Study One of this research aimed to assess interpersonal problem-solving ability in individuals who evidenced suicidal behaviour. Suicide attempters were compared with mixed psychiatric outpatients and normal controls on a measure of means-ends problem-solving. The results of Study One suggested that suicidal individuals produced significantly fewer relevant means, story directed responses and sufficient narratives compared to both normal and psychiatric subjects. On qualitative indices of introspection, emotional relevant means and on time and obstacle recognition suicidals were significantly more deficient than control groups. Amongst suicidal subjects greater social dysfunction, stress and affective disturbance was associated with poorer interpersonal problem-solving. A model for the development of suicidal behaviour which suggested possible points of entry for intervention was proposed. In Study Two three treatment strategies for suicidal behaviour - Cognitive Therapy, Problem-solving Training and Psychiatric After Care were compared. In general the results suggested that all treatments were having some positive effects. The most significant changes in problem-solving skills occurred in the group receiving such training but improvement in this area was also noted in the Cognitive Therapy Group. It was proposed that aspects of Cognitive Therapy may have direct influence on problem-solving behaviour. Affective change seen at the end of eight weeks of treatment followed a different time course compared to cognitive change and the maintenance of such change to follow-up was shown to be dependent upon skills learnt during Cognitive Therapy and Problem-solving Training. Problem-solving Training had the most significant impact in improving social dysfunction and all treatments were shown to reduce suicidal ideation but at differing rates. One episode of suicide attempt occurred in the Psychiatric After Care Group representing a 6.25 percent rate of reoccurrence. It was concluded that the acquisition of interpersonal and cognitive skills held implications for the prophylaxis of suicidal behaviour. Suggestions for early primary intervention within the family and education systems were proposed.

ABSTRACT The increasing prevalence of suicidal behaviour especially among adolescents is an important public health problem. With the increasing adverse global economic conditions and HIV/AIDS prevalence, especially in developing world, the problem of suicidal behaviours is expected to get worse, and the impact on the healthcare systems will increase. Objective: This study was done to evaluate the socio-demographic and clinical profile of the patients who were admitted into Leratong Hospital for suicidal behaviours, and the factors associated with these suicidal behaviours. In the context of worsening social and economic problems, and the increasing HIV/AIDS epidemic, it is hoped that the results of this study will help in quantifying needs, defining appropriate management protocols and referral systems, and informing capacity building processes. Methods: This was a descriptive cross-sectional study. All patients admitted to the medical wards for parasuicides and attempted suicide from November 2007 to February 2008 (n=162) were interviewed during the course of their admission. Data on their socio-demographic characteristics, history of previous suicide ideations and attempts, methods of and reasons for the present suicidal behaviours, and past personal and family histories of the patients were extracted and analyzed. Results: Patients admitted for suicidal behaviours constituted about 5% of all medical patients. More than 67% of the patients were younger than 30 years, and more than 60% were females. Only about 16% of the patients were married, and about 45% were unemployed, and among those employed about 40% were unskilled, though more than 60% were living in either formal or RDP houses. Majority of the patients (60%) completed only grade 11 or less. Majority of the patients attempted suicide by ingesting overdose of medications (43%) and organophosphates (32%). The commonest reason given by patients for attempting suicide was domestic or relationship conflicts (75%). About 21% and 14% of the patients had histories of previous suicide ideation and attempt respectively. Common adverse events in the background histories of the patients were stress from their families (56%), unemployment (38%), alcohol abuse (32%), and abandoned by spouse (25%). Common adverse events in the family histories of these patients include at least one death in family in the last two years (70%), alcohol abuse (60%), family member in prison (46%), family member was a victim of crime (46%), and family member had a severe disease (42%). Risk factors found to be significantly associated with suicidal behaviours and the different methods of suicidal attempt include race, sex, younger age group, type of house, and family history of severe illness, death, divorce and substance abuse. The study has demonstrated the socio-demographic profile of these patients, the burden posed by suicidal behaviours on our health systems, and the risk factors associated with such behaviours. Based on these results, it is therefore recommended that health workers should look out for, and assess all patients for, risk factors associated with suicidal behaviours, and patients admitted for suicidal behaviours should be evaluated and managed properly, with appropriate referrals, before they are discharged.

