28th World Congress of the International Association for Suicide

Table of Contents / Table des matières
Presentations / Présentations ....................................................................................................... 7
SP17: Plenary Session 1 [séance plénière 1] .......................................................................... 7
Poster Session A: June 17 / 17 juin - Poster Session [séance par affiche].............................. 9
PP17-1: Parallel Plenary: Treatment of Suicidal and Self-Harming Behavior in People with
Borderline Personality Disorder - Results from New Psychotherapy Trials / [Traitement des
comportements suicidaires et de l'automutilation chez les personnes ayant un TPL] .......... 28
PP17-2: Parallel Plenary: An Internationally Applicable Nomenclature for Suicide and
Suicide-Related Phenomena [Plénière parallèle: Une nomenclature applicable
internationalement pour le suicide et les phénomènes qui y sont reliés] .............................. 31
PP17-3: Parallel Plenary: Increasing the Rigor and Yield from Clinical Trials: MultiNational Considerations and Future Directions .................................................................... 34
OP17-1A: Atelier: Formations et recherche - Atelier animé par le Groupement d'Etudes et
de Prévention du Suicide (France) ........................................................................................ 37
OP17-1B: Best Practices and Recent Findings [Meilleures pratiques et découvertes récentes]
.............................................................................................................................................. 38
OP17-1C: Workshop: Country Needs and Plans for the Implementation of Suicide
Prevention Programmes and Strategies / [Besoins en matière de planification et
d'implantation d'un programme national de prévention du suicide] ..................................... 41
OP17-1D: Symposium: Cultural Aspects Related to Suicide Behaviors in Latin American
Countries ............................................................................................................................... 42
OP17-1E: Symposium: Hello, Partner: The Emerging Voice of Attempt Survivors and How
to Turn It Into Action ............................................................................................................ 45
OP17-1F: Workshop: Brief Cognitive Behavior Therapy to Prevention Suicide Attempts . 47
OP17-1G: Symposium: Best Practice for Helplines ............................................................. 48
OP17-1H: Symposium: Culture and Morality: Perspectives on Suicide from Different
African Cultures.................................................................................................................... 50
OP17-1I: Suicide Prevention with Indigenous People.......................................................... 52
OP17-1J: Predictors and Correlates of Self-Harm and Suicidal Behaviours in Youths ....... 55
OP17-1K: Understanding Suicide from Epidemiological Research I .................................. 58
OP17-1L: Mental Illness, Gambling and Other Risk Factors ............................................... 61
OP17-1M: Symposium: Alcohol and Suicidal Behavior: Individual-, Population-, and MetaAnalytic Findings.................................................................................................................. 64
OP17-1N: New Technologies and Suicide Prevention I....................................................... 67
OP17-2A: Atelier: Notre regard d'intervenant et son impact sur le client ............................ 70
OP17-2B: Symposium: High Risk Occupations and Workplace Suicide Prevention [Emplois
à risque élevé et prévention du suicide en milieu de travail] ................................................ 71
OP17-2C: Workshop: Surveillance Systems for Non-Fatal Suicidal Behaviour / [Atelier:
Systèmes de surveillance des comportements suicidaires non fatals] .................................. 74
OP17-2D: Symposium: Empathic Responses to Suicidal Individuals ................................. 76
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OP17-2E: Symposium: Raising All Boats: Disruptive Innovation in Suicide Prevention
through Lived Experience Leadership .................................................................................. 78
OP17-2F: Workshop: Applying the Cost Benefit Analysis to Suicide Prevention............... 80
OP17-2G: Symposium: Crisis Chat Services - Development and Evaluation...................... 81
OP17-2H: Symposium: Cultural Suicide Research (IASP SIG on Culture and Suicidal
Behaviour) ............................................................................................................................ 83
OP17-2I: Symposium: Suicidal Behavior, Depression and Borderline Personality Disorder
in Adolescence, Clinical Research and Best Practice ........................................................... 85
OP17-2J: Symposium: Life Experiences and Patterns of Distress in Chinese and ChineseCanadian Women with a History of Suicidal Behaviour ...................................................... 87
OP17-2K: Gender and Suicide Risk and Behaviours ........................................................... 89
OP17-2L: Self Harm and Deliberate Self Harm ................................................................... 92
OP17-2N: Understanding Suicide and Suicidal Behaviours I .............................................. 94
SP18: Plenary Session 2 [séance plénière 2] ........................................................................ 97
Poster Session B: June 18 / 18 juin - Poster Session [séance par affiche] ............................ 99
PP18-1: Parallel Plenary: Genetics and Neurobiology of Suicidal Behavior [Plénière
parallèle: Génétique et neurobiologie des comportements suicidaires] .............................. 119
PP18-2: Parallel Plenary: Qualitative Suicide Research [Plénière parallèle: Recherche
qualitative en suicidologie] ................................................................................................. 121
PP18-3: Parallel Plenary: Historical Trauma in Indigenous Societies: Theoretical
Approaches, and Implications for Youth Suicide Prevention ............................................. 124
OP18-3A: Atelier: Mobiliser les communautés pour prévenir le suicide : paradigmes et
exemples québécois, dont l’engagement citoyen des auteurs d’un téléroman à succès...... 126
OP18-3B: Symposium: Task Force Media & Suicide Symposium II: Suicide Preventive
Interventions via Online Media and Preventive Aspects of Communication in Social Media
[Groupe de travail Médias & Suicide II: Prévention du suicide par internet et les médias
sociaux] ............................................................................................................................... 127
OP18-3C: Symposium: Suicidal Behaviour in People with an Intellectual Deficiency or an
Autism Spectrum Disorder: Understand, Assess Risk and Intervene [Le comportement
suicidaire chez les personnes avec une DI ou un TSA: comprendre, évaluer et intervenir] 130
OP18-3D: Symposium: IASP Special Interest Group, Clusters and Contagion: New
Research and Practice ......................................................................................................... 132
OP18-3E: Current Research on Suicide Bereavement (Survivors) .................................... 135
OP18-3F: Workshop: Intersecting Indigenous Rainbows - International LGBT First Nations
and Two-Spirited People in Suicide Prevention ................................................................. 137
OP18-3G: Atelier: S'entraider pour prévenir le suicide: les proches, de précieux alliés .... 139
OP18-3H: Symposium: Suicide Prevention in Different Cultural Settings ........................ 140
OP18-3I: Suicide and the Elderly ....................................................................................... 142
OP18-3J: Suicide and Self-Harm in Students ..................................................................... 144
OP18-3K: Understanding Suicide from Epidemiological Research II ............................... 147
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OP18-3M: Symposium: Preventing Pesticide Suicide - Restricting Access to the Means of
Suicide ................................................................................................................................ 151
OP18-3N: New Technologies and Suicide Prevention II ................................................... 153
OP18-4A: Atelier: Décloisonnement des pratiques et réseaux - Atelier en coopération
UNPS-GEPS ....................................................................................................................... 156
OP18-4B: Symposium: Psychosocial Treatment for People at Risk of Suicide [Traitement
psychosocial pour les personnes à risque de se suicider] ................................................... 157
OP18-4C: Evaluating Individuals and Evaluating Programmes [Évaluation des individus et
évaluation de programmes] ................................................................................................. 160
OP18-4D: Symposium: Media Recommendations: A Review of Their Use and Impact
Internationally ..................................................................................................................... 164
OP18-4E: Attempt Survivors as Allies in Suicide Prevention............................................ 166
OP18-4F: Workshop: The Waka Hourua Programme: Insights into Indigenous Suicide
Prevention in Aotearoa - New Zealand............................................................................... 169
OP18-4G: Opportunities and Priorities in Research and Stakeholder Engagement ........... 171
OP18-4H: National Strategies and Approaches II .............................................................. 173
OP18-4I: Symposium: Advances in Understanding Suicide in the US Military ................ 176
OP18-4J: Effective Prevention Programmes ...................................................................... 178
OP18-4K: Understanding Suicide: Biology, Air Pollution and Distress Tolerance ........... 181
OP18-4L: Medication, Firearms and Railways: Specificities of Means ............................. 184
OP18-4M: Workshop: Suicide Prevention among Older Adults: Enhancing Risk Assessment
and Care Provision Incorporating Older Adult Suicide Prevention Knowledge Translation
............................................................................................................................................ 187
OP18-4N: Understanding and Helping Suicide Attempters I ............................................. 188
SP19: Plenary Session 3 [séance plénière 3] ...................................................................... 190
Poster Session C: June 19 / 19 juin - Poster Session [séance par affiche] .......................... 191
PP19-1: Parallel Plenary: Bridging the Gap between Emergency Department and
Community by Psychosocial Assessments and Interventions in the Care of Suicide
Attempters [Plénière parallèle: Faire le pont entre les services d'urgence et la communauté]
............................................................................................................................................ 210
PP19-2: Parallel Plenary: Methodological Developments for the Study of Social Media,
Self-Harm and Suicide [Plénière parallèle: Développements méthodologiques pour l'étude
des médias sociaux, de l'automutilation et du suicide] ....................................................... 213
PP19-3: Parallel Plenary: Mapping an Agenda for Suicide Bereavement and Postvention
Research - Outcomes from the IASP SIG Taskforce on Suicide Bereavement Research .. 216
OP19-5B: Symposium: Post-Treatment Technology-Based Caring Contacts for Suicide
Prevention [Suivi post-tentative et prévention des récidives par l'utilisation des nouvelles
technologies d'intervention] ................................................................................................ 218
OP19-5C: Symposium: Living with a Suicidal Person: Support for Families in Crisis [Vivre
avec une personne suicidaire: soutien pour les familles en crise] ...................................... 221
OP19-5D: Symposium: Use of Health Services and Cost-Effectiveness of Treatment for
Patients with Suicidal Behaviour ........................................................................................ 224
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OP19-5E: Symposium: Adolescent Suicide and Adolescent Suicide Bereavement ........... 226
OP19-5F: Symposium: Comparing National Models and Guidelines for Suicide Postvention
............................................................................................................................................ 228
OP19-5G: Symposium: North Atlantic Treaty Organization (NATO) Research Task Group
(RTG) on Military Suicide.................................................................................................. 230
OP19-5H: Symposium: Promising Practices on Suicide Prevention in Circumpolar Regions
............................................................................................................................................ 232
OP19-5I: Veterans, Law Enforcement and Prisons ............................................................ 234
OP19-5J: Symposium: Suicide Prevention in Older Adults: New Discoveries and Innovative
Programs ............................................................................................................................. 237
OP19-5K: Assessment and Risk Factors ............................................................................ 240
OP19-5L: Prevention and Postvention with Youth ............................................................ 242
OP19-5M: Workshop: Making Suicide Prevention a Health and Safety Priority in the
Workplace ........................................................................................................................... 245
OP19-5N: New Technologies and Suicide Prevention III .................................................. 247
OP19-6A: Atelier: Citoyenneté - Atelier animé par l'UNPS. Développement de pratiques
d'accompagnement et de soutien participatif ...................................................................... 250
OP19-6B: Symposium: Task Force Media & Suicide Symposium I: Advances in Basic
Knowledge on Suicide Contagion via Traditional and Emergent Media [Groupe de travail
Médias & Suicide: Développements des connaissances sur la contagion du suicide par les
médias]................................................................................................................................ 252
OP19-6C: Symposium: Suicide Prevention among Aboriginal Communities around the
World: New Approaches Working with the Local Population [Prévention du suicide au sein
des communautés autochtones dans le monde: nouvelles approches en partenariat avec la
communaut ......................................................................................................................... 255
OP19-6D: Symposium: Men and Suicide: Addressing the Gender Gap ............................ 258
OP19-6E: Helping People Bereaved by Suicide (Survivors) ............................................. 260
OP19-6F: Workshop: Integrating the Voice of Suicide Attempt Survivors - Changing the
Conversation ....................................................................................................................... 263
OP19-6G: Media and Suicide Positive Uses and Negative Impacts................................... 264
OP19-6H: Symposium: Diverse Perspectives on Wellness, Resiliency, and Suicide
Prevention in the Circumpolar World ................................................................................. 266
OP19-6I: Gender and Sexual Orientation ........................................................................... 269
OP19-6J: Understanding Youth Suicide and Self-Harm .................................................... 272
OP19-6K: Suicide Prevention in Different Cultures .......................................................... 275
OP19-6L: Emergency Services in Suicide Prevention ....................................................... 277
OP19-6M: Workshop: The Injury Control Research Center for Suicide Prevention (ICRCS): Integrating Public Health & Mental Health Perspectives to Prevent Suicide ............... 280
OP19-6N: Understanding Suicide and Suicidal Behaviours II ........................................... 281
OP20-7A: Recherches et nouvelles pratiques des milieux francophones ........................... 284
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OP20-7B: Symposium: Interactive Online and Smartphone Intervention of Suicidal Ideation
[Interventions par internet et par téléphone intelligent en cas d'idéations suicidaires] ....... 286
OP20-7C: Symposium: Suicide Prevention Efforts in the Workplace [Efforts de prévention
du suicide en milieu de travail] ........................................................................................... 290
OP20-7D: Hospital and Post-Hospitalization Treatment .................................................... 293
OP20-7E: Understanding the Aftermath of Suicide Death ................................................. 296
OP20-7F: Symposium: Nonsuicidal Self-Injury in School Settings................................... 299
OP20-7G: Symposium: Workplace Suicide Prevention: Justification and Approaches ..... 301
OP20-7H: Symposium: Multifaceted Community-Based Interventions around the World Learning from Each Other .................................................................................................. 304
OP20-7I: Gatekeeper Roles and Effectiveness ................................................................... 306
OP20-7J: National Strategies and Approaches III .............................................................. 308
OP20-7K: Understanding Suicide from Epidemiological Research III .............................. 311
OP20-7L: Helplines and Helpline Programmes ................................................................. 314
OP20-7M: Workshop: New US Guidelines for Postvention: Implications for Policy,
Communities and Practice .................................................................................................. 317
OP20-7N: Understanding and Helping Suicide Attempters II ........................................... 318
SP20: Closing Ceremony / Cérémonie de clôture .............................................................. 321
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Presentations / Présentations
SP17: Plenary Session 1 [séance plénière 1]
Cracked, Not Broken / [Le corps fracturé, mais l'esprit indemne]
Kevin Hines
Kevin Hines, United States of America; jkevin057@gmail.com
Kevin Hines is a Golden Gate Bridge suicide attempt jump survivor. He is a speaker, author and mental health advocate.
Kevin continues his fight for wellness and dedicates his life to working for mental health equality, awareness, and
education.
Since the Golden Gate Bridge opened in 1937, thousands of people, in their desperation and loss of hope, would leap off
and die by suicide. Miraculously, 34 of the people who jumped – survived. Kevin Hines is a survivor.
On September 24, 2000, the paranoid and hallucinating 19 year old flung himself off the bridge in a suicide attempt. He
fell 220 feet straight down into the San Francisco bay, shattering three vertebrae and lacerating his lower organs. The
Coast Guard pulled Hines from the frigid waters and he was transported to Marin General Hospital. Thanks to an
experimental surgery, the plunge into the water left almost no physical evidence on Hines’ body. He has a few scars, but
otherwise his body is whole again. He now works as a mental-health advocate, traveling the world to share his story in
the hopes of preventing death by suicide and offering hope to those suffering from mental illness. His first book and
memoir, Cracked Not Broken, was released in July 2013. He was featured in the documentary film, The Bridge. He sat
across the table from Larry King on CNN. Every newspaper in San Francisco featured an article about his experience on
the bridge. He has spoken to school kids, corporate executives, and military personnel.
California Highway Patrol Sgt. Kevin Briggs is nicknamed the “Guardian of the Golden Gate Bridge.” Since 1994, through
sheer compassion and active listening skills, Sgt. Briggs helped convince more than 200 people on the Golden Gate
Bridge, not to take their lives. Sgt. Briggs is the California Highway Patrol Sergeant who handled Kevin Hines’ case in
2000 and who is responsible for saving Kevin Berthia’s life in 2005.
Kevin Briggs spent three years in the US Army. In 1990, he entered the California Highway Patrol (CHP) academy. He
was assigned to the Hayward, CA, Area Office, later transferring to the Marin Area Office. As an officer Briggs worked
predominately on the Golden Gate Bridge (GGB.) This assignment proved to be very challenging, as the Bridge is the site
of an average of four to six suicidal individuals, multiple traffic collisions, and dozens of other general law enforcement
(LE) “calls” each month. After 9/11, a greater emphasis was placed on security of the Golden Gate Bridge.
Today Briggs is active in providing training and education in Crisis Management, Suicide Prevention and Intervention, and
Leadership Skills. His speaking engagements include conferences, events, and advocacy for mental, physical, and
behavioral health; CIT, law enforcement, FBI; college students and professionals; and major companies and
corporations.
Best Practices for Online Technologies / [Meilleures pratiques pour les technologies en ligne]
Daniel Reidenberg
SAVE, United States of America; dreidenberg@save.org
An exhaustive review of the literature from 2000-2012 revealed no established best practices for online technologies
relative to suicide prevention. Led by SAVE, Facebook and SAMHSA in the United States, a team from the major
technology platforms met and using a consensus model developed the first agreed upon best practices for online
technology companies and organizations in the suicide prevention field. In this presentation you will learn about the
history and development of the tool as well as ways in which it can be used to help standardize basic, mid-level and
advanced best practices for safety in the online world.
Des constats français actuels aux actions innovantes en prévention du suicide / [Suicide Prevention
in France : From Current Findings to Innovative Actions in Suicide Prevention]
Françoise Facy, Marc Fillatre
UNPS, France; ritevesinet@gmail.com
L’actualité française en suicidologie montre des évolutions notables depuis la fin du Plan National d’Actions contre le
Suicide 2011-2014 qui devraient être soutenues et amplifiées par le projet de loi sur la Santé, prévu pour 2015.
Suite aux états des lieux établis depuis 2004, un Observatoire National du Suicide a été créé début 2014 dans une
pérennité essentielle pour la connaissance tant épidémiologique que clinique et sociale. Le rapport présenté pour la
France en novembre 2014 constitue une base de repères actualisés sur les sources de données, les résultats établis sur
les groupes exposés aux facteurs de risque et les engagements actuels de mieux prendre en compte les facteurs de
protection pour les populations.
Par ailleurs, les axes de recherche qui y sont proposés sont de mettre en œuvre les actions priorisées et de réaliser leur
évaluation. L’IRESP (Santé Publique) est chargée de construire un appel à projets, ouvert aux universitaires et aux
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chercheurs dans le cadre d’une pluridisciplinarité renforcée.
Des dynamiques de réseau vivantes comme le sont l’UNPS, pour le territoire national et VIES 37 en Touraine, PEGASPE
en Bretagne et Sud Manche en Normandie... pour ce qui des territoires de proximité, illustrent bien l’engagement des
pouvoirs publiques (à un niveau qui pourrait être renforcé) dans la territorialisation de ces actions.
Perspectives adoptées par l’UNPS : pluridisciplinaires par nécessité et interdisciplinaires par choix
L’UNPS est par nature concertante, interdisciplinaire, interinstitutionnelle, elle contribue au développement d’échanges et
de liens avec l’Europe et les organismes internationaux.
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Poster Session A: June 17 / 17 juin - Poster Session [séance par affiche]
Last Wills and Testaments in a Large Sample of Suicide Notes in Toronto: Implications for
Testamentary Capacity
Mark Sinyor1, Ayal Schaffer1, Ian Hull2, Carmelle Peisah3, Kenneth Shulman1
University of Toronto / Sunnybrook Health Sciences Centre, Canada; 2Hull & Hull LLP, Lawyers; 3University of
NSW/University of Sydney; mark.sinyor@sunnybrook.ca
Objective: To determine how frequently a last will and testament is included in suicide notes and whether, in such
instances, factors are present that may affect a person’s testamentary capacity.
1
Method: Of 1,565 suicide deaths in Toronto from 2003-2009, we identified 285 cases where suicide notes were left and
were present in coroner charts. These notes were examined for will content. Charts were further examined to determine
the presence of depression, psychotic illness, dementia and intoxication at the time of death.
Results: 59 (20.7%) of 285 available suicide notes were found to have will content. Of those who left a will, 43 (72.9%)
were reported to have suffered from a major mood or psychotic disorder. No cases of dementia were detected. Fifteen of
19 toxicology samples showed alcohol, sedative hypnotic/benzodiazepine, opioid and/or recreational drugs were present.
Conclusions: A substantial minority of suicide notes may also include testamentary intent. The observed high rate of
mental illness and substance use around the time of death has important clinical implications for understanding the
mindset of people who die from suicide and hence also legal implications regarding testamentary capacity.
Primitive Accumulation, Corruption and Under-Development in the Power Sector: A Marxist
Analysis
Godson Chidiebere Ajuzie
University of Benin, Nigeria; ajuzie.gold@hotmail.co.uk
This paper tends to unravel the crisis that is affecting the power sector in nigeria.since independence,nigeria has been
undergoing through an unstable power supply,which has affected the countries economy growth and developement.this
paper tends to proffer a possible solution in resolving this problem
The VOZZ, a Dutch, Culturally Sensitive Self-Report Instrument for Suicidality among Adolescents
Annemiek Huisman, Ad Kerkhof, Niels Smits
VU University Amsterdam, Netherlands, The; a.huisman@vu.nl
Suicide and suicidal behavior among adolescents are a significant public health problem worldwide. Suicide is the third
cause of death for youths in both the US and Europe (Lubell et al 2007, Center for Disease Control and Prevention 2010
& Kokkevi et al 2012). The prevalence of a lifetime suicide attempt ranges between 4.1%–23.5% among 17 countries in
Europe (Kokkevi et al 2012) and was estimated to be 4,1% in the USA for youngsters (Nock et al 2013).
Early intervention and support for suicidal youths is therefore essential for the prevention of suicide in both adolescents
and later on in adulthood. In order to identify high-risk youth in the general population, screening can promote early
detection and intervention. The most feasible manner of screening is the administration of self-report screening
instruments in schools. School based screening improves the possibility to offer help to suicidal youths who would remain
undetected otherwise (Scott et al., 2009) and effectively enhances the likelihood of high-risk youths to be referred and
actually receive treatment (Gould et al., 2009).
Several self-report instruments for assessing suicidal behavior and suicide risk in adolescents have been developed such
as the SIQ (Reynolds, 1988), CASPI (Peffer, 2000), SPS (Cull & Gill, 1982) and CSS (Shaffer, 2004), and these have
been reviewed comprehensively (Goldston, 2000; Winters, 2002; Range, 2005; Pena, 2006). The general problem with
most available screening instruments for suicidal behavior is that their sensitivity is high but the specificity is low. In
addition, most screening instruments were not specifically developed with special attention for suicide in ethnic minority
groups.
This paper will describe the validation of a Dutch, culturally sensitive questionnaire for the assessment of adolescent
suicide risk: the VOZZ. This self-report instrument is being developed for the “Mental Health Online” program, aimed to
prevent suicide among adolescent through screening and the development of e-learning modules on suicide prevention
for gatekeepers.
The Register for Suicide Attempts – Self-Poisoning
Christina Petrea Larsen, Anne Katrine Thrue Mikkelsen
Centre for Suicide Research, Denmark; crpe@cfsmail.dk, akm@cfsmail.dk
Introduction:
Knowledge of the extent of attempted suicides in Denmark can be found in the Register for Suicide Attempts. The register
has existed since 1989 covering the former County of Funen. An extension of the register was initiated thus, data from
2011was collected from the entire Region of Southern Denmark. The aim of the present study is that within a few years
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The Register for Suicide Attempts is a nationwide register. Furthermore, the Register for Suicide Attempts will i.a.
illuminate the association between suicide attempts and the use of psychopharmacological drugs. In addition to the
variable collected since 1989, a new variable - Circumstances - was included from 2011. Circumstances cover the
triggering and underlying factors connected to the individuals’ suicide attempt. The results are based on 1,143 registered
suicide attempts (women 737) (men 406) during 2012 and 2013 collected from various Regions of Denmark - not the
entire country.
Methods:
We received transcripts of all civil registration numbers that had been in contact with an emergency ward (somatic), due to
a suicide attempt in 2012 and 2013. From each patient’s medical record, we registered the following variables: age,
gender, place of registration, time and date of attempt, code for cause of contact, method, circumstances in relation to the
attempt (proximal- and distal factors) and medicinal product if the used method was self-poisoning. Results concern most
frequently registered medicinal groups and medicinal products.
Results:
The main results: Self-poisoning is recorded as method in 954 suicide attempts out of a total of 1,143 (Women: 634, Men:
320).
The most frequent medicinal group is Other analgesics and antipyretics with Paracetamol as the most used product: 445
registrations (Women: 335, Men: 110). The following medicinal groups are Antipsychotics: 170 registrations (Women: 120,
Men: 50) and Antidepressants: 153 registrations (Women 110, Men 43).
Discussion:
The number of attempted suicides is only the tip of the iceberg as not all suicide attempters have subsequent contact with
emergency wards. The information in the patient’s medical record depends on what information the attending doctor is
able to gather. It is sometimes difficult to obtain a precise description of used medicinal product as well as quantity of pills
ingested which affects the results. Thus conclusions based on the registered medicinal products must be made with
reservations.
Conclusion:
Results are consistent with existing research in this field. Further knowledge of self-poisoning as method and ingested
medicinal products will be generated during the ongoing data collection. A new legislation on Paracetamol’s package size
became effective in October 2013; it will be interesting to study its impact on suicide attempts utilising the register.
Lithium Concentrations in Drinking Water and Regional Suicide Rates
Maurizio Pompili, Monica Vichi
Sapienza University of Rome, Italy; maurizio.pompili@uniroma1.it
An evident antisuicidal effect of clinical treatment with lithium makes particularly interesting several reports of possible
associations between higher natural trace concentrations of lithium in drinking water with lower local rates of suicide in
different countries. To evaluate associations between local lithium concentrations in drinking water and suicide rates in
Italy we performed a nationwide study accounting both lithium concentration in drinking tap-water and regional suicide
rates.
Lithium concentration in drinking water was assayed by mass spectrometry at 145 sites, and compared with reported local
suicide rates for men and women between 1980 and 2011. Lithium concentrations in drinking water averaged 5.28 [CI:
4.08–6.48] µg/L (0.761 [0.588–0.934] µEq/L) and ranged from 0.110 µg/L to 60.8 µg/L (1.58 to 8.76 µEq/L). Lithium
concentrations and local suicide rates were not significantly related, except for negative linear correlations in 1980–1989,
particularly among women.
A proposed association between trace lithium concentrations in drinking water and risk of suicide was only partially
supported. Remaining unclear are reasons for the apparently preferential association in women in Italy in only one
decade, and mechanisms for potential clinical effects of trace levels of lithium.
Understanding and Responding to Self-Perceived Suicide Stigma in Australian Male Farmers – an
Innovative Approach
Alison Kennedy1,2, Susan Brumby1,2, Tom Whitty3,4, Sam Haren5, Dan Koerner5, Alison Fairleigh6
Deakin University, Australia; 2National Centre for Farmer Health, Australia; 3Victorian Farmers Federation; 4AgChat Oz;
5
Sandpit; 6Mental Illness Fellowship of Northern Queensland; akenne31@myune.edu.au
In Australia, suicide occurs at higher rates among rural farming males than within the general population. This pattern is
also reflected in comparable populations internationally in both developed and, to a lesser extent, developing countries.
This is possibly due to the similarities of farming cultures globally and the role that being ‘a provider’ creates.
1
Previous research confirms that the unique socially constructed patterns of behaviour in farmers are a significant
contributing factor to these higher suicide rates. For males particularly, this often results in an unwillingness to admit
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vulnerability and restrictive mind-sets, which are unhelpful when needing to seek assistance. Self-perceived stigmatising
attitudes towards mental health and suicide are likely to reduce the potential for seeking help even further. Such stigma
contributes to heightened suicide risk, and affects males who have experienced suicidal thoughts, survived a suicide
attempt, cared for someone who has attempted suicide, been bereaved by suicide, or been touched by suicide in another
way.
This presentation describes the development of an on line presentation designed to raise awareness of the prevalence of
suicide in Australia and its impact on communities. This will highlight the ongoing ripple effect that occurs through selfperceived suicide stigma among males in Australia’s rural farming communities. In response this challenge, the
presentation will discuss an emerging cross-sectoral partnership to develop an innovative digitally based intervention to
reduce self-perceived suicide stigma in rural farming males with a lived experience of suicide.
Japanese Teachers’ Attitudes toward Suicide
Reiko Taketani, Emi Tsujimoto, Hisae Ono
Department of Psychological Science, Graduate School of Humanities, Kwansei Gakuin University, Hyogo, Japan;
aua81545@kwansei.ac.jp
Background and objective: Suicide among elementary, junior high, and high school students is recognized as a growing
public health problem in Japan. Teachers’ attitudes toward suicide may influence prevention of suicide in students.
However, no studies have explored this in Japan. Therefore, we studied teachers’ attitudes toward suicide and suicide
prevention in Japan.
Methods: This study was a preliminary survey conducted between September 2009 and May 2012. A self-administered
questionnaire was distributed to 320 elementary, junior high, and high school teachers in western Japan. The
questionnaire comprised 9 items regarding attitudes toward suicide and suicide prevention. The survey was conducted
anonymously and no identifying information was collected.
Results: In total, 80 respondents participated in the study (response rate: 25.0%; 34 males, 45 females, and the gender of
one participant was unknown; age: Mean = 43.7, Standard deviation = 11.5, 24–65 years; 16 elementary school teachers,
39 junior high school teachers, and 6 high school teachers). Seventy-five (93.8%) respondents answered that people
should not commit suicide for the world. The most common reason for the answer was the grief of the bereaved close
persons, such as families (n = 78, 97.5%). However, 22 (27.5%) respondents answered that suicide could be allowed as a
problem solution method. With reference to suicide prevention, 71 respondents (88.8%) placed importance on family, 58
(72.5%) on educational institutions, 56 (70.0%) on psychiatric services, and 21 (26.3%) on religion.
Conclusions: This was the first survey on Japanese teachers’ attitudes toward suicide. This study suggested that most
Japanese teachers consider suicide wrong, but some accepted suicide as a problem solution method. The results also
suggested that family was regarded as the most important factor for suicide prevention. The sample size and the
response rate of the study were small; therefore, further studies need to be conducted with more samples.
Is Attempted Suicide Becoming More Lethal? Findings from a Monitoring Study of Attempted
Suicide in Ghent, Belgium between 1987 and 2013
Nikita Vancayseele, Gwendolyn Portzky, Kees van Heeringen
University Ghent, Belgium; Nikita.Vancayseele@UGent.be
Introduction
Attempted suicide constitutes a major public health problem due to its common occurrence and association with an
increased risk of suicide. Epidemiological changes can have important consequences for treatment and prevention.
Methods
Data on attempted suicide referrals to A&E departments of the three major general hospitals in Ghent were collected
using a standardized monitoring form between January 1987 and December 2013. We analysed epidemiological and
clinical characteristics including gender, age and method of attempted suicide. Attempted suicide was defined as “an act
with nonfatal outcome, in which an individual initiates a deliberate, well-considered, and unusual behaviour, that without
intervention of another will lead to self-harm or destruction, or when an individual deliberately takes a substance in a
higher quantity then subscribed or generally suitable doses, with the intention by means of actual or expected physical
consequences to initiate desired changes” (Bille-Brahe et al., 1994).
Results
During the 26-year study period, the monitoring system reported 8.692 episodes of attempted suicide in individuals aged
15+ years and older, including 4.868 (56.0%) females. Self-poisoning (n= 6.781; 78%) was involved more commonly than
self-injury (n= 1.430; 16.4%) or the use of both methods (n = 485; 5.6%). Significant more males than females (23.8%
versus 12.5%) used only self-injury. Among males and females the proportion of episodes involving self-poisoning
decreased. Numbers of episodes of self-injury increased among both genders. There was an increase in the use of
hanging, drowning, jumping and the use of other violent methods, the latter including use of firearms, jumping before a
moving object or other traffic-related injury over the 26-year study period. Self-injury using a sharp object (i.e. cutting) was
the most commonly used violent method without statistically significant changes over time. Hanging was most common
11
between 15-19 years and 50-59 years and significant more frequent among males (4.8%) than among females (2.0%).
Drowning was most commonly used by people aged 65 and older. Cutting was most common between 15 – 24 years and
decreased with increasing age. Significantly more males (9.9%) than females (5.0%) used cutting as method. Jumping
was most common between 15-19 years, and significantly more males (2.8%) than females (2.0%) used this method.
Discussion/conclusions
In conclusion, using data from A&E departments in major general hospitals this long-term monitoring study of the
occurrence and characteristics of attempted suicide shows decreasing rates of attempted suicide, however with
significantly increasing use of self-injurious methods. The relative increase in self-injury, as indicated by the current
findings, poses an additional challenge to prevention, as it appears to be difficult or even impossible to restrict access to
involved methods such as cutting, hanging and jumping from heights. Prevention strategies targeting physicians and their
prescription practices may be more appropriate than public health interventions aiming at restricting access to means.
Using New Technologies to Improve Suicide Risk Assessment and Treatment in Primary Care
Derek de Beurs1, Ad Kerkhof2
Netherlands Institute of Health Services Research (NIVEL), Utrecht, the Netherlands; 2VU Amsterdam, Netherlands,
The; dp.de.beurs@vu.nl
Background
1
In the Netherlands, the general practitioner and his/her team of mental health care nurses play a pivotal role in the
identification and assessment of suicidal behavior. A recent survey showed that more than 50% of the patients had
contact with a general practitioner in the month before their suicide. In only 7%,suicidal thoughts were discussed. New
technologies such as e-learning and online self-help might improve recognition and care for suicidal patients in primary
care.
Method
The Netherlands institute of Health Services (NIVEL) and the VU University Amsterdam are currently developing a
research program to improve the assessment and treatment of suicidal behavior in primary care by using new
technologies. An e-learning module to train mental health professionals in suicide prevention skills will be the starting
point for the training of professionals in primary care. For the first line of treatment of patients, we will focus on an online
self-help module for suicidal thoughts, developed by the VU University Amsterdam. In a pilot study 30 GP practices are
being trained and patients are being provided with the self-help online intervention module.
Results
By training professionals in primary care in the assessment of suicidal thoughts and basic suicide prevention skills, we
aim to improve the recognition and primary caretreatment of suicidal behavior. This will help to better identify patients at
risk, and will improve referral too specialized care. By offering an evidence based online self-help module, patients can
start working on their suicidal thoughts while waiting for specialized treatment. In the Montreal presentation first results of
this pilot phase will be released
Discussion
The assessment and primary care treatment of suicidal thoughts remains a difficult task for professionals. By providing
adequate online training and online self-help intervention, we aim to improve care for suicidal patients in primary care.
Developing and Testing the Efficacy of a Cognitive-Behavioral Program for Suicide Attempters
Jong-Ik Park1, Jin-young Ong2
Kangwon University University Hospital, Korea, Republic of (South Korea); 2Korea Suicide Prevention Center, Korea,
Republic of (South Korea); lugar@kangwon.ac.kr
Introduction
1
In 2013, suicide was the cause of 14,427 deaths, which represents a 32.4% increase from the 10,989 suicide deaths that
occurred ten years ago. Among these cases, 25-50% of the individuals had attempted suicide before. If suicide has been
attempted, the probability that another attempt will be made again within the next five years is very high—at 37%.
Additionally, 2013 national survey on suicides showed that suicide deaths resulting from reattempts were 25 times higher
than those resulting from first attempts. Despite the high rates of suicide reattempts and deaths, there have not been
many programs intended to improve this situation. The results of our investigations regarding workers at suicide
prevention centers showed that they found programs for suicide attempters to be the most difficult and the desire for
education concerning these types of programs was high.
After developing a program for suicide attempters and implementing education concerning such programs, we will attempt
to uncover changes in users’(working staffs at suicide prevention centers) awareness levels, feelings of self-efficacy and
psychological empowerment related to programs for suicide attempters.
12
Methods
A committee with specialists in related fields, including six development committee members and one advisory committee
member was created. This committee held a total of 11 meetings from May 2014 to November 2014. The program content
was based on cognitive-behavior approach concerning suicide attempters. A workshop was conducted for 30 workers at
mental health promotion and suicide prevention centers and 10 case managers from emergency room suicide
management programs for suicide attempters. During the workshop, the pre- and post-evaluation of awareness levels,
self-efficacy, and psychological empowerment were implemented.
Results
The aim of this program was to understand the ways that suicide attempters’ contorted perception may influence
automatic thoughts, emotional responses, and behaviors, and to induce positive life changes and learn methods of
alleviating suicidal impulses in order to prevent suicide attempts. The program consisted of a total of 8 sessions (one
session per week for 8 weeks). Each session ran for 50 minutes and included evaluation of suicide risk, homework
review, a summary of last session’s content, topical discussion, assignment of homework, summary, and feedback.
When comparing pre- and post-test results of awareness levels, self-efficacy, and psychological empowerment related to
the program for suicide attempters, all the results indicated significant improvement following the workshop
implementation.
Discussion and Conclusions
Because programs geared toward suicide attempters have been severely lacking in the past, the workers who were
questioned believed it would be difficult to prevent suicide reattempts. However, we witnessed a change in the workers’
awareness. They became more motivated to implement programs for suicide attempters. Further research needs to be
conducted in order to assess the effects of monitoring on suicide reattempts.
A Pilot Study on Interpersonal Counseling for Depression, Suicidal Ideation, and Stress Coping
Strategies in Japanese Undergraduates
Emi Tsujimoto, Ami Yamamoto, Reiko Taketani, Hisae Ono
Department of Psychological Science, Graduate School of Humanities, Kwansei Gakuin University, Hyogo, Japan;
etsujimoto@kwansei.ac.jp
Objective: Depression and suicide in young people are some of the most important public health problems in Japan.
Interpersonal Counseling (IPC) was a simplified manual directly developed from Interpersonal Psychotherapy (IPT). IPC
has clear scripts, and can be used to train non-mental health professionals for use in primary care with the many patients
who were being seeing with depressive symptoms. The objective of this study was to examine if IPC was superior to
ordinary supportive counseling (OSC) in improving depression, suicidal ideation, and stress coping strategies in Japanese
undergraduates.
