Befindet sich eine Person in Haft, unterliegt diese der staatlichen Obhut. Inwiefern der Bedarf einer medizinischen Behandlung der Inhaftierten besteht, ist jedoch bei Haftbeginn oftmals unklar. In der vorliegenden Untersuchung wurden im Zeitraum Februar 2012 - März 2013 randomisiert Inhaftierte aus sechs verschiedenen sächsischen Justizvollzugsanstalten hinsichtlich Suizidalität und psychischer Erkrankungen befragt. Die Suizidalität wurde mittels Selbstangaben der Inhaftierten zur aktuellen Suizidalität, zur lifetime Suizidalität und zu lifetime Suizidversuchen sowie verschiedener Fragebögen erfasst. Die für die vorliegende Untersuchung relevanten psychischen Erkrankungen, genauer Persönlichkeitsstörungen bzw. Persönlichkeitsauffälligkeiten, wurden mittels des Assessment of DSM-IV Personality Disorders (ADP-IV) und des Persönlichkeits-Stil-und-Störungs-Inventares (PSSI) ermittelt. Für Inhaftierte mit Hinweisen auf Persönlichkeitsstörungen bzw. Persönlichkeitsauffälligkeiten konnte eine signifikant höhere Suizidalität im Vergleich zu Inhaftierten ohne derartige Hinweise oder Persönlichkeitsauffälligkeiten festgestellt werden. Ein signifikanter Zusammenhang zwischen der bereits abgeleisteten Haftdauer oder der Gesamthaftdauer (Strafmaß) und der Suizidalität aller Inhaftierten konnte nicht ermittelt werden. Die verbleibende Haftzeit (Resthaftdauer) zeigte keinen signifikanten Einfluss auf die Suizidalität der Inhaftierten. Zwischen der Suizidalität von Untersuchungs- und Strafgefangenen konnte kein signifikanter Unterschied nachgewiesen werden. Außerdem konnte für die Selbstangabe der aktuellen Suizidalität kein signifikanter Zusammenhang zu den Suizidalitätsangaben in den verwendeten Fragebögen gefunden werden. / By law it is the responsibility of the government to secure the well-being of all imprisoned persons. In this study inmates of six prisons in Saxony were interviewed about suicidality and mental illnesses from February 2012 till March 2013. The interviews included questions about self reported suicidal tendencies at the present and the past of the inmates, self reported suicide attempts and some other questionnaires. Personality disorders were recorded by the Assessment of DSM-IV Personality Disorders (ADP-IV). Additionally, specific characteristics of the inmates' personalities were recorded by a special questionnaire (PSSI - Persönlichkeits-Stil-und-Störungs-Inventar). In comparison to inmates without personality disorders or without specific characteristics of their personality inmates with personality disorders or specific characteristics of their personality showed a significant relation to suicidality. A significant correlation between the time spent already in prison and the suicidality could not be found, neither was there a significant difference between the suicidality of prisoners, who are in a pre-trial custody and other prisoners. Furthermore there was no significant link between self reported suicidality and suicidality that was ascertained by the questionnaires.

Background: The psychosocial benefits of participating in physical activity (PA) are well known; less is known about the relationship between suicidal behaviors and PA among adolescents, especially among middle school-aged youth. This study seeks to fill that gap by assessing the cross-sectional relationship between these variables. Methods: A secondary analysis of the 2010 Tennessee Middle School Youth Risk Behavior Survey data was conducted among 65,182 middle school students. Items examined were PA, sports team engagement, physical education (PE) class, screen time, suicidal behaviors, drug/substance use, extreme weight control behaviors, weight status and weight misperceptions, and selected personal characteristics. Multiple logistic regression analysis was used to estimate the association between PA, sports team engagement, and PE class attendance on suicidal behaviors. Results: Sports team engagement was significantly associated with suicidal thoughts, plans, and attempts even after controlling for other important variables. There was no relationship, however, between total PA or PE class attendance in univariate or multivariate models, respectively. Conclusions: Findings suggest that sports team engagement is associated with reduced risk for suicidal thoughts, plans, and attempts, whereas, no relationships were found for PA or PE class attendance. Asking adolescents questions about sports team engagement may help clinicians screen for risk of suicidal behaviors.

Based on past research findings with college students, we tested whether perceived burdensomeness and thwarted belongingness represent important mediators of the association between future orientation and suicide risk (namely, depression and suicidality) in primary care patients. We conducted a multiple mediator test in a sample of 97 primary care patients. Our results indicated that perceived burdensomeness and thwarted belongingness accounted for the negative associations present between future orientation and measures of suicide risk. These findings provide evidence for perceived burdensomeness and thwarted belongingness as mechanisms accounting for the association between future orientation and suicide risk in primary care patients.