This qualitative study attempted to develop a process theory of suicidal behaviour. The Arthur Inman diary, which documents the thoughts and feelings of a suicidal individual (Arthur Crew Inman) who eventually died by suicide, was the primary data source from which the theory emerged. Aspects of the qualitative grounded theory procedure were used to develop the theory. Purposeful intensity sampling, theoretical sampling, open and discriminant sampling were applied at different stages of the research process. In addition, the constant comparative method, which forms the hallmark of grounded theory procedures, was an integral part of the analytic procedure. The emergent process theory, which was firmly grounded in the primary data source and extant literature sources, hopefully offers a new paradigm within which suicidal behaviour can be understood. It proposes the processional aspects of suicide and puts forward phases, which a potentially suicidal individual goes through. It thus attempts to bridge a major gap in the study of suicidal behaviour by providing dynamic pathways that link vulnerability to suicide with the suicide act. / Thesis (M.Soc.Sci.)-University of KwaZulu-Natal, Pietermaritzburg, 2002.

There appears to be a need to demystify suicidal behaviour not just for the benefit of researchers and health workers but equally for parents, teachers and most importantly for adolescents themselves. The focus in this study was on attempting to provide a fresh perspective of adolescent suicidal behaviour by viewing some delinquent and deviant behaviour as possible manifestation of suicidal behaviour and by decoding and making an attempt to understand the non-verbal voices/cries of suicidal adolescents. In general, suicide and suicidal behaviour among adolescents, has received relatively little attention from Education Departments throughout South Africa. Suicide-prevention is also sadly neglected by government and public health authorities. Unfortunately, despite the fact that the phenomenon has become the first cause of death among the younger age groups, with a higher mortality rate than for road accidents, it has not so far managed to provide backing for preventive schemes within the school and community systems of the same magnitude as the ones developed to tackle other public health problems, such as Aids. The purpose of this study was to gain greater insight into the phenomenon of adolescent suicidal behaviour so that a clearer and broader definition (that included both overt and covert behaviour) was formulated. This will then assist, amongst others, educators, parents and adolescents to identify more easily adolescent suicidal behaviour in its various forms . The study also hoped to investigate and identify the factors that could contribute to suicidal behaviour in adolescents. It also hoped to explore what support systems were available and accessible to the adolescents, more especially those manifesting deviant and delinquent forms of suicidal behaviour and to investigate the effectiveness of the support systems. The concept of networking and creating supportive connections is strongly supported when facing problems of suicide and suicidal behaviour. In creating a connection with the parents, teachers are able to better connect with learners because they will be more aware of the stressors that adolescents are experiencing. Since evidence indicates (Snyder, 1971) that potential suicide victims typically turn first to family and everyday friends and to the more traditional and perhaps formal sources such as clergy, psychiatrists, social workers only later, the need for the school to be more ready to play the role of referrer to other established sources of help is apparent. Teachers should not mistake adolescent suicidal behaviour for just delinquent 'brat' behaviour. In many situations adolescent suicidal behaviour becomes a way of communicating with others after all other forms of communication have broken down - when connections with the outer world is tenuous or non-existent. Stigma keeps adolescent suicidal behaviour from being identified as a public health problem that is preventable. This could be the reason (besides financial ones) why the Department of Education has not seen the urgency to strengthen counselling services in schools. In the absence of such support parents, educators and adolescents need to join forces - create a network of connections - both physical and emotional - so that desperate cries of adolescents are heard, interpreted and eliminated. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2007.

