Introduction: Experiences of negative parenting and childhood abuse can have adverse consequences for the child‟s development particularly in relation to the ability to regulate emotions effectively. There has been extensive research in this area and attachment theory is pivotal. Problems in regulating emotions can involve not being able to recognise, label or manage internal and external states of mind and behaviour. Therefore research has shown that problems in emotion regulation skills due to negative parental and/or abusive experiences can result in long-term psychosocial problems such as depression. Research has suggested that adults with adverse childhood experiences exhibit risky behaviours as a means of managing their emotions such as self-harming, dangerous sexual encounters and substance misuse. Although research has shown that there is an association between these factors no real understanding of the pathways and the potential mediating roles these factors play has been investigated with people presenting with suicidal behaviour, which could be argued as the ultimate form of managing emotions and therefore the internal and external self. Therefore this study aims to answer the following question: Does childhood abuse and dysfunctional emotion regulation mediate the relationship between parental bonding and suicidal behaviour. Method: This study involved sixty participants from a suicidal behaviour sample presenting at an Accident and Emergency department aged between 18 - 65. Measures assessing childhood abuse, emotion regulation, parental bonding, suicidal intent, risk of repeating suicidal behaviour, depression and anxiety were completed. Results: Childhood emotional abuse was found to significantly mediate the relationship between low parental care and risk of repeating suicidal behaviour. A lack of external functional emotion regulation strategies was also found to mediate the relationship between parental care and risk of repeating suicidal behaviour. Finally, a lack of internal functional emotion regulation strategies was found to mediate the relationship between childhood physical abuse and risk of repeating suicidal behaviour. Conclusion: Preliminary findings of this study suggest that childhood emotional abuse and dysfunctional emotion regulation play a crucial role in further understanding those who engage in and are at risk of repeating suicidal behaviour. Therefore, emotions and emotion regulation within a developmental framework are important when considering long-term adult psychosocial functioning.

Some studies have shown that children who witness domestic violence against a family member or experience physical, emotional, or sexual abuse will often display behavioral risk factors such as increased suicidal ideation. Using social learning as the theoretical basis, this study examined factors that are associated with suicidal ideation in children of domestic violence, such as witnessing domestic violence, experiencing physical, emotional and sexual abuse, and experiencing abuse perpetrated by a parental figure. Results showed that while witnessing domestic violence alone did not affect suicidal ideation, the combination of witnessing domestic violence and being sexually abused was strongly associated with suicidal ideation, as was having a perpetrator who was a stepparent, and having a perpetrator who was a parental figure who threatened suicide and/or homicide. Implications for further research are addressed.

Ce travail s’articule autour du constat de l’hétérogénéité phénotypique des conduitessuicidaires conjointement à celui de l’existence de nombreux facteurs de validité nosologique.En suivant la méthode du symptôme candidat, nous avons pu montrer que la distribution del’âge à la première tentative de suicide (TS) était une mixture de deux distributionsgaussiennes. Ce symptôme candidat nous a permis de délimiter deux sous groupes distincts depatients en terme de caractéristiques cliniques. Parallèlement, l’exploration des dysfonctionscognitives de patients suicidants nous a permis de proposer un deuxième symptôme candidat :le déficit de l’inhibition cognitive. Enfin, grâce à l’analyse en composante principale d’uninstrument de mesure de la léthalité suicidaire, nous avons pu montrer que la sous dimensionde léthalité « implémentation du patient » constituait un symptôme candidat du fait de sesliens probables avec l’intentionnalité suicidaire, deux dimensions intriquées et déterminantesdans la genèse de conduites suicidaires. Notre contribution a la validation nosologique desconduites suicidaires concerne les résultats obtenus à partir de l’étude d’une population depatients bipolaires au sein de laquelle l’héritabilité des conduites suicidaires est apparuindépendante de celle du trouble bipolaire de l’humeur. Enfin, au sein d’une populationépidémiologique psychiatrique martiniquaise homogène sur le plan ethnique, 18% despatients avaient des antécédents de TS. Ce chiffre est inférieur à celui mesuré au sein d’étudesmenées en population cliniques majoritairement caucasiennes et conforte l’idée d’une « hyposuicidalité» dans les populations d’origine africaine. / This work starts with the report of the phenotypic heterogeneity of suicidal behavior jointly tothat of the existence of several nosological validity factors. While following the candidatesymptom approach, we could show that the distribution of the age at first suicide attempt(SA) was a mixture of two Gaussian distributions. This candidate symptom enabled us todelimit two distinct groups of patients in term of clinical characteristics. In parallel, theexploration of the cognitive dysfunctions among suicidal patients enabled us to propose asecond candidate symptom: the impaired cognitive inhibition. Lastly, by the study of asuicidal lethality scale, we could show that the “patient’s implementation” represented acandidate symptom because of its probable relationship with suicidal intent, two intricate anddetermining dimensions in the genesis of suicidal behavior. Our contribution to thenosological validation of suicidal behavior relates to the results obtained from the study of apopulation of bipolar patients within whom the heritability of suicidal behavior appearedindependent of that of the bipolar disorder. Lastly, among an Afro-Caribbeanepidemiological psychiatric sample, 18% of the patients had a history of SA. This rate islower than that measured within studies conducted among mainly Caucasian clinical samplesand strengthen the idea of a “hypo-suicidality” in the populations of African origin.

