This qualitative study explored the subjective experiences of young people and staff around self-cutting behaviour in residential settings. Ten young people and twelve staff members from three settings were interviewed. Three main areas were explored: 1) explanatory frameworks used to make sense of cutting; 2) the impact of cutting on others; 3) staff responses to cutting and how these were experienced by young people. An interpretative phenomenological approach was used to analyse the data. A wide range of accounts was articulated and there was a high level of consistency in the data. Intrapersonal explanations for cutting predominated, but the cutting had a powerful and generally negative effect on others. The role of carer was identified as central and parallel processes occurred for young people and staff when they were in the carer role. The findings were discussed and developed into a model which attempted to bring together the intrapersonal and interpersonal cycles that appeared to be operating. Wider social issues were also considered. It appeared that the phenomenon of self-cutting occurred in the context of overwheh-ning experiences which were unbearable for all concerned. There was significant difficulty in integrating the confusing and conflicting experiences associated with cutting and this led to polarised and rigid views. It was concluded that a multi-dimensional approach which includes intrapersonal, interpersonal and group processes as well as wider social issues is needed to increase understanding of this challenging area. The findings were related to the literature and research and clinical implications suggested.

It was suspected that about 2 cases of parasuicide were admitted daily to RK Khan Hospital and this suspicion was confirmed by this study. Most of the cases were female, and in the 15 - 24 year age group. Patients were admitted mainly in the evenings and on Sundays. The majority earned less than R500 per month and were mainly manual-skilled and semi-skilled workers predominantly from Chatsworth. Non-violent means were the common mode of parasuicide, the causes being family, marital and romantic problems. The hospital social worker dealt with the cases and referred patients to relevant organisations outside the hospital for management. Certain patients were referred to the Psychiatric Outpatient Clinic at the Hospital as there was no resident psychiatrist. / Thesis (MMed-Community Health)-University of Natal, 1984.

Thesis (Ph. D.)--University of Washington, 2004. / Vita. Includes bibliographical references (leaves 101-124).

Thesis (Ph. D.)--University of Washington, 2002. / Vita. Includes bibliographical references (leaves 63-77).

This thesis explores mental health problems relating to war and natural disaster and suicidal behaviour in the Nicaraguan population. The more specific aims of the study were to assess the prevalence and sociodemographic correlates of mental disorder in a community-based study during time of war (Paper I), to assess the mental health impact of Hurricane Mitch in 1998 (Paper II), to assess the incidence of hospitalized parasuicide cases and groups at risk (Paper III), and to examine suicide intent among attempters relating to gender, suicide method and sociodemographic factors and identify predictors for repetition of an attempt (Paper IV). Method: Based on 4453 family food ration books for families living in an urban area of León, Subtiava, 219 families including 746 adults were selected through a systematic sampling procedure. The study was conducted in 1987 during the war. We were able to reach 584 adults for interview according to the Present State Examination for ICD-9 diagnoses and Self-Report Questionnaire (Paper I). In Paper II, 496 adult primary health care attendees were interviewed six months after Hurricane Mitch according to the Harvard Trauma Questionnaire and were diagnosed for post-traumatic stress disorder (PTSD) according to DSM-IV. In Papers III and IV, all cases from León city admitted to HEODRA Hospital for a suicide attempt over a three-year period (n=233) were interviewed regarding sociodemographic factors and method, time and place of the suicide attempt. A subgroup of 204 cases was interviewed using the Suicide Intent Scale (SIS). Out of those 106 cases were followed-up regarding repetition of attempt or completed suicide after a mean period of 1172 days. Results: In the Paper I study, the one-month prevalence of any mental disorder was 28.8% for men and 30.8% for women. Among men, alcoholism was the most common diagnosis, whereas neurosis, crisis reaction and depression were dominant among women. Alcoholism was scored as the second most severe disorder after psychosis in terms of functional level. In the Mitch study six months after the hurricane, traumatic events were common and 39% reported death or serious injury of a close relative as a result of the hurricane. The prevalence of PTSD ranged from 4.5% in the least damaged area to 9.0% in the worst damaged area. At the prolonged follow-up six months later, half of the cases still retained their diagnosis. Trauma-related symptoms were common and death of a relative, destroyed house, female sex, illiteracy and previous mental health problems were associated with a higher level of symptoms. Suicidal ideation was reported among 8.5% and was significantly associated with previous mental health problems and illiteracy. The studies regarding hospitalized parasuicides showed the highest rate among girls aged 15–19 years (302 attempts per 100 000 inhabitants and year). After drug intoxication, pesticide was the second most common method and most often used by men (23%). Half of the women had recent contact with health care services before attempting suicide. There were significant peaks regarding time of attempt in terms of seasonal and diurnal distribution. Overall scores regarding seriousness of the intent (SIS) were equal between the sexes, but the pattern of SIS items showed significant gender differences in terms of relation to background factors and method used. For women, having a child was one factor associated with higher seriousness. Factor analysis of SIS items revealed a four-factor solution, explaining 59% of the variance. Risk for fatal repetition was 3.2% after three years and for non-fatal repetition 4.8%. During follow-up, three men (11%) had completed suicide but no women. We failed to identify any predictors for repetition from background factors or SIS. Conclusion: The studies have identified different groups at risk for mental health problems relating to war and disasters. Parasuicide rates equalled those from European countries. Whereas young girls dominated, attempts among men were more severe in terms of the methods used and completed suicide at follow-up. SIS seemed to give a meaningful pattern among women but not for men. In our study, seriousness of attempt in terms of method or suicide intent did not predict repetition. Overall non-fatal repetition rate was very low as compared to other studies.

