La collecte de données a été effectuée à partir d’entrevues individuelles semi-structurées, d’un questionnaire sur la recherche d’aide par les TIC et d’observations d’une recherche d’aide réelle par les adolescents de l’étude. Un n de 15 participants, âgés de 13 à 17 ans ayant un suivi pour leur risque suicidaire a été atteint par la saturation théorique. Les données recueillies ont été transcrites, puis soumises à une analyse de contenu par codification ouverte, axiale et sélective. Le modèle paradigmatique de Corbin et Strauss (2015) et la méthode de la comparaison constante ont été utilisés jusqu’à la saturation des données et l’émergence d’une théorie substantive, soit la théorie de la noyade émotive virtuelle. Il en résulte que les TIC les plus utilisées par les jeunes de l’étude étaient les sites Internet d’information et de ressources, les vidéos en ligne ainsi que les outils d’autoformation. Cette utilisation des TIC s’avérait fréquente, rapide et efficace. Pour « composer virtuellement avec sa noyade émotive » (catégorie centrale), l’adolescent peut adopter plusieurs stratégies, parfois dans une même séance: se distraire, s’informer, se dévoiler et aider les autres. Ces stratégies peuvent entraîner une croissance émotive, l’obtention d’aide, un soulagement temporaire, aucun changement, une exacerbation des idées suicidaires ou un passage à l’acte. Des recommandations pour la pratique clinique, la formation ainsi que la recherche sont émises. / A growing number of adolescents are seeking answers to health problems through Information and Communication Technologies (ICT), especially regarding mental health. Some studies even report that adolescents highly at risk of suicide do not seek help in person and prefer seeking help through ICT. To our knowledge, no study in Quebec has yet explored the ICT help-seeking process of adolescents at risk of suicide. Thus, the aim of this study was to understand and generate a theory on the ICT help-seeking process of adolescents at risk of suicide. The objectives were to: (1) describe the use of ICT by adolescents at risk of suicide seeking help and (2) understand the ICT help-seeking process of adolescents at risk of suicide. Grounded theory methodology was used in response to these objectives to help model the help-seeking process of adolescents at risk of suicide. Data was collected through semi-structured interviews, an ICT help-seeking questionnaire and live observations of ICT help-seeking by the adolescents of this study. Theoretical saturation was reached with a total of 15 adolescents, aged 13 to 17, at risk of suicide. Data was analyzed using Corbin and Strauss’s paradigm model and the constant comparative method until data saturation occurred and a substantive theory was generated called the virtual emotional drowning theory. In order to “virtually cope with emotional drowning” (central category), the participating adolescents tried different strategies and sometimes, more than one strategy was used in the same session. These strategies included distracting themselves, getting informed, revealing themselves and helping others. The use of these strategies resulted in emotional growth, getting help, getting temporary relief, having no changes or sadly, having an exacerbation of suicidal thoughts or an actual suicide attempt. Finally, suggestions for clinical practice, training programs and future research are presented. The results of this study allow a better understanding of the use of ICT by adolescents at risk of suicide in order to develop, implement and evaluate ICT nursing interventions that will better respond to these adolescents’ needs.

