The purpose of this study is to analyze the interaction of (1) the secondary school teacher's knowledge concerning both the problem of adolescent suicide and the potential for teacher intervention and (2) selected demographic variables on the dependent variables of the teacher's attitudes concerning both the problem of adolescent suicide and the potential for teacher intervention in order to develop a data base upon which to examine the prospects for realizing the intervention potential of secondary school teachers in the area of adolescent suicide. Findings indicate that there are significant differences in knowledge concerning the problem of adolescent suicide and the potential for teacher intervention as a function of particular demographics. Similarly, there are significant differences in attitude toward the problem of adolescent suicide and the potential for teacher intervention as a function of particular demographics. Findings further reveal that level of knowledge appears to be a significant contributing factor in the secondary school teacher's attitude as a function of selected demographics. Secondary school teachers appear to possess a low level of knowledge concerning both the problem of adolescent suicide and the potential for teacher intervention, and they exhibit a range of predominantly negative attitudes toward the problem of adolescent suicide. However, the teachers appear to possess a tenuously positive attitude toward the potential for teacher intervention.

O suicídio é um fenômeno complexo, multifatorial e não decorre de uma causa única. A mídia desempenha um papel significativo para determinar percepções do público sobre o tema visto que influencia atitudes, crenças, visão de mundo, potencializa comportamentos, gerando impactos na sociedade. Essa pesquisa de natureza qualitativa teve como objetivo compreender como a mídia aborda o suicídio e a possibilidade de influenciar o seu contágio. Foram realizadas entrevistas abertas com cinco jornalistas que atuam na cidade de São Paulo, com o intuito de investigar como o suicídio é noticiado nos meios de comunicação. As unidades de significado foram extraídas tendo como base o método fenomenológico proposto por Moustakas (1994). A análise das entrevistas apontou três categorias temáticas principais: 1) Dos medos e das incertezas diante do contágio aos questionamentos sobre o papel da mídia nos suicídios; 2) As percepções e as posturas dos jornalistas quanto à publicação de suicídios na mídia; 3) Os desafios do jornalismo atual: imediatismo, pressão e sofrimento psíquico. A presente investigação mostrou que os jornalistas contestaram o risco de contágio, mas também apontaram a possível influência midiática nesse processo, sendo que reportagens sobre suicídios têm influência positiva ou negativa dependendo da abordagem e dos temas incluídos. Destacam-se as dificuldades enfrentadas pelos jornalistas: rapidez na publicação, busca por audiência, imediatismo e pressão sofrida no trabalho, que têm como consequência a publicação de reportagens menos reflexivas e mais informativas. Essa pesquisa pode contribuir com reflexões acerca da publicação do suicídio e compreender o papel dos meios de comunicação para fomentar a conscientização pública, acreditando que uma reportagem bem elaborada sobre o tema pode colaborar com a prevenção do suicídio e evitar o efeito do contágio por meio da mídia / Suicide is a complex, multifactorial phenomenon and does not stem from a single cause. The media plays a significant role in determining public perceptions on the subject as it influences attitudes, beliefs, worldviews, as well as shaping behaviors, all of which impact society. The goal of this qualitative study is to understand how the media approaches suicide and the possibility that it may influence its contagion. Open interviews were conducted with five journalists who work in the city of São Paulo, with the intent of investigating how suicide is reported in the media. The units of meaning were extracted on the basis of the phenomenological method proposed by Moustakas (1994). Analysis of the interviews pointed to three main thematic categories: 1) Fears and uncertainties concerning contagion, stemming from questions about the medias role in suicides; 2) Journalists perceptions and viewpoints regarding the publication of suicides in the media; 3) The challenges currently faced by journalists: immediateness, pressure and psychic suffering. The present study shows that the journalists disputed the risk of contagion, but they also pointed out the possible media influence on this process, given that reporting on suicides has a positive or negative influence depending on the approach taken and the topics included. Of particular note are the difficulties faced by journalists: speed of publication, search for audience, and immediacy and pressure at work, which result in the publication of less reflective and more informative reports. This study presents reflections on suicide reporting and helps to understand the medias role in promoting public awareness, with the belief that a well-written report on the subject can contribute to suicide prevention and avoid the effect of contagion through mass media communication