Thesis advisor: Thomas O'Hare / Substance use and suicide among adolescents is a pervasive problem in the United States. It is estimated that over 190,000 youth go to the emergency department each year as a result of alcohol related injuries and over 5,000 youth are estimated to die each year from alcohol related incidents. Moreover, suicide is the second leading cause of death for adolescents, resulting in more than one in ten deaths among adolescents. Research has demonstrated that a history of childhood abuse is a strong risk factor for suicidal ideation and alcohol misuse and related problems. It is estimated that 29% of maltreated youth engage in substance use with 9% reporting moderate to high levels of use and 5% reporting risky suicidal behavior. Although prior studies provide a foundation for understanding substance use and suicidal thoughts among maltreated youth, some significant gaps remain in the knowledge base including the use of older data, treating all maltreated youth as a homogenous group, and looking at substance use and suicidal thoughts as independent outcomes. This dissertation fills some of these gaps in the empirical literature by focusing on three specific aims: 1) examine the co-occurrence of substance use and suicidal thoughts among maltreated youth; 2) investigate the longitudinal predictors of substance use and suicidal thoughts among maltreated youth; and 3) assess whether the predictors of substance use and suicidal thoughts are similar or different across placement types (in-home care, kinship care, or foster care). The National Survey on Child and Adolescent Wellbeing (NSCAW II) restricted dataset is used as the primary source for the analyses to address each aim. Policy and practice implications are provided for the fields of addiction, mental health, and child welfare. / Thesis (PhD) — Boston College, 2018. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Doctor of Philosophy / School of Family Studies and Human Services / Jared A. Durtschi / Each year in the United States, 40,000 individuals die by suicide, 7,000 of whom are young adults between the ages of 25-34. For every death, it is estimated that another 25 suicide attempts are made and that over 8% of young adults experience thoughts of suicide each year. Suicide rates are climbing, but identification of protective factors to reduce suicide risk remains elusive. Using a sample of 4,208 young adults from the National Longitudinal Study of Adolescent to Adult Health, a latent profile analysis was used to test the number of profiles that best fit the data based on indicators that were hypothesized to be risk or protective features, and those profiles were analyzed using logistic regression to assess suicide risk. Hypothesized protective indicators included parent and romantic relationship quality, parental satisfaction, job satisfaction, and religiosity. Hypothesized risk indicators included parental demands, depressive symptoms, job demands, isolation, alcohol use, and adverse childhood experiences. A four-profile solution was optimal for this data and yielded four distinct profiles named: Satisfied with Life (n = 2,442), Relationship Stress (n = 669), Demanding Jobs (n = 658), and Challenging Childhood (n = 427). Individuals in the Satisfied with Life profile reported positive relationship quality with parents, partners, and children, and low depressive symptoms, isolation, and adverse childhood experiences. This profile was associated with a 60% decrease in risk for suicidal ideation. Participants in the Relationship Stress profile reported low relationship satisfaction, lack of confidence that their romantic relationship was going to be permanent, and high alcohol consumption. Individuals in this profile were 104% more likely to experience suicidal ideation compared to those not in this profile. The Demanding Jobs profile included individuals who felt their work interfered with their family time, and vice versa, but still had moderately high satisfaction in each area. This profile was not significantly associated with suicidal ideation. The final profile, Challenging Childhood, included individuals who reported low quality of relationships with their parents, high levels of isolation and depressive symptoms, and significantly higher adverse childhood experiences than other individuals in this sample. Individuals in this profile were associated with 192% increase in risk for suicidal ideation than those not in this profile. The results of this study underscore the importance of positive relationships as a protective factor against suicide, and provide new information about how job satisfaction and demands can also serve as protective features. Therapeutic interventions that address improving social support, coping with traumatic events, and decreasing alcohol consumption are recommended to decrease suicidal thoughts.