There is limited research on the relationship between trauma exposure, depression, and suicidality, particularly in high-risk primary care samples. The present study aims to: 1) characterize the prevalence of suicidality, depression, and trauma exposure in this sample; 2)develop and test models of the relationships between suicidality, depression, and trauma exposure in this sample; 3) augment the selected model with key protective factors, including social support and religiosity; and 4) further elaborate the nature of religiosity as a potential protective factor using the subscales of the Attitudes toward God scale, Anger toward God and Comfort with God. Patients (n=207) in a safety net primary care clinic waiting room completed measures assessing childhood and adult trauma, depression, and suicidal ideation. Approximately half of patients in this sample report having experienced at least four traumatic events, 82.13% of individuals were in the clinical range for depression, and nearly half of the sample endorsed some level of suicidality. In the first model, trauma exposure moderated the relationship between depression and in the second model, suicidality and depression mediated the relationship between trauma exposure and suicidality. Both models were then augmented with social support, religiosity, Anger toward God, and Comfort with God. All moderated moderational and moderated mediational models were nonsignificant, though certain paths were found to be significant. Social support had some protective effects, but all three aspects of religiosity exacerbated the models tested, in contrast to existing literature. These findings may be used to encourage more extensive and nuanced assessment for suicidality.

This thesis examines three main themes; depression, suicidality, and non-fatal overdose involving pharmaceutical and over-the-counter (OTC) medications. At any given time depression affects approximately one in every twenty adults in Australia. People with depression are at elevated risk of attempted and completed suicide compared to those without. Medication overdose is a frequently chosen method of suicidal behaviour, and accounts for one in ten suicide deaths and close to nine out of ten non-fatal episodes of suicidal behaviour for which hospital treatment is sought. The study reported here had six primary aims; (i) to quantify medication overdose presentations over a 12-month period to the Emergency Department (ED) of a major metropolitan public hospital in Melbourne, Australia, (ii) to describe the medication overdose patient group, including comparison with two other relevant types of presentation, illicit drug overdose, and actual or potential self-harm by means other than overdose, (iii) to explore the relationship between depression, suicidal ideation and medication overdose, (iv) to identify the medications typically used in overdose and their means of acquisition, (v) to explore patient experiences of emergency care following a medication overdose, and (vi) to comment on the feasibility of introducing a brief intervention within the ED with the intention of addressing the issue of medication overdose. Three data sources were employed: computerised ED records, interviews with a sub-sample of patients attending the ED following a medication overdose, and observation of ED processes in relation to these cases. / One of the most important findings of the study was the large contribution made by benzodiazepine medications to the overall medication overdose statistics. When considered in conjunction with the patient interview data, it appeared that many patients included in the study were prescribed benzodiazepines in a manner that contradicts current national prescribing guidelines. The problem of medication overdose could be partially addressed by working with doctors to ensure the appropriateness of their prescribing practices, to encourage them to more closely monitor the treatment progress of at-risk patients, and to increase awareness of other evidence-based forms of treatment for depression and anxiety.

Suicide is the second leading cause of death among college students, making it a prime target for prevention initiatives on college campuses. Efforts to manage the problem of suicidality on campus frequently involve shepherding students at elevated risk into treatment services through the college counseling center. Several scholars have called for suicide prevention efforts to take a public health approach, seeking to intervene more broadly by improving the mental health of the general population that is currently at little to no risk of developing an imminent suicidal crisis. One manner of expanding these prevention efforts is to investigate those factors that preserve the emotional and mental resilience of college students facing similar life stressors and distress levels. As such, scholars of suicidality have called for closer examination of those protective factors that prevent some students--experiencing comparable levels of stress as compared to their suicidal peers--from ever entering into or progressing along the suicidality continuum. Mindfulness is a construct that has shown promise in the intervention literature for its ameliorative affect on a range of disorders and problematic coping behaviors. The possible protective benefit of dispositional levels of mindfulness at varying points along the suicidal continuum is not well understood, and the present study seeks to remedy this gap in the literature in a large sample of college students. Using archival data from a national survey of college student coping collected in 2011 by The National Research Consortium of Counseling Centers in Higher Education, this study explored the effect of trait mindfulness levels on entry into and progression along the continuum of suicidality. Multilevel modeling was used to explore associations between historical and demographic predictors of suicidality, dispositional mindfulness levels, self-reported distress levels during a recent stressful period, strength of intent during a recent suicidal crisis, and suicidal thoughts and behaviors along a continuum of suicidality. Results indicated that mindfulness conveys protection at the threshold of developing suicidal thoughts during a recent stressor, but is not associated with the shift from suicidal thoughts to the development of suicidal behaviors. Implications are discussed with respect to the role mindfulness can play in the development of comprehensive, population-based suicide prevention programming and mental health promotion initiatives on college campuses. / text