Background: Primary care may be a key setting for suicide prevention as many patients visit their General Practitioner (GP) in the weeks leading up to their death. Comparatively little is known about GPs’ perspectives on risk assessment, treatment adherence, management of and interactions with suicidal patients prior to the patient’s suicide and the services available in primary care for suicide prevention. Aim: This study aimed to explore primary care data on a clinical sample of individuals who died by suicide and were in recent contact with mental health services in order to: investigate the frequency and nature of general practice consultations; examine risk assessment, treatment adherence and management in primary and secondary care; gain GPs’ views on patient non-adherence to treatment and service availability for the management of suicidal patients. Method: A mixed-methods study design including data from the National Confidential Inquiry on 336 patients who died by suicide, data from 286 patient coroner files, primary care medical notes on 291 patients and 198 semi-structured face–to-face interviews with GPs across the North West of England. We collected data on GPs' views on the treatment and management of patients in the year prior to suicide, suicide prevention generally and local mental health service provision. Quantitative data were analysed using SPSS. Interviews were transcribed verbatim and analysed using a thematic approach. Results: Overall, 91% of individuals consulted their GP on at least one occasion in the year before suicide. GPs reported concerns about their patient’s safety in 27% of cases, but only 16% of them thought that the suicide could have been prevented. The overall agreement in the rating of risk between primary and specialist care was poor (overall kappa = 0.127; p = 0.10). Non-adherence was reported for 43% of patients. The main reasons for non-adherence were lack of insight, reported side effects and multiple psychiatric diagnoses. We obtained qualitative data from GPs on their interpretations of suicide attempts or self-harm, professional isolation and GP responsibilities when managing suicidal patients. Limitations: Our findings may not be generalisable to people who died by suicide and were not under the care of specialist services. GPs recruited for the study may have had different views from GPs who have never experienced a patient suicide. Our findings may not be representative of the rest of the UK although many of the issues identified are likely to apply across services. Conclusion: Suicide prevention in primary care is challenging. Possible strategies for future suicide prevention in general practice include: increasing GP awareness of suicide-related issues and improving training and risk assessment skills; increasing awareness in primary care about why patients may not want treatments offered by focusing on each individual’s situational context; removing barriers to accessing therapies and treatments; and, better liaison and collaboration between services to improve patient outcomes.

The long-term goal of this research is to reduce the number of deaths by suicide. Suicide is the leading cause of violent death in the United States, and is currently the 10th most common cause of death across all age groups. Suicide prevention efforts have historically been focused on youth/young adults, and the elderly, with less attention on programming for individuals in the working years. Our intention is to generally broaden the understanding of suicide, depression and the workplace, with the hope of improving interventions for this underserved population. The research activities outlined below were conducted under the auspices of a larger quasi-experiment at the University of Iowa. We first sought to assess the experiences of professional, nonclinical staff identifying and responding to apparently mental health problems in the workplace. We looked at the impact of two exposures on engagement with individuals in crisis: self-reported contact (the number of students or coworkers a participant interacted with each week), and participation in any suicide prevention training/programming over the previous five years. High contact with students was generally associated with a greater capacity for recognizing and responding to depression and potential suicidality. In contrast, the association between high contact with employees and recognition and response was insignificant for four of the six recognition and response behaviors. Participation in any form of suicide prevention training or programming in the previous five years was highly associated with recognizing and responding to depressed or suicidal coworkers and students. Next, we considered the impact of a personal prior experience with suicide and prior suicide prevention training/programming on four constructs: preparedness to respond to someone in crisis, familiarity with appropriate resources, gatekeeper self-efficacy, and gatekeeper reluctance. Suicide prevention training/programming was significantly associated with higher perception of three constructs: preparedness, familiarity, and self-efficacy. There was no statistical difference in reluctance between previously training participants and participants who had not previously taken suicide prevention training or programming. Individuals who had a personal prior experience with suicide were less reluctant to engage, although the results were not significant. There was an association between individuals who had a personal prior experience with suicide and suicide prevention training/programming, suggesting that individuals with a personal connection to suicide might be more likely to enroll in suicide prevention programming. Finally, we examined how a suicide prevention training programming impacted the perception of safety culture in the workplace. On the 10 item safety scale, there was a significant difference between the means scores reported by the intervention and control group on 7 of the 10 questions. Individuals who participated in QPR gatekeeper training reported a higher sum safety culture score than individuals who did not participate in the training; the overall model was statistically significant. This project shows that suicide prevention training/programming of any kind in the workplace can have a persistent, positive training impact on employees by informing and empowering them to act. It suggests that individuals with a personal prior experience with suicide may be more likely to take suicide prevention training, and may be less reluctant to engage with someone in crisis. It also demonstrates that suicide prevention training may have a positive impact on other workplace psychosocial factors, and deserves prioritization in workplace wellness programming.