Method: Seventeen undergraduates (4 men and 13 women; mean age = 21.2 years, SD = 1.3) participated in a
randomized controlled trial of 1 to 3 weekly sessions of IPC (n = 8) or OSC (n = 9). IPC was performed according to the
manual (Myrna Weissman Revised, February 12, 2013). The 2 groups were compared using t-test, in terms of the mean
with-in subject changes from baseline to post-intervention, on the total score of the Zung Self-Rating Depression Scale
(SDS), the score of the suicide related item of the SDS, and scores of the three types of stress-coping (task-oriented
coping, emotion-oriented coping, and avoidance-oriented coping) on the Coping Inventory for Stressful Situations (CISS).
Results: At baseline, no significant differences were found between the two groups in the total score of SDS, the score of
the suicide related item of the SDS, and each of the scores of the three types of stress coping on the CISS. The score of
the suicide related item of the SDS was the lowest in both the groups. After intervention, the change in the total score of
the SDS was -1.63 in the IPC group and -0.22 in the OSC group, which was not statistically significant. The score of the
suicide related item of the SDS did not change, and continued to be the lowest score in the two groups. No statistical
differences were found in scores of the three coping types. However, there were some differences: the change in the
score of task-oriented coping increased in the IPC group (1.88), while it decreased in OSC group (-1.22).
Conclusions: Some differences were observed between the IPC and OSC groups, however, statistical significances were
not found in the study. This may be because of the low sample size Further studies with more participants should be
conducted.
This study was supported by JSPS KAKENHI Grant Number 25380965.
13
Case Management Regarding Suicide Attempters Based on Emergency Room
Yu Mi Jung1, Soojung Lee1, Kyoung Jun Song2, Jong-Ik Park3
Korea Suicide Prevention Center, Korea, Republic of (South Korea); 2Department of Emergency Medicine, Seoul
National University Hospital, Korea, Republic of (South Korea); 3Kangwon University University Hospital, Korea, Republic
of (South Korea); lugar@kangwon.ac.kr
1
Ⅰ. Introduction
According to the results of 2013 National Survey on Suicide in Korea, the suicide rate among suicide attempters was
approximately 25 times more than that of general population. It is estimated that over 40,000 people are admitted to
emergency rooms from suicide attempts annually but approximately 92% of them are discharged without any psychiatric
services provided, becoming exposed to the risk of reattempt of suicide. Therefore, Korean government tried to introduce
crisis intervention system to prevent reattempts of suicide by providing case management to suicide attempters admitted
to emergency rooms.
Ⅱ. Methods
Case management services regarding suicide attempters based on emergency room have been implemented in 25
hospitals nationwide on a funding from the Ministry of Health & Welfare from August 2013 to December 2014. The service
process consisted of the following: first, conducting physical assessment and initial stabilization on suicide attempters
admitted to emergency rooms in the department of emergency medicine; second, conducting a psychiatric assessment in
the department of psychiatry and nextly providing information on case management by the case management team; and
then, providing those who agree to receive service with a short term case management for crisis intervention. After total 4
weeks of case management including monitoring stabilized suicide attempters and if necessary, referring them to
outpatient psychiatric treatment, final step is to refer them to mental health center or suicide prevention center for
continuous care service on community.
Ⅲ. Results
The number of suicide attempters admitted to emergency rooms in 25 hospitals between August 2013 and October 31,
2014 was 7,491, with average 16 people a day. Sixty-four percents of them received initial assessment in which all of the
department of emergency medicine, the department of psychiatry, and the case management team involved. In addition,
the patients who were referred to outpatient treatment thanks to case management service system accounted for
approximately 25% of all suicide attempter to ER. Approximately 49% of the suicide attempters gave consent to case
management service, and 91% of them were found to have received case management service at least once.
Ⅳ. Conclusions
Although it is still at initial stage, we plan to expand it to 40 hospitals nationwide starting from the year 2015, and
ultimately, effectiveness evaluation of service should be conducted on how much it can contribute to reducing suicide
rates among suicide attempters.
Ethiopian Males Account for the Double Acts of Murder and Suicide Committed by Males in
Ethiopian Families Postmigration to Israel
Brenda Geiger
Western Galilee college, Israel; geigerb@netvision.net.il
This qualitative research turns to 24 male members of the Ethiopian Jewish community living in Israel to probe their
feelings and thoughts concerning the changes that have occurred to their traditions and community post migration, and
gain insight into the disproportionate rise in domestic murder and subsequent suicide committed by males in their
community. During semi-structured interviews conducted in Amharit, the interviewees opposed the dominant discourse
that cast murder and suicide as pathologies resulting from Ethiopian males' failure to assimilate. In a resistant discourse,
they revealed the oppression and destruction of a cultural heritage and identity and their struggles to regain their family
and community. Paradoxically, these men perceived the Israeli democratic system of law and order as discriminating
against men, and as depriving the Ethiopian community of the basic right to choose its own traditions and spiritual leaders
(Kessim and Shmagaleh) who helped resolving marital disputes. Fearing court restraining orders, arrest, and
imprisonment in the midst of a cultural and social void, Ethiopian males felt isolated and alienated with no community
support. In a last resistant effort to regain their dignity while protesting against the oppression of the Israeli system of law
and social order that discriminated against men and a dominant culture that had destroyed their community, Ethiopian
males killed their spouse and committed suicide.
14
Suicides within a Neuropsychiatric Centre over Three Decades
Linda Sherine Alfred, Ajit Dahale, SK Chaturvedi
National Institute of Mental Health and Neuroscience,Bangalore, India; lindasherine@gmail.com
Suicides within a neuropsychiatric centre over three decades.
Background:
Inpatient suicide is a traumatic event not only to the patients and family members, but also to the treating team as well as
other inpatients. It also indirectly expresses the hidden distress experienced by the inpatients who committed suicide
which was left unaddressed. Studying the factors associated with it would help us to understand the problem better and
help us to prevent such incidents in future by improving our assessment and care.
Objective:
To examine the suicides amongst psychiatric inpatients in the National Institute of Mental health and Neuroscience,
Bangalore India for the period 1985-2014 and to determine the associated clinical factors.
Method:
The data was derived from the hospital database and the case records of inpatients with death due to suicide happened
from January 1985 till December 2014 in National Institute of Mental Health and Neuroscience, Bangalore India.
Results:
During the 30 year duration 13 psychiatric inpatients died due to suicide, less than 1 for every two years. Among them
84% were males and 61% belonged to urban background. 30 % of the patients had affective disorders. Most of the
suicides i.e. 91% were committed by hanging and 77 % committed suicide within the first week of inpatient care. Past
history of suicidal attempt was found in 46% and 23% had family history of psychiatric illness. Suicidal risk assessment
was done for 46% and none of them had left suicidal note. Most suicides happened in the toilets.
Conclusion:
Inpatient suicide is an important occurrence in mental health care services. This report gives us information about different
factors involved to plan preventive methods to avoid occurrence of inpatient suicides.
Suicidability and Pregnancy
Humberto Correa, Tiago castro, Mayra Brancaglion
Federal University of Minas Gerais, Brazil; correa@task.com.br
Major Depression is a common psychiatric disorder during the women' reproductive cycle. Such prevalence allows it to
manifest while those women are pregnant, situation that has been called Antenatal Depression (AND). This circumstance
generates important consequences, since besides the "stress" in which the binomial mother-baby is subjected there are
some therapeutic particularities that stand out.
A cohort of four hundred fifty women that attended to the prenatal care at the HC-UFMG had its data analyzed in this
study. It was filled in a semi-structured interview with questions made by the researchers; a structured psychiatric
interview (MINI Plus 5.0); depressive symptoms quetionnaires: the Edinburgh Postpartum Depression Scale (EPDS),
Beck Depression Inventory (BDI) and Hamilton Depression Scale (HAM-D). Those data were collected in the second and
third gestational trimesters.
The respective AND prevalencies, for the second and third trimesters, 27,95% / 16,66% (BDI); 25,53% / 8,75% (EPDS)
and 19,05% / 13,76% (MINI) were found. AND risk factors are: previous history of being abused (p=0,007), larger number
of sons (p=0,011), DPMS (p=0,021) and lower socioeconomic level (p=0,003). The first three only in the second trimester
and the last one only in the third. As well as prenatal support is a protective factor (p=0,038) in the second trimester.
The influence of the obstetric risk on the AND differs if it is perceived or objective. Only perceived risk has demontrated an
association with the mood disorder (p.=0,017), nevertheless solely on the second trimester. Already, in the suicidality
data, high obstetric risk is invariably asociated with it.
In conclusion, this study supports the notion that AND e suicidality suffer several influences and those can have a different
impact depending on the variables involved. It is encouraged independent replications in larger samples and further
investigation on postpartum outcomes implications.
15
Influence of ATTS(Attitude Toward Suicide) on Suicidal Thoughts
Sang-Uk Lee1, Jong-Ik Park2
Korea Suicide Prevention Center, Korea, Republic of (South Korea); 2Department of Psychiatry, Kangwon National
University School of Medicine, Chunchon, Korea; sanguk@khu.ac.kr, lugar@kangwon.ac.kr
I. Introduction
1
An understanding of suicide awareness is very useful for its prevention. People who have suicidal tendencies or a history
of suicide attempts have more permissive attitudes towards suicide than those who do not. However, research on suicide
awareness in South Korea is still lacking. The goal of this study is to investigate whether suicide awareness influences
suicidal thoughts. This will be applied to the implementation of suicide prevention programs throughout the country.
II. Method
To investigate citizens’ suicide awareness, the Attitude Toward Suicide 20(ATTS) survey was used to conduct one-on-one
interviews with the subjects from October 2013 to November 2013. The 2010 Population and Housing Census information
was used, and the regional multi-stage stratified method was applied in the sampling process. One thousand five hundred
people of both genders from the ages of 15 to 75 in 16 metropolitan Korean cities were included. The factor analysis
results of ATTS 20 questions were used for the data analysis. Four factors of suicide awareness were extracted as
follows: Factor 1 “acceptability and non-intervention,” Factor 2 “possibility of prevention and incomprehensibility,” Factor 3
“universality,” and Factor 4 “unpredictability.” Logistic regression analysis on these different factors with suicidal thoughts
as the dependent variable was conducted.
III. Result
Basic demographic information including age, gender, region, income level, and educational background were set as the
control variables, and the four factors of suicide awareness were included as the independent variables for the logistic
regression analysis. The results were as follows: As Factors 1, 2, and 3 increased, the probability of suicidal thoughts
increased 1.08 times (p = 0.002**), 1.09 times (p = 0.001**), and 1.24 times (p = 0.0001***), respectively. No statistically
significant results were seen for Factor 4.
IV. Conclusion
The objective of this research was to investigate the effect of suicide awareness on the presence of suicidal thoughts.
Suicide awareness was found to exert some influence on suicidal thoughts, and this may be the first step in generating
plans for suicide, suicide attempt, and finally suicide completion. Further research needs to be conducted into the
relationships between suicide awareness and behavior.
A Study on the Experience and Opinion Regarding Suicide Prevention for Workers in Metropolitan
Rapid Transit Corp. - Based on Focus Group Interview
Soojung Lee1, Jong-Ik Park2
Korea Suicide Prevention Center, Seoul, Republic of Korea; 2Department of Psychiatry, Kangwon National Universtiy
School of Medicine, Chuncheon, Republic of Korea; tocrystal@naver.com
Purpose : A chain of suicidal deaths have happened to workers in Seoul Metropolitan Rapid Transit Corporation(SMRTC)
over past ten years. Accordingly, mental health researchers were invited to get involved in establishment of suicide
prevention strategy in SMRTC. This study aimed to explore how much workers in SMRTC experience job stress and
satisfaction, and what opinion they have regarding suicide prevention. Focus group interview(FGI), one of the qualitative
research methods was used for this purpose.
1
Methods : Total 34 participants in SMRTC were divided into 6 groups by their job specialty and an average of 2 hours was
spent on each group. Semi-structured questions were applied during an interview and the researchers later analyzed the
coded contents with informed consent from participants. The interview results were interpreted by method presented from
Colaizzi's Phenomenological analysis and categorized based on the themes.
Results : The results of FGI were classified into 3 domains as follows: 1) Opinions about job stress; 2) Past personal
experience; 3) Opinions about cause and prevention of suicide.
Job stress also was analyzed in organizational, interpersonal and personal categories, respectively. In organizational
category, total 8 themes including dissatisfaction with the restructuring and change of work, maladaptation through
change of work and career, the burden of downsizing and single duty, insufficiency of welfare, complaints of performance
evaluation system, fear of contingency, and 2 others were discussed.
In interpersonal category, 4 themes such as discomfort and dissatisfaction with the seniors, peer groups, union members,
and customers were tackled. In personal category, difficulty with their personality trait and personal copying strategy were
described.
As past personal experience was painful and troublesome in various areas such as restructuring, displacement,
contingency, interpersonal stress and others, most of participants stated that problems are not totally solved but they got
shrank or forgiven, sometimes adapted.
16
Opinions about cause and prevention of suicide were analyzed in organizational, interpersonal and personal categories,
respectively. Organizational categories were 2 themes such as reduction in burden of single duty and improvement in
working environment and welfare state. Interpersonal categories were 2 themes including strengthening the leadership of
seniors and harmonizing relationships within an organization. In personal category, total 6 themes such as finding suicidal
risk and prompt intervention, prevention of copycat suicide, creating atmosphere to block suicide and others were
described.
Conclusion : FGI on workers in SMRTC may suggest that three staged(universal, selective, indicated) strategy is needed
for mental health promotion and suicide prevention. Universal prevention is to develop customer-oriented manual and
leadership training program for high-ranking officials. Selective prevention includes expansion of gatekeeper education
and activation of referral system. Indicated prevention is to apply crisis intervention program to high-risk groups.
Use of Alcohol Prior to Suicide and Motor Vehicle Accident Fatalities during Young- and Middle
Adulthood
Kenneth R. Conner1, Sarah Lathrop2, Vincent Silenzio1, Kurt B. Nolte2
University of Rochester Medical Center, United States of America; 2University of New Mexico, United States of America;
kenneth_conner@urmc.rochester.edu
Objective: Suicide and unintentional injury, with motor vehicle accidents (MVA) being most common, are leading causes
of death during young- and middle adulthood. Acute use of alcohol confers increased risk for these outcomes, particularly
at high drinking levels, yet there is wide variability in alcohol consumption as a function of age, sex, and race/ethnicity,
underscoring the importance of considering these factors. The purpose of the current study is to examine a wide spectrum
of blood alcohol concentrations (BAC) among young- and middle adult suicides and MVAs, with a focus on age, sex, and
race/ethnic patterns. Method: The sample consists of individuals in New Mexico ages 18 to 54 that died in 2012 by suicide
using any method or MVA including operators of motor vehicles and passengers but excluding pedestrians and bicyclists.
All decedents were examined at the state’s centralized medical examiner office based in Albuquerque. Data are based on
information abstracted from the medical examiner files including blood alcohol concentration (BAC) results and
demographic variables. Postmortem BAC levels were categorized based on 0.08 g/dl, the legal limit for drinking and
driving in the United States, yielding categories that ranged from no alcohol (0 g/dl) to three times or more the legal limit
(0.24 g/dl or more). Results: There were 264 suicides and 185 MVA fatalities, with 11.4% in each group excluded from
analysis due to absence of BAC data, yielding a sample of 234 suicides and 174 MVA fatalities. BAC results varied
somewhat within the decedent groups as a function of age and sex and varied widely as a function of race/ethnicity, yet
BAC results between the decedent groups generally mirrored one another including in age, sex, and race/ethnic strata.
For example, the highest level of alcohol (> 0.24 g/dl) was observed at similar percentages in suicides and MVA fatalities
among 18-24 year olds (17% suicides, 18% MVAs), men (13%, 16%), whites (9%, 10%) and Alaskan Indians/Native
Americans (46%, 40%). Conclusion: Preliminarily, the results suggest that effective alcohol policies may be expected to
have similar overall impact on suicide and MVA fatalities in young- and middle adults in the southwestern United States,
but may be expected to have differential impact on subpopulations defined by age, sex, and particularly race/ethnicity.
Further study is needed including use of controlled study designs and examinations of the impact of alcohol policy
interventions on differing injury outcomes and subpopulations. Limitations included the focus on one U.S. state and cell
sizes generally precluded stratifying by multiple demographic factors simultaneously.
1
Clinical and Demographic Characteristics Differentiating Non-Attempters, Single Attempters, and
Repeat Suicide Attempters, in Psychiatric Adolescents
Claire Eileen Hatkevich, Babetta Betsy Mathai, William Harrison Mellick, Carla Sharp
University of Houston, United States of America; clairehatkevich@gmail.com
In the United States, suicide is the second leading cause of death in individuals aged 10-24, with previous suicide
attempts standing as one of the most prominent predictors of suicide-related death (Centers for Disease Control, 2011;
Harris & Barraclough, 1997). Among youth attempting suicide, important clinical and demographic characteristics have
been found to distinguish adolescents engaging in one attempt (i.e., single attempters) from those engaging in multiple
attempts (i.e., repeat attempters) and no attempts (non-attempters; Miranda et al., 2008). Despite this work, empirical
studies have not yet investigated racial differences across attempting subsets in a diverse sample of psychiatric
adolescents. Differential findings may serve to inform personalized risk assessment and treatment-based approaches for
suicidal adolescents in acute-care settings. Against this background, the purpose of the current study was to identify
distinct clinical and demographic variables differentiating such subsets (non-attempters, single attempters, repeat
attempters). A total of N=331 adolescent inpatients (M= 14.74 years, SD = 1.4) treated for psychiatric disorders were
recruited and divided into three subsets based on the number of lifetime suicide attempts: n=148 non-attempters (NA),
n=94 single attempters (SA), and n=89 repeat attempters (RA); racial breakdown of the sample was 39% Hispanic, 26%
Black, 26% Caucasian, and 9% Other. Semi-structured clinical interviews (Youth Self-Report) and self-report measures
were used to capture demographic variables and diagnostic symptoms. One-way ANOVAs and post-hoc comparisons
revealed significant, escalating differences among attempting subsets on depressive symptoms, such that RA reported
greater levels than SA, and SA greater than NA. Significant differences were also evident between RA and NA on
symptoms of conduct disorder, PTSD, anxiety, and OCD, such that RA reported greater levels of each. Chi-square
analyses revealed significant racial differences among attempting subsets, such that the RA subset included significantly
fewer Black adolescents than what would be expected from chance, with no other significant findings. Cumulatively, the
current study indicated an escalating pattern of clinical symptomatology among attempting subsets. Racial findings
suggested that certain variables might be at play, which serve to protect Black adolescents from becoming repeat
17
attempters. Although such mechanisms have been investigated in regards to adolescent depression, further research is
needed to explore potential protective (e.g., religiosity, communality) and familial-specific (e.g., shame) factors that may
account for these findings in acute suicide attempting subsets. These results suggest that suicide-risk assessments and
interventions highlighting clinical symptoms and protective mechanisms may be best suited for preventatively identifying
and treating adolescents at-risk of becoming repeat suicide attempters.
Nationwide Spread of Korean Gatekeeper Education Program [Bogo(Observing), Deuggo(Listening),
Malhagi(Referring)]
Sun-Young Park1, Jin-Young Ong1, Jong-Ik Park2
Korea Suicide Prevention Center, Korea, Republic of (South Korea); 2Kangwon University University Hospital, Korea,
Republic of (South Korea); madesori@daum.net
Purpose: [Bogo Deuggo Malhagi] is a suicide prevention training program which was developed for cultivating
gatekeepers who can identify and connect the person who’s at risk of suicide to a specialized agency in 2012.
1
Methods: Since 2013, Korea Suicide Prevention Center has tried to train lecturers who are eligible for educating
gatekeepers in community, schools, companies and the army bases for two years. The gatekeepers were trained through
three-hours educations of [Bogo, Deuggo, Malhagi] by lecturers nationwide.
Results: Total 1,521 sessions of the education was conducted and 92,000 gatekeepers were cultivated in the 17
megalopolis, cities and provinces nationwide. About 71.5% of responders have provided information on special agencies
and tried to refer high-risk persons to them.
Conclusion: [Bogo Deuggo Malhagi] program may be effective for gatekeeper education program and it should be
expanded to raise awareness of suicide prevention further.
Workplace Mental Health Promotion
Vera Oziransky
Vitality Institute, United States of America; voziransky@thevitalitygroup.com
Presentation Overview
Define the problem, by demonstrating the prevalence and burden of mental illness in the workplace, and outline solutions:
• Impact of mental illness on healthcare costs and productivity
• Projected impact on economic development worldwide
• Barriers to effective workplace mental health promotion, e.g. stigma
• Strategies to promote mental well-being through comprehensive workplace health promotion programs
• Technologies to improve employee mental health and prevent suicide
Background
Worldwide, one in four people will be affected by mental or neurological disorders at some point in their lives. Mental
disorders – including depression, which affects more than 350 million people globally according to the WHO – also have a
negative impact on business through significant disability, absenteeism, and productivity loss among working-age adults.
Ample scientific evidence demonstrates the costs of mental illness in the workplace and its impact on comorbidities (1-4).
Employers are increasingly concerned about the health/productivity costs of chronic disease. A survey of business
executives by the World Economic Forum and the Harvard School of Public Health identified NCDs as a leading threat to
economic growth (3). The same report demonstrated that over the next 20 years, NCDs will cost more than US$ 30 trillion
(48% of global GDP in 2010) and push millions of people below the poverty line. Mental health conditions alone will
account for the loss of an additional US$ 16.1 trillion over this timespan, with dramatic impact on productivity and quality
of life (3).
Suicide is the 10th leading cause of death in the US (homicide is the 18th), yet 90% of individuals who complete suicide
suffer from a potentially treatable mental disorder (5). Most of us spend the majority of our time in the workplace, where
health promotion strategies are currently being implemented and could be leveraged to promote brain health and prevent
suicide. There is growing evidence of the positive impact of diet and physical activity and much evidence supporting the
pivotal role of sleep in recharging the brain and enhancing memory recently emerged. A range of cognitive and behavioral
tools exist. Critical to the management of individuals already experiencing brain health ailments are effective screening
and rapid referral to quality treatment. Employers should leverage existing technology to promote mental well-being.
There are now opportunities to connect people to preventive interventions and real-time care. The market is ripe for this
and technology and innovation is mounting, with online coaching/support communities and mental health promotion apps.
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Suicide in the Region of Mechelen, 1366 – 1795: An Historical Perspective
Karl Andriessen1, Karolina Krysinska2
University of New South Wales, Australia; KU Leuven - University of Leuven, Belgium; 2Black Dog Institute, Australia;
karl.andriessen@gmail.com, k.krysinska@unsw.edu.au
In Medieval European societies suicide was a crime and subjected to severe punishment. However, the extent and the
meaning of that punishment within its local and historical context are not well understood. This study examines the
punishment of all capital crimes, including suicide, sentenced by the court of Mechelen (Belgium) from 1366 to 1795,
based on the inventory of Maes (1947). During this 400+ years period, the court sentenced 696 capital crimes including
25 suicides The male/female suicide ratio was 1.5/1, and the annual suicide rate is estimated at 0.25/100,000 inhabitants.
The punishment of suicide aimed at punishing the corpse, the memory of the deceased and his/her property. Throughout
the centuries, the judicial punishment of suicide remained the same, though it appears that suicides were rare. Moreover,
it was noted that capital punishment could be commuted with financial compensation for the local rulers. The practice of
punishment of suicides diminished in the 18th century and was officially abolished before the end of the century (Emperor
Joseph II decriminalised suicide in 1782). It is concluded that though the punishment of suicide was severe, the actual
practice of its punishment was rare. The findings are further discussed in light of the historical context.
1
Maes, L. Th. (1947). Vijf eeuwen stedelijk strafrecht [Five centuries of urban criminal justice]. Antwerpen: De Sikkel.
MYPLAN: A Mobile Application (App) for People in Suicidal Crisis
Hanne Frandsen, Jette Louise Skovgaard Larsen, Annette Erlangsen
Psychiatric Centre Copenhagen, Denmark; hanne.frandsen@regionh.dk
INTRODUCTION: Crisis plans are recommended for people in suicidal crisis. However, crisis plans typically consist of a
physical box that is kept at home. The aim of this project is to present the app, MYPLAN, specifically developed for people
in suicidal crisis.
METHODS: The app was developed during summer 2013 as an electronic crisis plan in Denmark and is currently being
adapted for Norwegian users. Users fill in personal information, own coping strategies for crisis situations as well as
phone numbers. MYPLAN has direct link to telephone hotlines and geo-mapping of nearest emergency departments.
Currently an updated and extended ‘cloud-solution’ of MYPLAN is being developed for both android and IOS platforms. It
includes new features, such as geo-tracking and messaging. It is hoped that new version will appeal to a wider user group
and offer better support options to users in crisis.
RESULTS: MYPLAN was first distributed during the autumn of 2013. It is freely available for downloads and it has been
downloaded 150-200 times during the first 6 months. Regional suicide preventive clinics in Denmark are using MYPLAN
and have provided encouraging feedback from users on the App. The Norwegian Patient Safety Program, ‘In Safe
Hands’, will start using a Norwegian edition of MYPLAN nationally during 2014.
DISCUSSION AND CONCLUSIONS: Mobile crisis plans is a new and rapidly expanding field. Evidence-based research
on its potential effect is needed. Based users comments, mobile crisis plans constitute an innovative improvement
compared to ‘traditional’ crisis plans.
Suicide Survivors: Barriers to Social Help-Seeking
Odeta Geležėlytė, Vaiva Klimaitė, Danutė Gailienė
Vilnius University, Lithuania; danute.gailiene@fsf.vu.lt
Background. Every suicide leaves 10 to 15 suffering people (Dyregrov, 2009). Suicide survivors face emotional, somatic
and social difficulties (McMenamy, Jordan, & Mitchell, 2008; Pitman et al., 2014). As a result, they are often in need of
help. However, the main problem is that the bereaved may not seek desirable help from their social circles or
professionals. Previous studies do not provide clear and broad view of what discourages suicide survivors from seeking
help from their family or friends.
Objective. As part of a larger study, the objective of this presentation is to analyze and describe suicide survivors’ social
help-seeking barriers.
Method. 23 suicide survivors (20 female, 3 male, average age 42 y.), who lost a close relative (parent, child, sibling or
spouse) from 1 to 2 years before, were interviewed (average duration 67 min.). Thematic analysis (Boyatzis, 1998; Braun
& Clarke, 2006) was used for the data examination. 2429 citations, 299 themes, 44 subcategories and 15 categories were
discovered.
Results. The research revealed that factors affecting avoidance of seeking support from social network are associated
with suicide survivor himself/herself, survivor’s social network, cultural context as well as relations among all three levels.
The survivor’s state after the loss, negative attitudes towards seeking help, mistrust of social networks’ ability or
willingness to help affect survivors’ help-seeking behavior. Self-stigma appeared to be a serious barrier. Results showed
that interviewees’ beliefs about inappropriateness, sinfulness of suicide discouraged them from seeking support,
stimulated avoidance and withdrawal even when there was no previous experience of others’ hurtful or stigmatizing
behavior. However, experience of inappropriate behavior or help offered (rumors, accusation, pointless advice,
insensibility to conversation topics, etc.) induced anger, disappointment and avoidance too. The study also revealed
19
interaction gaps between survivor and his/her social network that are caused by lack of open mutual communication (eg.
survivor tends to hide his/her feelings or the fact of the suicide and feels the burden of pressure to stop mourning; survivor
wishes to be understood, but does not communicate how he/she feels). These gaps increase subjective sense of being
misunderstood or ignored, which provokes anger and withdrawal and makes satisfactory communication even more
difficult. Mutual misunderstanding ends up in vicious circles and affects survivors’ social support availability. Furthermore,
study results also revealed cultural barriers to help-seeking (stigmatization, common religious beliefs, historical
background, etc.).
Conclusion. These results suggest that it is important to take into account help-seeking barriers in and among all three
levels - individual, survivor’s surroundings and cultural context - when motivating the bereaved to seek help.
Disability Profiles in a French-Canadian Population with Affective Symptomatology Surveyed in
Primary Care Settings
Nina Nguyen1, Pasquale Roberge1,2, Mathieu Philibert3, Louise Fournier4,5, Arnaud Duhoux4, Annie Benoît1,2
Université de Sherbrooke, Canada; 2CRCHUS, Canada; 3Université du Québec à Montréal, Canada; 4Université de
Montréal, Canada; 5CRCHUM, Canada; nina.nguyen@usherbrooke.ca, pasquale.roberge@usherbrooke.ca
Depression is associated with significant disability, but less is known about the contribution of anxiety symptoms to
disability. Objective: To examine the disability profiles pertaining to depressive and/or anxious symptomatology (DAS).
Design: Data were drawn from the Dialogue Project, an observational study conducted in 64 primary care clinics (Quebec,
Canada). Setting: Primary care clinics. Participants: The sample of 14,833 adults was recruited in clinics’ waiting rooms
when consulting a general practitioner for oneself. Instruments: The Hospital Anxiety and Depression Scale (HADS) was
used to assess DAS. The World Health Organization Disability Schedule (WHODAS; short 12-item version) was used to
assess disability in six domains: mobility, life activities, cognition, social participation, self-care and getting along.
Measures: Respondents were divided in four groups according to their HADS score: anxious subjects (n=4667),
depressive subjects (n=2304), anxious-depressive subjects (n=1785) and control subjects (n=9543). Results: Preliminary
results indicate that depressive subjects, compared to anxious subjects, presented higher levels of disability for all six
domains, and anxious-depressive subjects presented the worst loss of functionality. For the social participation domain,
multiple logistic regression models showed that anxious subjects (OR = 4,10; CI=3,72-4,52), depressive subjects (OR =
7,50; CI=5,95-9,46) and anxious-depressive subjects (OR= 18,62; CI=15,76-22,01) were more likely to present disability
than control subjects. Conclusions: Depressive symptoms were associated with more disability than anxiety, but comorbid
depressive-anxious symptomatology significantly increased disability levels in all domains. Anxious symptoms are also
associated with a higher level of disability than the absence of DAS. Recognizing that any type of DAS likely causes
disability will further the efforts to improve diagnosis and treatment in primary care of common mental disorders and their
related consequences, including suicide.
1
Psychological Pain Measures: Operational Equivalence and Relationship with Psychological
Distress and Self
Margaret Alicja Prysak1, Peter Chamberlain2
The University of Adelaide, Australia; 2The University of Adelaide; The University of Canberra, Australia;
margaret.prysak@adelaide.edu.au
The idiosyncratic experience of inner suffering, often described as psychological pain, has been implicated in suicide risk
(Shneidman, 1986). Diverse terms, assigned to this psychological event, have been earlier examined, denoting a
semantic correspondence of the labels: psychache, emotional, mental, and psychological pain (Meerwijk & Weiss, 2011;
Orbach, 2003; Tossani, 2013). However, with several measures attempting to capture the construct, the equivalence of its
operationalization is still foregoing. To fill this research gap, the two most frequently reported psychological pain
measures: the Psychache Scale (PS; Holden, Mehta, Cunningham, & McLeod, 2001) and the Orbach and Mikulincer
Mental Pain scale (OMMP; Orbach, Mikulincer, Sirota, & Gilboa-Schechtman, 2003) were subjected to the exploratory
factor analysis (EFA), with the Schmid-Leiman solution procedure (SLS). Also, the association of psychological pain with
psychological distress was investigated, verifying the interchangeable use of these terms in literature. Considering the
theoretically and empirically established links between psychological distress, self-esteem, and self-cohesion, the
following scales were added to the survey: the Depression Anxiety Stress Scales (DASS 21; Lovibond & Lovibond, 1995),
Beck Self-Esteem (BSE; Beck, Brown, Steer, Kuyken, & Grisham, 2001), and Adelaide Self-Cohesion Scale (ASCS;
Chamberlain, 2010). The study was approved by the University of Adelaide Human Research Ethics Committee, and its
359 participants comprised the university and community members (71.9% female, 28.1% male, mean age 28.7 years).
1
The SLS revealed a bi-factor solution, with 78.6% of variance explained by one general factor of Psychological Distress
and 21.4% of the variance assigned to four group factors: Self-Beliefs, Psychological Pain, Inner Turmoil, and Discontent.
The PS and OMMP measures merged into one distinct group factor, validating their operational equivalence status, as
targeting the same construct of psychological pain. Further, with the Psychological Pain factor comprising a unique and
independent of the general factor variance, it is inferred the notions of psychological pain and psychological distress are
not synonymous, although highly related.
Furthermore, all the measures included in the EFA revealed higher loadings with the general factor than their respective
group factors, suggestive of their strong utility in the psychological distress assessment. All the measures’ items could
thus be combined and reduced to a single measure, useful in quantification of psychological distress.
This study’s main implication for future research is the raised confidence in the PS and OMMP results comparability. Also,
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as psychological distress assessment methodologies vary, in accord with theoretical underpinnings driving their
development, a psychological distress definition consensus needs to be reached and a comprehensive measure,
reflecting that agreement, constructed.
References:
Beck, A. T., Brown, G. K., Steer, R. A., Kuyken, W., & Grisham, J. (2001). Psychometric properties of the Beck SelfEsteem scales. Behaviour Research and Therapy, 39, 115-124. doi: 10.1016/S0005-7967(00)00028-0
Chamberlain, P. (2010). Self murder: Suicide and the intolerable state of the fragmented self. (Unpublished doctoral
dissertation thesis), The University of Adelaide, Australia.
Holden, R. R., Mehta, K., Cunningham, E. J., & McLeod, L. D. (2001). Development and preliminary validation of a scale
of psychache. Canadian Journal of Behavioural Science, 33, 224-232.
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales. Sydney: Psychology
Foundation.
Meerwijk, E. L., & Weiss, S. J. (2011). Toward a unifying definition of psychological pain. Journal of Loss and Trauma, 16,
402-412. doi: 10.1080/15325024.2011.572044
Orbach, I. (2003). Mental pain and suicide. Israel Journal of Psychiatry and Related Sciences, 40, 191-201.
Orbach, I., Mikulincer, M., Sirota, P., & Gilboa-Schechtman, E. (2003). Mental pain: A multidimensional operationalization
and definition. Suicide and Life-Threatening Behavior, 33, 219-230.
Shneidman, E. S. (1986). Ten commonalities of suicide and their implications for response. Crisis, 7, 88-93.
Tossani, E. (2013). The concept of mental pain. Psychotherapy and Psychosomatics, 82, 67-73. doi: 10.1159/000343003
Short Term Effectiveness of a Community-Based Suicide Postvention Training
Thomas Delaney
University of Vermont, United States of America; thomas.delaney@uvm.edu
Background: Postvention trainings in communities affected by suicide may be important for building resiliency and
preventing future suicide. Inappropriate response in the aftermath of suicide can trigger suicide contagion, however
communities often lack systems and supports to implement effective postvention efforts. Many Vermont communities lack
basic awareness of best practices for suicide postvention. A team of prevention specialists have developed and
implemented a daylong suicide postvention training called the Umatter for Communities—Postvention training. This
training aims to increase knowledge of, and promote helpful attitudes about, suicide postvention across different roles and
settings in a geographical community. This contrasts with earlier training efforts in our state that targeted a single group or
organization within a community (e.g., the staff at a school).
Methods: Trainings were conducted in 5 predominantly rural communities. In order to foster learning across disciplines
and settings, attendees were recruited from public health and mental health agencies, volunteer organizations, healthcare
organizations, educational institutions, law enforcement agencies and correctional systems. Short-term effectiveness of
the trainings was assessed using immediate pre- and post-test surveys of participants’ knowledge (12 items) and attitudes
(8 items) relating to suicide postvention. Knowledge items were presented as true/false statements and attitude items
used an agreement scale (strongly disagree, disagree, agree, strongly agree) with a series of statements. The
assessment also collected participants’ demographic data, roles in the community (e.g., professional role) and previous
experience/training relating to suicide postvention. Pre- and post-tests took approximately 10 minutes each to complete.
Results: 55 participants completed the pre- and post-training assessments; mean age was 45 years, 31% were male. To
compare pre- versus post-training changes in participants’ knowledge and attitudes about suicide postvention, composite
variables were created for each participant, separately for the pre- and post-tests. The knowledge score reflects the total
number of knowledge-based items answered correctly (possible range 0-12) and the attitude score reflects how strongly
respondents agreed with each attitude statement (possible range 0-24). T-tests of the composite scores showed a
significant pre vs post effect for knowledge items, t(93) = 3.01, p < .01; averaged post scores were higher than pre scores
(10.2 vs 9.5). Attitude scores showed a significant pre vs post effect, t(96) = 5.1, p < .001, with average post scores higher
than pre scores (16.6 vs 13.3).
Conclusions: The Umatter training is associated with increases in participants’ knowledge and positive/helpful attitudes
relating to suicide postvention. Follow-up surveys will assess the extent to which these changes persisted.
Violence from Adult Cohabitants, Bullying Involvement, and Suicidal Ideation in Adolescence
21
Shinya Fujikawa1, Shuntaro Ando1,2, Shinji Shimodera3, Shinsuke Koike4,5, Satoshi Usami6, Rie Toriyama1, Sho
Kanata1, Tsukasa Sasaki7, Kiyoto Kasai1, Yuji Okazaki8, Atsushi Nishida2
1
Department of Neuropsychiatry, Graduate School of Medicine, the University of Tokyo, Japan; 2Department of
Psychiatry & Behavioral Science, Tokyo Metropolitan Institute of Medical Science; 3Department of Neuropsychiatry, Kochi
Medical School; 4Office for Mental Health Support, the University of Tokyo; 5Medical Research Council Unit for Lifelong
Health and Ageing at University College London; 6Faculty of Human Sciences, Division of Psychology, University of
Tsukuba; 7Department of Health Education, Graduate School of Education and Office for Mental Health Support, The
University of Tokyo; 8Matsuzawa Hospital; fjkwsny@gmail.com
Background:
Bullying is a serious problem in adolescence which may lead to severe mental health problems including suicidality.