The present study examined community/tribe, peer/family, and individual correlates of suicidal behaviour in a representative on-reserve sample of First Nations adolescents. Data came from the 2002-2003 Manitoba First Nations Regional Longitudinal Health Survey of Youth. Household interviews were conducted with adolescents ages 12-17 (n=1,125) from 23 First Nations communities in Manitoba. Bivariate logistic regression analyses were used to examine the relationships between a range of factors and lifetime suicidal ideation, suicide attempts, and any suicidality. A multivariate logistic regression analysis identified those correlates most strongly related to any suicidality. Findings showed that several correlates were found to be associated with an increased likelihood of suicidal behaviour, including being female, depressed mood, abuse/fear of abuse, a hospital stay, and substance use. Results of this study will likely be of importance in informing First Nations and government policy related to the implementation of suicide prevention strategies in Manitoban First Nations communities.

The present study examined community/tribe, peer/family, and individual correlates of suicidal behaviour in a representative on-reserve sample of First Nations adolescents. Data came from the 2002-2003 Manitoba First Nations Regional Longitudinal Health Survey of Youth. Household interviews were conducted with adolescents ages 12-17 (n=1,125) from 23 First Nations communities in Manitoba. Bivariate logistic regression analyses were used to examine the relationships between a range of factors and lifetime suicidal ideation, suicide attempts, and any suicidality. A multivariate logistic regression analysis identified those correlates most strongly related to any suicidality. Findings showed that several correlates were found to be associated with an increased likelihood of suicidal behaviour, including being female, depressed mood, abuse/fear of abuse, a hospital stay, and substance use. Results of this study will likely be of importance in informing First Nations and government policy related to the implementation of suicide prevention strategies in Manitoban First Nations communities.

This study focused on the quantitative and qualitative aspects of suicidal behaviour of 90 people who had come to the attention of the Accident and Emergency Department of Westmead Hospital, Sydney, N.S.W., after an attempt to harm themselves. The risk factors identified in the study were combined with the circumstances and motive of attempt. Participants were regrouped according to whether the problems the respondent described were chronic (longstanding) or acute (pivotal). The participants were further classified according to the persistence of thoughts of self-harm ( impulsive or non-impulsive/deliberate) and the presence or absence of these feelings at the time of the interview (the resolution of the attempt) and the types of problems/situations and triggering events the person described as wanting to escape. By developing strategies and treatments for the problems as they were identified in this study and by raising the awareness that there is help available for these different issues, we may be able to reduce the pain which results in an attempt to self harm. / Doctor of Philosophy (PhD)

Whilst much has been written about the determinants of suicidal behaviour within a South African context, few studies have investigated suicidal behaviour from a developmental context. This study explored the relationship between suicidal tendencies, coping styles, and Intimacy vs. Isolation. There were 175 participants between the ages of 18 to 24 years. Scales measuring coping, suicidal attitudes, and intimacy resolution were administered. The data was analysed quantitatively. Most significant in the findings is the relationship that exists between intimacy resolution, suicidal attitudes and active coping styles. These and other findings provide an initial but empirically important platform for future research endeavours that aim to understand the incidence of suicide amongst one of the most at-risk groups in South Africa today. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2010.