While the manifestation of suicidal thoughts and/or behavior is more common among adolescents, children are capable of, and do experience, suicidal ideation as well as demonstrate suicidal behaviors. Suicide is the sixth leading cause of death among children aged 5-14 years (Center for Disease Control [CDC], 2008). However, children may not always be referred or brought to the attention of the school psychologist, as their threats may be considered immature and unfounded. The purpose of this study is to provide data that clarifies the need for the provision of suicide-related services for children in elementary school. An archival dataset of 226 National Association of School Psychologist (NASP) practitioners was analyzed. In regards to referrals for potentially suicidal youth, within a two year period, practitioners who served elementary schools received an average of 1.64 referrals, practitioners who served middle/junior high schools received 2.95 referrals, and practitioners at the high school level received 3.95 referrals. Within the same time period, practitioners who served elementary schools experienced an average of .05 completed suicides, middle/junior high school practitioners experienced .07 completed suicides, and practitioners at the high school level experienced .16 completed suicides. Results indicated that overall, practitioners felt "moderately prepared" to provide suicide-related services to youth. School psychologists who predominantly served high schools perceived themselves to be significantly more prepared to engage in suicide-related roles than their elementary school colleagues. School psychologists who predominantly served middle/junior high schools were similar to their colleagues who served either elementary or high schools on three out of four professional roles. Implications for future research, training, and practice are discussed.

Bakgrund Suicid är ett globalt folkhälsoproblem och trots att mycket arbete har lagts ner på att förebygga suicid tycks statistiken inte minska. Tidigare suicidförsök är en av de största riskfaktorerna för suicid och majoriteten av de som genomgått suicid har tidigare haft kontakt med vården bara månader innan. Därav väcktes frågan om varför vården inte lyckats förhindra fler suicider. Överallt inom vården finns suicidala patienter vilket gör att alla sjuksköterskor kommer möta denna patientgrupp. Därför är det viktigt att sjuksköterskor besitter kunskapen och kompetensen i att bemöta suicidala patienter.  Syfte Syftet var att belysa patienters upplevelse av vården efter ett suicidförsök.  Metod För denna icke-systematiska litteraturöversikt söktes vetenskapliga artiklar i PubMed, CINAHL och PsycInfo. Sökningar gjordes med olika sökordskombinationer, 16 artiklar ansågs vara relevanta och inkluderades i resultatet. Av de vetenskapliga artiklarna var 14 kvalitativa och två kvantitativa. Genom att använda Sophiahemmets högskolas bedömningsinstrument kvalitetsgranskades de 16 artiklarna för att sedan ingå i en integrerad analys där artiklarna delades in i tre teman och tio subteman. Resultat Resultatet presenterades i tre huvudteman och tio subteman som belyste hur patienter upplever vården efter ett suicidförsök. De huvudteman som skapades var: upplevelser av brister i vården, upplevelser av god vård samt upplevelser av värdefulla aspekter. Slutsats Upplevelser av vård efter suicidförsök var både positiva och negativa. Upplevelsen av en god vård grundades ofta i förtroende, att bli lyssnad på, respekterad och behandlad som en medmänniska med delaktighet. Det som däremot beskrevs som en bristande vård var när vårdpersonalen saknade kunskap om kompetens, när bemötandet var distanserat och oengagerat samt när en tydlig stigmatisering fanns. Den bristande vården ledde många gånger till att patienter upplevde en rädsla för att erkänna suicid. / Background Suicide is a global public health problem and although much work has been done to prevent suicide, the statistics do not seem to decrease. Previous suicide attempts are one of the biggest risk factors for suicide and the majority of those who have committed suicide have previously had contact with healthcare only months before. The question of why healthcare has not succeeded in preventing more suicides was raised among the authors. There are suicidal patients everywhere in all healthcare sections, which means that all nurses will meet this patient group. Therefore, it is important that nurses have the knowledge and competence to respond to suicidal patients. Aim The aim was to shed light on patients experience of health care after suicide attempt. Method For this non-systematic literature review, scientific articles were searched in PubMed, CINAHL and PsycInfo. Searches were done with different keyword combinations and 16 articles were considered relevant and included in the results. Of the scientific articles, 14 were qualitative and two was quantitative. Using Sophiahemmet University's assessment instrument, the 16 articles were quality reviewed and then included in an integrated analysis where the articles were divided into three themes and ten subthemes. Results The results were presented in three main themes and ten sub-themes that shed light on how patients experience care after a suicide attempt. The main themes that were created were: experiences of shortcomings in care, experiences of good care and experiences of valuable aspects. Conclusions Experiences of care after suicide attempts were both positive and negative. The experience of good care was often based on trust, being listened to, respected and treated as a fellow human being with participation. On the other hand, what was described as a lack of care was when the care staff lacked knowledge of competence, when the treatment was distanced and uninvolved and when there was a clear stigma. The lack of care often led to patients experiencing a fear of acknowledging suicide.