Furthermore, its harmful effect on children’s mental health can last for as long as about forty years. Therefore, intervention
into risk factors in adolescence for bullying involvement has been required. Although several studies have reported that
past violence from adult cohabitants was a risk of being bullied, the association between current violence from adult
cohabitants (CVAC) and bullying involvement in adolescence, and the influence of CVAC in combination with bullying
involvement on suicidal ideation has not been simultaneously examined.
Methods:
This is a large cross-sectional survey on students in public schools in Japan (grades 7th to 12th). The data were collected
by self-report questionnaire which was anonymously responded by 15,540 students. Based on the responses to two
questions about bullying involvement, the participants were classified into the following four groups: 1) uninvolved (those
who had not bullied others and not been victimized), 2) pure bullies (those who had bullied others but not been bullied), 3)
pure victims (those who had been bullied but not bullied others), and 4) bully-victims (those who had both bullied others
and been bullied). Logistic regression analysis and multiple regression analysis were performed to explore the association
of CVAC with bullying involvement and suicidal ideation.
Results:
CVAC was associated with the increased odds of bullying involvement (pure bullies, pure victims, and bully-victims).
Furthermore, CVAC additionally increased the odds of suicidal ideation considering the effect of bullying involvement on
suicidal ideation. For example, bully-victims with CVAC had about 15-fold higher odds of suicidal ideation compared with
uninvolved adolescents without CVAC.
Discussion:
CVAC was associated with the increased odds of bullying involvement, and additionally increased the odds of suicidal
ideation among adolescents. There were several strengths of this study. First, since this study used a large sample of
general adolescents and the response rate was very high, the generalizability of the results was assured. Second, as the
students could respond to the questionnaire anonymously, the responses were substantially reliable. Intervention into
CVAC should be considered to prevent bullying involvement and suicidal ideation among general adolescents.
The Role of Religion in Suicide Prevention, Preliminary Findings of Phenomenological Research
Urška Mali Kovačič1, Borut Škodlar2
University of Ljubljana, Faculty of Theology, Slovenia; 2University Osychiatric Hospital Ljubljana; maliurska@gmail.com
Religion represents an important preventive factor in suicide prevention. Previous studies found that those who are more
religious have less positive attitudes toward suicide, fewer suicide attempts and fewer completed suicides.
1
The role of different elements of religion has been insufficiently studied. Studies mostly focus on preventive role of
different elements and consider them very partially, such as focussing only on; religional practises, personal prayer, moral
impediments toward suicide or lower possibility to develop aggressive behaviour among religious people.
As none of the studies manage to capture a holistic understanding of the phenomenon, that is the aim of our study. Our
study focussed on declared Christian Catholics (followers of mayor religious denomination in a country) that were
hospitalized because of the recent suicide attempt. We studied their understanding of different elements of religion
(myths, personal perception of religion, rituals they follow, doctrine, ethical norms and prohibitions and social ties with
influence of religion on society) with conducting semi structured interviews few days after their hospitalization and their
suicide attempt. These were analysed with qualitative research method called Phenomenological Interpretative Analysis.
The major contribution of the research is the use of qualitative analysis, deep research of the meaning of religion and it's
role as expressed and described by the patients.
22
Suicide Risk Assessment Using the Interpersonal-Psychological Theory of Suicidal Behavior among
Selected College Students
Clarisza Corazon Castillo Arceo, Socorro GuanHing
University of Santo Tomas, Philippines; yszadiamonds@yahoo.com
According to the World Health Organization (2014), suicide accounts for more than 800 deaths worldwide, yearly which
amounts to one death every 40 seconds. In the Philippines, an average of 2.7 per 100,000 Filipinos each year die
because of suicide. Recently, a growing number of foreign studies have investigated the use of Joiner’s interpersonalpsychological theory (2005) on providing a better understanding of suicidal behavior. The theory introduces three risk
factors of suicide namely: (1) perceived burdensomeness, (2) thwarted belongingness, where the confluence of these two
factors produces the suicidal desire; and (3) acquired capability to enact lethal self-injury distinguishes those who are
capable to enact lethal self-injury. It proposes that “only the convergence of all three factors – perceived
burdensomeness, thwarted belongingness, and acquired capability to engage in lethal self-injury – is enough to result in
serious suicidal behavior” (Ribiero & Joiner, 2009 p.1294).
This comparative correlational study aims to assess suicidal risk using the interpersonal-psychological theory of suicidal
behavior among selected college students. Specifically, it studied the relationship of the theory’s constructs namely:
perceived burdensomeness, thwarted belongingness, and acquired capability to enact lethal self-injury; and also the
difference in suicide risk when grouped according to the said constructs. The self-report questionnaires used were
Interpersonal Needs Questionnaire (INQ), Acquired Capability Suicidal Scale (ACSS), and Suicidal Behavior
Questionnaire – Revised (SBQ-R), that assessed thwarted belongingness, perceived burdensomeness, acquired
capability, and suicidal risk respectively. The questionnaires were completed by selected college students (N = 186).
This study partially supports the interpersonal-psychological theory of suicidal behavior, wherein the elements perceived
burdensomeness (p value < 0.01) and thwarted belongingness (p < 0.01) are independently associated to suicide risk.
Acquired capability (p > 0.01) is limited unless it interacts with perceived burdensomeness (AC x PB, p < 0.01) in the
three-way interaction, wherein the interaction of these two variables predicts suicide risk. Moreover, There is a significant
difference in suicide risk when respondents are grouped according to perceived burdensomeness and thwarted
belongingness.
Thus, these risk factors may be an important element in assessing suicidal risks among college students. Furthermore,
these results offer targets for intervention aimed at identifying and preventing suicidal behavior among college students.
A Solution-Focused Approach for Suicidal Clients and their Families
Maura Weir
CHC, United States of America; mauraweir@gmail.com
The traditional therapy for a suicidal person is risk assessment and management and concentration on what is making
them feel this way. Solution-focused therapy is a wonderful addition to the different models that are used to help client’s
with suicidal thought. Many prevention and intervention models for suicide have some level of empowering and involving
the client in the process. Prevention programs use questioning, connecting, understanding and assisting regularly with
suicidal people. If trained, a prevention person looks for clues and invitations that can help keep this person alive. If
trained, a clinician doing and intervention may look for the ambivalence about the problem and use scaling and exception
questions to carry on the conversation. Asking direct, nonjudgmental questions goes along way with clients to assessing
their needs about suicidal risk. This session describes a solution-focused approach to working with suicidal clients that
can be used as an alternative or in addition to traditional approaches that assess for safety of the individual.
Because the solution-focused model advocates a brief and nonpathological approach to therapy and families (de Shazer,
1985) it can be used to identify strengths, facilitate change and help clients come up with their own solutions or
alternatives to coping with the suicidal thought. An underlying belief is that clients are resourceful and strengths go
unnoticed often. By focusing on existing resources, previously applied effective solutions, and understanding the principle
that clients know what is best for them (de Shazer 1994), this approach can highlight client’s good coping skills, help
clients envision a more positive future and bring hope back into the world of the client. This approach could help clients
change behavior and look beyond the problem of feeling suicidal to a solution that does not involve death. The therapist
who is using a solution-focused approach will aid clients in their own power to change, help clients articulate goals, create
alternative pathways on how to reach that goal and recognize when they have done so. By working through the five
stages of the solution-focused approach and following a line of strategic questioning clinicians can elicit a change in the
client’s thought and work at creating a better solution than killing oneself and focus on the exceptions when the client is
not feeling this way.
Differences between Occupations and Sex in Suicide Attempts in the Fifth Largest City of Brazil
Renata Eudocia Melo Barreto, Lia Wagner Plutarco, Aline Cajado Alves, Thais Augusta Ferreira Barbosa De
Aguiar, Maria Ivoneide Verissimo De Oliveira, Fabio Gomes de Matos Souza
Federal University of Ceará, Brazil; fgmsouza@yahoo.com.br
Introduction: According to WHO, Brazil is the 8th country with the largest number of suicides. The state of Ceara occupies
the 9th position in suicide rates among the 27 states in the country. In England, it was found that high-risk occupations for
suicide were professions which require graduation. In Australia, it was found a higher suicide rate in the elementary
professions, which include labours and cleaners. This research aims to investigate the difference between occupations
and sex in patients who were admitted in the José Frota Institute (IJF), the main public emergency hospital in Ceara for
23
suicide attempts.Method: Programa de Apoio à Vida (PRAVIDA), a prevention suicide program of the Federal University
of Ceara (UFC), conducted a survey between the years of 2007-2014 at IJF, located in the city of Fortaleza, capital of
Ceara. IJF receives suicide cases not only from the capital, but also from other cities and small towns of the state.
Sociodemographic and clinical data was gathered either by a semi-structured interview with the patient or companion
and/or by the medical records of IJF. Data collection was conducted through interviewes by 21 interviewers trained
specifically for this study. A structured questionnaire was used, including data referring sex, age and method used in the
attempt. The sample was selected systematically, with statistical analysis performed by SPSS. Results: The total number
of patients was 1,184, of which 41.5% were male and 58.5% female. The mean age of these patients was 33 ( + 14)
years for males and 28 (+ 12) years for females. The majority of the sample (n=1,164) has only elementary education just 20 people have university education. In the sample, for each self employed woman (2.3%) there were two men
(5.06%). An inverse relation was found for farmers - four men (3.6%) to one woman (1%). The percentage found of
unemployed women in this survey were 6.5% and 4.9% for man. In the sample, there was 9.45% of female students and
2.36% of male students, also 0.6% were male housewives and 7.2% female housewives. Discussion: This study
corroborates the survey done in Australia. It is not possible to compare with the study performed in England, due to the
minimal number people with university degree. This study has a limitation due to the fact that IJF is a public hospital,
which mainly admits patients from lower educational classes with elementary professions. It was not possible to study
higher educational classes in this sample because approximately 25% of Brazilians, with this profile, are assisted mainly
by private hospitals. Conclusion: Suicide prevention programs for these occupations with high rates of suicide should be
increased.
Initial Evaluation on Suicide Completers in the Emergency Room of a General Hospital in Japan
Yoko Yoshida1, Satoshi Hashimoto1, Kensho Yamashita1, Kenjiro Watanabe1, Daisuke Fujisawa2
National Hospital Organization Kumamoto Medical Center, Japan; 2Keio University School of Medicine, Japan;
y.yoko58@gmail.com
Background: Suicide attempt is one of the most important risk factors for later suicide completion. Most patients who
attempted suicide visit emergency departments. However there are few reports of the actual intervention in emergency
room in a large general hospital. In order to create an effective intervention program, we investigated psychosocial and
psychiatric characteristics of suicide completers who came to the emergency room(ER) in a general hospital.
1
Methods: In this retrospective study, the subjects included patients who were transported to the emergency room of
National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan, following an episode of suicide attempt or
self-harm. The study period was between January 2009 and March 2014. We conducted a retrospective chart review in
May 2014, after obtaining an IRB approval.
Findings: A total of 2627 cases were included in this survey. Among them, there were 110 suicide completers. The
leading methods of suicide completion was hanging of 47 patients (42.7 %). Forty-one patients (37.3 %) have previous
history of self-harm, and 30 patients (75.6 %) of them have history of drug overdose or cutting wrists Twenty-nine patients
have previous visit to our ER because of self-harm and 7 patients (24.1%) of them didn’t see a psychiatrist at that time.
Only 14.3% of the medical charts had documentation on whether primary care providers in the ER evaluated suicidal
thoughts of patients. We found only a few descriptions about psychosocial and psychiatric issues in medical records
documented in the ER.
Discussion: Method of suicide attempts change into more serious ones, leading to suicide completion. It suggest that risk
management for suicide attempts in the ER is very important to prevent later suicide completion. Our findings show that
emergency departments have some difficulties in getting information about psychosocial and psychiatric issues, including
suicide thoughts. Our survey suggest that there is a need for developing tools of initial evaluation on suicide attempts and
self-harm by non-psychiatrists.
Emergency departments have a very important role for crisis intervention of suicide issues. Developing trainings and
educational programs about the standard evaluation for suicide risk management are essential.
Recently, a training program for medical staff in emergency departments, which is called “PEEC (Psychiatry Evaluation in
Emergency Care)” has been developed. This program provides primary medical providers with a set of skills to address
patients who have psychiatric problems including suicidal issues.
Efficacy of Online Gatekeeper Training Among College Faculty, Staff, and Students
Kevin Joseph Yeates, Leah Wentworth
University of Iowa, United States of America; kevin-yeates@uiowa.edu
In January 2013, the Leveraging Campus- Community Collaborations to Enhance Suicide Prevention at the University of
Iowa grant (a grant awarded through SAMHSA’s Garrett Lee Smith Memorial Suicide Prevention Program) purchased two
Kognito At-Risk modules (For College Students and For Faculty and Staff) to train students, faculty, and staff members at
the University of Iowa. Kognito At-Risk is an avatar based suicide prevention program designed to train participants to
become gatekeepers for suicide prevention. The two modules of the Kognito At-Risk program are specifically designed to
train individuals within the context of a college environment on how to intervene with students in distress. This program is
currently listed in SAMHSA’s National Registry of Evidence-Based Programs and Practices. However, thus far the only
published data on the effectiveness of this program has been funded by the organization itself.
This poster presentation seeks to explore the effectiveness of this program at the University of Iowa as well as to provide
24
evidence of Kognito At-Risk’s effectiveness from an external organization. The evaluation of the training was designed to
assess two basic factors: the difference in a participant’s knowledge of suicidality including risk factors and the difference
in the participant’s perceived self-efficacy in approaching those at-risk for psychological distress. As a function of the
Kognito At-Risk program, each participant is asked to complete a pre-survey, a post-survey, and a six-month follow-up
survey. The pre-survey is administered prior to the training in order to assess baseline knowledge of the participant and
the post-survey is administered immediately following the completion of the training. A solicitation to complete a follow-up
survey is sent at six month after the individual completes the training. This poster presentation will explore the
effectiveness of the program among faculty, staff, and students and explore the differences between each group.
Peer Education Approach for School Suicide Prevention – Experiences from a Three Year
Participatory Action Research Approach
Bobby Zachariah, Jyotsna Bahirat
Connecting...NGO, India; bobbyzac@gmail.com
Reaching students via their peers is known to be a successful approach to address many social issues. Peers are
available, approachable and can be moulded with appropriate skills for appropriate program delivery.
Increasing distress and suicides among school students in India is becoming a concern to schools, parents and mental
health professionals who having been watching an alarming trend of self harming behaviours, attempted and completed
suicides among adolescents.
Connecting...NGO has implemented a peer based program to build capacity of volunteers students to reach out to their
peers who are in distress. The outcome of this approach alerted the team to the need to involve the school counsellor,
teachers and parents as a part of the program. Interactive listening oriented sessions have allowed the participants to
share the factors that cause distress to each of the constituents including the parents and teachers. The program is being
implemented in 8 schools for the whole academic year i.e. June-March.
The volunteer peer educators are mentored in their knowledge and approach to suicide, listening skills, team work and
leadership skills via one hour weekly sessions. The students are mentored by trained Connecting volunteers.
Each peer educator students has reached out to those students in emotional distress, those practising self harming
behaviours, those who are having suicidal thoughts and a few have reached out to suicide survivors. Those needing
further support are referred to school counsellors and Connecting volunteers. Such are referred to trained psychologists
and psychiatrists where needed.
The peer education program, though originally designed to support students have become an opportunity to every
participant to share their concern and design appropriate responses to address the root causes of the distress. The
resulting open conversations have helped the participants to be appreciative of each other’s concerns and adjust their
expectations accordingly. The relationships built over a period of time have resulted in invitations by schools to address
deeper issues among students, by parents to handle difficult relationship issues and suicidal thoughts and support suicide
survivors in the neighbourhood. The students thus trained by Connecting are now training other junior students for further
action. This program can be replicated across the city for wider impact.
Exploration of the Association between Physical Health and Suicidal Behavior and Ideation in
Psychiatric Outpatients
Jessica Carbajal, Nolan Kordsmeier, Erick Messias, Ricardo Caceda
University of Arkansas for Medical Sciences, United States of America; rcaceda@uams.edu
There is growing evidence of association between physical health and suicide. Suicide and suicide attempts could reflect
a high mark of a longstanding pattern of impaired decision making that would extend to poor choices regarding health
maintenance. In turn, poor physical health is a known risk factor for suicide. We hypothesize that: a) individuals with
history of suicide attempts will also make faulty choices in everyday life, leading to impaired physical health, and b)
Individuals with active suicidal ideation will display poorer physical health. For this purpose we reviewed medical records
of 210 new adult patients seen at the general outpatient clinic at the Psychiatric Research Institute at the University of
Arkansas for Medical Sciences between May 2013 and September 2014. We collected demographic and clinical
information, including suicide related history, as well as measures of depression (Patient Health Questionnaire 9), anxiety
(Generalized Anxiety Disorder 7-item), childhood trauma (Childhood Trauma Inventory) and health status (Short Survey
Instrument (SF-12). Of the 115 patients with complete data, 38 had a previous history of suicide. Patients with and without
history of suicide attempts did not show difference in physical [t(2,113) = -0.73, p = 0.46] or mental health [t(2,113) = 0.61, p =0.54]. Patients with current suicidal ideation reported poorer physical [t(2,113) = -1.98, p=0.04] and mental health
[t(2,113) = -4.52, p <0.01]. Even though our sample size is limited our results do not support the notion of widespread
decision making deficits that include healthcare. However, there is a need to screen for suicide in populations with serious
medical problems, who may benefit from secondary or even primary suicide prevention.
Régulation émotionnelle, perception de soi et de l'alliance thérapeutique chez les stagiaires en
psychologie confrontés à une clientèle suicidaire
Sophie Bertrand, Marc-Simon Drouin
25
Université du Québec à Montréal, Canada; buddhiso@hotmail.com
L’étude présentée avait initialement pour objectif de mesurer l’impact potentiel d’un suivi avec un patient présentant un
risque suicidaire sur la régulation de soi et sur le développement professionnel d’un stagiaire en psychologie. Pour se
faire, nous avons demandé à des étudiants au doctorat en psychologie ayant eu, dans le cadre d’un stage récent, une
expérience de psychothérapie avec un ou une patient/-te ayant présenté des idéations ou des comportements suicidaires
durant le suivi de se référer à cette expérience pour remplir 5 questionnaires portant sur: 1) des données sociodémographiques, 2) l’évaluation de l’alliance thérapeutique 3) la gestion de la honte, 4) le sentiment d’imposture et 5)
l’expérience de supervision. Nous avons vérifiés la présence de corrélations entre les résultats obtenus à ces tests et
avons recherché des patrons dominants dans les réponses aux tests. Malgré la présence de corrélations significatives,
nous n’avons pu statuer sur la validité de ces corrélations, l’échantillon de huit sujets étant trop restreint. Néanmoins, une
hypothèse quant à la protection offerte par une meilleure perception de soi ainsi que l’utilisation de certaines stratégies
régulatrices dans la situation de suivi avec un patient présentant un risque suicidaire est discutée.
Necessity of the Suicide Prevention Measure which Considered Each Age Group: Suggestion by
their Viewpoints
Ken Inoue1,2, Tatsushige Fukunaga3, Yuji Okazaki4,5, Yoshitsugu Fujita6, Yuumi Yamamura7, Haruo Takeshita8,
Mari Sampei9, Tadayuki Iida10, Satoko Ezoe11, Tsuyoshi Miyaoka12, Jun Horiguchi12, Yasuyuki Fujita1
1
Department of Public Health, Faculty of Medicine, Shimane University, Japan; 2The International Research Group on
Suicide in Older Adults; 3Tokyo Medical Examiner’s Office, Tokyo Metropolitan Government, Japan; 4Michinoo Hospital,
Japan; 5Tokyo Metropolitan Matsuzawa Hospital, Japan; 6Department of Internal Medicine, FukuiKen Saiseikai Hosipital,
Japan; 7Meiyokai Medical Corporation, NaritaKinen Hosipital, Japan; 8Department of Legal Medicine, Faculty of Medicine,
Shimane University, Japan; 9Department of Clinical Nursing, Faculty of Medicine, Shimane University, Japan;
10
Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Japan; 11Shimane
University Health Service Center Izumo, Japan; 12Department of Psychiatry, Faculty of Medicine, Shimane University,
Japan; ke-inoue@fujita-hu.ac.jp
Introduction: In Japan, the annual number of suicides during 1995-1997 was from 22,000 level to 24,000 level, and the
number of suicides in 1998 has been increased 32,863. There were over 30,000 annual suicides during 14 years since
then. The number of suicides in 2012 and 2013 was less than 30,000, but it was not unusual when compared to the
number of suicides in 1997. Therefore, it is important to continue and carry out suicide prevention measures. Especially,
since rapid increase of suicides, suicide prevention was carried out middle-age and elderly groups. Recently, the
Japanese government decided to enhance suicide prevention for young people. We described the results of our
investigation into suicide trends focusing on age groups, and this investigation was discussed trends of younger age
group. We also proposed measures to prevent suicide.
Methods: In this report, we investigated the annual number of suicides and the proportion of causative factors in the
following age groups: under 19, 20–29, and 30–39 age groups for each gender in 2000, 2001, 2005 and 2006 in Japan
based on numerical data from reports of the National Police Agency in the Journal of Health and Welfare Statistics. In the
classification of causative factors, “family problems”, “health problems”, “economic and life problems”, “work problems”,
“problems of relations between the sexes”, “problems in schools”, “others”, and “unknown” was included in ‘suicide note
left’ , and other classification was included in ‘suicide note none’. In addition, we focused on the proportions of causative
factors of suicides in several age groups during the periods 2000–2001 and 2005–2006 and based on the results. We
also showed the necessity of further specific suicide prevention measures.
Results: During 2000–2001 and 2005–2006, significant causative factors among men were “problems in school” and
“health problems” in the under 19 age group, and the most common causative factors were “health problems”, “economic
and life problems”, and “work problems” in the 20–29 and 30–39 age groups. Among women, significant causative factors
were “health problems” and “problems in schools” in the under 19 age group, and the most common causative factors
were “health problems”, “family problems”, and “problems of relations between the sexes” in the 20–29 and 30–39 age
groups.
Discussion and Conclusion: These findings suggest that suicide prevention measures should be formulated with a focus
on the specific factors unique to each age group. Experts in organizations and fields related to suicide prevention must
consider which suicide prevention measures to formulate, and they must coordinate the implementation of those
measures when necessary.
Adolescent Depression, Aggressive Behaviours, Suicidality, and Lithium Level in Tap Water
Shuntaro Ando1, Shinsuke Koike2, Shinji Shimodera3, Ryosuke Fujito3, Ken Sawada3, Takeshi Terao4, Furukawa
Toshi A5, Tsukasa Sasaki6, Shimpei Inoue7, Nozomu Asukai1, Yuji Okazaki8, Atsushi Nishida1
1
Tokyo Metropolitan Institute of Medical Science, Japan; 2Office for Mental Health Support, Division for Counseling and
Support, the University of Tokyo; 3Department of Neuropsychiatry, Kochi Medical School; 4Department of
Neuropsychiatry, Oita University Faculty of Medicine; 5Department of Cognitive-Behavioral Medicine, Kyoto University
School of Public Health; 6Department of Health Education, Graduate School of Education and Office for Mental Health
Support, The University of Tokyo; 7Department of Neuropsychiatry, Aizu Medical Center, Fukushima Medical University;
8
Tokyo Metropolitan Matsuzawa Hospital; ando-st@igakuken.or.jp
Mental health problem in adolescence is a public health issue in the world. Previous ecological studies have suggested
the inverse association between lithium level in tap water and regional suicide rate. However, there has been no
individual-level study which examined lithium level in tap water and mental health problems in general adolescents.
26
This study was a multi-center cross sectional survey conducted in Kochi Prefecture which has a population of
approximately 790000 and both urban and rural areas in Japan. A total of 3040 students in 24 public junior high schools
responded to self-report questionnaire. Main outcome measures were mental health related measurements including the
12-itm General Health Questionnaire, interpersonal violence, bullying, destructive behavior, self-harm, and suicidal
ideation. Water samples were collected from water sources which supply drinking water. We used regression model for
statistical analysis.
Lithium levels in tap water were relatively low compared with the previous studies. In multivariable regression analysis,
lithium level in tap water had an inverse association with interpersonal violence (p<0•05) and depressive symptoms
(p<0•05), but had no association with suicidal behaviors.
Lithium level in tap water had an inverse association with interpersonal violence and depressive symptoms among
general adolescents.
Suicide Mortality in Canada and Quebec, 1926-2008: An Age-Period-Cohort Analysis
Lise Thibodeau1, Robert Bourbeau1, Marianne Kempeneers2
Université de Montréal, Department of Demography, Canada; 2Université de Montréal, Department of Sociology,
Canada; lise.thibodeau@umontreal.ca
The increase of suicide rates with age has remained consistent for more than 150 years appearing as suicide law and
Durkheim paradigm of integration and regulation strongly influenced contemporary sociology and the studies on suicide.
However, major changes have occurred over the last 50 years: important growth of suicide rate by 60% worldwide; and a
marked rise of those of the youth to such an extent that they are, at the beginning of the twentieth-first century, the group
at highest risk in a third of countries (WHO-SUPRE 2012: 2; World Health Organization 2012: 4). Since then, Durkheim’s
suicide law has been challenged.
1
Substantial researches had been done on suicide and its demographic evolution in Canada (National Task Force on
Suicide in Canada 1994). While previous studies captured suicide mortality rates increases on shorter timeframe, they did
not cover net (independent) APC effect by sex from vital statistics debut 1926 until the beginning of the 21st century,
which provide highly valuable information and retrieve more cohorts. Moreover, national characteristics’ revealing of at
large societal trends were reported but they left out it is not uniformly distributed across the country. Additionally, the
challenge to explain APC temporal evolution is to determine whether the process under study is some combination of age,
period, and cohort phenomena, which points to the necessity of statistically estimating and delimiting the age, period and
cohort effects (Y. Yang 2007: 20).
This study examines independent APC effects on suicide mortality by gender in Canada from 1926 to 2008, and
compares the evolution in Quebec to the rest of Canada. Specifically, we seek to distinguish whether the trends of suicide
by age have changed in nearly a century namely to determine; (i) if the highest rates occur among the youth; (ii) if
sensitive periods can be distinguished; and (iii) if some cohort groups are at greater risk than others. Correlations with
Durkheim’s paradigm of integration and regulation provide the theoretical framework to interpret our findings. Descriptive
analysis and APC Intrinsic Estimator (IE) were used to assess these effects. The patterns were interpreted within
Durkheim theoretical framework.
IE result shows a net age effect in Canada; for males suicide death rate increased until 25 years old before reaching a
plateau; and for females resembles an inverted "U" shape peaking at mid-adulthood. The net period suicide effect differs
in Quebec; extended by 25 years compared to the rest of Canada. Canada experienced a net cohort effect for the male
baby boomers and X generation, and was found much stronger in Quebec. Females in Canada (similar for Quebec)
present a net cohort effect for those born 1981 until most recent cohorts.
Les filles– consommation SPA, comportements à risques, santé mentale et gestion des émotions :
Comment prévenir?
Julie-Soleil Meeson, Jessica Turmel
GRIP Montréal, Canada; jturmel@gripmontreal.org
Nous avons réalisé une étude exploratoire en lien avec les filles et la consommation de substances psychoactives. Nous
avons rencontré 15 filles âgées de 19 à 22 ans qui ont pu être catégorisé en 4 groupes : les abstinentes, les récréatives,
les à risque et les problématiques. Nous présentons un portrait des filles, de leurs trajectoires de consommations et des
événements significatifs. Les comportements à risques, les facteurs intériorisés (dépression et anxiété) et la gestion des
émotions seront abordés. Nous finirons avec une réflexion sur ce que nous pouvons faire en prévention/réduction des
méfaits avec elles pour les aider à faire des choix éclairés face à leur situation.
27
PP17-1: Parallel Plenary: Treatment of Suicidal and Self-Harming Behavior
in People with Borderline Personality Disorder - Results from New
Psychotherapy Trials / [Traitement des comportements suicidaires et de
l'automutilation chez les personnes ayant un TPL]
Treatment of Suicidal and Self-Harming Behavior in People with Borderline Personality Disorder –
Results from New Psychotherapy Trials
Chair(s): Lars Mehlum (National Centre for Suicide Research and Prevention, University of Oslo), Shelley McMain
(Centre for Addiction and Mental Health, University of Toronto)
Background
Self-harming behavior (non-fatal self-poisoning or self-injury with or without suicide intent) is a serious public health
problem in many countries, but only a minor proportion of individuals who have self-harmed, report receiving any kind of
subsequent treatment. Among those who actually become referred to specialized care, many will be non-compliant with
the treatment or drop out prematurely due to treatment-interfering characteristics of the patient, families or the clinical
services. This problem is particularly prominent in individuals with repetitive self-harm which is very often linked to
personality disorders such as Borderline Personality Disorder (BPD). Individuals diagnosed with BPD are typically highly
emotionally reactive, their reactions tend to be extreme and the time taken to return to their baseline affective state is
often considerably longer than for individuals without BPD. These characteristics pave the way for self-harming behavior
and they represent intriguing and important challenges to treatment developers.
Self-harm remains a powerful predictor of completed suicide; thus there is a strong need to develop effective, accessible
and acceptable interventions that are feasible to deliver by clinicians in community mental health settings. Still, there is a
relative paucity of randomized controlled trials (RCTs) to offer evidence for effective treatments for self-harming
individuals.
Objective
In this session we will present and discuss results from ongoing clinical trials of novel psychotherapeutic interventions in
adults as well as adolescents with a focus on important outcomes such as self-harm frequency, depressive symptoms,
borderline pathology, utilization of health services and emergency interventions and on various measures of functioning.
We include outcome studies in both short- and long-term perspective and discuss how different data sources may be
used to get a better picture of how individuals change during treatment.
Presentations of the Symposium
Suicide and Self Harm Response Trajectories: Findings from a Randomized Controlled Trial for
Borderline Personality Disorder
Shelley McMain1, Greg Williams2, Ryan Barnhart1
Centre for Addiction and Mental Health, University of Toronto, 2Department of Psychology, University of Toronto
Objective: Borderline personality disorder (BPD) is a severe disorder that is often characterized by recurrent suicidal and
self-harm behaviour. In recent years, several disorder-specific treatments have shown to be effective in reducing suicide
and self-harm behaviours, as well as a broad range of other symptoms associated with BPD. However, examining only
the overall effect sizes from randomized controlled trials can over- or underestimate the response to treatment for some
patients; variability of treatment response is a inevitable. Identifying heterogeneities in treatment response can improve
our understanding of how to personalize treatment for each patient. The goal of this study was to examine suicide and
self-harm response trajectories in two outpatient treatments for BPD to determine the existence of latent subgroups.
Methods: One-hundred and eighty chronically suicidal individuals reliably diagnosed with BPD were randomly assigned to
either one-year of Dialectical Behaviour Therapy (DBT) or General Psychiatric Management (GPM). Suicide and selfharm behavior outcomes were assessed every four months over the course of the one year treatment and every six
months over the two-year post-discharge follow-up. Growth mixture modeling methods was conducted on suicide and
self-harm data. Results: Three latent trajectories were identified: “Steady Remitting”, “Slow Remitting” and “Relapse”.
Membership in the “relapse” group was characterized by higher levels of depression, unemployment and higher
emergency room visits at baseline compared to the other two groups. Conclusions: Our results will be discussed in terms
of their implications for enhancing treatment efficacy for this population.
1
Outcomes and Predictors of Change in a Randomized Controlled Trial of DBT vs SSRIs for Suicidal
Behavior and Self-Harm in BPD
Barbara Stanley, Beth Brodsky, Hanga Galfalvy, Sadia Chaudhury, Emily Biggs
Columbia University, New York
Borderline Personality Disorder (BPD) is a prevalent disorder affecting up to nearly 6% of the population. It carries
substantial risk for suicide and other forms of self-harm, substance and alcohol problems, eating disorders, anxiety and
impaired social relationships. About 5-9% of those with BPD die by suicide. Effective psychosocial and pharmacological
treatments that target suicidal behavior and self injury in the context of BPD are few in number. While Dialectical Behavior
Therapy (DBT) has been found to be efficacious in treating individuals with suicidal behavior and self injury, little is known
about the predictors of change and mechanisms of action and whether it is effective in a briefer version (6 months). We
28
report on a 6-month RCT comparing DBT with SSRI/medication management in a sample of 84 individuals diagnosed
with BPD and a recent history of self-harm behaviors. We hypothesized that DBT would be more efficacious than SSRI
treatment in decreasing self-harm behaviors, and that this outcome would be mediated by changes in emotion and stress
regulation. Methods: In addition to a comprehensive battery of structured interview ratings, we used the Ecological
Momentary Assessment (EMA) tool that provides “real time” assessments of moods, thoughts, events and behaviors
without relying on subjects’ recollection. Self-harm behaviors, suicidal ideation, negative life events, ratings regarding
mood and coping strategies were measured using EMA for 1-week periods at baseline, 3 and 6 months of
treatment. Biobehavioral measures included a pre- and post- treatment fMRI protocol using two paradigms that
investigate the neural correlates of using emotion regulation strategies when exposed to affectively- laden stimuli. The
Trier Social Stress Test (TSST) measured pre-and post- treatment cortisol stress response. Results: At baseline, there
were no significant demographic, diagnostic or clinical differences between those in the DBT (n=42) and SSRI condition
(n=42). When measured through EMA, we found a significant decrease in suicidal ideation in both groups. A significant
decrease in self-harm behaviors (performed with and without suicide intent) was found among participants in the DBT
condition but not in the SSRI condition. With no differences in negative life events between the two groups, there was
nevertheless a significant increase in coping behaviors among those in the DBT but not the SSRI group. In addition to
these findings, data describing the correspondence of EMA to interview ratings of suicidality, and biobehavioral correlates
of treatment response from fMRI and TSST measures, will be presented and discussed.
Depressive Symptoms in Self-Harming Adolescents with Borderline Personality Disorder
Ruth-Kari Ramleth, Berit Grøholt, Lien My Diep, Lars Mehlum
National Centre for Suicide Research and Prevention, Univ Oslo
Self-harming behavior, defined as self-poisoning or injury irrespective of the apparent purpose of the act (NICE 2004), is
alarmingly prevalent in adolescents (Muehlenkamp, 2012). One of the challenges encountered by health care providers is
that although self-harming adolescents frequently report high levels of depressive symptoms and even suicidal intent, this
strong level of negative emotions experienced by the patients often do not correspond well with the outcome of the
clinicians’ assessments.
Studies on adults indicate a strong association between a heightened subjective experience of depression and traits of
borderline personality disorder (BPD) (Abela, Payne, & Moussaly, 2003; Silk, 2010; Stanley, 2006). In the present study
we used data from a randomized trial on the efficacy of Dialectical Behaviour Therapy (DBT) for adolescents with
repeated suicidal and self-harming behavior and borderline traits (Mehlum et al., 2014), to examine whether such an
association exists among self-harming adolescents in outpatient psychiatric treatment and if so, whether such an
association would be related to treatment outcome.
We found a high level of depression in the sample; however, there was a discrepancy between the self-reported and the
clinical-rated level of depression. In line with findings from studies on adults, we found an association between a
heightened level of depressive symptoms and BPD. At baseline the majority of the adolescents diagnosed with BPD rated
their depression as more severe or similar to the clinical ratings. In contrast, all of the adolescents diagnosed with major
depressive disorder rated their depression as less severe or similar to the clinical ratings. At trial completion the
discrepancy between the self-reported and the clinical-rated levels of depression was reduced; associated with a greater
reduction in the level of self-reported- compared to clinical-rated depression. As to the adolescents with BPD, the clinicalrated depression was in fact unchanged after treatment. Various explanations to these findings are discussed, including
the possibility of DBT being superior to enhanced treatment as usual in reducing depressive symptoms in adolescents
with BPD.
Abela, J. R., Payne, A. V., & Moussaly, N. (2003). Cognitive vulnerability to depression in individuals with borderline
personality disorder. J Pers Disord, 17(4), 319-329.
Mehlum, L., Tørmoen, A. J., Ramberg, M., Haga, E., Diep, L. M., Laberg, S., . . . Grøholt, B. (2014). Dialectical Behavior
Therapy for Adolescents With Repeated Suicidal and Self-harming Behavior – A Randomized Trial. J Am Acad Child
Adolesc Psych. 2014;53:10:1082-91.
Muehlenkamp, J. J. (2012). International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child
Adolesc Psychiatry Ment Health, 6(1), 10.
Silk, K. R. (2010). The quality of depression in borderline personality disorder and the diagnostic process. J Pers Disord,
24(1), 25.
Stanley, B. (2006). Heightened subjective experience of depression in borderline personality disorder. J Pers Disord,
20(4), 307.
Changes in Response Inhibition and Non-Suicidal Self-Injury after Dialectical Behaviour Therapy in
Patients with Borderline Personality Disorder
Anthony C. Ruocco
Department of psychology, University of Toronto
Borderline personality disorder (BPD) is associated with neurocognitive deficits in response inhibition, which may underlie
the physical self-injurious behaviours that frequently accompany the disorder. In the current study, 17 patients with BPD
engaging in non-suicidal self-injury (NSSI) completed a six-month course of standard outpatient dialectical behaviour
therapy (DBT). Prior to beginning treatment and after six months, patients completed a neurocognitive measure of
response inhibition that required them to withhold a manual response to a visual stimulus on a continuous performance
task. The frequency of NSSI was assessed both in the period prior to starting treatment and during the six-month course
of DBT. Patients with the greatest response inhibition deficits before starting treatment witnessed the greatest reductions
in NSSI over the follow-up period. Additionally, worsening response inhibition between pre- and post-treatment
29
assessments was associated with increasing frequency of NSSI after six months of treatment. These findings suggest that
neurocognitive deficits in response inhibition may prospectively predict improvements in NSSI during a six-month course
of DBT, whereas worsening response inhibition may connote a resistance of self-injurious behaviours to treatment with
DBT.