Bakgrund: Suicid är en självdestruktiv handling som leder till döden och är oftast en konsekvens av ett ohanterbart lidande. Bedömning av suicidrisk utgör en betydande del av den psykiatriska omvårdnaden som både ställer krav och är en stor stressfaktor för sjuksköterskan. Syfte: Syftet med studien var att identifiera och syntetisera sjuksköterskors erfarenheter av att bedöma suicidrisk inom psykiatrisk vård. Metod: En kvalitativ studie med en metaetnografisk design av Noblit och Hare (1988). Resultat: I studien framkom huvudmetaforen Livräddande arbete utan flytväst på stormiga hav som symboliserar sjuksköterskans roll och förutsättningar i arbetet med att bedöma suicidrisk. Sjuksköterskor ansåg att bedömning av suicidrisk gav dem en känsla av ansvar för personens liv. Syntetiseringen genererade temat Balansera mellan ytterligheter med tre subteman Autonomi kontra Begränsningar, Transparens kontra Distans och Magkänsla kontra Bedömningsinstrument samt temat Härbärgera känslor med tre subteman Bära ansvaret, Ha ryggen fri och Söka stöd och bekräftelse. Slutsats: Sjuksköterskor inom psykiatrisk vård behöver stöd i arbetet med suicidnära personer och bedömningar av suicidrisk. Tid och möjlighet till reflektion är viktigt för sjuksköterskans hantering av de känslor som arbetet med suicidnära personer medför. Förslag till klinisk tillämpning är att införa tydliga rutiner gällande stöd i omvårdnadsarbetet samt regelbunden avsatt tid för reflektion. / Background: Suicide is a self-destructive act that leads to death and is usually a consequence of a suffering the person has not been able to handle. Suicide risk assessment constitutes a significant part of psychiatric care, which both place demands and is a major stress factor for the psychiatric nurse. Aim: The purpose of the study was to identify and synthesize psychiatric nurses' experiences of assessing suicide risk. Method: A qualitive study with a Meta ethnographic design by Noblit and Hare (1988). Results: The study revealed the main metaphor Life-saving work without a life jacket on stormy seas that symbolizes the nurse’s role and conditions in the work of assessing suicide risk. Nurses felt that assessing suicide risk gave them a sense of responsibility for the person’s life. The synthesis generated the theme Balancing between extremes with the three subthemes Autonomy versus Limitations, Transparency versus Distance and Gut feeling versus Assessment instruments and the theme Harboring emotions with the three subthemes Bear the responsibility, Cover your back and Seek support and affirmation. Conclusion: Nurses in psychiatric care need support. There´s a need for clinical supervision and scheduled time for self-reflection so the nurse can be able to handle the feelings working with assessing suicide risk may trigger. Suggestions for clinical application include introducing clear routines regarding support at work and regular time set aside for reflection.

Bakgrund: Psykisk ohälsa präglas ofta av samsjuklighet och/eller komplexa behov som försvårar bedömningar. Suicid är ett globalt folkhälsoproblem och hälso- och sjukvården skall arbeta med suicidprevention för att undvika vårdskador av såväl given som utebliven vård och omvårdnad. Tusentals personer utför självmordsförsök varje år och det är vanligare att dö i fullbordat suicid än i trafikolycka i Sverige. Sjuksköterskor träffar prehospitalt frekvent suicidnära patienter. Suicidriskbedömning är komplext och dess kvalité beror på kompetens och erfarenhet. Bristfällig suicidriskbedömning kan leda till undvikbara vårdskador för patienter. Syfte: Att undersöka och beskriva upplevelser och erfarenheter av suicidriskbedömning prehospitalt. Metod: Mixad metod av kvantitativ och kvalitativ design bestående av enkät och semistrukturerade intervjuer med sjuksköterskor i ambulanssjukvården. Resultat: Sjuksköterskor upplevde stress, oro och fysiska symtom som ont i magen och tungt i bröstet på väg fram till suicidnära patienter liksom känsla av osäkerhet och otillräcklighet gällande bedömning och bemötande. Sjuksköterskor upplevde skyldighet att förebygga suicid och de flesta hade både identifierat suicidnära patienter liksom utfört suicidriskbedömning prehospitalt utan att ha fått utbildning i det. Diskussion: Resultatet överensstämde med tidigare forskning gällande negativa upplevelser av att möta suicidnära patienter. Slutsats: Sjuksköterskor mötte