There is compelling evidence that helping adolescents develop certain traits (especially related to resiliency) can mitigate the confounding effects of suicide. Specific demographics of youth appear to have higher rates of suicidal behavior including those with mental health diagnoses and educational disabilities that affect students' academic achievement. We looked at evidence based social and emotional learning programs (SEL) that fostered adaptive coping skills and resilience. We identified Strong Teens (Carrizales-Engelmann, Merrell, Feuerborn, Gueldner, & Tran, 2016) as a program that could be easily administered and adapted into traditional and nontraditional school settings. This study was conducted in a residential treatment center (RTC) for adolescent males. The RTC permitted one of their therapists to implement the Strong Teens over the course of two consecutively run groups. Group 1 included seven boys and Group 2 included four boys. We relied on the therapist's self-assessment of modifications made to the program; the researcher's field notes collected during observations; emails between the therapist and researcher; the researcher's notes taken during conversations between the therapist and researcher; monthly Youth Outcome Questionnaire Self Report (Y-OQ-SR) test scores; youth Strong Teens pre and post test scores; and youth exit surveys conducted in one-one interviews at the conclusion of the Strong Teens lessons. Fidelity of program implementation was measured by the therapist and researcher completing the Strong Teens fidelity checklist (included in the Strong Teens manual). Based on collected data, we make the following recommendations: Adapt the Strong Teens program to increase student participation and receptiveness; carefully consider the size of the group, taking into account the capacity of the group leader to manage the group's behaviors and attend to individual needs; consider conducting groups sessions in settings that help youth feel safe and comfortable--groups held outside may be preferable to groups held inside classrooms; mental health professionals and teachers who lead the Strong Teens lessons may consider learning about a variety of basic therapeutic strategies and how these strategies might fit participants' needs; when evaluating the effectiveness of Strong Teens, carefully gather, consider, and contextualize a variety of data (quantitative and qualitative) from a variety of sources (youth participants, group leaders, and others who interact with the youth); in addition to focusing on teaching information and skills, group leaders must consider motivational strategies; focus initial conversations on why one would use such strategies to benefit oneself--later conversations may expand to include how strategies benefit others.

Looking for ways that dance could be used as a tool for health promotion, I sought to explore dance choreography and performance as an alternative medium for educating and increasing awareness about college student suicide. Suicide is the second leading cause of death amongst college students and while research suggests that suicide is decreasing, in terms of attempted suicides, the problem may be increasing. While attempts to understand, predict and prevent the loss of lives have resulted in extensive literature, there has been very little systematic research completed. Compounded by limited proposed models for addressing college student suicide, and lack of evidence there remains a growing need to find effective health communication practices and best health promotion practices. This research study is an autobiographical case study that explores my embodied experience of choreographing and performing a dance about college student suicide. As a health promotion professional and a trained dance artist, I assumed the role of researcher and dance choreographer and I and my experience became the subject of this research study. I launched and conducted a six-week project on my university campus called "Dance For Life" and worked with a small group of three female undergraduate dancers to make the new dance piece. This dance project was the case under investigation out of which I presented an autobiographical narrative in the findings and discussion section of this paper. Reviewed health information, research findings, and data, as well as knowledge extracted from the dance group became in part material used to make the dance. As the choreographer, my role in the choreographic process spanned from expert to collaborator and rested on my vision for the story told that would be told through the dance. I collected m data in the form of:- video recordings; audio recordings; pictures; journal entries; field/ observational notes; video diaries; drawings; interviews with community-based artists; and memory recall. I then worked to sort, label, group, and analyze the data, piecing together my findings to write an autobiography that answered my research questions. My exploration highlighted the importance of community involvement in community-based health programming.Through participation in this project the dancers\' knowledge and awareness of college student suicide increased and positively affected their empathetic response toward members of the community. Using non professional dancers with varied dance skill levels did not inhibit creativity or diminish the quality of work produced. Instead it brought together real life people with diverse perspectives, creative solutions, and a passion for dance to produce a piece of art effective in its ability to \'touch\' the audience and draw them in to a place of greater awareness. Stigmas, and the lack of  education and visibility about this particular health challenge, have resulted in a low community response to affecting change. The post performance discussion, brought the greatest gains, in terms of educating the audience. They interacted with the project, asked questions, gave feedback and provided comments about what they experienced, learned, and understood. The overall success of the project, points toward the possibility of dance as an art form playing a more significant role in educating communities about sensitive, and difficult to talk about, health challenges. Being able to affect the knowledge, attitudes, and empathetic response of communities is a beginning step  towards overcoming the health challenge of college student suicide. Future research needs to focus on best choreographing techniques as it relates to audience interpretation. / Ph. D.

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