One Year Follow-Up of Dialectical Behavior Therapy vs. Enhanced Usual Care for Self-Harming
Adolescents
Lars Mehlum1, Maria Ramberg1, Anita Tørmoen1, Egil Haga1, Lien My Diep1, Barbara Stanley2, Alec Miller3, Anne
Mari Sund4, Berit Grøholt1
1
National Centre for Suicide Research and Prevention, Univ Oslo, 2Columbia University, New York, 3Albert Einstein
College of Medicine, New York, 4NTNU, Trondheim
Objective: We conducted a 1-year prospective follow-up study to evaluate post-treatment clinical outcomes in adolescents
with recent and repetitive self-harm who had been a randomly allocated to receive either a shortened version of
Dialectical Behavior Therapy (DBT-A) or Enhanced Usual Care (EUC) at community child and adolescent psychiatric
outpatient clinics.
Method: Assessments of self-harm, suicidal ideation, depression, hopelessness, symptoms of borderline personality
disorder and global level of functioning were made at baseline and after 9, 15, 19 and 71 weeks. Frequencies of
hospitalizations, emergency-department visits and other use of mental health care during the follow-up period were
recorded. Change analyses were performed using mixed effects linear spline regression and generalized estimating
equations (GEE) with Poisson and robust variance.
Results: Over the 1-year follow-up DBT-A remained superior to EUC in reducing the frequency of self-harm. For other
clinical outcomes such as suicidal ideation, hopelessness and depressive or borderline symptoms and for the global level
of functioning inter-group differences apparent at the 19 week assessment were no longer observed, mainly due to
participants in the EUC group having significantly improved over the follow-up year.
Conclusions: DBT-A leads to a stronger reduction of self-harm frequency than enhanced usual care over a 71 weeks
period and a more rapid recovery in suicidal ideation, depression and borderline symptoms in adolescents with repetitive
self-harming behavior.
30
PP17-2: Parallel Plenary: An Internationally Applicable Nomenclature for
Suicide and Suicide-Related Phenomena [Plénière parallèle: Une
nomenclature applicable internationalement pour le suicide et les
phénomènes qui y sont reliés]
An Internationally Applicable Nomenclature for Suicide and Suicide-Related Phenomena / [Une
nomenclature applicable internationalement pour le suicide et les phénomènes qui y sont reliés]
Chair(s): Diego De Leo (Australian Institute for Su. Research and Prev., Griffith Univ.)
The need for a correct and shared labelling of suicide ideation and behaviours and its standardization has for long time
been recognized. However, all previous efforts to provide an acceptable basis for an internationally shared agreement on
the use of a given nomenclature have failed.
The implementation of the WHO START Study – through its international participants - is once again showing a wide
range of choices and habits in labelling suicide-related phenomena throughout the world. It is evident that cultural
background, traditions, criminalization of suicide-related behaviours, stigma embedded to them, health system practices,
and official recording procedures, all concur to creating serious obstacles to a sharable platform for labelling suicidality
signs in standardized ways. Even within western countries, huge discrepancies exist in data recording, put aside the
different opinions on interpretation and correct definition of each different form of suicidal (and non-suicidal)
manifestations.
Apart from ‘traditional’ difficulties in defining non-fatal suicidal behaviours, urgent appears the need for uniformity in
classifying ‘ideation’ (eg, death wishes, suicide ideation, transient, chronic, intense, etc). Standardizations would be very
useful also in the area of ‘survivors’ of suicide (bereavement, grief, mourning, surviving, etc), and in that of euthanasia
(eg, voluntary, involuntary, active, passive, self-euthansia, etc) and assisted suicide.
Following the call from the World Health Organization through its recent report “Suicide Prevention: A Global Imperative”,
the aim of the IASP Task Force is to obtain an international standardization of terminologies that may render research
more comparable across the globe, economize investment efforts, and favour meta-analytical evaluation.
Increased attention on nomenclatures in the area of suicide (short term goal) will be achieved through the international
distribution of a survey on use and attitudes towards current terminologies.
Long-term objective would be possibly reached through high-level publications, inclusive of volumes, booklets and
articles, in addition to all other forms of diffusion (e.g., conferences, media, etc). The participation of WHO Headquarters
and hopefully of national associations (eg, American Association of Suicidology, American Foundation for Suicide
Prevention, Canadian Association for Suicide Prevention, Suicide Prevention Australia, etc.) would greatly facilitate
diffusion of agreed terminology.
Presentations of the Symposium
Suicide Bereavement and Postvention: What Are We Talking About? / [Deuil par suicide et
postvention : de quoi parlons-nous exactement?]
Karl Andriessen
UNSW School of Psychiatry (Australia)
During the past half a century the postvention field has evolved enormously. Starting from neglect and lack of attention,
support has emerged, first in terms of peer support, followed by professional involvement, i.e., clinical support and
research activity. During the recent decade in several countries there is also emerging political interest. Due to these
mostly bottom-up evolutions, and related historical, local, and cultural differences, consensus definitions of key concepts
that are routinely used around the world are lacking. This is obvious from the discrepancy in the use of words such as
‘survivor’ and ‘bereaved’; ‘mourning’, ‘grief’ and ‘bereavement’, and ‘traumatic’, ‘complicated’ and ‘prolonged’; and other
variations.
In the past, several scholars from different parts in the world, and members of the IASP SIG on Suicide Bereavement and
Postvention have expressed the need to formulate consensus definitions in the field of suicide bereavement. As such, the
establishment of the IASP Taskforce on a transculturally applicable nomenclature of suicide-related phenomena is timely
and much needed. A shared nomenclature would improve our communication within the suicidology field as well as in the
community. In addition, it should strengthen our research activity and the development of (clinical or peer) bereavement
support programs.
This presentation will highlight the need for the development of consensus definitions in the field of suicide bereavement,
and invite all interested parties to collaborate in this effort.
A European Perspective on the Need for Shared Classification of Suicide / [Perspective européenne
sur la nécessité d’une classification uniformisée du suicide]
Ella Arensman1, Eileen Williamson2
Nat\'l Su. Res. Found., Dept epidem. & Pub. Health, U. Coll. Cork, 2National Suicide Research Foundation
The recently published WHO Report on Preventing Suicide: A Global Imperative, recommends up-to-date surveillance of
suicide and non-fatal suicidal behaviour as an essential component of national suicide prevention programmes. Lack of
1
31
consistency in the terminology and definition of suicide and non-fatal suicidal behaviour continues to provoke controversy.
Furthermore, the lack of standardisation in recording procedures limits our ability to make comparisons and
generalisations based on the research findings of others, whether from the same jurisdiction or not.
The presentation will focus on outcomes from research conducted by European research consortia aimed to enhance the
recording and classification of suicide.
Research into suicide recording procedures in eight European countries involved in Optimising Suicide Prevention
Programmes and their Implementation in Europe (OSPI-Europe) revealed that suicide registration was based on a
medico-legal system in six countries and on a coronial system in two countries. The coronial system applies the legal
approach i.e. the decision to classify a death as suicide is expected to be ‘beyond reasonable doubt’ whereas the medical
system uses a ‘balance of probabilities’ approach in line with the procedure for diagnostic assessment.
A particular challenge in coronial systems is to establish whether the death was self-inflicted. In addition, there is growing
evidence for the likelihood of underreporting of suicide. Outcomes of the Suicide Support and Information System (SSIS)
in Ireland showed that the characteristics of those who died prematurely and were classified as ‘open verdict’ are more
similar than dissimilar to confirmed cases of suicide.
The injury death of undetermined intent is often discussed in connection with the validity of suicide statistics.
Internationally, consistency is lacking in the classification of injury deaths of undetermined intent (UD) or ‘probable
suicides’, with some European countries adding UDs to suicide deaths and other countries classifying these separately. In
this context, on-going research conducted in conjunction with the SSIS in Ireland is currently updating international criteria
for probable suicide cases among a wide range of external cause of death verdicts including open verdicts, narrative
verdicts, death by misadventure, accidental drowning and single vehicle road traffic accidents. Outcomes and implications
of this research for the recording and classification of suicide will be discussed.
A Rose is a Rose is a Rose or Is It? / [Une rose est une rose est une rose… vraiment?]
Lanny Berman
ED
Problems in “communication” comprise the 2nd most frequent root cause of suicide events in, or within 72 hours of
discharge from, inpatient facilities in the U.S. Communications regarding suicidal patients , either inpatient of outpatient,
require clear understandings of described conditions, yet clinical practitioners rarely share a common language system
regarding suicidal behaviours. Notorious among these misunderstandings and unclear communications is the often used,
but non-standardized term, suicide gesture; but this is but one example of a multitude of clinician-to-clinician
communication problems based on our ill-defined nomenclature. This presentation will offer several such examples of
ambiguous clinical descriptors culled from actual cases to illustrate both the problem and the urgent need for standardized
and accepted common nomenclature.
The Need for an Internationally Applicable Standardized Nomenclature on Suicide-Related
Phenomena: The Constitution of the IASP Task Force / [La nécessité d’une nomenclature des
phénomènes liés au suicide qui soit applicable internationalement : La constitution du Groupe de
travail de l’IASP]
Diego De Leo
Australian Institute for Su. Research and Prev., Griffith Univ.
Nowadays, marked discrepancies exist in data recording procedures, put aside the different opinions on interpretation and
correct definition of different forms of suicidal (and non-suicidal) manifestations.
The need for an internationally shared labeling of suicide ideation and behaviors has for long time been recognized.
However, all previous efforts to provide an acceptable basis for a cross-culturally agreed nomenclature have failed.
The World Health Organization has recently provided specific booklets (the series on “Suicide Prevention’) to help
overcoming known difficulties in defining fatal and non-fatal suicidal behaviors. However, there are areas of urgent need
for uniform classification. This is the case of ‘suicide ideation’ (eg, death wishes, suicide ideation, transient, chronic,
intense, etc), frequently used in research as outcome measure of intervention trials and surveys of populations. A shared
standardization would be useful also in the area of ‘survivors’ of suicide (bereavement, grief, mourning, surviving, etc),
and in those of euthanasia (eg, voluntary, involuntary, active, passive, self-euthanasia, etc) and assisted suicide.
Following the call from the World Health Organization through its recent report “Suicide Prevention: A Global Imperative”,
the aim of the IASP Task Force is to obtain an international standardization of terminologies that may render research
more comparable across the globe, economize investment efforts, and favor meta-analytical evaluation. This presentation
will highlight suggested methodologies in collecting cultural background and attitudes towards current terminologies and
possible avenues to develop a common set of definitions.
The Language of Suicidology: Working Towards a Common Set of Terms, Definitions, and a
Classification System / [Le langage de la suicidologie : vers la constitution d’un lexique, de
définitions et d’un système de classification communs]
Morton Silverman
Suicide Prevention Resource Center, USA
The field of suicidology continues to lack clarity and consensus as to what is and what is not suicidal thoughts, intent,
motivations, attempts, or completions. There is confusion about how to determine whether self-injurious thoughts and
behaviours are suicidal or nonsuicidal. There are a plethora of terms and definitions to describe very similar thoughts and
behaviours, and there are many similar terms that are being used to describe different thoughts and behaviours. As a
32
result, it is often difficult for researchers, clinicians, epidemiologists, theorists, and public policy makers to agree upon the
terminology to describe what they are observing. Consequently there is a lack of clarify and consensus that affects how
we understand the suicidal process from a clinical, epidemiological, and research perspective. This has implications for
the development and evaluation of therapeutic interventions, preventive interventions, and public health policy programs.
This presentation will outline the problems regarding our current state of nomenclature and definitions, the consequences
on mental health and public health classification systems, and differences in existing and proposed systems of
classification. The presentation will call for an international consensus on a single, universal, theory neutral, and culturally
sensitive nomenclature and
classification system.
An ideal nomenclature of suicidal behavior needs to be consistent across cultures and context
Lakshmi Vijayakumar
SNEHA,VHS
Majority of suicides (75%) occur in low and middle income countries in Asia and Africa. In many LAMI countries, a social
reason for suicide is more acceptable than psychiatric disorder. The question often is “Who pushed him/her to suicide”
than “Why did he/she commit suicide?”. In Japan the classification of suicide traditionally has been on “motive” than intent
like Seppukku, Marakiri etc. In India suicides are termed as “Atmaghataka” or death of Soul.
The quantification of “Intent” on which classifications are based, probably has less value in Asian and African countries
where the concept of death is different.
It is necessary to incorporate cultural understanding of suicide to evolve a nomenclature which is acceptable and
understandable for all countries.
33
PP17-3: Parallel Plenary: Increasing the Rigor and Yield from Clinical
Trials: Multi-National Considerations and Future Directions
Increasing the Rigor and Yield from Clinical Trials: Multi-National Considerations and Future
Directions / [Augmenter la rigueur et la portée des essais cliniques: considérations multinationales
et orientations pour l'avenir]
Chair(s): Morton Silverman (Education Development Center)
Theme: Given limited resources, the rigor and yield from suicide intervention research must be improved. Goal: This
symposium will highlight current priorities and directions in clinical trial research from several countries that aim to improve
the rigor and yield from intervention research.
Format & Content: Drawing from critical literature reviews and a NIH ‘request for information,’ Dr. Pearson will highlight
knowledge gaps and methodological challenges that have slowed progress in suicide intervention clinical trials. In the
second presentation, Drs. Christensen and Shand will describe the feasibility and utility of e-mental health intervention for
suicide prevention in Australia. Using the design and data collection procedures of two online randomized controlled trials,
they will highlight the potential benefits of on-line interventions and methodological considerations, including defining
inclusion, reducing dropout, establishing appropriate safety protocols, and addressing community concerns about the lack
of face-to-face contact. Alternative designs that might be used to test the effectiveness of e-mental health interventions
will be proposed. Clinical trials with suicidal individuals typically include ‘treatment as usual’ (TAU) as the comparison
condition, and the experimental treatment is typically studied as an addition to TAU. The third presentation by Dr. Hawton
will address how TAU has been variably conceptualized and studied and illustrate how the content of TAU impacts study
outcomes in terms of the apparent benefit of the experimental treatment. As part of his involvement in the Cochrane
review process, some observations on current study quality and the implications for the evidence base will be provided.
Finally, Dr. Sherrill will describe priorities and funding approaches used by the National Institute of Mental Health (NIMH),
the principal suicide research funding entity in the United States. The presentation will highlight priorities for trials
identified by the Research Prioritization Task Force and provide an overview of NIMH’s current approach to funding
clinical trials, which emphasizes an experimental medicine based approached to clinical trials research as well as
strategies to improve the efficiency, oversight, and reporting of clinical trials research. Time will be reserved for discussion
among panelists/attendees focusing on strategies for overcoming research challenges, including data sharing and
integration, in order to improve the yield from clinical trials.
Presentations of the Symposium
Problems that Have Limited the Value of Suicide Prevention Clinical Trials / [Problèmes ayant limité
la valeur des essais cliniques en prévention du suicide]
Jane L. Pearson
National Institute of Mental Health
This presentation will highlight knowledge gaps and methodological challenges that have slowed progress in suicide
intervention research. Comprehensive literature reviews suggest relatively few trials focus on interventions to prevent
suicide, in general, and studies fielded within any given setting or with any specific population are more limited. Critiques
also question the interpretability of results from existing studies and their utility for informing practice and policy, citing
methodological limitations (e.g., problematic inclusion/exclusion criteria; insufficient attention to strategies for promoting
and quantifying intervention fidelity/implementation; and inconsistencies and problems with how outcomes are
operationalized and reported. Others cite challenges that complicate research on preventive strategies, in general. Many
of these challenges were identified in a “Request for Information” (RFI) issued by the National Institutes Health, which
solicited broad input regarding methodological roadblocks and new paradigms for suicide prevention research (“Request
for Information (RFI): A Call to Identify Key Methodological Roadblocks and Propose New Paradigms in Suicide
Prevention Research”; NOT-MH-12-017; http://grants.nih.gov/grants/guide/notice-files/NOT-MH-12-017.html ). For
example, suicide outcomes are low base-rate phenomena; therefore it is difficult to detect intervention-related changes in
outcomes such as attempts and deaths, and it is challenging to even launch adequately powered trials. With regard to
trial design, it is sometimes challenging to select appropriate, safe comparison conditions. While comparisons to
“treatment as usual” (TAU) are appropriate for examining the impact of introducing alternative intervention strategies into
practice, ensuring safety and quantifying delivery of TAU presents inherent challenges. Other considerations relate to
challenges associated with identifying, engaging and retaining individuals in intervention programs, and developing and
testing scalable interventions and strategies for extending the reach of research-informed strategies. This overview of
knowledge gaps and methodological challenges will highlight issues that are addressed in the remaining presentations.
Internet Interventions and Trial Considerations for Suicide Prevention [Interventions sur internet et
considérations d'essai pour la prévention du suicide]
Helen Christensen, Fiona Shand, Bregje van Spijker, Daniela Solomon
Black Dog Institute
The Australian Government has made a substantial investment in e-mental health programs. Efforts to increase the use of
evidence-based e-mental health interventions through wide scale education programs for general practitioners and allied
health professionals are currently underway. More recently, a new alliance of non-government and research organisations
has brought greater attention to the need to implement evidence-based suicide prevention strategies in order to reduce
Australia’s suicide deaths. While the efficacy of e-health interventions for depression and anxiety is now well established,
to our knowledge there have been only a handful of trials exploring the effects of e-mental health interventions for suicide
34
prevention. A small number of trials that have targeted depression and then examined the effects on suicidal ideation as a
secondary outcome have found web-based cognitive behavioural interventions to be effective in reducing suicidal
thinking. Even fewer e-mental health trials have targeted suicidal thinking as a primary outcome, using techniques to
reduce impulsivity or enhance control. In this presentation, we first examine the methodological challenges and benefits of
online randomised controlled trials of suicide prevention websites and apps, using the design and data collection from two
of these trials (Living With Deadly Thoughts and iBobbly). The issues we address here are: differences between online
and offline methodologies for internet and app trials; co-production of intervention contents; defining eligibility criteria;
reducing participant dropout; blinding; ethics; establishing safety protocols, interactions with data review boards;
addressing community concerns about limited or no face to face contact; and local vs national coverage in recruitment.
Secondly, we address the fundamental question of whether randomised controlled trials are the gold standard
methodology. Community and organisation-wide interventions are often conducted but rarely evaluated, in part because
the cost of conducting a randomised controlled trial is so high and because the other implications of such a design are
unacceptable to stakeholders. With increasing interest in using e-mental health interventions in these wider contexts, it is
important to consider whether or not other less costly research designs are adequate and feasible. One such approach
will be explored here, along with its limitations.
Methodological Issues in Treatment Trials with Self-harm Patients: Implications for Future Studies /
[Enjeux méthodologiques dans les essais de traitement en cas d'automutilation: implications pour
les recherches futures]
Keith Hawton1, Katrina Witt1, Daniela Pache de Moraes2, Tatiana Salisbury3, Ella Arensman4, Ellen Townsend5,
David Gunnell6, Philip Hazell7, Kees van Heeringen8
1
Oxford University, 2Pontifícia Universidade Católica do Paraná, Brazil, 3London School of Hygiene and Tropical Medicine
& King’s College, 4University College Cork, 5University of Nottingham, 6University of Bristol, 7University of Sydney,
8
University of Ghent
Self-harm (SH) is common in most countries (e.g. more than 200,000 presentation to hospitals each year in the UK), is
often repeated and is one of the strongest risk factors for suicide. It is important therefore to establish effect treatments for
patients who present to clinical services following SH.
Searches of the CENTRAL, EMBASE, MEDLINE, PsycInfo, PsycLit, and PROQUEST databases were undertaken,
supplemented by earlier hand-searching of several specialist journals. Reference lists of relevant reviews were also handsearched. Eligibility criteria was: (a) randomised allocation to intervention and control arms; (b) comparison between any
psychological and/or pharmacological intervention and a control treatment (e.g., standard care, placebo); and (c) all
participants had engaged in SH (including attempted suicide) in the six months prior to randomisation. The outcome
measures were repetition of SH, depression, hopelessness, problem solving, suicidal ideation and suicide.
Presently, a total of 73 completed studies have been identified (56 of psychosocial treatments for adults, 7 of
pharmacological treatments for adults and 10 trials in adolescents), with the number of trials increasing quite rapidly. In
the course of these reviews major methodological issues have been identified. One of the most important relates to
control treatment, especially ‘Treatment as Usual’ (TAU) in trials evaluating psychosocial interventions. TAU is often
poorly described. The content of TAU will also vary widely from one setting to another within countries and, especially,
between countries, making the interpretation of evaluations extremely difficult, including the extent to which results in one
setting can be generalised to another. This and other methodological issues identified in these reviews will be discussed,
together with recommendations for improving future trials in order to make them more informative for clinical practice and
prevention policies.
While in recent years an increasing number of treatments for self-harm patients have been conducted, many trials are
affected by methodological issues, a key one being TAU. If we are to generate a more informative evidence base such
issues need to be addressed, perhaps with clear general guidelines for the conduct and reporting of trials in this field,
particularly with regard to the nature and reporting of comparator treatments against which new psychosocial interventions
are being tested.
NIMH Priorities and Strategies for Increasing the Rigor and Yield from Research on Suicide
Prevention / Les priorités du NIMH pour augmenter la rigueur et la portée de la recherche en
prévention du suicide]
Joel Sherrill, Jane Pearson
National Institute of Mental Health
This presentation will provide an overview of priorities and funding approaches for interventions research on suicide
prevention strategies used by the National Institute of Mental Health (NIMH), the principal funding entity for mental health
research in the United States. First, the presentation will summarized updated priorities for suicide intervention research
recognized by the Research Prioritization Task Force of the National Action Alliance for Suicide Prevention. Identified
priorities address research on broad, community-based interventions aimed at reducing risk factors, as well as more
targeted, intensive interventions for preventing re-attempts and deaths among high-risk individuals. These priorities span
the full range of intervention approaches and modalities, including interventions targeting community-level factors,
psychosocial/psychotherapeutic approaches, pharmacological treatments, and consumer-, provider, and systems-level
services interventions aimed at improving access, engagement, quality and delivery of services. Next, the presentation
will highlight current approaches to increasing the rigor and yield from intervention research in general, as well as
initiatives specific to research on suicide prevention. These efforts include NIMH’s current approach to funding clinical
trials, which emphasizes an experimental medicine based approached. Under this approach, across all stages of
35
intervention research, from novel intervention development through effectiveness testing, trials are designed to not only
test whether study interventions yield clinical benefit, but also whether the intervention had the hypothesized effect on a
key target or targets presumed to account for clinical changes. In this manner, results of mechanism-based intervention
studies yield information regarding disorder mechanisms and change processes, regardless of trial outcomes. Additional
priorities and funding strategies for intervention research in general, and effectiveness research, specifically, include an
emphasis on the potential impact of the proposed study interventions/services models on practice and public
health. Finally, the presentation will provide an overview of cross-cutting strategies that focus on increasing the efficiency,
oversight, and reporting of clinical trials research, and include new efforts to facilitate data sharing and integration for trials
research, in general, and for studies testing suicide prevention strategies, in particular. The presentation will discuss
various strategies to increase the yield from research, including the use of common data elements in suicide research
(e.g., consistent approaches to self-reports, neurocognitive assessments, core biological markers), data banking (e.g.,
brain banks, imaging, and genetic repositories), and the development of infrastructure and approaches to facilitate data
sharing (e.g., appropriate consent and privacy provisions, cost models for data sharing).
36
OP17-1A: Atelier: Formations et recherche - Atelier animé par le
Groupement d'Etudes et de Prévention du Suicide (France)
Formations et recherche - Atelier animé par le Groupement d'Etudes et de Prévention du Suicide
(France)
Françoise Facy1, Michel Walter2, Sofian Berrouiguet2, Philippe Carette3, Nathalie Pauwels4
Union nationale de prévention du suicide, France; 2CHRU de Brest, France; 3Centre Popincourt, France; 4Fédération
régionale de recherche en santé mentale (F2RSM) Nord - Pas-de-Calais; ritevesinet@gmail.com, michel.walter@chubrest.fr, sofian.berrouiguet@chu-brest.fr, philcarette@yahoo.fr, presse.f2rsm@santementale5962.com
1- Le programme Papageno : sensibilisation des étudiants en journalisme à un traitement médiatique responsable du
suicide : M. Walter (GEPS, CHRU Brest), N. Pauwels (F2RSM, Lille), CE. Notredame, (ALI2P, CHRU Lille), G Vaiva
(CHRU Lille).
1
Résumé : Ce programme basé sur les recommandations de l'OMS (2008) vise à sensibiliser les étudiants en journalisme
à un traitement médiatique responsable du suicide en tenant compte des effets potentiels d'un tel traitement (effet
d'incitation ou "effet Werther" et effet de prévention ou "effet Papageno").
Michel Walter et coll.
Président du GEPS
CHRU de Brest
BP 17
29820 BREST
michel.walter@chu-brest.fr
2- Présentation du protocole SIAM (suicide intervention assisted by messages) : de l'étude de faisabilité à l'étude
d'efficacité d'un dispositif de veille par SMS destiné aux patients suicidaires: S. Berrouiguet (GEPS, CHRU Brest), Z.
Alavi, G. Vaiva, P. Courtet, E. Baca-García, P. Vidailhet, M. Gravey, E. Guillodo, S. Brandt, M. Walter
Résumé : Les dispositifs de veille permettent de rester en contact avec un patient après un passage à l’acte suicidaire et
de réduire le risque de récidive. Nous présenterons un outil de prévention du risque suicidaire basé sur le recontact par
SMS, de l’étude pilote à l’étude multicentrique d’efficacité.
Sofian Berrouiguet et coll.
CHRU de Brest
BP 17
29820 BREST
sofian.berrouiguet@chu-brest.fr
3- Présentation de MEmind : développement d'un outil de e-santé destiné à la prévention du risque suicidaire : S.
Berrouiguet (GEPS, CHRU Brest), P Courtet, J Lopez-Castroman, E Baca-García, M. Oquendo
Résumé : Les outils de santé électronique permettent de proposer de nouvelles modalités de suivi des patients. A partir
du programme MEMind portant sur 6000 patients utilisant un logiciel de suivi en ligne parallèlement aux consultations
traditionnelles, nous proposerons plusieurs applications possibles des technologies connectées à la prévention du
suicide.
Sofian Berrouiguet et coll.
CHRU de Brest
BP 17
29820 BREST
sofian.berrouiguet@chu-brest.fr
4- Des centres et des associations comme terrains de stage pour des étudiants en médecine, psychologues, sociologues,
travailleurs sociaux, AS, art thérapeute, représentant d'usagers de service et autres intervenants, par Philippe Carette,
Centre Popincourt, 6 rue de l’Asile Popincourt, 75011 Paris
centrepopincourt@orange.fr
Résumé : Dispositif qui vise à proposer une période d’étude pratique suffisamment longue en prévention du suicide à des
étudiants (licence ou master) des sciences humaines, de la santé, du médico-social ou du social. C’est le développement
de stages pratiques auprès d’équipes professionnelles engagées sur le terrain clinique, d’accompagnement médicosocial, éducatif ou associatif (téléphonie sociale). Les stages sont composés en fonction des intérêts et préoccupations
des stagiaires en négociation avec les écoles ou universités. Ouvert à l’international.
37
OP17-1B: Best Practices and Recent Findings [Meilleures pratiques et
découvertes récentes]
Demande euthanasique : Une étude de cas multiples sur les facteurs de risque et de protection /
[Requests for Euthanasia : A Multiple Case Study of Risk and Protective Factors]
Mélanie Vachon1,2
Université du Quebec a Montreal, Canada; Centre de recherche interdisciplinaire sur le suicide et l'euthanasie;
vachon.melanie@uqam.ca
L’euthanasie et ou le suicide assisté sont décriminalisés dans de plus en plus de juridictions à travers le monde. Au
Québec, la controverse bat son plein depuis 2009. La légalisation de l’euthanasie sous la forme de l’aide médicale à
mourir (loi 52) fait l’objet de contestation judiciaire depuis l’automne 2014. Ce contexte de débat social se reflète d’ailleurs
au quotidien dans plusieurs milieux de soins palliatifs (Lawlor, 2014). On assisterait à une augmentation des demandes
euthanasiques de la part des patients, ce qui place de plus en plus de soignants dans détresse morale, conflits de valeurs
et d’impuissance (Vachon, soumis). L’objectif de ce projet de recherche était de mieux comprendre la souffrance des
patients en fin de vie qui en venaient à formuler une demande euthanasique afin de tenter d’extraire certains des facteurs
de risque et de protection d’un désir de mort prématurée. Une étude de cas multiples auprès de six patients a été
réalisée. Les données qualitatives préliminaires ont été analysées avec une démarche de théorisation ancrée (Morrow,
1995). Les résultats feront état d’un modèle préliminaire, à valeur heuristique, lequel inclut des déterminants, des facteurs
contextuels et des conséquences de la demande euthanasique. Dans les cas explorés, les principales caractéristique de
la souffrance évoquée par le patient étaient rarement physique (douleur), mais surtout émotionnelle, relationnelle et
existentielle (5 des 6 cas). La souffrance morale exprimée par les patients pour évoquer leur désir de mort est interprétée
à la lumière de la théorie existentielle de Victor Frankl sur la recherche de sens. Des pistes d’évaluation, d’intervention et
de prévention pour éclairer les praticiens et intervenants seront discutées en conclusion.
1
2
Initiative en prévention du suicide chez les Premières Nations du Québec / [A Suicide Prevention
Initiative among Quebec’s First Nation Communities]
Normande Hébert1, Kathleen Dechenes Cayer2, Julie Lane1, Kim Basque3, Françoise Roy3
CSSS-IUGS, Canada; 2CSSSPNQL, Canada; 3AQPS, Canada; nhebert.csss-iugs@ssss.gouv.qc.ca,
Kathleen.DeschenesCayer@cssspnql.com, jlane.csss-iugs@ssss.gouv.qc.ca, kbasque@aqps.info,
consultationsfranco@hotmail.com
Le nombre de suicides dans les communautés autochtones du Canada est largement supérieur à la moyenne nationale,
bien qu’il soit très variable d’une communauté à l’autre (Chachamovich, 2011, Morin, 2011, Organisation nationale de la
santé autochtone). Le suicide chez les Autochtones au Canada touche principalement les jeunes âgés de 14 à 24 ans
(Kirmayer, 2007). Dans une majorité de décès par suicide, la personne autochtone avait cumulée plusieurs facteurs de
risque associés au suicide au cours de sa vie (Tousignant, 2013, White et Jodoin, 2005)
1
On peut espérer une baisse du nombre de suicides si les stratégies de prévention et d’intervention en milieu autochtone
sont fondées sur des données probantes, appuyées par la population locale et basées sur des approches respectueuses
de la culture (Tousignant, 2013, Chachamovich, 2011).
C’est avec cette intention que la Commission de la santé et des services sociaux des premières nations du Québec et du
Labrador (CSSSPNQL) et le ministère de la Santé et des Services sociaux (MSSS) demandent au Centre de santé et de
services sociaux- institut universitaire de gériatrie de Sherbrooke (CSSS-IUGS) de piloter L’Initiative en prévention du
suicide chez les premières nations. Le CSSS-IUGS a développé une expertise en implantation de bonnes pratiques et en
accompagnement du changement et a piloté la Démarche d’implantation des bonnes pratiques cliniques et de gestion en
prévention du suicide au Québec.
L’Initiative en prévention du suicide chez les Premières Nations vise à rendre accessibles les outils en prévention du
suicide développés pour le Québec en les arrimant à la réalité des Premières Nations. Cette initiative a débuté par la mise
sur pied d’un comité stratégique et par l’établissement d’un portrait de la situation (analyse des besoins, analyse des
rapports de coroners des décès par suicide, revue de littérature, etc.). Actuellement, une adaptation des outils et du plan
de déploiement est en cours en collaboration avec l’Association québécoise en prévention du suicide et Sucide Action
Montréal. Des projets pilotes se sont déroulés dans quatre communautés où un atelier de mobilisation pour la
communauté est proposé ainsi qu’une formation pour les intervenants. La conférence permettra :
•D’exposer le processus d’implantation mis en œuvre dans le projet;
•De décrire l’atelier de mobilisation des communautés;
•De décrire la formation pour les intervenants;
•De discuter des constats qui ressortent des projets pilotes.
38
Prévenir le suicide par le développement des compétences infirmières pour l'évaluation de la
condition mentale / [Preventing Suicide by Developing Nurse Competency in Mental Health
Assessment]
Philippe Asselin
CHU de Québec, Canada; philippe_asselin@outlook.com
La Direction des soins infirmiers du CHU de Québec s’est engagée dans le développement des compétences infirmières
pour l’évaluation de la condition mentale. Lors de cette communication, il sera présenté les données probantes qui
appuient ces travaux. Ensuite, la démarche de création des outils, les formations réalisées, ainsi que le soutien clinique
apporté aux infirmières seront présentés. En terminant, les principales retombées cliniques préliminaires seront
exposées.
Tout d’abord, l’évaluation du risque suicidaire doit tenir compte de la condition mentale de la personne (AIIO, 2009;
CAMH, 2010 ; OIIQ, 2007). Cette évaluation est essentielle, compte tenu de l’importante relation entre le suicide et les
problèmes de santé mentale (AIIO, 2009). D’ailleurs, plusieurs organismes reconnus, dont l’Association des infirmières et
infirmiers de l’Ontario (AIIO) et l’Ordre des infirmières et infirmiers du Québec (OIIQ), rappellent que l’évaluation du risque
suicidaire ne peut pas reposer uniquement sur des grilles d’évaluation et que ces dernières ne doivent pas remplacer le
jugement clinique (AIIO, 2009, CAHM, 2010 ; OIIQ, 2007). Lors de l’évaluation de la condition mentale, l’infirmière
recueille des données sur le problème de santé actuel, les antécédents de santé, l’histoire psychosociale, etc. Elle
effectue son examen mental et recherche la présence de signes et symptômes d’un trouble mental tel un état dépressif
(AIIO, 2013; CAMH, 2010; Fortinash & Holoday Worret, 2013).
L’infirmière est une professionnelle indispensable dans la prévention du suicide, compte tenu de son expertise, de son
champ d’exercice et de sa proximité auprès de la clientèle. Le développement des compétences cliniques des infirmières
devient primordial, et surtout, en ce qui concerne l’évaluation de la condition mentale et du risque suicidaire. Afin de
rendre cette évaluation de la condition mentale accessible à toutes les infirmières, tout en maintenant un processus
rigoureux et basé sur les meilleures pratiques, des outils cliniques ont été développés en collaboration avec l’Institut
universitaire en santé mentale de Québec.
Ensuite, des formations ont été réalisées auprès des infirmières en santé mentale et psychiatrie. Une conférence à large
auditoire a également été réalisée. La formation a été intégrée au programme d’intégration en psychiatrie, et ce, selon
une approche par compétence. Afin d’assurer une intégration à la pratique clinique, du soutien clinique est offert aux
infirmières. À partir de l’hiver 2015, cette formation sera offerte aux infirmières des unités de médecine et d’urgence du
CHU de Québec.
En terminant, il sera présenté les principaux constats préliminaires. On note que l’infirmière évalue davantage la condition
mentale et que les termes utilisés dans sa note d’évolution sont plus précis. On constate également que lors de
l’évaluation du risque suicidaire, l’infirmière tient compte davantage de l’évaluation de la condition mentale.
Prévention du suicide par maintien d'un contact à Tahiti: Dispositif OMS START par téléphone et
projet de contact par soins à médiation corporelle / [Suicide Prevention by Maintaining Contact in
Tahiti : The OMS START Telephone Project and the Body Treatment Project]
Stéphane Amadéo1,2,3, Aurelia Malogne2, Moerani Rereao1, Patrick Favro4, Ngoc Lam Nguyen5
Centre Hospitalier de Polynésie Française (CHPF), Tahiti, Polynésie française; 2Centre de Prévention du Suicide de
Polynésie française (CPSPF), Tahiti, Polynésie française; 3Unité Inserm U1178, Paris, France; 4Université de Polynésie
française (UPF), Tahiti, Polynésie française; 5Direction de la Santé Publique de Polynésie française, Tahiti, Polynésie
française; amadeo@mail.pf
Objectifs: "Les comportements suicidaires dans les Pays à Risque » (« Suicide Trends in At-Risk Territories"-START) est
une étude de l'OMS multi-sites menée initialement en Polynésie française et dans les pays du Pacifique occidental, puis
étendue en Europe et en Amérique du Sud. Les objectifs de l'étude en Polynésie française étaient: 1) de mettre en place
un système de surveillance des comportements suicidaires, et 2) de procéder à un essai clinique randomisé avec groupe
contrôle sur une intervention de prévention des comportements suicidaires.
1
Méthode: Au cours de la période de 2008 à 2010, 557 personnes (31,1% de sexe masculin, féminin 68,4%, 0,5% de
trans-sexuel) ont été admis au service des urgences du Centre Hospitalier de Polynésie Française (CHPF) après
tentative de suicide. Une partie de ces personnes, celles hospitalisées en Psychiatrie, ont été invitées à participer à un
programme de prévention, une Intervention Brève et Contact (BIC), consistant en une séance de psychoéducation puis
un suivi par 9 contacts téléphoniques sur une période de 18 mois. Après avoir donné son leur consentement, 100
personnes ont été assignées au hasard à un traitement comme à l'habitude (TAU) tandis que 100 participants ont été
assignés au groupe BIC. Seulement 90 étaient éligibles au suivi après une sortie d’essai prématurée.
Résultats: Il n'y avait pas de différence significative dans le nombre de suicide et de récidives de tentatives de suicidaire
dans le groupe BIC comparé au groupe TAU à la fin du suivi. Cependant, il n'y avait pas de décès par suicide dans le
groupe BIC, comparativement à deux cas dans le groupe TAU. Une limitation majeure méthodologique a été le taux
d'abandon dans les deux groupes BIC et TAU.