frekvent suicidnära patienter och utförde suicidriskbedömningar samtidigt som de hade negativa känslor inför mötet med suicidnära patienter och upplevde sig ha varierande såväl reell som formell kompetens för suicidriskbedömning. / Background: Mental illness often characterizes by comorbidity and / or complex needs that complicate assessments. Suicide is a global public health problem and health services must work with suicide prevention to avoid injuries from poor assessment. Thousands of people commit suicide attempts every year and it is more common to die in suicide than in a traffic accident in Sweden. Nurses frequently see suicidal patients outside of hospital. Suicide risk assessment is complex, and its quality depends on competence and experience. Poor suicide assessment could lead to avoidable injuries in patients. Aim: To investigate and describe experiences of suicide risk assessment in emergency setting outside of hospital. Method: Mixed method consisting of quantitative and qualitative design with questionnaire and semi structured interviews with nurses. Results: Nurses experience stress, anxiety, and physical symptoms such as pain in the stomach and heavy feeling in the chest on the way to suicidal patients as well as feelings of insecurity and inadequacy regarding assessment and treatment. Nurses feel an obligation to prevent suicide, and most have both identified suicidal patients as well as performed a suicide risk assessment prehospital without having received training in it. Discussion: The results was consisted with previous research about negative emotions when caring for and assessing the suicidal patient. Conclusion: Nurses frequently meet suicidal patients and perform suicide risk assessments. At the same time, they have negative feelings towards meeting suicidal patients and have a variety of both real and formal competence for the task of suicide risk assessment. / <p>Datum för godkännande: 2022-01-17</p>

В статье анализируется необходимость формирования осознанного отношения у молодежи к смерти. Было выяснено, что сегодня молодёжь живёт в благополучной среде и в основном довольна жизнью, но есть факторы, провоцирующие рост риска суицидального поведения. Результатом представляется проект «Развитие осознанного отношения к смерти у молодёжи». / The article analyzes the necessity of forming an informed attitude to death among young people. It was found out that today young people live in a prosperous environment and are mostly satisfied with life, but there are factors provoking the growth of risk of suicidal behavior. The result is the project "Development of conscious attitude to death in youth".

La prévention du suicide est une activité importante pour les professionnels de la santé et particulièrement pour les infirmières . Or, le processus d’évaluation du risque suicidaire n’est pas effectué de façon systématique d’un milieu de soins à un autre auprès d’une population adulte. De plus, il y a peu d’information sur ce processus d’évaluation du risque suicidaire auprès des enfants de moins de 12 ans. C’est un sujet difficile à aborder et à comprendre dans une société où l’accent est mis sur grandir en santé. Cette étude vise à décrire, comprendre et schématiser le processus d’évaluation du risque suicidaire auprès des enfants de moins de 12 ans selon une perspective infirmière en santé mentale. Le modèle humaniste des soins infirmiers-UdeM constitue la toile de fond de cette étude compte tenu de sa vision centrée sur la Personne , ses relations interpersonnelles significatives, son expérience de santé ainsi que les significations qu’elle lui accorde. Pour atteindre le but de notre étude, une approche par théorisation ancrée inspirée de Strauss et Corbin (1998) a été retenue. L’échantillon a été obtenu à l’aide d’entrevues semi-structurées avec des infirmières (n=11) provenant de cinq régions administratives différentes au Québec ainsi qu’à l’aide de questionnaires socio-démographiques, d’outil de collecte de données utilisées par les infirmières ainsi que de notes de terrain. Une analyse comparative continue à travers une triple codification a permis de proposer une schématisation spécifique au processus d’évaluation du risque suicidaire auprès des moins de 12 ans en santé mentale. Les principaux résultats indiquent qu’il y a deux phases à ce processus d’évaluation. La première phase est centrée sur comprendre le sens