Considering the escalating rate of suicidal behaviour in adolescents, not much is known about the risk and protective factors that mediate non-fatal suicidal behaviour among this group. This study has focused on exploring the subjective worlds of Indian adolescents who have engaged in non-fatal suicidal behaviour in order to identify such factors, which are crucial in the designing of effective intervention programmes. The sample consisted of 10 adolescent patients who were admitted to R.K. Khan Hospital in Chatsworth, Durban after non-fatal suicide attempts. The emergent risk and protective factors were conceptualised according to Bronfenbrenner’s (1979) Social Ecology Theory, which facilitated an understanding of the multiple levels of risk and protective factors that mediate NFSB in adolescents. The results of this study highlight the collective influences of individual, familial, cultural and societal factors on adolescents’ decisions to engage in non-fatal suicidal behaviour. A number of clear priorities for prevention programmes emerged from the results of this study. As such, recommendations were made to facilitate prevention and intervention programmes at a site, familial, peer and community level. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2008.

High school adolescent's suicidal behaviour caused a concern to the Umzimkulu community and the multi - disciplinary team in the local Psychiatric institution during the years 1997 - 1999 . The purpose the study was to identify and describe the charactics of adolescents who committed suicide. Rutter's (1995) model of risk. resilience and recovery has been used as a theoretical frame work for the study. A descriptive, exploratory case study design is most suitable for the incidence of suicide at Umzimkulu District .The case study approach was best suited as it assists in an indepth study focussing on contemporary phenomena with sum real life contexts . The distinctive need for the case study design arises out the desire to understand complex psycho-social phenomena of adolescent suicide (Yin, 1989).Each adolescent who committed suicide over the last two years in Umzimkulu District will form a case . All data about the particular person will be the case description Adolescents who committed suicide were identified from the records at the police intelligence office of Umzimkulu Police Station. Parents, identified friends, teachers and health workers who had known the adolescents. Semi structured interviews with open ended questions were used. Interview schedules for teachers, parents and close friends differed slightly. A tape recorder for later transcription was utilised. To analyse the data, Ruttter's model was utilised to do cross case analysis. Results according to Rutter's model, were that, due to inconstant support received by the adolescents, high levels of stress in early child hood, had left them insuffiently resilient to with stand the problems they encountered during adolescence. / Thesis (M.Cur.)-University of Natal, Durban, 2001.

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.

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.

Suicide attempts and opioid dependence are important clinical issues, as both are associated with a high degree of psychiatric morbidity and elevated risk of mortality. Research has identified a number of risk factors for suicide attempts among the general population, and to a lesser extent, among heroin users. Due to a lack of case-control studies, however, it is still not known to what extent opioid dependence per se is a risk factor for suicide attempts. This thesis comprised the first study to directly examine whether opioid dependence is a unique risk factor of suicide attempts. This thesis examined suicide attempts, associated risk factors, and related comorbidity among an opioid-dependent case group and a non-opioid-dependent control group. A structured interview was used to collect data from 726 opioid-dependent cases and 399 non-opioid-dependent controls. This thesis identified a number of important findings. Firstly, although opioid-dependent individuals were more likely to report lifetime suicide attempts compared to controls, the risk factors were largely the same for both groups. It appeared that opioid-dependent individuals were characterised by a higher likelihood of the same risk factors for suicide attempts, rather than having different risks. Cases appeared to be at increased risk of suicide attempts because of increased levels of multiple risk factors. Secondly, borderline personality disorder (BPD) and impulsivity were identified as important risk markers for suicidal behaviour, especially among opioid-dependent individuals. The study concluded that the treatment of BPD should be prioritised among this group. Third, self-mutilation was identified as a clinically significant problem in its own right, however, when combined with a history of attempted suicide, the psychological dysfunction observed was found to be very high. Fourth, non-fatal opioid overdose and suicide attempts were found to be distinct behaviours. The risk factors for each were completely different. While drug-related risks were associated with non-fatal overdose, the risk markers for suicide attempts were related to the presence of psychological disorders. This thesis has highlighted important areas of concern for clinical interventions as well as for future research to explore. Considering this is the first study of its kind, future research should focus on its replication.

Aim: This study aims to investigate the experience of stress and the factors that impact on the intern psychologist in relation to first consultation with a non-fatal suicidal client. Intra and interpersonal factors, as well as institutional/environmental factors that influence/impact on intern clinical/counselling psychologist level of stress when assessing and managing a non-fatal suicidal client were identified. Methodology: The research methodology chosen for this study is based on the aim of the study, which is to investigate the experience of stress perceived by intern clinical/counselling psychologists in relation to consultation with a non-fatal suicidal client. A qualitative methodological approach will be used in this study as it allows for greater in-depth investigation and understanding of the experiences of intern clinical/counselling psychologists towards suicidal clients than would be generated by quantitative research methods. Five intern clinical/counseling psychologists were used in this qualitative study. They were interviewed using a semi-structured in- depth interview. The data was transcribed and analysed using thematic analysis. Findings: A variety of stressors were identified by the interns, but the majority described common variables. The main sources of stress for the interns was first contact with suicidal clients and lack of practical training and experience. The working environment, which included work load, administrative work and academic and competency based requirements, was also deemed stressful. In terms of personal stress, interns reported family and friends to be a source of stress at times. Personality also contributed to the interns levels of stress. Socio-cultural factors which impacted on the interns experience of stress in relation to consultation with non-fatal suicidal clients included, language difficulties and cultural differences. Recommendations: The internship was generally described as stressful. Recommendations included more practical experience and training prior to the commencement of the internship. This will equip interns with the skills and abilities necessary in successfully assessing and managing high risk clients. Organisational and professional factors can also be modified and include support as well as an understanding of the policies and procedures of the institution in which the internship is being done. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2007.