Perspectives: Le modèle BIC est bien adapté au contexte géographique et sanitaire de la Polynésie française mais son
efficacité nécessite d’être améliorée. Les soins à médiation corporelle sont une intervention additionnelle qui pourrait
39
renforcer l’efficacité du dispositif. D’une part, ces soins culturellement sont bien acceptés en Polynésie française (ainsi
que dans toute la région du Pacifique), où il existe une forte tradition de soins du corps (appelé « Taurumi », massages
au monoi avec éventuels extraits de plantes médicinales) et ils sont une autre façon de maintenir un contact. D’autre part,
ces soins peuvent réduire les symptômes anxieux souvent associés aux passages à l’acte suicidaire et aussi renforcer
l'alliance thérapeutique. Deux études pilotes réalisées à Tahiti montrent que cette approche a un intérêt potentiel dans la
prévention de la crise suicidaire et du passage à l’acte chez les patients anxio-dépressifs.
Le rôle des associations dans la prévention du suicide en Polynésie / [The Role of Associations in
Suicide Prevention in French Polynesia]
Stéphane Amadéo1, Annie Meunier-Tuheiava2, Olivier De Longeaux2, Germaine David-Vanquin2, Jean Vaimeho2
1
Centre Hospitalier de Polynésie Française, CPS de Polynésie française, Association SOS Suicide, Tahiti, French
Polynesia; 2SOS Suicide - Polynésie française; amadeo@mail.pf
Créée en 2001, l'association SOS Suicide mène des actions opérationnelles en Polynésie française depuis 2006,
lesquelles se définissent « en interne » et « en parallèle ». En interne : 1) les membres formés à l'intervention en crise
suicidaire gèrent la ligne d'écoute, respectant l'anonymat des écoutants et appelants, puis la confidentialité des
correspondances. 2) Les membres actifs de l'association mènent également des actions de sensibilisation dans le cadre
du programme « SUicide-PREvention – SUPRE » de l'Organisation Mondiale de la Santé (OMS) sous la forme
d'interventions préventives en Polynésie française, auprès d'institutions (associatives, caritatives, scolaires ou bien
religieuses) et de professionnels (médecins, infirmiers, pompiers, travailleurs sociaux) qui les sollicitent d'une part et au
travers de manifestations, telles que la Journée Nationale de Prévention du Suicide (JNPS) du 5 février ou de la Journée
Mondiale de Prévention du Suicide (JMPS) du 10 septembre d'autre part ; 3) Une psychologue accompagne les
endeuillés par le suicide d'un proche dans leur travail de deuil, prévenant ainsi les risques de passage à l'acte parmi cette
population. L'exercice se déroule dans un groupe de soutien mis en place depuis octobre 2009; 4) Un Centre de
prévention du suicide situé à Punaauia permet à l'association de rendre ses actions opérationnelles : y seront appliquées
des méthodes de prévention avec des soins culturellement bien adaptées à la population polynésienne, tels que les soins
à médiation corporelle (inspirés du « taurumi »). En parallèle, les professionnels de la santé, eux-mêmes membres de
l'association, ont mené une enquête épidémiologique « Suicide Trends At-Risks Territories - START » de l'OMS auprès
des suicidants admis au Département psychiatrique du Centre hospitalier de la Polynésie française de 2008 à 2010 et
des personnes décédées de suicide (autopsies psychologiques). L'étude fait le point sur les facteurs de risque des
conduites suicidaires, en Polynésie française et de propose des stratégies de prévention aux politiques publiques à partir
des résultats.
Même s’il est difficile d’évaluer l’impact de ces actions associatives dans la diminution des suicides aboutis ou non, il est
certain que sur le plan humain et individuel, leur rôle de soutien est indéniable et correspond à un besoin palpable. Les
personnes qui font appel à l’association terminent très souvent leurs entretiens par des remerciements ou un apaisement
manifeste de leurs angoisses. Reconnues dans les évaluations globales des stratégies de prévention, ces actions
méritent d’être encore mieux intégrées dans le cadre des dispositifs préventifs de santé publique.
40
OP17-1C: Workshop: Country Needs and Plans for the Implementation of
Suicide Prevention Programmes and Strategies / [Besoins en matière de
planification et d'implantation d'un programme national de prévention du
suicide]
Country Needs and Plans for the Implementation of Suicide Prevention Programmes and Strategies
/ [Besoins en matière de planification et d'implantation d'un programme national de prévention du
suicide]
Shekhar Saxena1, Steve Platt2
WHO, Switzerland; University of Edinburgh; fleischmanna@who.int, Steve.Platt@ed.ac.uk
Background
1
2
In its recent 2014 publication ‘Preventing Suicide: a Global Imperative’, the World Health Organization (WHO) strongly
encourages Member States to develop a comprehensive strategic approach to suicide prevention, further to the 2012
WHO publication of “Public Health Action for the Prevention of Suicide: A Framework”. In countries with a developed
national strategy, WHO recommends to focus on evaluation and improvement, updating the knowledge with new data and
ensuring that the national response improves in effectiveness and efficacy. In countries with some existing suicide
prevention activities, WHO highlights the importance of identifying gaps that need to be filled, while in countries which
have not yet undertaken suicide prevention activities, the emphasis should be on identifying and engaging stakeholders,
developing activities where there is greatest need or where resources already exist, and improving surveillance.
Participants
This workshop is intended to attract participants from countries (especially LMICs) which are interested in receiving
technical assistance from IASP, WHO, and other collaborators in developing, implementing and evaluating suicide
preventive work, in particular if they have undertaken limited or no suicide prevention activities to date.
Aims
1. To highlight the value and key elements of a comprehensive approach to suicide prevention at national level
2. To exchange experience and plans of suicide prevention programmes and strategies development, implementation and
evaluation among participants, IASP and WHO
3. To assess the usefulness of the WHO suicide prevention report and framework document in making progress in suicide
prevention programmes and strategies in countries
4. To identify types of support that are required from IASP, WHO, or other collaborators in order to reach the objectives of
suicide prevention programmes and strategies in countries.
5. To strengthen collaboration between countries in progressing the development, implementation and evaluation of
suicide prevention programmes and strategies.
Educational objectives
By the end of the workshop participants will:
1. Understand the importance of adopting a comprehensive approach to suicide prevention
2. Be familiar with the key elements of comprehensive national suicide prevention strategies
3. Have identified the strengths, weaknesses, opportunities and threats (SWOT) of suicide prevention efforts in countries
4. Have identified the types of support that are required in order to reach the objectives of suicide prevention programmes
and strategies in countries.
Programme
- Welcome and Introduction: large group discussion (5 min.) - IASP
- Comprehensive approach to suicide prevention: presentation (10 min.) - IASP
- Concrete plans in suicide prevention in the countries (1 year and 2-5 years), situation analysis (SWOT) relating to
suicide prevention efforts carried out, usefulness of WHO suicide prevention report in making progress: work in small
groups (25 min.)
- Identification of types of support needed to achieve objectives in countries’ suicide prevention programmes and
strategies: work in small groups (20 min.)
- Feedback from small groups to large group: rapporteurs of small groups (20 min.)
- Conclusion and next steps: presentation (10 min.) - IASP
41
OP17-1D: Symposium: Cultural Aspects Related to Suicide Behaviors in
Latin American Countries
Cultural Aspects Related to Suicide Behaviors in Latin-American Countries
Chair(s): Luis Miguel Sanchez-Loyo (University of Guadalajara), Roque Quintanilla-Montoya (University of
Guadalajara)
The aims of the present simposium are to discuss relevant information about cultural aspects of suicide behavior in LatinAmerican countries. Especially, the gender and age group differences in beliefs, meanings, attitudes and emotions about
suicidal behavior. Furthermore, the possible implications of cultural aspects in programs of suicide prevention in Latin
American populations.
The most recent studies on suicide consider it as a multicausal problem, by the interaction of several risk factors. Beliefs
that legitimize suicide are among the social and cultural aspects associated with suicide and the social stigma that is
generated by search of helps in mental health, among other professionals (WHO, 2012). However, this view is limited.
According to Hjelmeland (2010) to understand the suicidal phenomenon is necessary to begin what the individuals of that
culture think and express around suicide.
Studies on the socio-cultural aspects associated with suicide allow us to understand the representations and meanings of
situations related to the suicide behavior. For example, European men feel burdened by economic problems (Nock et al.,
2009), and Mexican women feel the same related to family conflicts (Zayas Pilat, 2008).
The simposium seek to identify the meanings and acts of people with conduct suicide behavior from the perspective of the
own suicide persons, the health professionals and the general population.
The cultural factors related to the suicide phenomenon in Latin American countries makes it possible to identify both risk
factors and protective factors and consider ways to prevent suicide differentially, according to the results found and
adjusted to the culture of a particular social group, for instance, gender or age groups. This is particularly important for
Latin American countries, in which the knowledge about suicide behaviors from a cultural dimension is limited.
Presentations of the Symposium
Suicide Attempts: Children and Teenagers in Matozinhos, Minas Gerais, Brazil
Michelle Alexandra Gomes-Alves, Matilde Meire Miranda-Cadete
Centro Universitário UNA-BH
Introduction: In recent years, the rate of juvenile suicide has increased despite the indices of Brazil are relatively low when
compared with other nations, this fact is alarming. Often people believe that children do not attempt suicide and this myth
precludes its registration as violence and it is seen and interpreted as "accidents". What differs from the accident to a
suicide attempt is precisely its intent; the children, if heard, can tell about their suffering and intention. Teenagers are also
neglected and their attempts are viewed as irresponsible actions like "asking for attention”. From the use of power in the
attention and care services for children and teenagers and also within the family and social core, they are sometimes
ridiculed and discriminated. They, like children, are once again "violated" in their rights to be an individual.
Objective: analyze the number of cases of suicide attempts among children and adolescents in Matozinhos between 2008
and 2012 as well as the vision of these subjects regarding the attempt to self-extermination.
Methodology: Study with quantitative and qualitative approaches was divided into two distinct stages, but complementary:
first, we searched the knowledge of quantitative and way of suicide attempts among children and adolescents, with data
collected in the epidemiology section of the municipality, in the medical records of the Emergency Care and also in the
Children and Youth Clinic. The collected data were analyzed in Statistical Package for Social Sciences (SPSS) version
19.0. In the second step, we proceeded to the listening the subjects in order to assimilate the reasons that led them to
attempt suicide, using the technique of focal groups with teens and the sensitive and creative approach with children
group. The information obtained was analyzed based on Bardin and in the articulation of the following concepts: violence,
health, suicide attempt, quality of life, prevention, health promotion, local development and social management.
Results: From the 137.000 medical records analyzed, it was detected 185 cases of suicide attempts among children and
teenagers. The main findings results were the confirmation of underreporting cases of juvenile suicide attempt and the
non-involvement of health professionals on cases received and an average of two cases of suicide attempt per month. As
for the qualitative data, it was found that the relationships and fragile social links established by children and teenagers
are risk factors for suicide attempts.
Conclusion: The innovation of this work lies in demystification, for quantitative and qualitative data, that the child does not
attempt suicide. In listening these subjects it was possible to construct proposals for intervention to the quality of life
through the prevention, protection and promotion of mental health for children and teenagers in Matozinhos.
Cultural Factors in Suicidal Attempt among Mexican Youth
Teresita Morfín-López1, Luis Miguel Sánchez-Loyo2
Instituto Tecnológico de Estudios Superiores de Occidente, 2Universidad de Guadalajara
This qualitative observational study used the cultural consensus theory (Weller & Romney, 1988) to identify cultural
factors in the phenomenon of suicide in Jalisco, México. This theory brings a cultural dimension to the study of suicidal
behavior which also includes a cognitive model constructed by the very same social actors involved in the phenomenon of
suicide, and the distribution of cultural knowledge among a given group of informants (Weller, 2007).
1
42
The aim is to identify the semantic structure of the cultural domain of suicide attempt, regarding its causes among young
people. In order to obtain the free listings, semi-structured interviews were individually applied to 30 young men and
women (19 to 39 years old) with suicide attempt, and 30 young men and women with no history of suicidal attempts.
Results showed that the family conflicts, partner conflicts, economic problems, unemployment, loneliness, depression,
drugs misuse, lost of meaning of daily activities were the most frequent responses as causes of suicidal attempt among
young people in México. Both participants groups considered the family and partner conflicts as main cause of suicide
behavior.
Certain social indicators point to social stress in the family, for example the number of divorces has doubled over the last
25 years (INEGI, 2012); and 23% of Jalisco homes live with domestic violence (INEGI, 2008). Economic situation has had
an impact in many young people. Also, gender roles have changed with 1 of every 3 married women working outside the
home, which has impacted the traditional role of mother-wife, homemaker and family dynamics. Infidelity, family
aggression, violence (physical, emotional and psychosocially) are experimented in the daily life of the participants with
history of suicide attempt. Mexican families have been undergoing structural changes for the last 30 years having decisive
impacts on what young people feel, think and do with respect to the different circumstances of their daily life including
suicidal attempts.To deepen the knowledge on the suicidal phenomenon it is necessary to develop more cultural studies.
Gender Influence in the Cultural Construction of Suicide Attempt among Mexican Adolescents
Catalina González-Forteza1, Fernando Wagner2
Instituo Nacional de Psiquiatria, 2Morgan State University
The qualitative approach is a valuable when trying to show the cultural construction that individuals have from different
phenomena of living. This approach emphasizes the understanding of social processes by observing, listening and
understanding the reality from the actors’ perspective in order to analyze the meaning they attribute to their actions and
their environment, thereby enabling an interpretive approach of the subjectivity of individuals and products resulting from
their interaction.
Adolescence is by no means a natural or universal phenomenon. Although large parts of society recognizes a period of
transition between childhood and adulthood, it can be as short as a rite of passage or as extensive as in modern
industrialized societies often lengthened.
In adolescence, the increased intensity of the mechanisms of gender identification, norms, stereotypes and different
expectations of males and females is an important part of this life stage. Such gender values influence the determination
of the presence and specific cultural expression of the suicide behavior in this age group. This work is based on a
conceptual framework to understand the relationship between gender stereotype and norms and adolescent suicide
attempt with its characteristics from the perspective of adolescents.
Focus groups with junior high school students (12 to 15 years old) from the Historic Center of Mexico City were conduted
to obtain the cultural construction of the suicide problem from a viewpoint of gender. The main issues discussed in the
focus groups were the definition of suicide attempts in adolescents, their methods, motives, purposes, consequences,
reactions and seeking help behaviors.
The results indicate a clear influence of gender in the cultural construction of adolescent suicide attempts and their
characteristics. Mainly, risks of death as manipulation in male and female adolescents; Recrimination to the males
because the suicide attempt is considered an act of cowardly which demerit the adolescent masculinity; whereas in
females this same behavior strengthens their femininity in terms of manipulation and blackmail. The gender stereotypes in
adolescents between 12 and 15 years old are sharp in both permeate the process of sexual identity in which they are
involved just past puberty in males and females.
Other results concerning the characteristics of the method, motive, purpose and also help seeking meet the needs for
self-assertion and recognition of their peculiarities of the follows from the other gender. The distinction between genders
responded to their need for affirmation and recognition of the other in terms of gender differences, some similarities due to
the stage of life you share all early adolescence.
Gender cultural construction influence the meaning, the manifestation and the acceptability of suicide behavior in male
and female adolescents. The culturally-based gender stereotypes are important to be considered in suicide prevention
programs.
1
How do Brazilian Health Professionals Deal with Suicide and Suicidal Patients?
Nadia Veronica Halboth1, Elaine Oliveira Leite2, Lenniara Pereira Mendes1, Elisângela Maria Borges3
1
Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2Fundação hospitalar do estado de Minas Gerais, 3Private
Physiotherapist
INTRODUCTION: Even so the global age-standardized suicide rate has fallen 26% in the 12-year period from 2000 to
2012, in Brazil it increased 10,4% (from 5,3 to 5,8/ 100.000 inhabitants), despite the fact that the phenomena is underreported in the country. Through collective actions to recognize and intervene in this serious public health problem,
suicide is preventable in most cases. On the other hand, low mental health literacy and experience, stigma and poor
interviewing skills are related to poor assessment and management abilities of patients with suicidal behaviors by health
workers, increasing the individual risk for suicide. This study aimed to analyze the views of Brazilian health professionals
about suicidal behaviors, to verify how they treat patients with such behaviors and to know if they consider suicides
preventable.
METHODOLOGY: Compilation of the analysis of in-depth interviews from different health professionals working in
Diamantina - Brazil. Each research project - involving nurses, physicians and physiotherapists - was evaluated and
approved by the University Research Ethics Board.
RESULTS AND DISCUSSION: Participants included 11 nurses, 13 physicians and 10 physiotherapists. Most of them
were very uncomfortable when asked about the issue. Only one nurse and one physician had never seen a suicidal
patient. Among physiotherapists, four said they had never provided care for such patients, or did not know about it.
Suicide attempts were more related to women and men to suicide. All ages appeared in the reports of treatment related to
43
suicidal behaviors, but adolescence was highlighted. Other risk factors cited were, in general, well known biological,
psychological, social and religious aspects, but value judgments, such as courage, weakness, and wish to call attention to
oneself were also considered reasons for suicidal behaviors. Suicide prevention was considered possible through
psychiatric and psychological treatment plus religious support, social networks, education and a better perception of
health professionals and relatives about suicidal behavior. However, few developed effective prevention actions: Most of
them reported they performed only clinical procedures and many did not even refer the patient to a psychiatrist or
psychologist.
CONCLUSIONS: Suicidal behaviors are part of health professionals’ practice. For most of them suicide is preventable, but
they have misconceptions about the theme, and their assessment and management abilities to deal with such patients
are, in general, poor. So, strategies to prevent suicide should be addressed to these professionals.
Social and Psychological Characteristics Associated with Attempted Suicide in Young Mexicans
Everardo Camacho-Gutiérrez1, Claudia Vega-Michel1, Luis Miguel Sánchez-Loyo2
Instituto Tecnológico y de Estudios Superiores de Occidente, 2Universidad de Guadalajara
Background: Suicidal behaviors in young Mexicans have increased in recent decades. The psychological and social
variables associated with suicide attempt in mexican youngsters remain unclear. Aim: To identify psychological and social
characteristics associated with suicide attempt in young Mexicans. Material and method: It was carried out a nonexperimental cross-sectional descriptive study. 222 young adults (19-35 years) of the metropolitan area of Guadalajara,
Mexico participated. The social variables that were evaluated are age, education, marital status, occupation and religion.
In addition, it was identified those who had a history of suicide attempts, as well as the level of depression, hopelessness,
anxiety trait and anxiety state, family history of conduct suicide, alcohol abuse and perception of social problems, social
support and future expectatives for the community. Results: 24 subjects reported suicide attempts. Subjects with suicidal
attempt were mostly without a partner, while half were parents, it was most common to observe a family history of conduct
suicide and alcohol abuse. Young people with suicide attempt had a less negative perception of society, but perceive their
nation with less social support and consider a more negative future of their community. All subjects with suicidal attempt
showed higher scores for depression, hopelessness, anxiety state and anxiety trait compared to the rest of the sample.
Conclusions: Patients with suicide attempt showed have had life as a couple, but they broke the relationship up, they were
parents, they abused of alcohol, that probably increased mental health problems like they reported as depression, anxiety,
and hopelessness, coupled with a pessimistic perception of his/her community.
1
Characterization of Suicidal Act in the State of Aguascalientes, Mexico. A Temporal Analysis of
Social Context
Ana Edith Hermosillo-De-la-Torre, María de los Angeles Vacio-Muro
Universidad Autónoma de Aguascalientes
The phenomenon of suicide in the state of Aguascalientes, Mexico has increased dramatically in the past three years.
According to official data from the State Department of Health, in 2010 the suicide rate showed the most dramatic
increase in its history 96.5%, being 53% of cases in adolescents and young people. In recent years, rates of occurrence
have increased so that have placed to Aguascaliente with the second highest rate in Mexico (9.4 cases per 100,000)
(INEGI, 2013). Given this substantial increase is necessary to characterize the act of suicide in the social context,
specifically in relation to the temporal dimension. The average occurrence of cases was 9 per month, with the month of
June, the highest incidence. The months of November, April and May the suicide occurrence was more than the annual
average (9 cases). The trend of suicides showed a downward logarithmic trajectory from Sunday to Saturday with an
almost perfect fit for females (R2 = 0.924). This suggests that the impact of suicides was higher on Sunday and decreases
steadily the rest of the weekdays. On the other side, the male group showed a trend change about your settings were as
far away from 1; however stockings high elevations were observed in the next couple of days: Sun-Mon> and Fri-Sat>,
very similar to that observed in the overall population incidence of suicidal behavior. The suicide occurrence interacted
significantly with the days of the week in which it was found the body and reported the suicide. The data reveal that
suicide occurs mostly during weekends and Mondays, concentrating about 70% of the incidents in the year. Polynomial
trend analysis (R2 = 0.54) showed a curve fit where the trend values are higher at the ends of the weekdays. These
findings suggest that, according to Espada, Méndez, and Bolvin Griffin (2003), weekends are an enabling environment for
individuals to be exposed to situations of alcohol and other drugs, such circumstance promotes abuse substance which,
combined with exposure to emotional stress, occurring in scenarios involving marriage and family relationships that would
be pivotal to suicide behaviors in Aguascalientes (González -Fernández and Alonso-Fernandez, 2009).
44
OP17-1E: Symposium: Hello, Partner: The Emerging Voice of Attempt
Survivors and How to Turn It Into Action
Hello, Partner: The Emerging Voice of Attempt Survivors and How to Turn It Into Action
Chair(s): Mic Eales (Suicide Prevention Australia), Cara Anna (Attemptsurvivors.com)
This symposium is an introduction to the growing, and global, attempt survivor movement and the creative ways it is
building relationships with communities ranging from policy to peers. The goals are to show how we can move attempt
survivors, and anyone who has been suicidal, into a central role in all discussions about suicidal thinking; to draw on these
voices to shape new approaches to research, engagement, support and messaging; and to open a more confident, goaldriven conversation that casts attempt survivors no longer as passive patients but as active partners. Attendees will learn
how people both inside and outside the mental health field can be engaged as collaborators at all levels. The speakers
from Canada, Australia and the United States are well-versed in everything from academic research to national policy to
tweetchats. We divide the first hour into presentations by each of the speakers, with the remaining 30 minutes for
moderated general discussion. Resources shared during the presentation will be made available online shortly after the
conference.
Presentations of the Symposium
Partnering with Loss Survivors
Mic Eales
Suicide Prevention Australia
Australian artist Mic Eales, an IASP veteran who recently earned his PhD, will discuss his participation in Suicide
Prevention Australia's outspoken Lived Experience Committee, a pioneering work group that brings together attempt
survivors and loss survivors.
Partnering with the Policy World
Cheryl Sharp
National Council for Behavioral Health
Cheryl Sharp, who leads the suicide prevention activities of the National Council for Behavioral Health in the U.S., will
discuss how she effectively draws on personal experience in a professional setting as she coordinates policy and program
development.
Go Where Others Fear to Tread: Organize an Attempt Survivors’ Group
Robert Stohr, Richard Grant-Coons, Madonna Cadiz
Didi Hirsch Mental Health Services, United States of America
It is estimated that there are more than a million suicide attempts in the United States each year. While most people just
attempt once, more than a third will try again. Yet there are few places where people with histories of suicide attempts can
go for help. Los Angeles is an exception. Didi Hirsch Mental Health Services’ Suicide Prevention Center has developed an
innovative support group, Survivors of Suicide Attempts. Co-led by a clinician and a peer facilitator, this session will take a
close look at the group’s evolution and curriculum, the support system that develops among members, and the benefits of
a team-led approach. Attendees of this session will engage in the interactive process of developing a safety plan. A
training manual surrounding this attempts survivors' support support group has been developed and recognized as a best
practice by the Suicide Prevention Resource Center's Best Practices Registry. This support group is a lifesaving
intervention—learn how to establish one in your community.
Learning Objective 1: At the end of this presentation the participant will be able to....: Understand the unique needs of
individuals who have had a past suicide attempt(s) and discuss potentially useful strategies for intervening in a support
group setting.
Learning Objective 2: At the end of this presentation the participant will be able to....: Identify and describe methods for
development and evaluation of a group such as Survivors of a Suicide Attempts.
Learning Objective 3: At the end of this presentation the participant will be able to....: Understand specific reasons that
suicide attempt survivors benefit from a support group versus a standard group therapy approach.
Learning Objective 4: At the end of this presentation the participants will be able to...Understand the process of creating a
safety plan.
Partnering with Peers
Ursula Whiteside
Group Health Research Institute
U.S. researcher Ursula Whiteside will discuss her new evidence-based program for training suicidal people in coping
skills, Now Matters Now, which was created in collaboration with a team of peers who have lived with suicidal thinking.
45
Partnering with the Media
Cara Anna
Attemptsurvivors.com
U.S. journalist Cara Anna, the founder of Attemptsurvivors.com for the American Association of Suicidology, will moderate
the symposium's discussion.
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OP17-1F: Workshop: Brief Cognitive Behavior Therapy to Prevention
Suicide Attempts
Brief Cognitive Behavior Therapy to Prevent Suicide Attempts
Craig Joseph Bryan1,2
National Center for Veterans Studies, United States of America; 2The University of Utah, United States of America;
craig.bryan@utah.edu
Brief Cognitive Behavioral Therapy (BCBT) to prevent suicide attempts is a 12-session outpatient psychological treatment
that reduces subsequent suicide attempts by 60%. The treatment proceeds through three stages: (1) crisis management,
focused on behavioral strategies for managing emotional distress; (2) cognitive restructuring, focused on dismantling the
suicidal belief system; (3) and relapse prevention, focused on behavioral rehearsal of emotion regulation and problem
solving to ensure skill competency. The current workshop is designed to provide participants with in-depth understanding
of BCBT and concrete instruction for successfully delivering the treatment.
1
Research has shown that less than half of psychologists receive training specific to the assessment and treatment of
suicide while in graduate school, and where training is received, it is insufficient. The typical psychologist receives only 2
hours, on average, of suicide-focused training during their entire career, despite the fact that almost all practicing
psychologists will have contact with a suicidal patient at some point. Due to this lack of training, many clinicians develop
treatment plans that target the psychiatric conditions associated with suicide (usually assumed to be depression), but do
not directly target suicide risk itself, although this latter strategy has been shown to be more effective. Furthermore,
hospitalization is frequently utilized as a risk management strategy although outpatient psychotherapy has shown the
most effective and promising outcome.
This full-day workshop is geared towards mental health clinicians seeking to acquire entry-level information and training
on the assessment, management, and treatment of suicidal patients. The first portion of the workshop provides intensive
training in core competencies for the clinical care of suicidal patients, including general interpersonal dynamics,
standardization of suicide-related terminology, documentation strategies, and informed consent. The workshop then
provides a detailed, step-by-step review of the 12-session brief cognitive behavioral therapy (BCBT) protocol to prevent
suicide attempts, which has been shown to reduce suicide attempts by 60% as compared to treatment as usual. Practical
strategies for effective treatment delivery are provided using case examples to illustrate concepts and interventions.
Participants will receive a copy of the BCBT manual for future use with patients, so they can make copies of handouts,
worksheets, and templates designed to meet legal standards for documentation. Methods for adapting the treatment for
high risk groups such as military personnel and veterans, and patients with co-occurring substance use disorders, will be
included.
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OP17-1G: Symposium: Best Practice for Helplines
Best Practice for Helplines
Chair(s): Alan Roger Woodward (Lifeline Research Foundation)
Throughout the world, telephone helplines and related online services are identifying evidence based practice, drawing on
research and expert knowledge. This Symposium highlights recent developments in best practice from several countries,
and across service delivery, volunteer motivation and the processes of responding effectively to suicidal helpline callers.
The common interests and discoveries are examined from specific insights applicable to the context of particular studies
and helpline operations. The implications for helplines - and online services - worldwide are explored.
The session presentations will canvass the translation of research and knowledge into the delivery of helplines and
related online services. Some discussion questions would be:
- The framing of ‘best practice’ when helplines across the world have differing service models i.e. are there some ‘baseline
principles’ around best practice?
- Workforce as a factor in service quality – is volunteer provision a help or hindrance?
- How do ‘best practice’ processes in responding to suicidal persons actually deliver effective outcomes in suicide
prevention – what other factors influence outcomes?
Presentations of the Symposium
The National Suicide Prevention Lifeline (USA): Best Practice Development for Crisis Hotlines
Shari Sinwelski
National Suicide Prevention Lifeline US
The National Suicide Prevention Lifeline (USA) is a network of over 160 crisis centers throughout the US that are linked
through one toll free number. A primary mission of the Lifeline is to prevent suicide through reaching and effectively
serving those at risk and a significant focus is placed on developing standards of service delivery that underscore both
best practices in the field of suicide prevention and innovative approaches to reaching those at risk. All Lifeline centers are
independently owned and operated and as member centers must adhere to Lifeline established practice standards.
One of the most unique aspects of the work undertaken by the Lifeline involves the focus placed on aligning practice
recommendations with findings from the ongoing Substance Abuse and Mental Health Services Administration (SAMHSA)
funded Lifeline evaluation studies undertaken by Columbia University/Research Foundation for Mental Hygiene (RFMH).
The Lifeline partnership with RFMH provides an opportunity for the Lifeline to promote standards of practice that are
developed from the combined expertise of crisis center staff and experts in the field of suicide prevention while directly
informed by evaluation findings. This iterative process through which crisis line practices are implemented, evaluated,
refined, and evaluated once more is evident through a review of the SAMHSA funded evaluation studies that have been
undertaken since 2001. When one of the first study findings, for example, indicated the need for more consistent, uniform
suicide risk assessment practices for crisis call centers, the Lifeline focused on the development of evidence-informed
suicide risk assessment standards, provided ASIST trainings to centers, and facilitated evaluation of the impact and
benefit of ASIST.
In early 2014, the Lifeline released to its network a document entitled Lifeline Best Practices for Helping Callers to provide
an accessible resource for crisis centers that highlighted the process through which Lifeline practice standards were
developed. This presentation will review the elements included in this document and detail the Lifeline establishment of
Best Practices for crisis hotlines.
Quality Standards for a Volunteer-Operated Suicide Specific Hotline
Kirsten Pauwels, M. Bloemen, E. Muijzers
Flemish Suicide Prevention Centre
Hotlines play an important role in many suicide prevention strategies. In most countries, these hotlines are operated by
volunteers. This is also the case in Flanders, Belgium, where the suicide hotline ‘Zelfmoordlijn 1813’ is one of the only
services which is operated 24/7 and which targets and reaches people in a suicidal crisis.
The Flemish Suicide Prevention Centre developed quality standards for it's volunteers, inspired on other international
examples and research. Next to a presentation of these standards, we look at the system we created to support
volunteers to meet these standards, and how we try to guarantee these standards within the follow-up of the volunteers.
In the session, we also present the results of a study we conducted concerning the responses of our volunteers on
addressing suicidal statements by callers to the helpline. Every person applying at the Flemish Suicide Prevention Centre
to become a volunteer, is asked to fill out the Suicide Intervention Response Inventory (SIRI2 – Neimeyer & Bonnelle,
1997). After their training, they do this again. In 2014 all volunteers were asked to fill out the questionnaire again. We
compared their results to the results of professionals, but also looked at the different items in the questionnaire.
In this session we present the results of our volunteers compared to the results of different other professional groups. We
also draw attention on the different aspects we revealed, and how we integrated the results in the training of the
volunteers.
Survey on Volunteer Satisfaction and Motivation – Telephone Emergency Services of Europe
48
Diana Rucli1, András Székely2
International Federation of Telephone Emergency Services, 2Hungarian TES LESZ
Today Telephone Emergency Services (TES) exist for more than half a century in Europe. Each registered TES offers
emotional support, crisis intervention and suicide prevention counseling in a strictly non-judgmental, anonymous way - via
telephone, email and chat. TES work is being done by trained volunteers.
1
Those who seek counseling benefit from a genuine personal encounter, available mostly 24 hours a day, seven days a
week. Topics range from feelings of loneliness to questions of parenting, domestic and sexual violence, psychiatric illness
and suicidal tendencies. All TES support is strictly confidential and free of charge, available to every human being
regardless of age, gender and faith. Most European TES-organisations have joined IFOTES, the International Federation
of Telephone Emergency Services. IFOTES works with 25.000 trained volunteers. 600 full- and part time staff cover over
five million calls and 40.000 internet encounters annually. All volunteers benefit from training, supervision and counseling.
To further optimize TES´ work, the partners intend to develop a detailed, standardized European wide questionnaire
(TESVolSat), evaluating volunteer dedication, motivation and satisfaction among Europe´s TES volunteers. Based on the
results of TESVolSat, each European TES head organisation and each individual TES post in Europe will be able to
enhance the quality of its work, to calibrate their training programs and to better provide for their volunteers and callers. In
turn this will lead to a higher degree of commitment and more satisfaction among the volunteers, the callers and counsel
seekers across Europe. The outcome and results of TESVolSat will be published in a booklet, serving as a tool for future
learning.
RATIONALE
In a time when Europe is facing a crisis, volunteer work across Europe cannot and should not be taken for granted.
TESVolSat will show interest in the needs and attitudes of 25.000 IFOTES volunteers. It will be worked on, analysed and
published simultaneously across Europe, thus enhancing the volunteers´ sense of self-worth and belonging.
The project TESVolSat, is based on a twofold motivation: 1. To enhance the satisfaction of TES trained volunteers, and 2.
to better serve the callers and those who seek counseling via mail, chat or personal encounters.
In order to fulfill their task, all volunteers need in-depth training, proper supervision and a professional surrounding. It is
our understanding that those volunteers who experience a deep sense of understanding and identification with TES and
its goals are also highly beneficial in their work.
Since each European TES head organisation, and even each TES post works on the basis of individual standards and
procedures, so far it has been difficult to gain an in depth understanding into the volunteers´ commitment, their questions
and needs on a European basis.
A common European questionnaire will serve as a tool to scientifically evaluate the degree of motivation, identification,
and satisfaction on a wider European level, thereby gaining insight into the level of satisfaction of European TES
volunteers. The questionnaire´s outcome will be the development of common standards, ground rules and best practice
tools for all European TES organisations alike.
In the past this has been elaborated on a strictly national or regional level only. Thus, this survey may provide answers to
some of the following questions: What do we in Europe know about the needs, and attitudes of our TES volunteers? How
do they experience themselves and their work? How well do they cooperate with the TES post´s staff and with other
volunteers? What do our volunteers need long-term from the staff, the head organization, or even the public, to stay
committed and motivated. Do they need different methods of training, supervision or individual counseling? How do we
invite physically handicapped people to join TES volunteer work? How do we work best with non-native speakers,
volunteers ‘and callers´ accents and dialects? How do we combine the anonymous character of TES work with the rising
need for fundraising?
Since the results of the questionnaire will be published in form of a synopsis, all countries will be granted the chance to
learn from one another and their best practice. For example, one country´s TES head organization might find that it is
valuable to invest more into advertisement and public awareness, while another will learn that its volunteers may benefit
from more frequent supervision and coaching. A third country might detect the need to establish new training tools. A
fourth will learn how to welcome non-native speakers into their team.
Through participating in TESVolSat, and by experiencing positive changes as a direct result of the survey, the volunteers
will feel a renewed sense of appreciation, and a professional, as well as caring attitude towards their work - ultimately
leading to more satisfaction.
It is our belief, that this will enhance the commitment to the callers and counsel seekers alike.
49
OP17-1H: Symposium: Culture and Morality: Perspectives on Suicide from
Different African Cultures
Culture and Morality: Perspectives on Suicide from Different African Cultures
Chair(s): Birthe Loa Knizek (Sør-Trøndelag University College), Eugene Kinyanda (MRC/UVRI Uganda Research Unit
on AIDS/Psychiatry, Makerere U.)
Culture and morality are the building bricks of every society and they saturate the subjective experience of every person.
Attitudes towards suicidal behavior are born out of the cultural, normative setting in which they exist. In addition, increased
migration and the global invasion of the human mind by communication technologies provide possibilities for new ways of
living culture and morality. Culture and morality thus are complex and dynamic, difficult to grasp but unavoidably
necessary to study in suicide research. This symposium goes into moral discourses in both professional and layperson
samples in Ghana and Uganda, as well suicide attempters in Ghana, thus trying to grasp a variety of different
preconditions for attitude formation on suicide. The insights gained from the presented studies are an important entry
point for public education aimed at reducing the negative community attitude.
The first paper looks at the moral discourses that Ugandan mental health workers employ towards suicide and suicidal
individuals. The juridical, religious and traditional cultural systems condemn suicidal behavior, while the health
professionals are bound to the demands to help a person in need, regardless of the cause of their suffering. The
obligations originating from different moral discourses are contradictory in principle and each professional solves this in
his/her specific way by means of reasoning with arguments from the moral discourses.
The second paper focuses on religious involvement in the health care systems. Neo-prophetic ministers and Pentecostal
clergy’s role in the treatment of mentally ill persons is focused on. The goal of this study is to contribute towards the
general discourse on collaborating with religious groups on mental healthcare and reflect on the implications of such
religious imperatives in the maintenance of stigma towards suicidal persons in Ghana.
In the third paper the focus is on how Ugandan lay people in two different ethnic groups try to “repair” the damage a
suicide has done to the community by means of performing rituals. In their efforts to distance themselves both physically
and cognitively from the suicide, the communities use different methods to reach the same goal: to reestablish the safety
of the community.
In another study in Uganda the process of moral judgment towards suicidal behavior was assessed by examining lay
person attitudes to vignettes that described completed suicide/ attempted suicide scenarios under different circumstances
such when it is associated with mental illness. The findings showed that the informants’ ability to judge the seriousness
associated with the moral transgression of suicidal behavior was a dynamic process that was influenced by multiple
variables including whether an individual had a mental illness or not.
Presentations of the Symposium
Four Moral Discourses as the Basis of Attitude Formation among Health Personnel in Uganda
Birthe Loa Knizek1, Eugene Kinyanda2, Charity Akotia3, Heidi Hjelmeland4
Sør-Trøndelag University College, 2MRC/UVRI Uganda Research Unit on AIDS Uganda/Department of Psy, 3University
of Ghana, LEGON, 4Norwegian University of Science and Technology
Background: In Uganda, attitudes towards suicide and suicidal persons develop in the context of suicide attempts being
criminalized, the church condemning suicidal behavior and the cultural tradition perceiving suicide and suicidal behavior
as an abomination. However, health personnel are bound to help people in need, regardless of the origin of their suffering.