Background: Suicide prevention strategies recognise the need to address suicide in high-risk groups, such as people with psychiatric illness. People with bipolar disorder are known to be at particularly high risk of suicide and self-harm, with around half of people diagnosed with bipolar disorder making at least one suicide attempt during their lifetime. It is important that clinicians can identify who is most at risk among people with bipolar disorder so that interventions that meet the needs of this high risk group can be implemented. Method: A multiple-methods approach was used to explore suicidal behaviour in bipolar disorder. Descriptive analysis, case-control methods, and survival analysis were used on data held by The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI), and the Manchester Self-Harm (MaSH) Project, to identify characteristics and risk factors associated with suicide in bipolar disorder. Semi-structure interviews were carried out with people who had a range of experiences of suicidal behaviour in bipolar disorder, and these data were analysed using Thematic Analysis to add context and depth to the quantitative results. Results: Suicidal behaviours were common in people with bipolar disorder, accounting for around 10% of all psychiatric suicide deaths in England; this rate was fairly stable over time. Characteristics associated with suicidal behaviour in bipolar disorder included; being aged 45 to 64 years old, experiencing negative life events, comorbid alcohol use, multiple inpatient admissions; there was a particularly strong association with a history of self-harm. It is clinically important that people with bipolar disorder were often seen by services in the 24 hours before they died. This both emphasises the weaknesses in current risk assessment, and highlights the potential for successful intervention if risk can be determined more accurately. Key issues identified in the interview study included being able to access care rapidly during time periods when risk was elevated, the importance of obtaining a correct diagnosis of bipolar disorder, and the potential benefits of including family in the care of people with bipolar disorder. Conclusion: Suicidal behaviours are common in people with bipolar disorder. People with bipolar disorder who die by suicide tend to have several markers that may indicate a more severe (e.g. multiple inpatient admission, history of self-harm) and complex course of illness (e.g. comorbid alcohol use, personality disorder). Diagnosis-specific risk assessment is needed to better identify risk of suicide in an illness that is often characterised by fluctuating mood states. Family involvement in care may aid detection of increased suicide risk.

Background: Every 40 seconds a person experience feelings of hopelessness and falls victim to suicide. The persons who are suicidal can be found all through the health care system. The health care personnel can change the outlook on life for the person, or at least ease the suffering for a while in the meeting. But health care personnel can also cause suffering by care if they don't see the person as a unique human being. Aim: The aim of this study was to highlight the suicidal persons experience meeting with health care professional. Method: A literature-based study were conducted in accordance to Friberg (2012). Analysis were made of ten qualitative scientific studies. Results: The result was presented in one theme, The significans of the relationship. And four subthemes arose; To be or not to be listened to, to feel or not to feel commitment, to be or not to be seen and to feel or not to feel trust and security. Conclusion: The result show how the persons who were suicidal experienced ease in their suffering when healthcare personnel listened, saw the person, were commited and gave a sense of trust and security. When the healthcare personnel listened and validated the persons who were suicidal it led to feelings of hope for the future. When the persons experienced that they were seen by the healthcare personnel they felt a positivity and as human beings on equal terms. When the persons who were suicidal felt security and trust for the healthcare personnel it led to a better relationship. When the persons experienced commitment from healthcare personnel they felt as they were able to let go of feelings of despair and anxiety. This resulted in a sense of wellbeing for the persons. / I Sverige begick 1189 personer självmord 2017, dessa människor såg ingen annan utväg än döden. Personerna som var självmordsbenägna hade både positiv och negativ erfarenhet av mötet med vårdpersonal. Om mötet blev dåligt ledde det till känslor av hopplöshet och när mötet blev bra kunde det leda till hopp för framtida relationer. Suicidnära personers erfarenhet av mötet med vårdpersonal visade att relationen med vårdpersonal var av betydelse och det innefattade att bli eller inte bli lyssnad på, att känna eller inte känna engagemang, att bli sedd eller inte bli sedd och att känna eller inte känna trygghet och tillit. Likt ett mynt har mötet två sidor där en sida leder till vårdlidande och den andra till ett hopp om livet. Att se personen innebar att vårdpersonal ingav hopp i mötet för personen som var självmordsbenägen. Det är därför viktigt för vårdpersonal att vara medveten om dessa personers erfarenhet för att kunna reflektera över sin egen roll, för att kunna ge god omvårdnad till hälsa och för att lindra lidande. När mötet var av positiv natur för individen kunde personerna berätta om sina innersta tankar och lära sig strategier för att ta itu med sina självmordstankar och uppleva en vändpunkt tillbaka till livet. Vårdpersonal kan göra en stor skillnad i mötet med personen som är självmordsbenägen genom att vara den livlina som gör att personen vill fortsätta leva. Att se personens lidande och lindra är vårdpersonalens uppgift, men detta sker inte alltid i mötet och det ledde till ett vårdlidande för personerna som präglades av känslor som uppgivenhet, förödmjukelse och att inte vara jämlika människor.