A growing body of research has indicated that the levels of suicidal behaviour are particularly heightened among individuals with Posttraumatic Stress Disorder (PTSD). Two theoretical models of suicide, the Cry of Pain Model of suicide (CoP; Williams, 1997) and the Schematic Appraisals Model of Suicide (SAMS; Johnson, Gooding & Tarrier, 2008) have proposed that perceptions of defeat and entrapment are key components of the psychological mechanisms which drive suicidal behaviour. The SAMS has also emphasized the importance of psychological resilience factors for preventing suicide risk. Resilience to suicide has been recently defined as a set of appraisals which buffer the impact of risk factors on suicidal behaviour. The first aim of this thesis was to investigate the role of perceptions of defeat and entrapment in suicidal behaviour in those with full or subthreshold PTSD. The second aim of this thesis was to obtain empirical evidence for the presence of resilience factors to suicidal behaviour in PTSD. Initially, a comprehensive narrative review and a meta-analysis were conducted to examine the magnitude of the association between various forms of suicidal behaviour and a PTSD diagnosis and the role of comorbid depression in this association. Both, the narrative review and the meta-analysis demonstrated a strong positive association between suicidal behaviour and PTSD, and supported the mediating impact of comorbid depression in this association. A re-analysis of a previous dataset of individuals with PTSD was also pursued to establish the relevance of negative perceptions/appraisals to suicidal behaviour in those with PTSD. Next, three empirical studies were designed to investigate the utility of perceptions of defeat and entrapment in explaining suicidal behaviour in those with full or subthreshold PTSD. The outcomes across the three studies supported the hypothesis that defeat and entrapment represent the proximal psychological drivers of suicidal behaviour in PTSD and fully account for the suicidogenic effects of negative self-appraisals and PTSD symptoms. Two additional empirical studies were conducted to examine resilience factors to suicidal behaviour among individuals with full or subthreshold PTSD. The first of these studies provided evidence that high levels of perceived social support buffered the impact of PTSD symptoms on suicidal behaviour. The last study supported the efficacy of a resilience-boosting technique, the Broad-Minded Affective Coping procedure (BMAC), to enhance the experience of positive emotions and improve mood amongst individuals diagnosed with PTSD. Together, the current results support the SAMS' postulation concerning the role of perceptions of defeat and entrapment in the emergence of suicidal behaviour in PTSD and highlight the importance of boosting resilience as a means of targeting suicidal behaviour in those with PTSD. Clinical implications of these findings are outlined throughout the thesis.

Background: Suicidal behaviour devastates families, communities, and societies, as well as the millions of individuals who survive suicide attempts. This thesis addresses an urgent need to develop new treatment and intervention strategies for millions of at-risk people by exploring potential metabolic risk factors of suicidal behaviour. Methods: A systematic review and meta-analysis was performed to assess the association between BMI and suicidal behaviour. We explored the association between attempted suicide and various metabolic factors and health behaviours using data from the Determinants of Suicide Conventional and Emergent Risk (DISCOVER) study. DISCOVER is an age and sex matched case-control study comparing adult psychiatric inpatients who had made a recent suicide attempt (n=84) to psychiatric inpatients (n=104) and community members (n=93) who have never attempted suicide. The following potential risk factors were assessed using logistic regression analyses: BMI, waist-circumference, serum total cholesterol, physical activity, tobacco use, and dietary food groups. Results: The systematic review included 38 studies. A meta-analysis established an inverse association between BMI and completed suicide, whereby being underweight is associated with the greatest risk of suicide and being obese or overweight is associated with a deceased risk of suicide relative to normal weight. Evidence for an association between BMI and attempted suicide remains equivocal. The review suggests no association between BMI and suicidal ideation. Analysis of DISCOVER data demonstrated that even a small amount of regular physical activity is significantly associated with decreased risk of attempted suicide. Tobacco use was associated with an increased risk of attempted suicide. Contrary to prior research, obesity, serum-total cholesterol, and diet were not found to be significant risk factors. Conclusion: BMI is inversely related to completed suicide. Obese individuals may be more likely to choose less lethal methods of suicide or may be less susceptible to fatal overdose or self-poisonings. Clinicians should monitor underweight patients for increased risk of suicide. Contrary to prior research, serum total cholesterol, BMI, and waist-circumference were not significantly associated with risk of attempted suicide. Increased physical activity was associated with a decreased risk of attempted suicide, and tobacco use was associated with an increased risk of attempted suicide. While people at risk of attempting suicide tend to use more tobacco products and exercise less than non-suicidal community members, so do non-suicidal psychiatric patients. For this reason, it remains unclear whether smoking habits represent a useful clinical predictor of suicide risk. / Thesis / Master of Science (MSc)