Thesis (Ph.D.)--University of Missouri-Columbia, 2006. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on April 27, 2009) Vita. Includes bibliographical references.

This study was motivated by encounters with persons with repeated suicidality in clinical psychiatry. Their suicide attempts are frequently regarded as manipulative, and the patients are often labelled a “borderline personality disorder”. They cause frustration and are sometimes met with repellent attitudes among clinicians, but clinical experience as well as research shows that their personal history regularly includes severe childhood trauma and often childhood sexual abuse. The first part of the study was undertaken to investigate the frequency of borderline personality disorder among consecutive persons admitted to hospital after a suicide attempt, the experience of adverse life events among them and the motives for the act. The concept and definition of parasuicide was used as inclusion criterion. During the 10 months of the study 81% of all parasuicide inpatients gave their consent to partake, altogether 64 patients, 41 women and 23 men. Standardized instruments were used for assessment of personality disorders, and self-report questionnaires were used to investigate motives and adverse life events. Seven years later, follow-up interviews were conducted with 51 of these persons, 32 women and 19 men. This second part of the study used qualitative methods in the form of thematic open-ended interviews to allow for the patients’ own descriptions of their suicidality and mental health in the years following the suicide attempt. The role of psychiatry in this process was one of the themes in the interview. Use of psychiatric treatment and support during the follow-up period was investigated through a review of the medical charts recorded at the psychiatric clinic. The quantitative part of the study showed that among the parasuicide patients there was a considerable overrepresentation of borderline personality disorder, and that the frequency of adverse life events was much higher in this subgroup. The motives for the parasuicide did not differ between those with borderline personality disorder and the others. Childhood sexual abuse could be identified as the most important factor influencing suicidality and extent of psychiatric treatment after the index parasuicide. The patients’ own descriptions in the follow-up interview were related to the theoretical perspectives of symbolic interactionism, therapeutic alliance, perception of difference, empowerment and the concept of modernity. In the narratives a picture emerges of a psychiatric health care that carries the potential to offer therapeutic relationships, but often fails in its aims. In therapeutic alliances built on personal relationships, characterized by close and frequent encounters and a focus not only the weaknesses but also the strengths of the patient, there was room for personal development. A reliance on therapeutic method instead of a therapeutic alliance with the patient and a lack of a collaborative perspective in therapeutic work set definite hindrances for the therapeutic process, according to the views of the patients. Regardless of the severity of the life experiences and personality dimensions that had lead to the parasuicide, the core prerequisite for subsequent stabilisation was an orientation towards significant others that saw and supported the potential for change and helped redefine the situation. These significant others were sometimes found in the psychiatric health care services, but were mainly found outside of psychiatry. The conclusions of the study are that there is a close correlation between repeated suicidality, borderline personality disorder, female gender and adverse events such as childhood sexual abuse, and that the repeated suicidality is better explained by adverse events such as childhood sexual abuse than by personality disorder. This background seriously challenges repellent attitudes towards these patients. The narratives of the patients pose definite challenges for the therapeutic community to embrace new ways to find working therapeutic alliances after a parasuicide, possibly based around perspectives of empowerment and mutuality. Identifying the processes that helps the person find “the difference that makes a difference” should be in focus of future psychiatric research and at the heart of psychiatric support and treatment after parasuicide, to enable the patients to find their own strengths and resources and in this way be able to leave it all behind.