Given the overall negative attitude towards suicidal behavior from both formal and informal institutions, the health
personnel, due to their duty to have a positive attitude towards every patient, must solve contradictory demands from the
four moral discourses (juridical, religious, traditional and professional) when making up their personal attitude towards
suicidal behavior and persons. The aim of our study was to investigate attitudes towards suicide and suicidal persons
among health professionals in Uganda.
Method: We conducted a qualitative interview study and interviewed 30 mental health workers in Kampala, the capital of
Uganda; ten psychiatrists, five clinical psychologists, eight psychiatric clinical officers and seven psychiatric nurses.
Fifteen men and 15 women were interviewed and both genders were represented in all groups. Most of the informants
professed to a specific religion. Eleven were Catholics, nine were Protestants, and the remaining ten were either Born
Again, Seventh Day Adventists, Pentecostal, Muslim or Christians with unspecified denomination. Only one person
described himself as not very religious, but interested in spirituality. They were asked about their principal attitude towards
suicide and suicidal people as well as their views on the current law criminalizing suicidal behavior in Uganda.
Findings: In general, the informants seemed to have no pangs of conscience when the patient was assumed mentally ill
and without any free will. A problem, though, was to define what mental illness is and whether all illnesses are
incompatible with free will. At this point, the professionals would employ the four moral discourses in order to make up
their minds. In addition, in case of suicidal behavior that could not be explained by mental illness, the professionals
seemed to experience a dilemma, which they solved by arguments from the different moral discourses. In terms of
juridical reasoning, about two thirds of the sample took the clear standpoint that the law criminalizing attempted suicide
should be abolished, whereas some took an equally clear standpoint that the law should remain in place. The religious
reasoning on the other hand, was strong in all informants and sometimes overruled the other moral discourses, especially
regarding a principal attitude towards suicide. However, the psychologists and psychiatrists seemed more bound to their
professional obligations than the nurses in case of suicidal behavior not explained by mental illness.
1
50
Can Moral Imperatives in Religion Become Bed-Fellows with Conventional Mental Health Systems in
Ghana?
Joseph Osafo
University of Ghana, LEGON
The role of religious beliefs in mental health of clients is a gobal and contemporary reality within psychotherapy and
mental health care systems. In Ghana religious involvement in mental health is an everyday occurrence with massive
droves of supplicants in constant search of solution to existential problems from religious groups. Policy discussions are
therefore underway on how to integrate and collaborate with religious groups in mental healthcare delivery. However,
such discusions are hampered by constant report of abuse and authoritarian controls of patients within religious
communities. This presentation examines the clash of religious ideals and dogma with orthodox curative systems. It
justaposes the problemtic moral imperatives of contemporary religious healing systems in Ghana, with
conventinal medical/psychological practices in order to highlight the points of departure and convergence. The goal is to
contribute towards the general discourse on collaborating with religious groups on mental healthcare and reflect on the
implications of such religious imperatives in the maintenenace of stigma towards suicidal persons in Ghana.
When White and Red Become Symbols of Purity and Restoration of Community Stability after a
Suicide in Two Cultures in Uganda
James Mugisha1, Heidi Hjelmeland2, Eugene Kinyanda3, Birthe Loa Knizek4
Butabika Hospital, 2Norwegian University of Science and Technology, 3MRC/UVRI Uganda Research Unit on AIDS
Uganda, 4Sør-Trøndelag University College
Rituals are extensively performed in many cultural activities/ceremonies in Africa. They are regarded as actions meant to
restore stability, ensure purification and social protection. Suicide is a moral digression in most cultures in Uganda. We
studied Baganda and Acholi and in both cultures suicide is deemed as an abomination and a moral digression to both the
current and future generations. However, suicide is more heavily condemned among the Baganda than the Acholi. Hence,
the Acholi use “softer” methods in dealing with the death due to suicide as compared to the Baganda who use “harder”
methods of dealing with it. Among the Acholi, white means purity and therefore the Acholi use rituals with white symbols
for regaining purity and stability after a suicide. Baganda, on the other hand, use very harsh methods that include red or
symbolized fire to deal with this (suicide) moral digression. However, whether white or red symbols are used to restore
purity and calmness, our findings indicate that they are meant for the following: a) cognitive distancing b) physical
distancing. Those that fail to perform these rituals are sanctioned by the community.
In absence of formal psychological and social welfare services in the study communities, these rituals are essential for
providing psychological and social protection of the communities. However, they also connote stigma since those that are
not able to perform them are condemned or sanctioned by the community and therefore public health interventions should
be developed to address this injustice.
1
Assessing the Seriousness of Suicide as a Moral Transgression among the Baganda of Central
Uganda
Eugene Kinyanda1, Heidi Hjelmeland2, Birthe Loa Knizek3, Charity Akotia4, James Mugisha5
MRC/UVRI Uganda Research Unit on AIDS/Psychiatry Makerere U., 2Norwegian University of Science and Technology,
3
Sør-Trøndelag University College, 4University of Ghana, LEGON, 5Butabika
Background: In most of sub-Saharan Africa, suicidal persons and families that have lost loved ones to suicide face
negative community attitudes. These negative attitudes are responsible for keeping suicidal individuals away from
professional help. To address these negative attitudes requires among others a better understanding of the moral
judgment process towards suicidal behavior in the African context. Methodology: A study was undertaken among
laypersons of the Baganda tribe from central Uganda. The process of moral judgment towards suicidal behavior
was assessed by examining lay person attitudes to vignettes that described completed suicide/ attempted suicide
scenarios under different circumstances such when it is associated with mental illness. Findings: Informants in this study
unanimously endorsed suicidal behavior as bad (evil). They were less condemnatory to suicidal behavior secondary to
mental illness but largely disapproved of suicidal behavior secondary to HIV/AIDS, financial problems, loss and
abandonment by spouse.
Conclusion: Informants’ ability to judge
the seriousness associated with the moral transgression of suicidal behavior was a dynamic process that was influenced
by multiple variables including whether an individual had a mental illness or not. This provides an important entry point for
public education aimed at reducing the negative community attitude.
1
51
OP17-1I: Suicide Prevention with Indigenous People
The Needs and Barriers for Help among Traumatic Bereaved in Indigenous Sami Areas of Norway
Kari Madeleine Dyregrov1,2,3, Anne Silviken1, Gro Berntsen4
Norwegian Institute of Public Health, division of Public Health, Oslo; 2Centre for Sami Health Research, Institute of
Community Medicine, UiT The Arctic University of Norway; 3Center for Crisis Psychology, Bergen, Norway; 4Northern
Norway Violence, Traumatic Stress and Suicide Prevention Resource Centre, University Hospital of North Norway;
kari@krisepsyk.no, anne.silviken@uit.no, Gro.Berntsen2@unn.no
This presentation will focus on a study of the situation of traumatic bereaved from indigenous Sámi areas in the North of
Norway. The main aim of the study was to secure appropriate follow-up for bereaved after traumatic deaths in multi ethnic
areas of North Norway, with a special focus on indigenous Sami bereaved. Thus, the study aimed at getting specific and
local knowledge of their psychosocial situation and bereavement process, their needs for help, and examine whether they
seek and get help from the health care system when needed.
1
The North Norwegian Bereavement Study included both qualitative and quantitative data. The total sample consisted of
182 close bereaved after unnatural/violent deaths (suicides, accidents, SIDS and murders, RR 75 %) from Northern
Norway. A majority of the bereaved sample had lost their children, siblings and partners by suicide (52 %). From the
bereaved that consented to be interviewed, 34 were invited to participate. Thirty-one of the latter agreed to take part in indepth interviews.
The results showed that most of the bereaved from Sami areas were strongly affected by the traumatic deaths of a close
person, but met with barriers and challenges preventing the psychosocial follow-up that they needed. The barriers and
challenges are discussed in relation to; a) failure of traditional Sami norms and support systems, b) shortcomings in
majority (Norwegian) support systems, c) knowledge and integration of new standards for help and help-seeking, d) tight
and multiplex relationships, e) lack of confidence in the local support services, and f) lack of flexibility and availability of
local support services. Finally, according to the needs of the indigenous bereaved, requirements for a culturally sensitive
support service are outlined. A culturally sensitive support service demands knowledge and understanding of the
bereaved ́s situation and the cultural context that they are a part of. The knowledge from the present study may be of
importance for other indigenous people or minority groups.
Going Off, Growing Strong: Advancing the Evaluation of Suicide Prevention Programming for
Indigenous Youth
Christina Hackett1, Dorothy Angnatok2, Sarah Karpik2, Danielle Baikie3, Rachel Hirsch4, Tom Sheldon2, Chris
Furgal5, Trevor Bell6
1
McMaster University, Canada; 2Department of Natural Lands and Resources, Nunatsiavut Government; 3Department of
Health and Social Development, Nunatsiavut Government; 4Social Justice Research Institute, Brock University; 5Health,
Environment, and Indigenous Communities Research Group, Trent University; 6Department of Geography, MUN;
hacketc@mcmaster.ca
Outcome measurement in mental health is universally fraught with difficulties across cultures, particularly so in Northern
contexts where psychometric tools tend to be culturally disconnected and irrelevant. In response to higher suicide rates
for Indigenous youth in Northern Canada, a number of initiatives such as youth mentorship programs have shown some
value in enhancing physical and emotional wellbeing. In this presentation, we reflect upon the implementation and
evaluation of the first year of the Aullak, Sangilivallianginnatuk (Going off, growing strong) program in Nain, Nunatsiavut.
This program was designed to build the resilience of a group of Inuit youth facing widespread social, environmental, and
cultural change. The overarching goals of this program are to: 1) enhance the mental, physical and spiritual health of a
group of suicidally ‘at-risk’ youth; 2) build social connections between the youth and other community members; and 3)
transmit environmental knowledge, skills and values from experienced harvesters to youth.
We consider the challenges and benefits to program evaluation in this context, with a focus on how to measure and
capture mental health indicators and change over time in this setting. We will highlight the common issues faced in
defining, measuring and interpreting programs aimed at improving mental health and wellbeing in the applied context of
Nain, Nunatsiavut. Conceptual and methodological issues including data collection, whether quantitative or qualitative,
and the translation of knowledge, will be explored. We reflect upon the evaluation process and offer ways to move forward
in empirically capturing mental health and wellbeing in Northern Indigenous populations. Specifically, we discuss the
process of designing a mixed-method evaluation, and the barriers to finding and selecting appropriate psychometric tools
and methods for collecting qualitative data.
‘I'm Going to Kill Myself If You Don't…’: Contextual Aspects of Suicide in Australian Aboriginal
Communities
Joe Tighe1, Kathy McKay2, Myfanwy Maple2
Alive & Kicking Goals! Australia; 2University of New England, Australia; kmckay8@une.edu.au
Aims: This study aimed to examine the definitions and acts of suicide using a sociological framework, incorporating ideas
of control, power and bodily inscription, within a remote Australian Aboriginal community context.
1
Methods: In undertaking a non-systematic review of both literature and personal experiences, this study unpacked the
experiences of impulsive threats and acts within Australian Aboriginal communities by first defining the threats and acts
themselves and then examining them through a sociological framework incorporating ideas of control, power and bodily
52
inscription. This allowed for historical, cultural and social contexts specific to post-colonial Indigenous communities in
Australia to be explored.
Relevance: As the sixth-leading cause of death, suicide rates are significantly higher among Indigenous Australians,
inclusive of both Aboriginals and Torres Strait Islanders, than non-Indigenous Australians. Further, suicide rates among
Aboriginal children younger than 15 years have also been increasing. Understanding how Aboriginal suicide is different to
non-Aboriginal suicide can help to develop more appropriate prevention strategies.
Results: Aboriginal suicidal behaviours in remote Australia present as very different phenomena to suicidal behaviours in
mainstream Australian society. Multiple suicide threats and behaviours often appear to express ways of executing
violence or retaliation, rather than the immediate wish to die. This may be a response to the lack of choices in the face of
an historical context of intergenerational trauma, grief and loss. Aboriginal youth are grasping the possibility of death, and
the threat of dying, as a violent means to gain control over their lives. This enactment of agency can give instant ‘power’ to
those violent and vulnerable enough to use it.
Conclusions: People who work within Australian Aboriginal communities need to better understand the continuing impacts
of colonialism and inter-generational trauma and ‘decolonisation’. Further, the approach taken in providing services to
communities may need to be adapted from the more orthodox approach of linear referral pathways. Understanding the
importance of cultural context and place allows for a more dynamic and beneficial therapeutic relationship to be formed. It
may also help to more effectively facilitate support for healthcare workers.While contextualised within Australian
Aboriginal experiences, these findings have important implications for understanding suicidal threats and acts within other
post-colonial countries where intergenerational trauma is experienced.
Exploring Possibilities for Indigenous Suicide Prevention: Responding to Cultural Understandings
and Practices
Lisa M Wexler1, Joseph Gone2
University of Massachusetts Amherst, United States of America; 2University of Michigan Ann Arbor; lwexler@umass.edu
Youth suicide is a tragic and pressing problem that plagues Arctic Indigenous communities disproportionately when
compared to other areas of the U.S. and the world. Previous research has shown that the unequal distribution of suicide
for Indigenous people is associated with cultural and community drivers, namely social disorganization, cultural disruption,
a collective sense of disempowerment and historical trauma. Similarly, lower suicide rates and higher indicators of
wellbeing in Indiginous communities are associated with collective efficacy, spirituality, in-tack community services and
systems, and cultural continuity. Despite the established connections between Indigenous suicide and social, material and
political issues, the most common suicide prevention services and interventions are individually and psychologicallyfocused and clinically-based, thus neglecting key spiritual, family and community-level factors shown to be protective and
culturally important. The presentation will describe the ways in which the conventional (Western) approach to suicide
prevention can be misaligned with key understandings and drivers of suicide in one arctic Indigenous region of Alaska.
The paper will offer alternative and promising approaches that aim to bolster community-level protective factors, enhance
professional-community collaborations and increase the capacity of service providers to prevent suicide.
1
Waka Hourua: A National Māori and Pasifika Suicide Prevention Programme for Aotearoa - New
Zealand
Marama Parore, Monique Faleafa
Maori and Pacific Suicide Prevention initiative; marama.parore@matatini.co.nz, Monique.faleafa@leva.co.nz
Suicide in Aotearoa - New Zealand is an ethnically disproportionate issue. One in five people who die by suicide are
Māori, and suicide death rates for Māori youth are two-and-a-half times higher than those for non-Māori youth. Pasifika
peoples have higher rates of suicidal ideation and suicide plans than all other ethnic groups, with a 12 month prevalence
of suicide attempts that is three times the rate of the general population. To address these disparities, indigenous-led nongovernment organisations Te Rau Matatini (Māori) and Le Va (Pasifika) have come together to deliver Waka Hourua, a
national suicide prevention programme for Māori and Pasifika communities.
Waka Hourua is the Māori name for a double hulled canoe developed by the Polynesians. Waka Hourua represents the
joint partnership formed between Māori and Pasifika peoples as we embark on a shared journey towards the prevention of
suicide in our communities. It reminds us to celebrate our distinctive cultures, and to develop a service response
appropriate to our communities’ beliefs, values and hopes for the future.
The prevention of suicide is complex and challenging, and no single initiative or organisation can prevent suicide on its
own. The objectives of the Waka Hourua programme align with the New Zealand Ministry of Health’s Suicide Prevention
Action Plan 2013-16 Action Item 1.1 to:
• Build the capacity and capability of Māori whānau (families), hapū (subtribes), iwi (tribes), Pasifika families and
communities to prevent suicide and to respond safely and effectively when suicide occurs.
• Ensure that culturally relevant education and training are available to Māori whānau, hapū, iwi, Pasifika families and
communities.
• Build the evidence base of what works for Māori whānau, hapū, iwi, Pasifika families and communities to prevent
53
suicide.
• Build the leadership for suicide prevention.
This presentation will showcase the programme’s learnings, outcomes and evaluation framework and five workstreams.
These include:
- A Leadership Group of sector experts and national change agents to serve as a voice for Māori and Pasifika suicide
prevention.
- A Community Fund that supports the establishment of community owned, designed and delivered suicide prevention
initiatives.
- Ko Au, Ko Koe, Ko Tātou, a kaupapa Māori suicide prevention and community development programme that fosters
local leadership and supports 20 communities across Aotearoa – New Zealand to develop and implement Suicide
Prevention Action Plans.
- FLO: Pasifika for Life, the first Pasifika-specific suicide prevention programme in Aotearoa – New Zealand and on an
international scale. The FLO programme leads the development of innovative prevention and postvention resources and
training for Pasifika families and communities, including specialised initiatives for ethnic-specific, youth and LGBTIQQ
Pasifika groups.
- A Strategic Research Agenda and funding pool that builds the evidence base for indigenous suicide prevention.
54
OP17-1J: Predictors and Correlates of Self-Harm and Suicidal Behaviours
in Youths
Perceptions of the Relationship between Deliberate Self-Harm (DSH) and Suicide among Ireland’s
Tiger Teens
Paul William George Surgenor
Pieta House, Ireland; paul.surgenor@pieta.ie
It is estimated that one-fifth of adolescents have engaged in deliberate self-harm (DSH), and increases in levels of DSH in
Ireland range from 23% to 117%. Evidence has suggested that the coping strategies developed and employed during
adolescence may be precursors to patterns of coping in adulthood. While there is ample evidence to link DSH with suicide
many researchers believe that adolescents do not comprehend the impact, harm, and predictive role of DSH in future
suicide attempts. This proposed lack of understanding may be the reason underpinning the ‘elusive etiology’ of teen
suicide and its prevalence among adolescents. This research aimed to establish the motivations and preconceptions of
DSH and its association with suicide among self-harming adolescents. Twenty-five interviews were conducted with
teenagers (14 to 18 years old) who grew up during Ireland’s years of rapid economic growth (i.e., the Tiger economy
years), and had presented to a suicide and DSH intervention charity due to self-harming behaviours. Results will be
discussed in relation to reasons provided for engaging in DSH, comprehension of the link between suicide and DSH
among adolescents, presence of suicidal intent during DSH activities, and recommendations for additional supports and
educational strategies to reduce DSH in adolescents.
Predictors of Suicidal Thoughts in Adolescents with and without History of Depression: Evidence
from a National Canadian Cohort
Murray Weeks1, Cameron Wild2, Ian Colman1
University of Ottawa, Canada; 2University of Alberta, Canada; icolman@uottawa.ca
Background: Depression is very highly prevalent among suicidal youth. Numerous other risk factors for suicidality are also
associated with depression. However, some suicidal adolescents do not have a history of depression, and it is unclear if
their risk factor profile differs from those with a history of depression. The objective of this study was to examine the effect
of risk factors during adolescence on subsequent suicidal ideation and suicide attempts between those with and without a
history of depression, using a Canadian national population cohort.
1
Methods: The sample for this study included 6788 members of the National Longitudinal Survey of Children and Youth
followed from age 10-11 to age 16-17. The primary outcome was whether 16-17 year old participants had seriously
considered suicide or had attempted suicide in the previous year. Risk factors included poverty, low family functioning,
physical illness, stressful events, maternal depression, conduct problems, and substance misuse. Participants were
grouped according to whether or not they had ever been above the median on a depressive symptoms scale from age 1011 to 14-15.
Results: Numerous factors were associated with suicidal thoughts and attempts: being female, previous suicidal thoughts
and attempts, cannabis and other drug use, maternal depression, major stressful life events, and conduct problems.
However, among those with no history of depression, cannabis use, other drug use, and chronic physical illness were
significantly more predictive of suicidal thoughts and attempts than among those with a history of depression.
Conclusion: Profiles of risk factors for suicidality among adolescents may differ between those with a history of depression
and those without. Notably, drug misuse and chronic physical illness may be stronger predictors of suicidal thoughts and
attempts among adolescents with no history of depression.
The Influences of Family Factors on the Development of Suicidal Ideation: A 13-Year Prospective
Study from Children to Young Adults
Yi-Chen Chiang1,2, Tony Szu-Hsien Lee3, Hsing-Yi Chang4, Chi-Chen Wu4, Lee-Lan Yen4,5
School of Public Health, Chung Shan Medical University, No.110,Sec.1,Jianguo N.Rd., Taichung, 40201, Taiwan;
2
Department of Family and Community Medicine, Chung Shan Medical University Hospital, Tai-Chung, Taiwan;
3
Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan; 4Institute of
Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan; 5Institute of Health Policy and
Management, College of public health, National Taiwan University, Taipei, Taiwan; jyjlove@gmail.com
The purposes were to describe the development of suicidal ideation from children to young adults (10 to 22 years old) and
to investigate the influence of family factors on suicidal ideation.
1
Method
Data were derived from a longitudinal study, Child and Adolescent Behaviors in Long-term Evolution (CABLE) conducted
in 2001 to 2013. A total of 1,812 students were followed from grade 4 to grade 16 in northern Taiwan. Generalized
estimating equations (GEE) was used to clarify the possible long-term effects, including simultaneous and lag effects.
Results
The highest proportions of students with suicidal ideation were observed during junior high school years. The rates of
55
having suicidal ideation in past month from grade 7 to grade 9 were 18.66%, 18.91%, and 15.89%. We further found that
family interaction, family support, and parents' punishment have simultaneous effects on their children's suicidal ideation
in one month, whereas parent conflict, family involvement, and parental psychological control have lag effects. In
particular, family involvement was a protective factor against children's suicidal ideation; nevertheless parental
psychological control was a risk factor for the occurrence of suicidal ideation.
Conclusion
In conclusion, children need sustained and higher family interaction, support and involvement. Parents should apply
appropriate punishment and parental psychological control, and avoid conflict. Furthermore, attention is needed for those
who were in junior high school for prevention. Life education and family communication should be emphasized in every
period.
Suicidal Ideation among Malaysian Pregnant Adolescents: The Role of Sexual and Religious
Knowledge, Attitudes and Practices
Lai Fong Chan1, Susan M.K. Tan1, Adam Bujang2, Voon Yee Lee1, Siti Haida Mohd Ijam1, Nor Azura Abdul
Wahab1, Ek Zakuan Kalil1, Norazlin Kamal Nor1,3
1
National University of Malaysia Medical Centre, Malaysia; 2Clinical Research Center, Kuala Lumpur, Malaysia; 3Johns
Hopkins Bloomberg School of Public Health, Baltimore, USA; laifchan@gmail.com
Objectives:
Pregnant adolescents are a high-risk population for suicide. Although common risk factors for suicidal behavior have been
established, a knowledge gap still exists on how sexual and religious knowledge, attitudes and practices (KAP) influence
suicidal ideation in teenage pregnancy. We aim to explore the interplay between psychiatric diagnoses, sociodemographic factors and KAP of sexual and religious issues as risk factors of suicidal ideation among pregnant
adolescents.
Methods: Cross-sectional data on 114 pregnant adolescents (11-19 years) from 6 shelter homes and a teaching hospital
in Malaysia were collected. Current suicidal ideation (CDI & MINIKid); Knowledge, Attitude and Practice regarding Risky
Sexual Behaviour (KAP) self-report questionnaire; psychiatric diagnoses (MINIKid) and socio-demographic factors were
assessed.
Results:
The majority of the participants (87.7%) were Malay Muslims. The percentage of participants with suicidal ideation was
46.5% (self-reported) and 10.5% (interviewer-rated). Univariate analysis showed that the following were significant factors
for current suicidal ideation: having had a single sexual partner in their lifetime (p=0.033), current or lifetime Major
Depressive Disorder (p=0.023) and the perception that heavy petting (p=0.013) is a risky sexual behavior. Absence of
current suicidal ideation was significantly associated with participants who were unsure about the statement that most
religions’ viewed sex outside marriage as wrong (p=0.04). Frequency of religious practice was non-significant. Multivariate
logistic regression found that having a single compared to multiple sexual partners in their lifetime (OR=2.8, 95% CI=1.26.3) was an independent predictor of current suicidal ideation. Participants who were unsure about the statement that
most religions’ viewed sex outside marriage as wrong had a lower risk of current suicidal ideation compared to those who
agreed with the statement (OR=0.2, 95% CI=0.1-0.7).
Conclusions:
Pregnant adolescents with a single rather than multiple sexual partners in their lifetime were significantly associated with
current suicidal ideation. This finding suggests that less sexual experience may play a role as a risk factor for suicidal
ideation even after accounting for major depression in teenage pregnancies. Interestingly, an ambivalent attitude towards
religious values on sexual abstinence appeared to be protective against suicidal ideation. In view of this study’s crosssectional design, causative factors cannot be determined. Future prospective research is needed to elucidate the
mechanisms underlying these findings in view of the implications on primary prevention of teenage pregnancy as well as
secondary prevention of suicidal behavior i.e. culturally sensitive sex education.
Primary Care Pathways Following Self-Harm: Diagnoses, Referrals and Prescribed Medications in a
Nationally Representative UK Cohort
Matthew Carr1, Darren Ashcroft2,3, Evangelos Kontopantelis4,5, David While6, Yvonne Awenat7, Jayne Cooper1,
Carolyn Chew-Graham8, Navneet Kapur1, Roger Webb1
1
Centre for Mental Health and Risk, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK;
2
Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, University of Manchester, UK;
3
NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre; 4Centre for Health Informatics,
Institute of Population Health, University of Manchester, UK; 5NIHR School for Primary Care research, University of
Manchester, UK; 6Centre for Suicide Prevention, Institute of Brain, Behaviour and Mental Health, University of
Manchester, UK; 7School of Psychological Sciences, University of Manchester, UK; 8Research Institute of Primary Care
and Health Sciences, Keele University, UK; matthew.carr@manchester.ac.uk
A recent study on primary care in the United Kingdom (UK) reported strong associations between the risk of suicide and
(i) mental health diagnoses; (ii) prescribed psychotropic drug treatments. [1] Given that self-harm is a major risk factor for
56
subsequent completed suicide, it is important for clinicians and commissioners of services to better understand the
epidemiological pathways and treatment outcomes for patients following an incident episode. General practitioners have
an important role to play in assessing and managing these high-risk patients, but very little is known about self-harm in the
context of primary care.
This study was undertaken using a nationally representative data set extracted from the Clinical Practice Research
Datalink (CPRD). In this presentation, we quantify and profile those patients that received a mental illness diagnosis in
response to a first recorded episode of self-harm during 2001-2013. We considered diagnoses of depression, neurosis,
bipolar disorder, schizophrenia, personality disorder and eating disorders. Our cohort is 'open' in that each patient's
person-time at risk began at differing time points, and some exited the study due to outward migration from the CPRD
prior to the study end date. Therefore follow-up times varied.
The dataset contains all primary care prescribed medication for the entire study cohort and the recording of referrals to
specialist mental health services is mandatory. In the group diagnosed with a mental illness, we assessed medication
prescribed and referrals in the year following the patients’ first episodes of self-harm. We profiled medication prescribed in
key psychotropic drug categories including antidepressants, antipsychotics and mood stabilisers. We also examined the
prescribing of psychotropic medication that is more likely to be fatally toxic when taken in overdose, including tricyclic
antidepressants.
We present new epidemiological evidence on heterogeneous patterns of treatment and referral according to age, gender
and socioeconomic status. The findings are then utilised in models of self-harm repetition and premature mortality
amongst our cohort. Comparisons were undertaken on treatment pathway subgroups: i.e. patients who receive a mental
illness diagnosis and were treated with prescribed medication versus those who were not, and patients who were referred
to specialist psychiatric services versus those who were not.
1. Suicide in primary care in England: 2002-2011. National Confidential Inquiry into Suicide and Homicide by People with
Mental Illness (NCISH). Manchester: University of Manchester 2014.
57
OP17-1K: Understanding Suicide from Epidemiological Research I
Epidemiology of Suicide in China
Yueqin Huang
Institute of Mental Health, Peking University, China, People's Republic of; dengy@mail.tsinghua.edu.cn
Epidemiology of suicide in China is important because Chinese population is one quarter of the World population. In
recent 30 years, there are tremendous changes in China, so epidemiology of suicide are influenced obviously. In 1987,
Ministry of Health of China started to report suicide rates in China to WHO. From 1998 to 2012, the suicide rates in rural
area were from 23.31/100,000 to 8.58/100,000. The highest rate was 23.31/100,000 in 1998, and the lowest rate was
8.25/100,000 in 2005. The suicide rates in urban area were from 6.83/100,000 to 4.82/100,000. The highest rate was
12.79/100,000 in 2002, and the lowest rate was 3.59/100,000 in 2008. The suicide rates in rural area are always higher
than that of urban area.
In both urban and rural areas in China, the suicide rates in male and female increased with age. Since 2000, the rural
suicide rate has decreased significantly. In the 25-29 age group, rural suicide rate in women was higher than that in men
(10.84/100,000 vs. 6.16/100,000) in 2003, while rural suicide rate in women was lower than that in men (4.49/100,000 vs.
4.94/100,000) in 2012. In the 30-34 age group, rural suicide rate in women was higher than that in men (15.07/100,000
vs. 9.24/100,000) in 2003, while rural suicide rate in women was lower than that in men (3.39/100,000 vs. 4.40/100,000)
in 2012. In the 35-39 age group, rural suicide rate in women was higher than that in men (16.94/100,000 vs.
11.61/100,000) in 2003, while rural suicide rate in women was lower than that in men (4.93/100,000 vs. 6.11/100,000) in
2012. In other age groups, suicide rates in women were always lower than those in men in both rural and urban areas.
All the suicide data in China is based on the national death surveillance network published by the Health Statistical
Yearbook of China. Regarding the distribution of suicide rate by time in China, the suicide tendency has been decreasing
since 2000. Regarding the distribution of suicide rate by region, the suicide rate in rural area is higher than that in urban
area. Regarding the distribution of suicide rate by population, the suicide rate increases with age, and the suicide rate in
the male is higher than that in the female. It should be emphasized that in rural China the suicide rate in young women is
no longer higher than that in men nowadays.
There are several impact factors of suicide tendency in China. First, Chinese government has paid more attention on
suicide prevention so that more resources are invested in recent 15 years. Second, multiple agencies and multidisciplines have made a good effort to suicide prevention. Third, lethal pesticide has strictly controlled in rural area by the
Ministry of Agriculture. Forth, mental health services have been more powerful so that mental disorders are treated. Fifty,
psycho-counseling services have been more and more available. Sixth, health education to the public has conducted
more effective to prevent suicide.
The Effect of Improving Death Classification on the Rapid Increase of Suicide in South Korea
Geoff Chee-Hon Chan1, Eric Caine2, Shu-Sen Chang3, Won-Jin Lee4, Eunshil Cha4, Paul Yip1
The University of Hong Kong, Hong Kong S.A.R. (China); 2The Injury Control Research Center for Suicide Prevention,
Department of Psychiatry, University of Rochester Medical Center, United States; 3National Taiwan University; 4Korea
University; gefchan@hku.hk
Background
1
The suicide rate of South Korea has increased dramatically during the past decade. Although the recent increase of
suicide in South Korea may be related to changing socioeconomic conditions and other contextual factors, it also may in
part reflect a reduction of misidentified suicide cases due to improving classification of manner of death
Methods
We compared the age-standardized rates and the annual proportional change of suicide, undetermined death, and
accidental death from South Korea with those of Japan and Hong Kong from 1992 to 2011.
Results
We found that, during the 20-year observation period, the age-standardized rates of suicide, undetermined death, and
accidental death generally moved in a parallel fashion in Japan and Hong Kong; in contrast, the increase of suicide in
South Korea occurred concomitantly with a significant reduction of its accidental death rate. The proportional change of
suicide as a component of overall deaths was significantly greater in South Korea than its Asian counterparts.
Conclusion
These data suggest that during its early years the increasing burden of suicide in South Korea was masked, in part, by
misclassification. Thus, the very rapid increase of suicides reflected steadily improving classification of manner of death,
as well as a more fundamental increase in deaths.
58
Suicides among Individuals Who Purchased Life Insurance Policy in Hong Kong
Geoff Chee-Hon Chan, Paul Yip
The University of Hong Kong, Hong Kong S.A.R. (China); gefchan@hku.hk
Aim:
This study explored the pattern of suicides among individuals who purchased life insurance policy in Hong Kong.
Data:
The study made use of two datasets: (1) the mortality dataset set provided by the coroner's court of Hong Kong, and (2)
the mortality dataset of the insured individuals provided by the Actuary Society of Hong Kong. The first dataset contains
3,451 individuals who committed suicides between 2005 and 2012 in Hong Kong. Information on demographic
characteristic, psychiatric history, and their experience of purchasing a life insurance policy in Hong Kong is included in
this dataset. The second dataset consists of 2,342 deaths cases of the insured individuals who died by suicide or accident
from 2002 to 2006 in Hong Kong and it summarizes their demographic profile and the purchasing details.
Results:
Compared to suicides of the never-insured individuals, those insured were more likely in their working-age (aged 20-59)
when committing suicide. Also, the proportion of the insured individuals in employment and having territory education was
greater than their never-insured counterparts. Furthermore, greater proportion of the insured individuals displayed
experiences of financial difficulty and gambling before committing suicides. Compared to policy holders who died by
accidents, policy holders who committed suicide had a greater amount of sum assured per policy and they also held
greater number of policies. We also noted the number of individuals who committed suicide in 12-month after purchasing
the policies (i.e., after the exclusion period) is greater than those who killed themselves in the first 12-month of purchasing
the policy (i.e., within the exclusion period).
Conclusion:
Suicide among individuals who purchased life insurance policy may display certain demographic characteristics. In
addition, the exclusion period, which is the first 12-month after purchasing a policy, may serve a “protection” of preventing
or delaying insured individuals from committing suicide.
A Comparison of Suicide with Other External Causes of Death
Eileen Williamson1, Paul Corcoran1,2, Ella Arensman1,2
National Suicide Research Foundation, Ireland; 2Department of Epidemiology and Public Health, University College
Cork, Ireland; ewilliamson@ucc.ie
Introduction
1
The World Suicide Report, Preventing Suicide: a global imperative, which was launched by the WHO in September 2014,
contained recommendations with regard to the putting in place of surveillance systems for deaths by suicide and
encouragement of efforts to improve data quality. The research which is the subject of this abstract, involving a
comparison between cases classified as suicide and other external causes of premature death, came about because of
growing concern for the quality of suicide data in Ireland and, in particular, the likelihood of underreporting of suicide. The
objective was to test the hypothesis that, due to the obligation on Irish coroners to satisfy the legal test of beyond
reasonable doubt, a significant number of suicides are given open verdicts. This research will also contribute to reviewing
and updating the Rosenberg Criteria for the Determination of Suicide, developed in 1988.
Methods
The National Suicide Research Foundation, working in close collaboration with the Irish coroners’ system, has established
an on-going, in-depth investigation, of the feasibility of implementing a standardised set of criteria for the determination of
suicide based on a balance of probabilities approach, utilising the Rosenberg criteria. Case files (n = 125) covering the
period August 14th 2013 to October 30th 2013, in one coroner’s district were examined. Cases with verdicts of suicide,
open verdict and misadventure based on the case-finding criteria were included in the research.
Results
Comparison between confirmed cases of suicide, open/misadventure verdicts revealed more similarities than differences
with regard to history of previous suicide attempts, prevalence of diagnosed serious depression or mental disorder,
alcohol consumption, use of psychotropic medication and reported expressions of great emotional or physical pain or
distress.
Conclusion
The results highlight the need for more detailed information on the psychosocial and psychiatric risk factors associated
with suicide in addition to the need for the development of a set of criteria or a manual to aid coroners in the determination
and case registration of suicide, which will in turn contribute to increased reliability of suicide mortality statistics.
59
Suicide in Elder People in Peru 2010-2012
Freddy Vasquez, Gonzales Gabriela, Caballero Katty, Ysela Nicolàs, Silvia Falconi, Vilma Vite
National Institute of Mental Health, Peru; freddyalber@hotmail.com
Objective: to study suicide in elder people of Peru 2010-2012 ,regarding psycho-social and clinical features,Method:
Descriptive and longitudinal trial gathering information about suicides in Peruvian elder people, from Police, Legal
Medicine, Hospital records, relative testimonies, media and Internet reports, by a multidisciplinary team and appropiate
statistical processing.Results: There were registered 89 suicides in Peruvian elder people in this period ,which represents
9,7 % of all suicides in the country, Male: 63 (70,8 %) female :26 (29,2 %), According sub-groups of age: between 60 to
67 years old there were 45 suicides (50,6 %), 68 to 75 y.o : 21 suicides (26,3 %), 76 to 83 y.o 18 suicides (20,2 %), and in
84 y.or more: 5 suicides (5,3 %). Regarding civil status 11 ( 12,7 %) were single, 30 (33,7 %) married, 27 (30.3 %) widow,
11 (12,3 %) separated, and 8 (3,4 %) convivial union. According level of instruction: 47 (52,8 %) had primary education,
31 (34,8 %) secondary level, 5 ( 5,6 %) technical, and 6 (6,7 %) university degree. The most frequent reported occupation
was informal or sub-employee : 18 (40,4 %); without occupation : 18 (20,2 %), and hosewife: 11 (12,3 %). Accounting
suicide motivation: physical disease 33 suicides (37,1 %), Cancer reported in 7 cases (21,2 %), then mental disease in 16
cases (18,0 %), conjugal conflicts in 11 cases (12,3 %), recent peer loosing in 8 victims (9,0 %), financial trouble in 6
(6,7 %). About clinical diagnoses:Depressive state was reported in 71 victims (79,8 %), personality disorders in 8 cases
(7,0 %) alcoholism in 5 of them (5,6 %) and schizophrenia in other 5 (5,6 %). Amongst lethal used method: 26 victims
(29,2 %) hanged, 21 (23,6 %) jumped, other 21 (23,6%) used a poison, 12 of them (13,5 %) a gun-fire , other 9 victims
(10,1 %) used other methods. 71 suicides (79,8 %) took place at capital city, while other 18 (20,2 %) occurred in other
cities. At least 12 of elder suicide (17,4 %) wrote a final appoint.Conclusions: According the trial, almost 10 % of suicide
occurred in Peruvian elder in 2010-2012, with a defined ratio: M:2.4/F: 1.0, more than seen in general population of
country: half of them affected early elder people, with a decreased tendency along aging. Also widows were at high risk as
well as unemployed. One of the most trigger factors was physical illness specially Cancer. Depressive states affected
near 80 % of victims, and suicides occurred mostly at capital city, being hanging the first method as seen in suicides of
general population. Authors recommend to be aware of risk factors for suicide in elder people, being them vulnerable per
se, so following studies are advisable about.