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.

Suicide attempts and opioid dependence are important clinical issues, as both are associated with a high degree of psychiatric morbidity and elevated risk of mortality. Research has identified a number of risk factors for suicide attempts among the general population, and to a lesser extent, among heroin users. Due to a lack of case-control studies, however, it is still not known to what extent opioid dependence per se is a risk factor for suicide attempts. This thesis comprised the first study to directly examine whether opioid dependence is a unique risk factor of suicide attempts. This thesis examined suicide attempts, associated risk factors, and related comorbidity among an opioid-dependent case group and a non-opioid-dependent control group. A structured interview was used to collect data from 726 opioid-dependent cases and 399 non-opioid-dependent controls. This thesis identified a number of important findings. Firstly, although opioid-dependent individuals were more likely to report lifetime suicide attempts compared to controls, the risk factors were largely the same for both groups. It appeared that opioid-dependent individuals were characterised by a higher likelihood of the same risk factors for suicide attempts, rather than having different risks. Cases appeared to be at increased risk of suicide attempts because of increased levels of multiple risk factors. Secondly, borderline personality disorder (BPD) and impulsivity were identified as important risk markers for suicidal behaviour, especially among opioid-dependent individuals. The study concluded that the treatment of BPD should be prioritised among this group. Third, self-mutilation was identified as a clinically significant problem in its own right, however, when combined with a history of attempted suicide, the psychological dysfunction observed was found to be very high. Fourth, non-fatal opioid overdose and suicide attempts were found to be distinct behaviours. The risk factors for each were completely different. While drug-related risks were associated with non-fatal overdose, the risk markers for suicide attempts were related to the presence of psychological disorders. This thesis has highlighted important areas of concern for clinical interventions as well as for future research to explore. Considering this is the first study of its kind, future research should focus on its replication.

Background: Social adversities are prevalent among those with psychiatric disorders and may be involved in poor outcomes among patients receiving treatment. Identification of social risk factors influencing outcomes will help provide targeted interventions for at-risk patients. This thesis explored the role of social and behavioural factors in relation to adverse psychiatric outcomes, specifically relapse to substance use and attempted suicide. Methods: We used scoping study methodology to perform a comprehensive review to identify the gaps in the literature examining social functioning and MMT outcomes. This review informed our primary cohort study examining the association between social factors and continued opioid use in MMT. Lastly, we conducted a case-control study to identify risk factors for suicide attempts by comparing psychiatric patients with and without suicide attempt history (cases and controls, respectively). Multivariable logistic regression analyses were conducted in both primary studies to examine the association between predictors and outcomes. Results: The review included 101 observational studies and determined the need for further research on social factors and MMT outcomes among a current sample of Canadian patients. Our cohort study included 1043 participants (mean age=38.4 years, standard deviation [SD]=11.06); 45.8% women) to investigate this and found that unemployment, criminal activity and interpersonal conflict with friends significantly increased odds of illicit opioid use. In examining risk factors for suicide attempts, we recruited 146 cases (mean age=45.18 years, SD=14.70 years; 55% female) and 104 control participants (mean age=45.01 years, SD=14.23 years; 50% female). No sociodemographic differences existed between groups, however higher impulsivity and borderline personality symptoms significantly increased odds of attempted suicide. Conclusions: Findings from these studies may indicate the need for structured monitoring of at-risk psychiatric patients. It may be important to develop tools to measure social and behavioural factors in clinical settings and promote further integration of social services in treatment settings. / Thesis / Master of Science (MSc)

The popularity of social capital and its potential benefit to understanding the complex arena of mental health research, has increased exponentially, despite the lack of consensus over a conceptual and empirical definition. Due to the escalation in adolescent suicide rates globally, the following research study sort to understand the association between Bonding Family Social Capital and Bonding Peer Social Capital and adolescent suicide risk. The sample was made up of 259 adolescent learners, from grades nine to eleven, from a school in the Durban Metropolitan area. The results of the study confirmed the hypothesis that adolescents categorized as being ‘at risk’ (i.e. had suicide ideation and/or attempt suicide) had lower mean Bonding Family Social Capital and Bonding Peer Social Capital then those adolescents categorized as ‘not at risk’ (i.e. did not have suicide ideation and/or attempted suicide). These findings are essentially supportive of contemporary multidisciplinary evidence indicating that supportive family and peer networks can serve as a protective buffer against adolescent suicide risk. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2009.