de la détresse chez l’enfant et la deuxième phase consiste à assurer la sécurité de l’enfant et de sa famille. Dans chacune des phases, nous avons remarqué l’importance de la relation interpersonnelle entre l’infirmière, d’un côté, et l’enfant et ses parents, de l’autre. Plus précisément, certaines caractéristiques de l’infirmière (tempérament, croyances et perceptions, expériences antérieures, formation) en relation avec celles de l’enfant et de sa famille (propos ou comportements suicidaires, conception de la mort, dynamique familiale ainsi qu’attitudes, perceptions et croyances des parents) s’inter-influencent de manière à produire des effets positifs ou négatifs sur l’ensemble du processus de cette évaluation. L’environnement, soit l’organisation des soins (fonction occupée par l’infirmière, acuité des soins, ressources humaines disponibles et collaboration interprofessionnelle), affecte également le processus. De plus, le processus d’évaluation du risque suicidaire chez l’enfant implique pour l’infirmière de prendre en compte le développement de l’enfant qu’elle rencontre, que ce soit lorsqu’elle tente de comprendre le sens de sa détresse ou lorsqu’elle cherche à assurer sa sécurité. Ainsi, l’infirmière doit être vigilante afin de maintenir une posture d’empathie et non se laisser envahir par les émotions qu’une telle évaluation peut engendrer. Cette étude permet d’approfondir la compréhension du processus d’évaluation du risque suicidaire auprès des moins de 12 ans afin d’aider les professionnels de la santé travaillant en prévention du suicide auprès des jeunes à comprendre ce qui est vécu pour mieux intervenir. / Suicide prevention is an important aspect of the work of any healthcare professional, especially for nurses working in mental healthcare settings. However, suicide risk assessment is not conducted systematically, varying from one setting to another. Furthermore, there is no information to our knowledge on this type of risk assessment process with children under 12 years old. This topic is particularly difficult to explore and to understand in a society where children are expected to grow to be healthy and happy. The aim of this study is to describe, understand and schematize nurses’ suicide risk assessment process with children under12 in a mental health setting. The background of this study is the humanistic model in nursing – UdeM. Centered on the Person, this model takes into account their significant interpersonal relationships, their subjective experience of care and its meaning. Strauss et Corbin’s (1998) approach in grounded theory was used to conduct this study. Using theoretical sampling, data was obtained through 11 semi-structed interviews with nurses working in five different administrative regions in the province of Quebec, nurses’ documents, socio-demographic questionnaires, and field notes. A constant comparative analysis of the data across triple coding allowed a better understanding and a schematization of the nurses’ suicide risk assessment process with children. The process includes two main phases relating to nurses’ actions. These two phases are: (1) Understanding the meaning of the child’s distress, and (2) Ensuring the child and their family’s safety. The different elements involved in each phase are not exclusive to one phase or the other. In fact, characteristics of nurses (temperament, beliefs and perceptions, past experiences) interact with those of the child and his or her family (suicidal ideations or behaviors, level of understanding of the concept of death, mental health state, family dynamics and attitudes, parents’ perceptions and beliefs ). This interaction can produce both positive and negative impacts. The environment (health and services organization) where this interaction occurs can also impact on the whole assessment process. Our findings reveal that for both phases of the assessment process with children, nurses have to take in account the developmental aspect of the child and must be careful to maintain their empathic posture, so they are not overwhelmed by emotions. Doing so will help lessen the level of emotional intensity for the nurse during the whole process. A better understanding of this process can help nurses and other professionals improve their interventions with children presenting a suicidal risk as well as their parents and in the long term, contribute to suicide prevention.