References:De Leo D, et al (2012) Suicide among the elderly;the long term, Journal of Psych, 181, 226-229.Vasquez F et
al (2006) Analysis of completed suicide in Peru during 2004 Acta española Psiquiatr:34 (numero extraord) 67, 141 pp 118
Madrid Spain
60
OP17-1L: Mental Illness, Gambling and Other Risk Factors
Suicidal Ideation as a Driver of Health Risk Behaviours among Men Who Inject Opioids in Delhi,
India
Gregory Damon Armstrong1, Anthony F Jorm2, Luke Samson3, Michelle Kermode1
Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne,
Australia; 2Population Mental Health Group, Melbourne School of Population and Global Health, University of Melbourne,
Australia; 3The Society for Service to Urban Poverty (SHARAN), Delhi, India; g.armstrong@unimelb.edu.au
Background: Sharing of needles and syringes and unprotected sex remain common practice among PWID in India and is
an important driver of new HIV infections. The reasons why PWID engage in behaviours that put themselves and others at
risk of HIV and other infections are multifaceted and dynamic and extend beyond rational decisions based on knowledge
about risks and the provision of needles/syringes and condoms. Empirical findings from large nationally representative
samples indicate that suicidal ideation is associated with a range of health risk behaviours. This paper reports on a crosssectional survey of men who inject opioids in Delhi, India. The objective of our analyses was to examine the association of
suicidal ideation with risky injecting and sexual practices.
1
Methodology: Participants (n = 420) were recruited from needle and syringe programs using time location sampling (TLS)
and were interviewed using an interviewer-administered questionnaire. The questionnaire contained measures of injecting
and sexual risk behaviours and assessed the presence of suicidal ideation within the preceding 12 months. Multivariate
regression models were used to examine the association of suicidal ideation with risky injecting and sexual practices.
Results: Of the participants, 47.6% had shared needles/syringes with at least 1 other injector in the preceding month and
35.8% had 2 or more female sexual partners in the preceding 6 months. Among female sexual partners in the preceding 6
months, condom use at last sex was highest with casual partners (95%) followed by paid partners (51%) and regular
partners (34%). One third (37%) of the men reported a history of having had anal sex with another man, among whom just
16% used a condom the last time they had anal sex with a man; participants who engaged in male-to-male anal sex were
more likely to have a higher number of female sexual partners, signifying an overall increase in sexual behavior rather
than being indicative of a homosexual orientation. Suicidal ideation (53%) and having attempted suicide (36%) during the
preceding 12 months was common. Participants who had recently experienced suicidal ideation were twice as likely to
engage in needle/syringe sharing in the preceding month; had shared needles/syringes with 62% more people in the
preceding month; were five times as likely to have had unprotected sex with a paid partner in the preceding six months;
had 82% more female sex partners; and were nearly twice as likely to engage in male-to-male anal sex.
Conclusions: Our findings add to a growing body of literature pointing to the importance of suicidality as a correlate of
health risk behaviours, supporting the theory that suicidality is connected to reckless behaviours that may not necessarily
be immediately life threatening, but rather self-destructive in nature. Addressing the determinants of suicidality could serve
to both prevent suicide and enhance the goal of reduced HIV transmission.
Completed Suicide and Suicidal Behaviour among People with Heavy Gambling Behaviours
Paul W.C. Wong
The University of Hong Kong, Hong Kong S.A.R. (China); paulw@hku.hk
Internationally, the average rates of past year problem gambling range between 0.5% and 7.6% with an average of 2.3%;
the lowest rates are observed in Europe and the highest rates in Asia such as Macao, Singapore and Hong Kong [1-3].
The most tragic outcomes of heavy gambling are completed suicide. There are limited studies about suicide and
gambling. Two Coroner’s Court record-based descriptive studies on suicides with gambling behaviour from Australia [4]
and Canada [5] suggested that gambling was a crucial risk factor for suicide. Two studies from the United States
examined suicide rates in counties with [6] and without [7] gaming facilities yielded mixed results. Hence, the link between
gambling and suicide is not or yet to be established. However, gambling and suicide has been found to be closely related
in Hong Kong.
This presentation will include sharing of findings of three studies about suicide and gambling conducted in Hong Kong by
the presenter and his colleagues. The three studies include a psychological autopsy study of people with pathological
gambling disorder [8], a retrospective coroner’s court files review study [9], and an analysis of 3,686 treatment seeking
gamblers and their suicidal and familicidal ideation [10]. Suicide is a global public health challenge. Like other addictions,
families of those addicted suffer. The issue about gambling and violent death is largely under-recognized, poorly
understood, and not addressed in an aggressive way [10]. More information is needed to formulate preventive and crisis
intervention approaches to minimize the harm caused by rapid expansion of both legal and illegal offshore gambling
availability in this digital era. If the social costs associated with gambling keeps being trivialized in front of gambling
revenues, more money, health, and even lives will be lost due to severe gambling.
Structural Equation Modeling on Help-Seeking for Mental Illness among Japanese Adults
Machi Suka1, Takashi Yamauchi2, Hiroki Sugimori3
The Jikei University School of Medicine, Japan; 2National Center of Neurology and Psychiatry, Japan; 3Daito Bunka
University, Japan; suka@jikei.ac.jp
Background: Encouraging help-seeking behavior is essential for early treatment of mental illness and prevention of
suicide. Decisions to seek professional services for mental illness may be determined by individual predispositions and
sociocultural environment, but epidemiological data is scarce in Japan. Policymakers and providers need an
1
61
understanding of the contextual factors that stimulate individuals into help-seeking to develop effective population-based
strategies.
Objective: To examine the direct and indirect effects of factors affecting intention to seek professional services for mental
illness to explore the pathways to professional services among Japanese adults.
Methods: A web-based survey was conducted among 3,365 Japanese adults aged 20-59 years. Participants were asked
how likely they would seek help from informal supports and professional services if they were suffering serious mental
illness. Structural equation modeling was used to determine the associations between various factors and intention to
seek professional services.
Results: Of 3,308 eligible respondents, 75.6% reported an intention to seek professional services for mental illness. The
acceptable fitting model (GFI=0.946; AGFI=0.918; RMSEA=0.072, 90%CI 0.068-0.075) indicated that those who can
easily talk to family and friends about everyday affairs were significantly more likely to report an intention to seek informal
support (β=0.36), which was significantly associated with the intention to seek professional services (β=0.28). Those living
in communities where neighbors say hello when they pass each other were significantly more likely to had the intentions
to seek professional services (β=0.12) and informal support (β=0.08). Those living in communities where neighbors work
together to solve neighborhood problems were significantly more likely to had the intention to seek informal support
(β=0.11). Health literacy measured by the 14-item Health Literacy Scale had a direct effect on the intention to seek
professional services (β=0.16), as well as indirect effects through the intention to seek informal support (β=0.17) and
positive expectations about professional services (β=0.12). Socioeconomic status had no significant direct effect on the
intention to seek professional services or informal support.
Conclusion: People who can usually interact easily with family and friends, who live in supportive neighborhoods, and who
achieve higher literacy levels were more likely to seek professional services for mental illness among Japanese adults.
The present findings suggest that population approaches to enhance communication and strengthen relationships
between family, friends, and neighbors may be a key to encouraging help-seeking behavior for mental illness.
This work was supported by JSPS KAKENHI 25460815.
Trajectories of Suicidal Ideation in Patients with First Episode Psychosis (FEP) and Subsequent
Suicidality - The OPUS Trial
Trine Madsen1, Karen-Inge Karstoft2, Merete Nordentoft1
Copenhagen Mental Health Center, Denmark; 2The Danish Veteran Centre, Denmark; trine.madsen@regionh.dk
Objective: Heterogeneity of suicidal ideation (SI) over time amongst patients with FEP is expected, but prototypical
trajectories of SI has not yet been established. The primary aim of this study is to identify three-year trajectories of suicidal
ideation and to examine if and how these trajectories relate to subsequent SI and behavior. Furthermore, we explore
predictors of trajectory group membership.
1
Method: Longitudinal data on 521 patients with FEP from the Danish OPUS trial was applied. Patients were assessed at
treatment initiation, and after one, two, five and ten years. Data on SI from the first three assessments were included in a
Latent Growth Mixture Modelling (LGMM) analysis to empirically identify heterogeneuos trajectories of SI. Predictors and
distal outcomes of the trajectories were estimated subsequently.
Results: Three trajectories of SI were identified. The largest class (60.7%) ‘Low-decreasing’, was described by patients
who at treatment initiation reported SI once or a few times last year followed by a decrease to almost no SI after two years
of treatment. A second trajectory ‘frequent-stable’ reported SI sometimes-to-frequent at treatment initiation which
remained stable over time (33.1%) and finally the last class ‘frequent-increasing’ represented patients reporting frequent
SI at treatment initiation followed by aggravation of SI (6.2%). Compared to the low-decreasing class, the risk of persistent
SI at five and ten years was significantly higher in patients from the frequent-stable and frequent-increasing classes.
Further, there was a tendency towards significant differences between classes in risk of actual suicide at the 10 year
follow-up. Clinical markers significantly predicted membership of SI trajectories.
Conclusion: Three prototypical trajectories of SI were established. Importantly the largest class consisted of patients, who
over time had fewer and fewer SI , but of clinically relevance we found that having relatively frequent suicidal ideations
persisted or increase for up to 40% of patients over the first couple of years in treatment.
Inpatient and Outpatient Mental Health Care for Deliberate Self-Harm: A Retrospective Cohort Study
Matthew Spittal1, Fiona Shand2, Lisa Brophy1, Helen Christensen2, Jane Pirkis1
The University of Melbourne, Australia; 2Black Dog Institute, University of NSW, Australia; m.spittal@unimelb.edu.au
Background
1
Presentation to an acute hospital for the treatment of deliberate self-harm presents an opportunity to initiate care for
underlying mental health problems. This study aimed to describe the pattern of health care contacts following admission
to hospital for self-harm.
Method
62
We undertook a data-linkage study to construct a retrospective cohort of all individuals admitted to hospital for deliberate
self-harm in New South Wales between 2005 and 2011. We identified the proportion of patients treated as a psychiatric
inpatient, the proportion who received mental health outpatient care within 30 days of discharge, and the type of care
these individuals received.
Results
A total of 43,207 individuals had 67,035 inpatient admissions for self-harm. In 10% of admissions the patient was treated
as a psychiatric inpatient, although this varied by a range of clinical and patient factors. Sixty-one percent of admissions
received mental health outpatient care within 30 days of discharge from hospital. When treated as an outpatient, the
majority of patients (59%) had only a single outpatient contact, typically less than 30 minutes duration (60%).
Conclusions
Rates of inpatient psychiatric care and mental health outpatient care appear to be low for people who have been treated
in hospital for deliberate self harm. Given the high rates of psychiatric comorbidity among this group, more sustained
community based mental health care is likely to be needed to address their complex needs.
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OP17-1M: Symposium: Alcohol and Suicidal Behavior: Individual-,
Population-, and Meta-Analytic Findings
Alcohol and Suicidal Behavior: Individual-, Population-, and Meta-Analytic Findings
Chair(s): Kenneth R. Conner (University of Rochester Medical Center)
Five papers are presented by investigators from the United States (Bagge, Conner), Canada (Giesbrecht), Germany
(Preuss), and China (Zhou) that examine associations between suicidal thoughts and behavior and several aspects of
alcohol including density of alcohol sales venues, acute use of alcohol prior to suicidal behavior, pattern of hazardous
drinking, and alcohol use disorder. Bagge and colleagues compare the degree of proximal premeditation and intent for
suicide attempts in 324 hospitalized individuals who did not drink prior to the attempt and two groups who drank prior to
the attempt but differed in their motivations for the use of alcohol. The results underscore that individuals who drink prior
to attempted suicide are heterogeneous. Giesbrecht and colleagues analyze a large epidemiological sample in the United
States (N=51,547) in order to examine the association between per capita alcohol retail outlet density (including on
premise and off premise outlets) and the use of alcohol prior to suicide and the level of alcohol use, based on blood
alcohol concentrations, including examination of race/ethnic differences. The results document associations between
outlet density and the presence of alcohol among suicide decedents, with the association increased among Native
Americans/Alaskan Natives. Preuss and colleagues analyze approximately 1600 individuals with cannabis dependence
selected from a family association study of alcoholism in order to identify prospective predictors of suicide attempts at 5year reassessment, with results underscoring that role of prior attempts and comorbid depression. Zhou and colleagues
analyze a survey sample of 840 rural Chinese adults ages 60 and over in order to compare suicidal ideation in individuals
with- and without a pattern of hazardous drinking. Results do not show group differences in suicidal ideation, potentially
due to limited hazardous drinking in Chinese older adults, although this situation may be expected to change if alcohol
consumption continues to increase in China. Conner and colleagues use a meta-analysis of published, case-control
psychological autopsy studies in order to examine risk for suicide across specific categories of mood (e.g., dysthymia) and
substance use disorders (e.g., alcohol dependence) and to explore moderating effects of age, sex, and region. The
results include that mood disorders generally show greater variability in risk for suicide and confer somewhat higher risk
than substance use disorders.
Presentations of the Symposium
Relations between Motives to Use Alcohol to Facilitate a Suicide Attempt and Proximal Suicide
Premeditation and Intent
Courtney L Bagge1, Kenneth R. Conner2, Lauren Reed3, Kevin Murray3
University of Mississippi Medical Center, USA, 2University of Rochester Medical Center, 3University of Mississippi
Medical Center
Objective: Overwhelmingly prior studies have treated those who drink prior to a suicide attempt as a homogeneous group
and have failed to consider their motivations for drinking. The current study compared the proximal suicide premeditation
and intent of suicide attempts among three groups: 1) individuals who acutely used alcohol to facilitate the attempt (e.g.,
to “numb fears” about attempting) 2) those who acutely used alcohol for non-facilitative motives (e.g., social,
enhancement, and coping reasons), and 3) those who did not use alcohol prior to the attempt. Method: Participants
included 324 (62% female) recent suicide attempters presenting to a Level 1 trauma hospital. Assessments based on the
Timeline Follow-Back for Suicide Attempts and a Suicide Facilitative Drinking Motives Scale were used to assess
facilitative motives for drinking and characteristics of the attempt. Results: One-third of participants drank prior to the
suicide attempt, and most (73%) who used alcohol did not do so to facilitate the attempt. Findings indicated that attempts
carried out by the group with non-facilitative drinking motives were less proximally premeditated and had lower suicide
intent compared to the other study groups; in contrast, the sample of individuals who drank to facilitate the attempt did not
differ on proximal premeditation or intent of attempts compared to non-alcohol users. Conclusions: Most individuals who
drink prior to suicide attempt do not do so to facilitate the act and, in this drinking context, their attempts are characterized
by less proximal premeditation and lower intent. Findings suggest that providers should consider the motivation for
drinking when evaluating key indicators of imminent risk for suicide. Further, extant data suggests that the presence of
acute alcohol use surrounding a suicide attempt contributes to less intensive treatment and referral by hospital providers.
Thus, in working with an intoxicated suicide attempter in an emergency department setting, the determination that a
drinking bout was “facilitative” of the attempt may give a provider pause before discharging the patient.
1
Off-Premise and On-Premise Alcohol Outlet Density and Acute Alcohol Use among 51,547 Suicide
Decedents in 14 U.S. States
Norman A Giesbrecht1, Nathalie Huguet2, Lauren Ogden3, Mark S Kaplan4, Bentson McFarland5, Raul Caetano6,
Kenneth R Conner7, Kurt B Nolte8
1
Centre for Addiction & Mental Health, Toronto, CA, 2Center for Public Health Studies, Portland State University, 3School
of Community Health, Portland State Univ, 4Dept of Social Welfare, UCLA Luskin School of Public Affairs, 5Dept
Psychiatry, Oregon Health and Science University, 6Univ of Texas School of Public Health, 7Univ of Rochester Medical
Center, 8Univ of New Mexico School of Medicine
Background and Aim: Studies focusing at the population level have shown that alcohol consumption, alcohol retail outlet
density, price, and sales are associated with suicide rates. Previous studies pointing to a positive association between
alcohol outlet density and suicide rates were typically at the aggregate level (suicide rates and alcohol outlet density for a
jurisdiction were assessed) and were not able to document whether individual decedents were alcohol positive at the time
of death. Our research is designed to address this issue. This study estimates the association between per capita alcohol
64
retail outlet density and blood alcohol concentration (BAC) from suicide decedents. It also analyzes the relationship
between alcohol outlet density and socio-demographic characteristics among alcohol positive suicide decedents in the
United States by racial/ethnic group and method of suicide. Design & Measurements: Analysis of data from the U.S. 200311 National Violent Death Reporting System (NVDRS) focusing on suicide decedents from 14 U.S. states. A total of
51,547 suicide decedents were tested for blood alcohol content. Blood alcohol content and levels were derived from
coroner/medical examiner reports. Densities of county level on-premise and off-premise alcohol retail outlets were
calculated using the 2010 Census. Findings: Multilevel logistic regression models suggested that higher off-premise
alcohol outlet densities were associated with greater proportions of alcohol-related suicides among men -- for suicides
with alcohol present (BAC>0; adjusted odds ratio [aOR]= 1.08, 95% confidence interval [CI]= 1.03-1.13). Interactions
between outlet density and decedents’ characteristics were also tested. There was an interaction between off-premise
alcohol availability and American Indian/Alaska Native race (aOR=1.36; 95% CI=1.10-1,69) such that this sub-group had
highest BAC positivity. On-premise density was also associated with BAC > 0 (aOR=1.05; 95% CI=1.03-1.11) and BAC≥
0.08 (aOR=1.05; 95% CI=1.02-1.09) among male decedents. Discussion & Conclusions: Overall, 34% of suicide
decedents tested were positive for alcohol and 22% of those tested had an elevated BAC (> 0.08 g/dl). Positive
associations were found for both on-premise and off-premise alcohol outlet density with the presence of alcohol in suicide
decedents. There was also an interaction between our measure of alcohol availability and American Indian/Alaska Native
race. County-level on- and off-premise densities are associated with alcohol-related suicide, especially among American
Indians/Alaska Natives. The results of this study provide support for alcohol policies that control availability of alcohol and
also more focused interventions, such as screening brief-intervention and referral (SBIR) programs that are relevant to
high-risk drinkers with suicidal intentions.
Suicidal Behavior in Cannabis-Dependent Individuals: Results from the COGA-(Collaborative Study
on Genetics in Alcoholism) Sample
Ulrich W Preuss1, Victor M Hesselbrock2
Dept Psychiatry University of Halle-Wittenberg, Germany, 2Dept. of Psychiatry, Univ of Connecticut School of Medicine
Various factors influence suicidal behavior in substance-dependent individuals, including psychiatric comorbidity, other
substance use and psychosocial characteristics. The aim of this pro- (5 year follow-up) and retrospective analyses of the
COGA (Collaborative Study on Genetics in Alcoholism) is to identify risk factors for individuals with cannabis dependence.
Methods: Approximately 1600 individuals with DSMIIIR cannabis dependence were included into the analyses, of whom
21.1% had a history of suicide attempts. Characteristics of suicidal behavior, psychiatric comorbidity and
sociodemography were obtained using the SSAGA (Semi-Structured Assessment on Genetics in Alcoholism) while
personality traits including impulsivity were assessed using the TPQ (Tridimensional Personality Questionnaire). Most
important predictors of suicide attempts during the 5-year follow-up were depressive episodes and history of previous
suicidal behaviors. Furthermore, in suicidal cannabis-dependent individuals, the onset of several psychiatric disorder
cumulate within three years before the first attempt. Depression and history of suicidal behavior significantly increase the
risk for suicide attempts in cannabis-dependent subjects. This finding parallels risk profiles for suicidal behaviors in other
samples with alcohol- and other substance use disorders beside cannabis. The accumulation of various psychiatric
disorders within 3 years before first suicide attempts indicates a possible treatment intervention to prevent subsequent
suicide attempts.
1
Meta-Analysis of Case-Control Psychological Autopsy Studies: Focus on Mood- and Alcohol Use
Disorders
Kenneth R Conner1, Jeffrey A Bridge2, Dustin J Davidson2, David A Brent3
Univ of Rochester Medical Center, Rochester, NY, USA, 2The Research Institute at Nationwide Children’s Hospital,
3
University of Pittsburgh Medical Center
Objective: Prior meta-analyses of case-control psychological autopsy studies (PA studies) have established that mood
and substance use disorders are the two most common mental disorders in suicide decedents worldwide but were limited
for the purpose of examining subcategories of mood (e.g., dysthymia) and substance use disorders (e.g., alcohol
dependence) and for of examining the moderating effects of age, sex, and region. The current study addresses these
limitations. Method: A systematic search of case-control PA studies published in English since 1985 was conducted in
PubMED and PscyhINFO and supplemented with hand searches of the reference sections of PA review articles and
reports identified in the search. Studies were excluded if they were uncontrolled, used only clinical controls or a suicide
control group, did not use direct interviews (e.g., records only), reported no information on variables targeted in the search
including mental disorder, and/or provided redundant information from a prior report of the same sample. The electronic
search identified all (100%) of the articles published since 1985 contained in three prior published meta-analyses of the
PA literature, a demonstration of sensitivity. The data are analyzed with Comprehensive Meta-Analysis Version
2. Results are based on odds ratios and 95% confidence intervals that were provided directly in the reports or, when
necessary, that were calculated based on descriptive information contained in the reports, with use of adjusted odds ratios
(as opposed to unadjusted) whenever available. Random effect models are conducted if there is evidence of
heterogeneity of results, otherwise fixed effects are used. Analyses of subcategories of mood and substance use
disorders were conducted if there were 3 or more reports available for analysis. Results: Detailed information on
demographics and mental disorders was abstracted from 199 case-control PA studies identified in the search. Twentyeight reports from 11 countries met eligibility criteria for the current analyses of mood and substance use disorders, and
between 4 and 17 reports provided data for the specific categories of mood disorders (e.g., dysthymia) and substance use
disorders (e.g., alcohol dependence). Preliminary results indicate that, with one exception, all categories of substance
use disorders and mood disorders considered confer increased risk for suicide, with mood disorders showing more
variability in risk across subcategories and, as a whole, conferring more pronounced risk compared to substance use
disorders. Analyses of moderating effects of age, sex, and region are forthcoming as data allow and will be presented
during the symposium. Conclusion: A wide range of specific categories of mood and substance use disorders confer risk
1
65
for suicide, with mood disorders showing greater variability in risk across categories and, overall, conferring more
pronounced risk for suicide than substance use disorders.
66
OP17-1N: New Technologies and Suicide Prevention I
Concerns of Older Veteran Callers to the VA Crisis Line
Kathy A. Rasmussen1,2, Madelyn S. Gould4, Wendi Cross2, Victoria E. Bridges3, Xin Tu2,1, Wan Tang2,1, Kimberly
Kaukeinen2,1, Kerry L. Knox2,1
1
VA VISN 2 Center of Excellence for Suicide Prevention, United States of America; 2University of Rochester School of
Medicine; 3Canandaigua VA Medical Center; 4Columbia University Medical Center; kathy.rasmussen@va.gov
In July 2007, the Department of Veterans Affairs (VA) partnered with the Department of Health and Human Services’
Substance Abuse and Mental Health Service Administration (SAMHSA) to become part of SAMHSA’s National Suicide
Prevention Lifeline Network. Veteran callers to the toll free suicide prevention number (1 800-273-TALK) are routed to
trained VA clinician responders at the VA Crisis Line (VCL). Earlier research on use of suicide crisis lines found that
females were more likely than males to use these lines, and that the callers most likely to benefit were younger females.
Thus, when the VCL began operation, it was unknown whether Veterans, and particularly older male Veterans, would
utilize the service. In this study we examined the use of the VCL by one of the groups at highest risk for suicide, Veterans
aged 60 and older.
Data were gathered on calls made by Veterans to the VCL between 07/2013-12/2013. Administrative, clinical data were
obtained during each call; these data were not part of a research protocol. In this study, we used a summary variable of
the call that represents the responder’s perception of the major problem area(s) that prompted the Veteran to call the
VCL. The responder selects from a list of 35 problem areas, and more than one can be selected for each call. Due to the
high number of options, a factor analysis was conducted in order to create a more succinct set of latent variables for
analysis. Three factors emerged; however, factor loadings for some problem areas were quite low. Internal consistency of
each factor was assessed, and some problem areas were dropped until an acceptable level of consistency was reached
for two of the three factors. Factor 1 consists of economic problems, such as employment issues or homelessness. Factor
2 consists of physical problems, such as medical issues, chronic pain, or sleep issues. Factor 3 will require further
refinement prior to the final analysis for this presentation. Factor 3 currently consists of mental health concerns, such as
PTSD symptoms or substance use, as well as items that may contribute to mental health concerns, such as relationship
issues or loneliness.
In the 6-month period of the study, the VCL received a total of 3660 eligible calls, 953 (26%) of which were from Veterans
aged 60 and older. Of the 953 calls from older Veterans, 885 (93%) were made by males. Differences between Veterans
under age 60 and Veterans age 60 and older were examined using t-tests. Results reveal that older Veterans were
significantly less likely than younger Veterans to call the VCL due to economic problems (p < .0001), whereas older
Veterans were significantly more likely than younger Veterans to call due to physical problems (p < .0001). These results
are consistent with known risk factors associated with each age group. Most importantly, results indicate that one of the
groups at highest risk for suicide, older male Veterans, will indeed utilize a Crisis Line service.
Online Help-Seeking by Suicidal Adolescents: A Qualitative Analysis of Emails, Chat Logs and
Forum Messages of a Youth Helpline
Eva Dumon1,2, Gwendolyn Portzky1,2, Kees van Heeringen1,2
Unit for Suicide Research (Ghent University); 2Flemish Suicide Prevention and Resource Center (VLESP);
eva.dumon@ugent.be
Background
1
Although a majority of young people experiencing mental health problems do not use mental health services, the Flemish
youth helpline ‘Awel’ reaches more than 500 youngsters every year who talk directly about suicidal thoughts in e-mails,
chat logs and on the forum of the helpline. These data provide information regarding suicidal thoughts and help-seeking
behaviour of young people.
Aims
The present study was designed to identify which stressful factors, thoughts and feelings suicidal young people report
while seeking online help. Furthermore, the study aimed at analyzing the severity of their suicidal thoughts and behaviour,
and exploring how easily they talk about their suicidal intentions.
Method
550 chat conversations, e-mails and forum messages were analyzed through a computer assisted qualitative data
analysis, making use of the software programme Nvivo.
Results
Difficulties in relation to the parents and in relationships with peers were reported most frequently. The most prevalent
reported thoughts were general thoughts about suicide and depressive thoughts, reflecting a negative self-image,
hopelessness and helplessness. Self-harming behaviour such as self-cutting, reported in 34% of the sources, was the
most common reaction to stressful factors and thoughts. Regarding the suicidal process, 18.9% of the adolescents
already made a suicide attempt in the past and 12.4% were making concrete plans at the moment of contacting the
helpline.
67
Conclusions
Suicidal adolescents seek help online to talk about their feelings and problems. In their messages they most often
address problems they experience within their family or within their peer group. Many of these adolescents are at high-risk
and in need of further professional help.
Suicide Prevention and Social Media
Jo Robinson1, Georgina Cox1, Eleanor Bailey1, Sarah Hetrick1, Maria Rodrigues2, Steve Fisher2, Helen Herrman1
1
Orygen the National Centre of Excellence for Youth Mental Health, Australia; 2Community Works, Australia;
jr@unimelb.edu.au
Background
The media is thought to play an important role in suicide prevention however the growth of social media presents new
challenges. For example, concerns have been expressed with regard to the use of social media sites for the expression of
suicidal feelings, and for the communication about methods of suicide-related behaviour. But given its increasing
popularity it also leads us to question the potential for social media to be used a preventative tool. Aims are to:
1. Present findings from a systematic review relating to social media and suicide prevention
2. Present findings of a stakeholder consultation that examined gaps in knowledge and future priorities for work in this
field
3. Describe a new project that involves the development of a suite of suicide prevention interventions to be delivered via
social media.
Methods
Systematic review: Electronic databases were searched for articles published between 1991 and April 2014. English
language articles with a focus on suicide-related behaviour and social media were included. Stakeholder consultation: A
series of online surveys were administered to: i) People who conduct research into suicide and social media; ii)
Organisations that use social media for suicide prevention; and iii) Social media users.
Results
Systematic review: Thirty studies were included, 4 described the development of social media sites designed for suicide
prevention, 6 examined the ability of social media to reach or identify people at risk; 15 examined ways in which people
used social media for suicide prevention-related purposes; and 5 examined the experiences of people who had used
social media sites for suicide prevention purposes.
Stakeholder consultation: In total 99 people completed the surveys. Overall social media was seen as a useful way of
delivering suicide prevention activities, and whilst risks were identified the benefits were seen to outweigh the risks.
Discussion
Together these studies demonstrated that social media platforms can reach large numbers of hard-to-engage individuals,
may allow others to intervene following an expression of suicidal ideation online, and provide an anonymous, accessible
and non-judgmental forum for sharing experiences. Challenges include difficulties controlling user behaviour and
accurately assessing risk, issues relating to privacy and confidentiality, and the possibility of contagion. However, overall
social media was recognised as holding potential for delivering suicide prevention activities.
A new study is currently underway in high schools; this involves the development and evaluation of a suite of suicide
prevention interventions that can be delivered via social media. The progress of this study will also be presented.
Fascinating. Star Trek’s Mr. Spock on the New Crisis Services Technologies
David W. Covington1, Fergus Cumiskey2, John Draper3, Annette Beautrais4
Recovery Innovations, United States of America; 2Contact NI, Northern Ireland, UK; 3NSPL, United States of America;
4
University of Canterbury, New Zealand; davidwcovington@gmail.com, Fergus.Cumiskey@contactni.com,
JohnD@mhaofnyc.org, louis.beautrais@gmail.com
At the end of November in 2013, Virginia State Senator Creigh Deeds told CNN that he was alive for just one reason: to
work for change in mental health. Just a week earlier, his son “Guss” stabbed him 10 times and then ended his own life by
suicide. This happened only hours after a MH evaluation determined that Guss needed more intensive services.
1
Sadly, it is common for individuals in crisis to initially receive support and then later “fall through the cracks.” The cracks
occur because of interminable delays for services that professional assessments have determined individuals clearly
need. They walk out of an ED “Against Medical Advice” and disappear from view until the next crisis occurs.
Far too many individuals are falling through the cracks. While they sometimes hurt themselves, it is infrequent that they
68
harm others. When it does occur, it’s rarer still that the person is a public figure. However, every time there is a
Columbine, Tucson, or Sandy Hook, we grieve… and we wring our hands and consider whether there is a better way.
Nearly 40,000 Americans die by suicide every year… and we assume nothing can be done. I contend it is time to raise the
bar in crisis services and innovate with solutions that will drive a different set of results.
The keys to advancements in aviation safety are simple. There are two vitally important objectives that, without them,
make it impossible to avoid tragedy:
Objective #1: always know where the aircraft is – in time and space – and never lose contact;
Objective #2; verify the hand-off has occurred and the airplane is safely in the hands of another controller.
In the Air Traffic Control example, technology systems and clear protocols ensure that there is absolute accountability at
all times, without fail. It was surprising to see in the movie the air traffic controllers using wooden blocks to represent each
plane, given all the high-tech tools at their disposal. But when an air traffic controller has the block, they have
responsibility for that plane… unless and until they physically give that block to someone else, who then assumes the
same care and attention. They simply do not allow an airplane to be unsupported and left on its own.
For a crisis service system to provide Level 5 “Close and Fully Integrated” care, it must implement an integrated suite of
software applications that employ online, real-time, and 24/7:
Key Elements Level 5 Crisis System (Air Traffic Control Approach)
• Status Disposition for Intensive Referrals
• 24/7 Outpatient Scheduling
• Shared Bed Inventory Tracking
• High-tech, GPS-enabled Mobile Crisis Dispatch
• Real-time Performance Outcomes Dashboards
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OP17-2A: Atelier: Notre regard d'intervenant et son impact sur le client
Notre regard d’intervenant et son impact sur le client
Françoise Roy1, Amélie Gauthier2, Danyelle Latreille3
Université du Québec en Outaouais, Centre de recherche et d'intervention sur le suicide et l'euthanasie; 2Centre de
prévention du suicide Le Faubourg; 3CSSS de Laval, Centre de recherche et d'intervention sur le suicide et l'euthanasie;
consultationsfranco@hotmail.com, amelie.g@cps-le-faubourg.org, danyelle_latreille@ssss.gouv.qc.ca
Thème : Intervention auprès des clientèles dites difficile.
1
Objectifs :
• Identifier ses enjeux personnels face à différents types de situations ou clientèles
• Augmenter son confort dans des contextes d’intervention plus difficiles.
Résumé:
Dans plusieurs situations d’intervention plus difficiles, les intervenants cherchent à développer des connaissances et des
compétences plus pointues, par le biais de lectures, d’échanges et de formation sur des nouvelles pratiques ou
approches.
Très souvent les intervenants oublient l’outil fondamental : soi-même. En ce sens, un moyen complémentaire de s’outiller
comme intervenant est d’identifier avec quelles lunettes on fait la lecture des ces situations et d’analyser l’importance de
cette vision sur nos interventions.
Plusieurs auteurs notent l’importance de la relation et de l’espoir que porte l’intervenant envers les personnes en
détresse, comme un facteur prédominant sur l’amélioration de leurs états. Notre lecture peut être influencé par nos
valeurs, nos croyances, notre vécu et aussi par la complexité, la proximité et la chronicité de la clientèle avec laquelle on
travaille.
Puisque de nombreux intervenants se retrouvent parfois dans des situations d’impasse et d’impuissance, cet atelier
propose l’opportunité d’un temps d’arrêt et d’échange, trop souvent mis de coté dans le travail quotidien, et ce faute de
temps. Cet atelier permettra d’identifier vos enjeux et augmenter votre confort dans des contextes d’intervention plus
difficile.
Format : Atelier d’échange et exploratoire
Contenu :
À partir de nos expérience de formatrice, de superviseur clinique et de différentes réflexions sur l’importance de porte un
regard sur nous-mêmes, comme principal outil d’intervention, cet atelier propose d’explorer les caractéristiques des
clientèles difficiles, d discuter des leviers que les intervenants ont développés pour faire face à leurs enjeux et d’identifier
ensemble des façons de garder espoir face à ces difficultés.
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OP17-2B: Symposium: High Risk Occupations and Workplace Suicide
Prevention [Emplois à risque élevé et prévention du suicide en milieu de
travail]
High Risk Occupations and Workplace Suicide Prevention / [Emplois à risque élevé et prévention du
suicide en milieu de travail]
Chair(s): Larry Berkowitz (Riverside Trauma Center)
There is increasing recognition that certain occupations are at elevated risk compared to others. These occupations
include those in the medical profession, law enforcement, and those in physically demanding jobs. This symposium
presents a description of the main work and non-work risk factors for suicide in at-risk occupations. It also describes
current suicide prevention programs operating in high risk occupations, with specific focus to the development and
implementation of prevention initiatives.
Presentations of the Symposium
Revue critique des écrits sur le suicide chez les infirmières: Qu'en est-il des facteurs liés au travail?
/ Critical Review of Literature on Suicide in Nurses : What is the role of Work-Related Factors?]
Marie Alderson1, Xavier Parent-Rocheleau1, Mishara Brian2
1
Université de Montréal, 2Université du Québec à Montréal
Si divers écrits notent une forte prévalence de suicides chez les infirmières, que sait-on réellement de ce qui porte ces
dernières à commettre l’irréparable? Cet exposé a pour but de faire le point sur la recherche entourant la problématique
du suicide chez les infirmières et d’indiquer la voie que devraient prendre les études à venir dans une perspective de
développement de connaissances permettant de mieux comprendre ladite problématique. La communication considère
l’apport que pourrait offrir l’approche théorique et méthodologique de la psychodynamique du travail qui ouvrirait, sur une
compréhension, à partir des infirmières elles-mêmes, de ce qui porte certaines d’entre elles à développer des idéations
suicidaires et à envisager, s’organiser et tenter de se donner la mort.
Igniting Suicide Prevention within the Massachussetts Fire Service: Helping Hope / Embraser la
prévention du suicide au sein du service de pompiers du Massachussetts : Susciter l’espoir]
Sarah Gaer, Larry Berkowitz
Riverside Trauma Center
The proposed presentation describes two workplace suicide prevention programs, designed specifically for fire fighters.
The Fire Service has been identified as a prime target for several reasons including cumulative secondary traumatic
stress and exposure to suicide completions. Moreover, 96.6 % of firefighters in Massachussetts are working aged males,
the demographic known to carry the burden of suicide. The workshop will present data from over 60 trainings involving
600 fire fighters representing 8 Departments using the Question, Persuade, Refer (QPR) program (QUINETTE, 1999) that
was attained through pre and post training surveys. Data reflects a significant shift in attitudes among participants.
You Can’t Fix Your Mental Health with Duct Tape: Suicide Prevention in the Construction Industry /
[On ne peut réparer sa santé mentale avec du ruban adhésif toilé : Prévention du suicide au sein de
l’industrie de la construction]
Jess Stohlmann-Rainey, Sally Spencer-Thomas
Carson J Spencer Foundation
As a male-dominated, transitional workforce industry with a substance-abuse and hyper-masculine culture, the
construction industry often sees higher than general population rates for suicide (Gullestrup, Lequertier & Martin, 2011).