This study seeks to attain understanding of attempted suicide in young women from non-English speaking backgrounds, constructing meaning(s) of attempted suicide and eliciting information about sociocultural influences and guided by philosophical hermeneutics and narrative inquiry using life story methods. Thematic analysis was used to explicate from the text 30 sub-themes, five themes (being in a gap between cultures and creating space for themselves, being traumatised and diminished by abuse, surviving dangerous relationships, suffering psychic pain, expressing the self by attempting suicide), and a meta-theme (paradoxically asserting the indefinite self). Interpretation was predicated on the belief that life stories are statements about self-identity, and represent coming into being through the interaction of coherence (the ability to establish connections between events, unifying themes, frames of reference and goal states), continuity (a longitudinal and sequential perspective on life) and connectedness (intrapersonal, interpersonal and transpersonal relationships). The paradox is that being unable to overcome the uncertainties of incoherence, discontinuity and problematic connectedness, participants were predisposed to act against self as a means of asserting agency. This understanding of attempted suicide represents a hermeneutic narrative reconceptualisation of the phenomenon, which places it outside discourses that sanction the language of psychopathology and provides a basis for developing alternative nursing theory and informing education and practice / Doctor of Philosophy (PhD)

Background Early interventions (EI) for psychosis are predicted to have an effect in reducing suicidal attempts and self harms for first episode psychosis (FEP) patients. However there is little evidence to reveal that early intervention has a long term effect in reducing suicidal behaviors. Also, the longitudinal patterns of suicidal behavior of patients under EI and standard care (SC) programme were remained unclear. Therefore, this study was performed to explore the longitudinal pattern of suicidal behaviors for EI and SC patients. The long term effect of EI in reducing suicidal attempts and self harms and possible predictors for suicide were also explored and analysed. Method A secondary analysis was performed with data retrieved from medical data in different hospitals. The data are matched up for SC patients and EI patients based on their demographic information. Data related to suicidal behaviors are collected. Longitudinal patterns of suicidal behaviors were analysis with generalized linear model (GENLIN) and descriptive analysis. Univariate regression was also performed to investigate predictors for suicide. Results EI has a significant effect in reducing the total number of suicidal attempts (X^2=5.779, p=0.016) and deliberate self harm (X2=7.817, 0.005) over 10 years but no effect on suicidal attempts in the first three year when effect was expected. However, data indicated EI has an effect of reducing the number of complete suicide. Patients do not receive EI is a significant predictor for increase in the suicidal attempts and younger age is a predictor for latter deliberate self harm behaviors. Conclusion The result demonstrated that EI has a long term effect in reducing suicidal behavior rather only short term and non-lasting effect as suggested by other researches. However, EI treatment might have a short term negative effect on suicidal ideations as suggested by the increase of suicidal attempts in the second and third years. EI services do not only improve in symptoms and quality of life but a long term effects in reducing the number suicidal behaviors. Although, there is a possible negative effect on suicidal attempts, it might be beneficial if EI programme can be apply to all psychotic patients. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

Orientador: Neury Jose Botega / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-06T23:30:18Z (GMT). No. of bitstreams: 1 Cais_CarlosFilintodaSilva_M.pdf: 11229550 bytes, checksum: a9dd21a89813b1247415690cf31f50e2 (MD5) Previous issue date: 2006 / Resumo: A quase totalidade dos dados sobre indivíduos que repetem tentativas de suicídio provêm de países desenvolvidos. O objetivo deste estudo é descrever o perfil clínico de 61 indivíduos que deram entrada no Pronto Socorro do Hospital das Clínicas da Universidade Estadual de Campinas por uma tentativa de suicídio que era, pelo menos, a terceira de suas vidas. Tal descrição foi feita através da comparação com 102 indivíduos que deram entrada no mesmo pronto socorro pela primeira tentativa de suicídio de suas vidas. Dados sociodemográfícos e clínicos foram coletados através do questionário WHO/SUPRE-MISS, o qual continha também diversas escalas psicométricas. No grupo dos repetidores havia maior proporção de mulheres (83.6% vs 56.8%; OR= 4,47), indivíduos na faixa etária entre 25 e 44 anos, em pior situação ocupacional e com maior disfunção no desempenho de papéis sociais (OR= 2,5; 3,1 e 1.05 respectivamente). Repetidores também apresentaram mais sintomas depressivos. Talvez em nossa cultura mulheres tenham melhor retomo em termos de pedido de socorro e/ou mudança de ambiente após a tentativa de suicídio, o que encorajaria a repetição do ato / Abstract: The great majority of data regarding individuals with repeated suicide attempts were obtained from developed countries- The aim of this study is to describe the clinical profile of 61 Brazilian individuals who attempted suicide at least three times and compare them to 102 who were brought to a university hospital for their first suicide attempt. Socio-démographie and clinical data were collected using the WHO/SUPRE-MISS questionnaire, which also comprises several psychometric scales. In the repeaters' group, there were more women (83.6% vs 56.8%; OR= 4,47), 25-44 year-old subjects, worse occupational status and social role performance disability (OR= 2.5, 3.1 and 1.05 respectively). Repeaters also had higher scores on depression. Maybe in our culture women would obtain better feedback with such behavior, that is, help and/or change in the environment, which would encourage the repetition of the act / Mestrado / Saude Mental / Mestre em Ciências Médicas