The present study compared the suicidal behaviour and related measures of adolescents in high school in Germany (N=318) and South Africa (N=299). Participants completed a series of self-report measures of the SPS (Suicide Probability Scale), PSS-Fa (Perceived Social Support From Family Scale), PSS-Fr (Perceived Social Support From Friends Scale), SIB (Scale Of Interpersonal Behaviour) and a number of demographic questions. Analyses were conducted using content analysis, correlation coefficients and logistic regression to determine variables related to previous suicide attempts, stepwise multiple regression to account for variables predicting currents suicidal risk; and multivariate analysis of variance (MANOVA) to examine differences among the groups and among suicide attempters and non-attempters. 36 German (11.3%) and 48 South African (16.1%) adolescents reported that they had made previous suicide attempts. German adolescents reported 45 (14.2%) suicide attempts in the family and 82 (25.8%) suicide attempts by friends. South African adolescents reported 43 (14.4%) suicide attempts in the family and 92 (30.7%) suicide attempts by friends. The following variables were associated with previous suicide attempts in the German sample: attempted suicide by friends, a life-threatening event, previous psychiatric contact, the death of a friend, low perceived family support, female gender, attempted suicide in the family, suicide of a friend, and low perceived friend support. The following variables were associated with previous suicide attempts in the South African sample: low perceived family support, death of a friend, attempted suicide by friends, female gender, a life-threatening event, previous psychiatric contact, suicide of friends, and attempted suicide in the family. The following variables for the German sample were found to be significant predictors of current suicidal risk: low perceived family and friend support, previous suicide attempts, suicide attempts in the family, a life-threatening event, suicide attempts of friends, suicide of friends, female gender, and previous psychiatric contact. The following variables for the South African sample were found to be significant predictors of current suicidal risk: previous suicide attempts, low perceived family and friend support, death of a friend, a life-threatening event, previous psychiatric contact, suicide attempts in the family, suicide of friends, and suicide attempts of friends. These findings show that suicidal behaviour is frequent in both countries. Suicidal deaths of friends and family is more prevalent in Germany, whereas religion or belief in god does not protect against suicide attempts in both countries. Results indicate that perceived support from family is a strong protective factor against suicide attempts. / Psychology / M.A. (Psychology)

The present study compared the suicidal behaviour and related measures of adolescents in high school in Germany (N=318) and South Africa (N=299). Participants completed a series of self-report measures of the SPS (Suicide Probability Scale), PSS-Fa (Perceived Social Support From Family Scale), PSS-Fr (Perceived Social Support From Friends Scale), SIB (Scale Of Interpersonal Behaviour) and a number of demographic questions. Analyses were conducted using content analysis, correlation coefficients and logistic regression to determine variables related to previous suicide attempts, stepwise multiple regression to account for variables predicting currents suicidal risk; and multivariate analysis of variance (MANOVA) to examine differences among the groups and among suicide attempters and non-attempters. 36 German (11.3%) and 48 South African (16.1%) adolescents reported that they had made previous suicide attempts. German adolescents reported 45 (14.2%) suicide attempts in the family and 82 (25.8%) suicide attempts by friends. South African adolescents reported 43 (14.4%) suicide attempts in the family and 92 (30.7%) suicide attempts by friends. The following variables were associated with previous suicide attempts in the German sample: attempted suicide by friends, a life-threatening event, previous psychiatric contact, the death of a friend, low perceived family support, female gender, attempted suicide in the family, suicide of a friend, and low perceived friend support. The following variables were associated with previous suicide attempts in the South African sample: low perceived family support, death of a friend, attempted suicide by friends, female gender, a life-threatening event, previous psychiatric contact, suicide of friends, and attempted suicide in the family. The following variables for the German sample were found to be significant predictors of current suicidal risk: low perceived family and friend support, previous suicide attempts, suicide attempts in the family, a life-threatening event, suicide attempts of friends, suicide of friends, female gender, and previous psychiatric contact. The following variables for the South African sample were found to be significant predictors of current suicidal risk: previous suicide attempts, low perceived family and friend support, death of a friend, a life-threatening event, previous psychiatric contact, suicide attempts in the family, suicide of friends, and suicide attempts of friends. These findings show that suicidal behaviour is frequent in both countries. Suicidal deaths of friends and family is more prevalent in Germany, whereas religion or belief in god does not protect against suicide attempts in both countries. Results indicate that perceived support from family is a strong protective factor against suicide attempts. / Psychology / M.A. (Psychology)