Death, dying, and the actual loss of life are some of the broadest sweeping concepts that typically evoke a wide array of emotions from sadness and anger to fear and despondence. It is unlikely that the first words associated with death are comedy, humor, or laughter. However, that is precisely what creators and comedians of dark, death, and gallows humor seek to achieve. For my senior capstone project, I have created a short fictional narrative film encompassing the traits of a dark comedy. However, noticing that few dark comedies delve into topics surrounding suicide, I wondered if it was possible to achieve the same comedic and filmic effects with suicide as dark comedies do with death. Is it possible to generate humor from suicide and desiring death? What is implied if humor is derived from the inability to reach death on one’s own volition?

Background: It is widely understood that survivors of childhood trauma (emotional abuse, physical abuse, sexual abuse and emotional, physical neglect) have poorer mental health outcomes than their non-abused counterparts; one of which is an increased risk of suicidality. The disclosure of childhood abuse is key to safeguarding against further victimization and promoting better psychosocial outcomes for survivors in the long-term. Aims: The aims of this thesis portfolio are twofold. Firstly, to review the published literature investigating the barriers and facilitators to disclosing sexual abuse as perceived by children and adolescents (Chapter 1). Secondly, to research the relationship between childhood trauma and suicidality in a cohort of socio-economically deprived men living in Scotland (Chapter 3). The bridging chapter (Chapter 2) discusses the main themes that connect chapters one and three, notably the possible negative impact of childhood trauma on adult psychosocial functioning. Method: An exploratory systematic review and meta-synthesis of the literature was carried out. Strict eligibility criteria were predefined and a comprehensive search strategy identified a total of thirteen studies for review. For the empirical study, a total of 86 adult men with past and/or present suicidality participated in a quantitative cohort study and completed measures on childhood trauma, emotion regulation, interpersonal difficulties and suicidal behaviour. Multiple mediation analysis was used to analyse the data and to answer the study’s research questions. Results: The exploratory review highlighted that existing research into child and adolescent disclosures of sexual abuse is still in its infancy and that robust, longitudinal studies with more sophisticated methodologies are required to replicate findings. The collective body of literature identified that limited support, perceived negative consequences and feelings of self-blame, shame and guilt serve as significant barriers to disclosure whilst being asked or prompted through the provision of developmentally appropriate information facilitates young people to tell. The empirical study found that emotion regulation and interpersonal difficulties mediate the relationship between childhood trauma and suicidality in a sample of adult men. Conclusion: Several important clinical implications were identified in both parts of the thesis portfolio. Firstly, the systematic review identified the need for family members, friends and frontline professionals to explicitly ask children about the possibility of sexual abuse. It was also considered imperative that recipients are supported in responding to disclosures in positive and supportive ways so as to reduce young peoples’ feelings of responsibility, self-blame, shame and guilt. The empirical study concluded that dysfunctional emotion regulation and interpersonal difficulties are implicated in the overall collateral and compounding psychosocial sequelae of childhood trauma. The provision of psychological interventions for men with past and/or present suicidality should support individuals to develop healthy social problem-solving and emotion regulation skills. Providing effective, trauma-informed interventions for these individuals will move their treatment beyond simple risk management and focus, instead, on instilling recovery and resilience.

No description available.

Objectives: The objective of this study was to prove concepts in the characterization of suicidal patients and the possible usefulness of those markers to potentially identify patients with a higher risk for suicidality. Methods: Patients with a recent suicide attempt were compared with patients suffering from depression, adjustment disorder, anxiety, or eating disorders without suicidality, healthy controls and remitted patients with a history of at least 1 suicide attempt (≥1 year). We analyzed impulsivity (Barratt Impulsivity Scale, BIS) and saliva cortisol concentrations. Results: Independently of suicidality and disease state patients display higher BIS scores than healthy controls. Saliva cortisol levels tend to be higher in patients in the acute disease state than in remitted patients and healthy controls. Conclusions: Saliva cortisol may be a useful marker that reveals alterations in nonsuicidal patients suffering from depression, adjustment disorder, anxiety, or eating disorders who might be at risk.