Research has long documented beneficial associations between forgiveness and numerous health outcomes; however, its relationship to suicidal behavior has been relatively neglected. Both cynicism, and psychache, or agonizing psychological pain, have displayed deleterious associations with suicidal behavior, but have rarely been incorporated into more comprehensive models of suicidal behavior. Recent work has resulted in the development of a theoretical model of the forgiveness-suicidal behavior association, which can incorporate several mediator variables including cynicism and psychache. The present study used an undergraduate sample of college students (N = 312) to test a serial mediation model of the cross-sectional associations between forgiveness, cynicism, psychache, and suicidal behavior. Forgiveness of self and of uncontrollable situations were indirectly associated with suicidal behavior via psychache, while forgiveness of others was indirectly associated via cynicism and psychache in serial fashion. Implications in the context of previous literature and treatment, particularly acceptance-based interventions, are discussed.

Perceived social problem-solving deficits are associated with suicide risk; however, little research has examined the mechanisms underlying this relationship. The interpersonal theory of suicide proposes 2 mechanisms in the pathogenesis of suicidal desire: intractable feelings of thwarted belongingness (TB) and perceived burdensomeness (PB). This study tested whether TB and PB serve as explanatory links in the relationship between perceived social problem-solving (SPS) deficits and suicidal thoughts and behaviors cross-sectionally and longitudinally. The specificity of TB and PB was evaluated by testing depression as a rival mediator. Self-report measures of perceived SPS deficits, TB, PB, suicidal ideation, and depression were administered in 5 adult samples: 336 and 105 undergraduates from 2 universities, 53 homeless individuals, 222 primary care patients, and 329 military members. Bias-corrected bootstrap mediation and meta-analyses were conducted to examine the magnitude of the direct and indirect effects, and the proposed mediation paths were tested using zero-inflated negative binomial regressions. Cross-sectionally, TB and PB were significant parallel mediators of the relationship between perceived SPS deficits and ideation, beyond depression. Longitudinally and beyond depression, in 1 study, both TB and PB emerged as significant explanatory factors, and in the other, only PB was a significant mediator. Findings supported the specificity of TB and PB: Depression and SPS deficits were not significant mediators. The relationship between perceived SPS deficits and ideation was explained by interpersonal theory variables, particularly PB. Findings support a novel application of the interpersonal theory, and bolster a growing compendium of literature implicating perceived SPS deficits in suicide risk.

The present study sought to examine optimism and hope as predictors of suicidal behaviors (viz., suicide ideation and suicide attempt) in a sample of 179 adult primary care patients. Furthermore, we aimed to determine if the combination of hope and optimism would account for additional variance in the prediction model for suicidal behaviors among this population. In this cross-sectional study, participants completed measures of hope (viz., agency and pathways), optimism, and suicidal behaviors, as well as a series of demographics questions. Hierarchical regression analyses were conducted to test the aforementioned hypotheses. Results indicated that hope and optimism were both significant and unique predictors of suicidal behaviors among adult primary care patients. However, the hope-by-optimism interaction terms were not found to be significant. Some implications of the present findings are discussed.