This paper will share results of a comprehensive needs assessment and preliminary evaluation results from the first
phase of a suicide prevention program implementation at a 1000-employee construction company. Over a six-month
period, several approaches were used to capture baseline information about mental health and suicide attitudes,
knowledge and behavior including focus groups, stakeholder interviews and a survey. The workforce, 85% male, shared
that many of them experienced depression (19%) and sleep disruption (26%) on a fairly consistent basis and 37%
indicated that in the last 12 months they had reached out to someone they thought might have been suicidal.
Nevertheless, many held stigmatized views of mental illness and help-seeking (e.g., 24% agreed “People tend to like
someone less if he or she is receiving professional help for a mental illness” and 31% disagreed with the statement “I
would be comfortable telling a friend or family member if I feel Ineeded professional help for suicidal thoughts”).
On World Suicide Prevention Day, the initial phase of a comprehensive approach to suicide prevention commenced with a
multi-pronged and sustained communications plan including a leadership call to action, social marketing (“Man Therapy”
campaign), promotion of national suicide prevention lifeline, weekly educational newsletter articles, and monthly “toolbox
talks.” Additional details of the plan, lessons learned and next steps will be covered in detail.
Finance Services and Suicide Risk: Media Hype or Real Concern? / [Services financiers et risque
suicidaire : bulle médiatique ou enjeu réel?]
Joel Bosch1, Gary Beringer2
eCD Market, 2Beringer & Associates
During the 10 weeks between January 20, 2014 and March 28, 2014, the media reported 13 suicides among financial
professionals. This spate of suicides shocked the world. All forms of media covered the unfolding events including social
1
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media. During April, there were 2 additional deaths, and 1 more in early July. This totaled 16 suicides linked to financial
professionals. Media quickly labeled them “The Wall Street Suicides”. However, the term “Wall Street Suicides” was a
misnomer. The deaths crossed financial services and lacked geographical boundaries. These were a collection of highprofile suicides drawn from throughout the world that happened to occur in time proximity. Further, 6 of 16 cases worked
for one global firm. The gender was heavily male (14 male, 2 female), the age range wide (28 through 70 years old), the
job titles spread from Chief Executive Officer to intern, and the means varied significantly although far more occurred by
jumping than would be expected (7 jumped, 3 shootings, 1 fall in front of train, 1 hanged, 3 unknown, 1
misclassified). There also were confounding factors present (murder-suicide, prior diagnosed mental illness, prior health,
problems at work, domestic circumstances). Review of media reports for August 2013-August 2014 revealed 14 other
“suicides” which were not identified as part of the same pattern because they were spread over time.
QUESTION: Are financial professionals at increased risk for suicide?
PREMISE: While financial services can be a high-pressure industry, financial professionals are no more likely than any
group of individuals to die by suicide. However, the industry is widely reported on in the media and there is a history of
media attention to deaths within the industry. We explore the impact of media coverage on the industry and its
culture. The corporate culture is demanding, and looks upon stress and mental/physical illness as a sign of
weakness. There is substantial stigma associated with any deviation from the expectations of the employer. Since many
financial institutions are multi-national or global, the problem crosses geographical and cultural boundaries.
CONCLUSION: We look at the industry’s response to the deaths and the media attention and make recommendations on
how the industry can address both. There must be better communication at the uppermost level of corporate
governance. Collaboration among industry corporations must be created to deal with improving such
communication. Open discussion by those at the top can reduce stigma and support suicide prevention efforts. Such
openness and support must be top down.
Reintegrating Police Officers Who Have Experienced Suicidal Intensity / [Réintégrer les policiers
après une crise suicidaire]
Govan Anthony Martin1, Sally Spencer-Thomas2
Pennsylvania Adult/Older Adult Suicide Prevention Coalition, 2Carson J Spencer Foundation
Law Enforcement agencies often disagree on how to reintegrate the law enforcement officer who has attempted suicide or
who has shown significant suicidal ideation. Many opinions exist as to whether or not these offers can or should return to
full duty or should be put on an administrative status. Concerns about the career consequences of the involuntary removal
of an officer’s department issued firearm may deter distressed officers from seeking further help, which only compounds
the risk. Some jurisdictions have designed “non-disciplinary” firearm removal policies in attempt to reduce this barrier to
seeking help. This presentation will compare case studies of successful and unsuccessful reintegration of police officers
after suicide attempt or significant mental health challenges.
A comprehensive reintegration program is suggested for the returning officer and his/her family is designed to facilitate a
smooth transition back to work while providing counseling and education for the LE officer and his/her family. Internal and
external resources such as internal EAP's, peer officers and psychologists that have knowledge of police culture are
recommended. “Safe and Compassionate Responses to the Aftermath of Law Enforcement Mental Health Crises” are
suggested as guidelines to reduce the impact of suicide, suicide attempts and other mental health crises for law
enforcement and include:
• Identity and reputation concerns
• Means restriction
• Future advancement
• Policy recommendations and legal issues (e.g., Americans with Disabilities)
• Recommendations for Law Enforcement EAP for successful reintegration
1
Facteurs contributifs au suicide des agriculteurs / [Contributing Factors in Farmers’ Suicides]
Ginette Lafleur
Centre for Research and Intervention on Suicide and Euthanasia (
Les exploitants agricoles de sexe masculin constituent un groupe professionnel régulièrement identifié comme étant plus
à risque de suicide (Bossard et al., 2013; Browning et al., 2008; Charlton et al., 1993; Gunderson et al., 1993; Kelly
& Bunting, 1998; Meltzer et al., 2008; Page & Fragar, 2002; Stallones, 1990; Stark et al., 2006; Cohidon et al., 2010).
Si le risque de surmortalité par suicide de cette population a été exposé dans plusieurs études, force est de constater que
nous en savons encore peu sur les facteurs pouvant contribuer à ce risque accru. En l’occurrence, plusieurs facteurs
explicatifs ne reposent que sur des hypothèses. Pourquoi les exploitants agricoles seraient-ils à risque plus élevé de
suicide que la population masculine générale ou des membres d’autres professions? Quelles spécificités de cette
profession peuvent nous éclairer sur le phénomène de suicide? Quelle est l’importance des crises économiques agricoles
dans leur suicide? Quels sont les facteurs de risque associés à la pratique du métier d’agriculteur et à leur environnement
de travail? La réponse n’est pas simple puisque le suicide est un phénomène complexe et multifactoriel dans lequel
l’activité professionnelle côtoie d’autres facteurs de risque. Sur une exploitation agricole de type familial, il est
particulièrement difficile de départager ce qui relève spécifiquement du domaine professionnel puisque les frontières entre
le travail, la maison et la famille sont généralement floues. De nombreux facteurs sont inévitablement reliés.
Le but de cette présentation est d’améliorer notre compréhension du suicide d’agriculteurs grâce aux données recueillies
dans les archives du Bureau du Coroner (Québec, Canada), de l’Office des juges d’instruction (canton de Fribourg,
Suisse) et de la Police cantonale (canton de Neuchâtel, Suisse). Grâce à l’étude de 98 dossiers d’agriculteurs décédés
par suicide entre 1999 et 2013 (74 québécois et 24 suisses), nous verrons qu’outre les problèmes de santé mentale, les
problèmes professionnels, de santé physique et financiers, tout comme la crainte de perdre leur ferme, jouent un rôle
important dans la trajectoire suicidaire des agriculteurs.
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Plus nous progresserons dans notre compréhension des agriculteurs, plus nous serons à même de concevoir des
stratégies efficaces de prévention du suicide. Koskinen et al. (2002) posaient la question : « Is occupation relevant in
suicide? ». Nous répondons « oui » en ce qui concerne les agriculteurs. Toutefois, l’étude des dossiers de suicide
comporte certaines lacunes, en particulier en ce qui concerne la Suisse. D'autres recherches seront nécessaires pour
mieux définir des stratégies de prévention adaptées à la « culture » agricole.
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OP17-2C: Workshop: Surveillance Systems for Non-Fatal Suicidal
Behaviour / [Atelier: Systèmes de surveillance des comportements
suicidaires non fatals]
Workshop: Surveillance Systems for Non-Fatal Suicidal Behaviour / [Atelier: Systèmes de
surveillance des comportements suicidaires non fatals]
Chair(s): Ella Arensman (National Suicide Research Foundation, University College Cork, I), Rory O'Connor (Institute
of Health & Wellbeing, University of Glasgow, Scotland)
Workshop organised by the International Association for Suicide Prevention and International Academy for Suicide
Research
Objectives:
In this workshop, we aim to explore the strengths, weaknesses, opportunities and threats of developing and maintaining
different types of surveillance systems. Although the workshop will be interactive, it will draw upon a joint IASP-IASR
initiative which involved reviewing the extant literature on surveillance systems. It will also involve contributions from
Professor Keith Hawton, University of Oxford, UK and Dr Alex Crosby form the US Centers of Disease Control, who will
share their experiences of developing and managing major surveillance systems in this area.
Background:
Improved surveillance and monitoring of non-fatal suicidal behaviour (suicide attempts/self-harm) is a core element of the
public health model of suicide prevention (WHO, 2014; CDC, 2014; 2011).
Having engaged in one or more acts of non-fatal suicidal behaviour is the single most important predictor of death by
suicide (Carroll et al, 2014; Zahl & Hawton, 2005; Owens et al, 2002). Therefore, monitoring the prevalence, demographic
patterns and methods involved in non-fatal suicidal behaviour in a country or region provides important information that
can assist in the development of suicide prevention strategies. Combining this with information on suicide deaths, casefatality rates can be estimated which will assist in identifying high-risk individuals (WHO, 2014).
There are two primary methods for obtaining information about national or regional rates of non-fatal suicidal behaviour:
self-reports of suicidal behaviour in surveys of representative samples of community residents, and medical records about
treatment for non-fatal suicidal behaviour in representative samples of health care institutions (usually hospitals) in the
community (WHO, 2014).
Hospital based surveillance systems of non-fatal suicidal behaviour, range from national registries, such as in Ireland
(Perry et al, 2012; Arensman et al, 2013) to regional registries in the UK , where in Oxford, Manchester, and Darby collect
data on episodes of non-fatal suicidal behaviour presenting to emergency departments (Bergen et al, 2010). Similarly, in
the United States (US) information on non-fatal suicidal behaviour is collected using several systems including the
National Electronic Injury Surveillance System-An All Injury Program (NEISS-AIP); the National Trauma Databank (NTDB)
of the American College of Surgeons; The Toxic Exposure Surveillance System (TESS) and the National Poison Data
System (NPDS). The National Trauma Registry which collects information on intentional injuries in Canada is
complemented by the Ontario Trauma Registry which gathers data on intentional and unintentional injuries from 11
leading hospitals (CIHI, 2013). In Australia, a state trauma registry is in operation in Victoria providing information on
intentional injuries (Department of Health, 2014).
Presentations of the Symposium
Achieving Consistency on Nomenclature and Definitions across Surveillance Systems for Non-Fatal
Suicidal Behaviour / [Réaliser une nomenclature et un lexique cohérent entre les divers systèmes de
surveillance des comportements suicidaires non fatals]
Morton Silverman
Education Development Center, US
Achieving Consistency on Nomenclature and Definitions across Surveillance Systems for Non-Fatal Suicidal Behaviour
Reviewing Characteristics of Registry Models for Other Medical Conditions / [Revue des
caractéristiques des modèles de registres d'autres conditions médicales]
Barbara Stanley
Columbia University Medical Center, New York, US
Reviewing characteristics of registry models for other medical conditions and their applicability to surveillance
internationally for non-fatal suicidal behaviour with a focus on characteristics such as, voluntary vs mandated reporting,
maintenance of the system, cost for maintaining the system, uses and access, will be discussed
Benefits, Challenges and Recommendations / [Avantages, défis et recommandations]
Keith Hawton1, Alex Crosby2
Centre for Suicide Research, University of Oxford, UK, 2Centers for Disease Control, US
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Interactive discussion of benefits, challenges and recommendations from the perspective of experts who have established
and sustained long-term surveillance systems for non-fatal suicidal behaviour
Making the Case for Developing Surveillance Systems for Non-Fatal Suicidal Behaviour /
[Promouvoir le développement de systèmes de surveillance des comportements suicidaires non
fatals]
Ella Arensman1, Rory O'Connor2, Morton Silverman3, Barbara Stanley4, Keith Hawton5, Alex Crosby6
National Suicide Research Foundation, University College Cork, I, 2Institute of Health & Wellbeing, University of
Glasgow, Scotland, 3Education Development Center, US, 4Columbia University Medical Center, New York, US, 5Centre
for Suicide Research, University of Oxford, UK, 6Centers for Disease Control, US
Interactive discussion of challenges, responses and actions in ‘making the case’ for developing, implementing and
sustaining surveillance systems for non-fatal suicidal behaviour towards policy makers and governments
1
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OP17-2D: Symposium: Empathic Responses to Suicidal Individuals
Empathic Responses to Suicidal Individuals
Chair(s): Maurizio Pompili (Sapienza University of Rome), David Jobes (The Catholic University of America)
Empathy is understanding and experiencing emotions from the perspective of another, a partial blurring of lines between
self and other. We put ourselves in the shoes of others with the intention of understanding what they are going through,
we employ empathy to make sense of their experiences.
In order for empathy to take place it is necessary that we should have in our own experience in our own minds, some
points of reference that correspond to those of the patients’ experience – in states of intense suicidal arousal or
excitement – we failure empathically, very commonly, because we have volatile representations in ourselves, we do not
imagine how much these patients suffer.
For decades we have know about the importance of empathy in mental health treatment; empathy is critical to the
formation of a therapeutic alliance and is central to major theories of treatment (e.g., Rogers' Client-Centered
Psychotherapy and Kohut's Self Psychology). While empathy is known to be crucial to effective mental health treatment
outcomes, it is sometimes challenging to be empathic of suicidal patients for fear of "endorsing" suicide. Yet Orbach
(2001) persuasively argued that "empathy with the suicide wish" is essential to any life-saving mental health treatment for
suicide risk. This presentation will examine this perspective in relation to evidence-based clinical interventions that
effectively treat suicidal risk. While aspects of these treatments vary, across these treatments there is a consistent
emphasis on a non-shaming, supportive, and empathic orientation to suicidality. More specifically, this presentation will
examine the role of empathy within Dialectical Behavior Therapy (Linehan et al., 2006), Cognitive Therapy for Suicide
(Brown et al., 2005), and the Collaborative Assessment and Management of Suicidality (Jobes, 2012). Finally, the
ongoing and future role of empathy in suicide-specific clinical research and clinical practice will be discussed.
Presentations of the Symposium
From Empathy to Mirror Neurons in the Understanding of Suicide Risk
Maurizio Pompili
Sapienza University of Rome
This presentation was developed with the aim of shedding light on the phenomenology of suicide, that is, to focus on
suicide as a phenomenon affecting a unique individual with unique motives for the suicidal act. Phenomenology studies
conscious experience as experienced from the subjective or first-person point of view. To explore this topic, the author
looks back at the past centuries to understand why suicide was thought to be confined to psychiatric illness and to
document the bias in studies supporting this notion. In contrast, here it is argued that suicide should not be considered to
be a symptom. Rather suicide is a separate dimension motivated by reasons which overlap the psychiatric dimension.
One major step forward in the conceptualization of suicide as a psychological disorder was provided by suicidology. Such
discipline described how the development of a state of the mind, that is, perturbation as a result of prolonged frustration of
vital psychological needs, can undermine individual’s life when the subject realizes that suicide is the best option to solve
unbearable psychological pain. This presentation also searches for new clues in the phenomenology of suicide and
proposes an integration of biological and psychological perspectives in order to describe and help suicidal individuals
comprehensively.
Brain imaging experiments using functional magnetic resonance imaging (fMRI) have shown that the human inferior
frontal cortex and superior parietal lobe are active when the person performs an action and also when the person sees
another individual performing an action. It has been suggested that these brain regions contain mirror neurons, and they
have been defined as the human mirror neuron system.
Seeing and doing can be synonymous when it comes to empathetic responses. When people see someone doing
something, they can imagine doing the same, naturally.
It can be argued, certainly, that people can grow desensitized to reactions like this, after being heavily exposed to violent
stimuli or otherwise.
The search for suicide risk factors, variables that indicate an increased likelihood for suicide, independent of diagnosis,
has been undertaken by a number of researchers and clinicians. Most studies have evaluated short-term risk factors for
suicidal behavior, such as current suicidal ideation and recent suicide attempts (particularly in the context of severe major
depressive episode), the major precursors and the most powerful predictors of attempted and completed suicide.
Nevertheless, during the course of this presentation, the author stresses the need to reconcile this with the fact that
suicide might be better understood as phenomenon centered in the individual. In other words, the motives for suicide can
be traced in the variables surrounding the individual viewed as a unique human being whose personality contains the real
reasons for wishing suicide.
The Role of Empathy in Evidence-Based Practices for Suicidal Risk
David Jobes
The Catholic University of America
For decades we have know about the importance of empathy in mental health treatment; empathy is critical to the
formation of a therapeutic alliance and is central to major theories of treatment (e.g., Rogers' Client-Centered
Psychotherapy and Kohut's Self Psychology). While empathy is known to be crucial to effective mental health treatment
outcomes, it is sometimes challenging to be empathic of suicidal patients for fear of "endorsing" suicide. Yet Orbach
(2001) persuasively argued that "empathy with the suicide wish" is essential to any life-saving mental health treatment for
suicide risk. This presentation will examine this perspective in relation to evidence-based clinical interventions that
76
effectively treat suicidal risk. While aspects of these treatments vary, across these treatments there is a consistent
emphasis on a non-shaming, supportive, and empathic orientation to suicidality. More specifically, this presentation will
examine the role of empathy within Dialectical Behavior Therapy (Linehan et al., 2006), Cognitive Therapy for Suicide
(Brown et al., 2005), and the Collaborative Assessment and Management of Suicidality (Jobes, 2012). Finally, the
ongoing and future role of empathy in suicide-specific clinical research and clinical practice will be discussed.
The Narrative Interview with the Suicidal Patient
Konrad Michel
University Hospital of Social and Community Psychiatry, Bern, Sw
Every suicidal act has a very individual background. A narrative is key for the validation of the patient’s own experience
and for establishing a therapeutic alliance. A narrative is defined as a story, which is told to an attentive listener, and in
which meaning to events is given, in order to explain a personal experience. Narratives provide a means of integrating the
suicidal crisis in the patient’s life story through emotional reactivation, which takes place in a secure, therapeutic setting. A
narrative approach requires acceptance and openness vis-à-vis the patients, recognizing them as the agents of their own
actions. Patients on the other hand have the narrative competence to describe and explain the subjective logic behind an
act of deliberate self-harm. The shared experience (in which narrator and listener learn together about hurt, pain, and
failure) is instrumental in re-establishing the teller’s broken sense of self. The interviewer does not compete as an expert
who knows more about the patient than the patient. Instead, the interviewer functions as an interested facilitator of an
injured person’s life story. From such an orientation it is possible for the therapist and the patient to review the past
together to learn how the patient's life and the perspectives for the future have become unendurable. Empathic
understanding allows the therapist, along with the patient, to grasp how suicide came to be seen as the only available
solution. Only then can a therapeutic process begin.
Narrative interviewing is a central element in ASSIP (Attempted Suicide Short Intervention Program), a brief and highly
effective therapy for suicide attempters. The theory and practice of narrative interviewing will be discussed, and examples
of video-recoded patient interviews will be shown.
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OP17-2E: Symposium: Raising All Boats: Disruptive Innovation in Suicide
Prevention through Lived Experience Leadership
Raising All Boats: Disruptive Innovation in Suicide Prevention through Lived Experience Leadership
Chair(s): Eduardo Robert Vega (Mental Health Assoc of San Francisco)
Millions of people experience suicidal thoughts and feelings on any given day. Over 4 million of these actually attempt to
kill themselves each year. Yet most of these individuals also survive theirdistress and attempts and go on to recover lives
of value and purpose, many as a reaction or development from these critical life challenges. Such people with lived
experience of suicide (PLES) have much to contribute to the knowledgebase, program design and social change
necessary to reduce suicide internationally. Only recently, however, have people disclosed with personal lived experience
of suicidal thoughts and feeling, and attempt survivors, been actively involved in shaping public and systemic perceptions
in ways that can make a difference for reduced suicide.
Today, across the globe people with personal experience of suicidal intensity, distress and attempts are challenging
thinking, building partnerships and creating change at the level of policy and systems on international, national, and local
levels. This symposium features leaders, researchers and advocates who are PLES on the forefront of transformative
systems and social change in five countries. Presenters from Canada, the United Kingdom, Australia, New Zealand and
continental Europe will discuss their areas of focus and impact, challenges to change, the role of personal disclosure in
policy and practices, and howPLES emerging as the catalytic agents for progress in reducing suicide around the world.
Presentations of the Symposium
Lived Expertise and the Way Forward: A Framework for Informing Suicide Supports and Prevention
Informed by Lived Experience of Suicide
DeQuincy Lezine
Center for Dignity Recovery and Empowerment
Earlier this year, the US National Action Alliance for Suicide Prevention released The Way Forward: Pathways to Hope,
Recovery, and Wellness with Insights from Lived Experience. This unprecedented document, developed by the Alliance's
Suicide Attempt Survivor Task Force, is the first to detail a comprehensive set of recommended practices, programs, and
policies for effective suicide prevention, from the perspective of persons who have lived through experiences of suicidal
thoughts and behaviors.
The Way Forward marks sea change in suicide prevention and highlihghts the possibilities for powerful innovation to
reduce suicide. Through its systematic look at the needs of people experiencing suicidal intensity, the experiences people
have had in services, both positive and negative, TWF reflects the braod potential of people who have been there to
innovate services that are truly helpful, create new policy and practice directions and foster supportive communities and
connectedness through challenging stigma and shame.
Protective Factors and Support for Suicidal People and Their Families in Aotearoa - New Zealand –
What Families Need
Corinda Taylor
Life Matters Suicide Prevention Trust
Many studies focus on suicidal behaviour but few focus on how and when support and education can be provided to
families to assist and guide their loved ones to cope with their illness. My family’s experience suggests not enough
provision is made for the support of affected families. The need for assistance to families seems to be poorly appreciated
by psychiatric professionals. The impact of confusion mixed with deeply disturbing emotion renders families helpless in
the face of their loved one’s distress. Exclusion and denial of families’ right to information is hidden behind supposed
concerns for patient privacy and/or confidentiality. The greatest transgression and disservice is thrust upon families and
their unwell relatives by suppression of information about suicidal ideation. Families, who have lay understanding of
mental illness and suicide, are not aware that certain illnesses have a higher risk of suicide. Factors which lead to the
induction of suicidal thoughts are beyond the understanding of families to whom mental illness is a foreign concept. It is
common for valid, even if uneducated, concerns of families to be dismissed by service providers. Even though the New
Zealand Ministry of Health mandates collaboration between mental health professionals and the families of those with
mental illness, that partnership is often overlooked by professionals. Since families may be unaware of the mandate, it is
the responsibility of health workers to initiate collaboration. However, workers often seem to disregard the deeper
understanding of a patient that kinship confers: families have a shared identity, shared history, familial intimacy, shared
use of language and customs, all of the idiosyncratic factors that constitute the connection promoted by affinity for those
of the same lineage.
In addition to respect for family knowledge of the patient, more objective matters of technical importance are vital, and
include: i. competent, careful electronic record keeping to permit continual review, consistent with best practice, and, ii.
utilisation of evidence-based medicine to ensure treatment accords with current best practice.
The predominant issue in New Zealand is an absence of education and training for key healthcare staff, especially
frontline staff, in all matters pertaining to procedures and processes of suicide prevention. Serious risk factors are not
identified. The risk significance of self-presentations to psychiatric services is not recognised. A laissez-faire attitude by
frontline staff, driven by complacency and desensitisation, leads to failures in insightful evaluation. These issues could be
addressed by mandated training in suicide prevention for all relevant healthcare staff.
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To summarise - family involvement and support are crucial in treatment and recovery of the mentally unwell person.
Promoting collaboration with families is vital.
Youth Lived Experience Leadership for Suicide Prevention in Canada
Alicia Raimundo
MH Commission of Canada
In Canada, Suicide is the # 1 cause of non-accidental death for young Canadians. And as many as 8% of young people
will try to take their own lives. But yet, young people are not included in the conversations about how to prevent suicide in
Canada. We struggle to include youth in the conversations, thinking we might "trigger" or "burden them". However, many
Canadian youth have started to ask to be engaged in the conversation. They are sharing their own lived experience story,
working along researchers in innovative youth-adult partnerships, and lobbying in parliament for policies and programs
that work. Sometimes, the change is as simple as asking someone the support they wanted. Other times it has been as
complex as changing provincial and federal funding structures, working with the UN on international change, or the
hardest of all: inspiring and encouraging others to seek help in a system that is constantly improving and changing. Youth
have taken leadership in the conversation, and are partnering with adults to create local and system wise change that
works for them.
What Should We Be Asking? Research and Practice Questions for Suicide Prevention and Lived
Experience
Eduardo Vega, DeQuincy Lezine
Center for Dignity, Reocvery and Empowerment
Once someone is experiencing suicidal intensity and distress what would they really want and benefit from as a support?
How do emergency rescus type interventions and inpatient care experienced by people and to what degree do they deter
further suicidal risk? What kinds of programs and messages need to be available to support people in the way they want?
How effective can peer support groups and self-help strategies be in reducing distress and attempts? To what degree is
shame and stigma a factor in isolation./thwarted belongingness? How can social connectness and other protective factors
be enhanced by open disclosure, peer support approaches? How could recovery oriented assesments that focus on hope
and engagement effect individuals in crisis as opposed to risk assessments?
The array of research studies and suicide prevention practices that actively engage with attempt survivors is currently very
narrow. Yet there is much to be gained and crucial research questions which could benefit individuals, the field of practice
and knowledge base. The Center for Dignity Recovery and Empowerment focuses on these questions and pilots potential
solutions driven by those who've experienced suicidality and attempts, to create a living laboratory for innovation of new
programs that could make a difference in peoplex lives, while simultaneoulsy evaluating and posing research questions
based on the findings of suicidology. This paper will highlight research in the field, current directions related to lived
experience and attempt survivors, and outline an agenda for new lines for inquiry relating theory and practice.
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OP17-2F: Workshop: Applying the Cost Benefit Analysis to Suicide
Prevention
Applying Cost Benefit Analysis to Suicide Prevention
Ramya Sundararaman, Chuck Lunati, Jim Frank
CALIBRE, United States of America; ramya.sundararaman@calibresys.com, chuck.lunati@calibresys.com
DISCUSSION LEADERS: Chuck Lunati, ORSA, CDFM, PMP, LSSBB, Vice President & Senior Economist, Health Policy
& Resource Analytics, CALIBRE Systems, member of the National Action Alliance for Suicide Prevention Zero Suicide
Advisory Group (ZSAG); Ramya Sundararaman, MD, LSSBB, Deputy Director, Health Policy & Resource Analytics,
CALIBRE Systems
Workshop Purpose: The aim of this workshop is to familiarize attendees with Cost-Benefit Analysis as a technique for
comparing alternative processes (including training, tools, and methodologies) of Suicide Prevention from healthcare
system perspective, and to understand the rationale and implications of using this method in health care decision-making.
Workshop Description: Healthcare System decision makers have limited resources and when presented with competing
Healthcare provider needs, they ultimately use (either formally or informally) some form of economic evaluation to provide
them with alternative solutions. A Cost Benefit Analysis (CBA) is a tool that provides a set of options (alternatives) to
decision makers to select a “course of action” from two (or more alternatives) that provides the most benefit for the least
cost. Both the benefit and cost are calculated in monetary values, so it is very flexible to comparing dissimilar alternatives.
In the field of suicide prevention, there have been discussions on and requests for CBAs – even this year, the Zero
Suicide Collaborative had tremendous activity associated with a need for more economic analysis. There are challenges
in the field. First, it is difficult to calculate the cost of each life saved in terms of perspective, assumptions, and social
sensibility. However, through a well-defined scope, agreed upon terms, and reasonable assumptions, we can estimate the
costs and benefits and hence, perform a (CBA). At the very least, two options concerning Suicide Prevention are: “no
action or change in current processes” (i.e., status quo) and “zero suicide”. In this workshop, we will discuss how a CBA
was applied to Zero Suicide. The overall approach will be presented and its strengths and limits will be discussed. We will
cover steps to conduct a CBA as well as the differences between a CBA and other economic evaluations. Participants will
be asked to complete and comment on a questionnaire. The key point for the discussion will be how participants can
apply a CBA for presenting their alternatives to decision-makers within their organizations.
Learning Objectives:
- Why do a CBA and when
- Learning the strengths and limitations of a CBA
- Reviewing the basic steps of a CBA for suicide prevention
- Sharing CBA references
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OP17-2G: Symposium: Crisis Chat Services - Development and Evaluation
Crisis Chat Services - Development and Evaluation
Chair(s): Alan Roger Woodward (Lifeline Australia)
Throughout the world, telephone helplines and related online crisis services are advancing in their understanding of
consumer needs and technological innovation.
This Symposium examines the development and evaluation of online crisis chat services from two countries that have
completed research on chat services.
The research discoveries are examined from specific insights applicable to the context of particular studies and
operations. The implications for online services worldwide are explored. The contribution of online crisis services to
suicide prevention will be drawn out through the presentations in the Symposium.
The session presentations will canvass the translation of research and evaluation knowledge into the delivery of online
crisis chat services. Some discussion questions would be:
- How to operationalize measures for research on crisis chat services?
- Can the research measures for telephone helplines be translated to online crisis chat?
- What do we know –and not know – about the consumers of crisis chat services?
Presentations of the Symposium
US Lifeline Crisis Chat – Evaluation and Development
Shari Sinwelski
US National Suicide Prevention Lifeline
The National Suicide Prevention Lifeline (USA) is a network of over 160 crisis centers throughout the US that are linked
through one toll free number. A primary mission of the Lifeline is to prevent suicide through reaching and effectively
serving those at risk and a significant focus is placed on developing standards of service delivery that underscore both
best practices in the field of suicide prevention and innovative approaches to reaching those at risk. All Lifeline centers are
independently owned and operated and as member centers must adhere to Lifeline established practice standards.
The Lifeline Crisis Chat program was established in early 2013 in partnership with CONTACT USA. Initially available 12
hours a day, the need for online service provision was immediately apparent and Lifeline has focused since its launch on
the expansion of the chat network (to be 24/7 in early 2015), the development of policies and procedures for chat service
provision, and the support of Online Emotional Support (OES) training and accreditation through CUSA. As of October
2014, the LCC centers were responding to an estimated 5,000 chats per month.
In early 2014, a Chat Quality Workgroup was established with participants from crisis center staff, Lifeline committee
members, the Columbia University Research Foundation for Mental Hygiene (RFMH) evaluation team, Contact USA, the
US Veterans Crisis Line (VCL), and Lifeline staff. Based on the newly distributed Lifeline Best Practices for Helping
Callers, this group began a review of chat transcripts to assess:
(a) the extent to which identified best practice elements are present in any given chat interaction,
(b) the extent to which they appear helpful/useful to the chatter, and
(c) the extent to which these best practice elements differ in an online context.
Developing a Methodology for the Evaluation of Crisis Chat Interventions
Madelyn S. Gould1, Alison Lake1, Rebecca Aspden2, Thomas Niederkrotenthaler2
1
Columbia University USA, 2Columbia University US
This presentation will describe an ongoing evaluation whose purpose is to develop and implement a methodology for
evaluating the process and outcomes of crisis interventions conducted via the new technology of online chat, as
implemented by the National Suicide Prevention Lifeline’s (USA) Crisis Chat program (LCC) Evaluation procedures have
been guided by those used in our earlier evaluations of telephone crisis interventions. The first step involved developing
an instrument that could be used to abstract information from crisis chat transcripts, after the model of earlier our silent
monitoring of crisis calls. An initial draft of a crisis chat coding form was prepared on the basis of a qualitative review of
de-identified chat transcripts provided by the LCC, a review of instruments used in our previous evaluations of telephone
crisis interventions, and a literature review of research on coding online and offline conversations. An iterative process of
revision of the crisis chat abstraction form ensued, followed by a series of inter-rater reliability exercises. The next step in
evaluating the impact of this emerging technology in crisis interventions involves coding a random sample of de-identified
transcripts of chat interventions with suicidal chatters implemented at the LCC crisis centers over a two year period. The
presentation will focus on the development and application of a crisis chat coding tool, based on the best clinical practices
of the Lifeline. We will present the inter-rater reliability of the new coding tool and the results from a pilot evaluation of
approximately 150 chats from suicidal individuals. The findings will focus on the risk profiles of the chat visitors, and the
interventions offered by the chat specialists.
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Lifeline Online Crisis Support Chat – Service Development
Jane Hayden
Lifeline Australia
Lifeline Australia is the largest helpline and crisis support service in Australia, answering more than 800,000 calls p.a. on
its telephone helpline and conducting more than 30,000 chat sessions. Lifeline Australia delivers services through a
network of 42 Lifeline Centres. Lifeline Australia has a Vision of an Australia free of suicide.
Lifeline Australia’s crisis support services use an evidence-informed service and practice model which underpins the
scope of service, the training and selection of personnel, supervision and quality assurance. For all Lifeline Australia crisis
support services, workers are trained using the LivingWorks ASIST program.
A challenge in the development of Lifeline Online Crisis Support Chat service was to test if the model and practice
standards applied to the telephone service could be replicated in a chat service environment.
External evaluation of a trial of Lifeline Online Crisis Support Chat service in 2011 used a set of process measures to
examine if the service and practice model could be applied to different modes of service delivery. The trial evaluation also
generated useful data on the profile of consumers of the chat service. The Chat service has now become a routine service
for Lifeline Australia.
More recent research has created a more detailed picture of consumers and their use of the Chat service. It has
established that about one-third of Chat visitors will not use telephone or other services when seeking help. This suggests
the online mode of service fills a previously unmet consumer need.
Social Return on Investment Study of Crisis Chat Service
Alan Woodward1, Arjun Ravi2, Luke Branagan3
Lifeline Research Foundation, 2Net Balance Consultants, 3MLC Community Foundation
Social Return on Investment (SROI) is a research and evaluation method that can be applied to suicide prevention
services.SROI combines outcome evaluation methods with economic analysis to examine the impact of a service on
consumers and other stakeholders, and to measure the economic value generated from the service. SROI is recognised
as an emerging methodology with its own peer review and practitioner recognition standards in place. It has been applied
to many social programs in the UK and is gaining in usage in other countries.
1
This presentation is on the findings of an SROI study on Lifeline Online Crisis Support Chat Service, Australia. The study
was conducted through the Lifeline Research Foundation, with external experts Net Balance engaged to ensure the
methdology complied with SROI standards. The Expert Advisory Group for the Lifeline Research Foundation, made up of
12 academic and clinical experts, reviewed the findings and report from this study.
The initial stage of the project involved a review of relevant research literature on crisis intervention and suicide
prevention, with particular focus on research studies concerning crisis support services such as helplines and crisis chat
services. For data collection on consumers, survey reseasrch was undertaken by the Lifeilne Research Foundation with
230 self-selected consumers of the service. This represented 1% of the number of visits to the Chat service in a year. The
demographic profile of the survey group aligns closely with the demographic profile of the overall popuation of service
consumers. Survey research using an online survey was used to collect data from respondents, incuding self-rated
experiences on the impact of the service against specified outcomes intended according to the Lifeline Crisis Support
Practice model, an evidence informed theory of change for the Lifeline Crisis Support services in Australia – and utilised
in New Zealand. Data analysis was undertaken by a third party through pro-bono support from the National Australia
Bank. Proxy indicators for economic analysis were developed to relate to the stated outcomes for the service. Cost of
suicide data from New Zealand studies were utilised due to the paucity of such data in Australia. Australian Bureau of
Statistics data helped inform the analysis on attribution estimates on the contribution the Crisis Chat service made to
consumer outcomes.
The value of the service was determined at $8.40 return for every dollar invested, which is considered relatively high by
SROI comparisons with other social programs. The SROI study also examined the spread of impact across different
service users and stakeholders. These findings are helpful in explaining the value of suicide prevention programs,
especially those oriented towards crisis intervention, to policy makers and potential donors/supporters. The SROI method
demonstrates the contribution short-term crisis support services make to suicide prevention.
Furthermore, this study shows how SROI methods may be used to establish effectiveness measures for suicide
prevention services – a challenge being identified in many national suicide prevention services.
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OP17-2H: Symposium: Cultural Suicide Research (IASP SIG on Culture and
Suicidal Behaviour)
Cultural Suicide Research (IASP SIG on Culture and Suicidal Behaviour)
Chair(s): Heidi Hjelmeland (Norwegian University of Science and Technology)
This symposium is rooted in an ongoing discussion within the IASP Special Interest Group on Culture and Suicidal
Behaviour about what culture is and how we best can conduct suicide research in different cultural contexts. In the
symposium there will be presentations from researchers working in different cultural contexts using different research
methods. We will discuss pros and cons, benefits and limitations of using research methods such as structured surveys,
ethnography, arts-based and visual methods. Speakers will also present about researching abstract concepts such as
‘religiosity’ and first-person research by people with lived-experience of suicide. The session will conclude by engaging
the audience in a discussion about ‘culture’ and what it might mean to do ‘cultural suicide research’.
Presentations of the Symposium
The Benefits and Pitfalls of Quantitative Suicide Research: Lessons Learned from a Survey of
People Who Inject Opioids in Delhi, India
Gregory Armstrong
Nossal Institute, The University of Melbourne
People who inject drugs (PWID) in Delhi, India are an impoverished and
Marginalized sub-population estimated to number 35,000. A quantitative survey of 420 PWID observed an alarmingly high
suicide risk in this community and uncovered some important psychological and culturally distinct suicide risk factors that
distinguish suicidal PWID from non-suicidal PWID. The survey used a probability-based sampling method for hidden
populations and community peers with intimate knowledge of the study population collected the data. Group discussions
with PWID and local community workers were held to validate the survey findings and to offer stakeholders a chance to
interpret the findings. Using members of the study population to interpret the findings is a powerful triangulation method
and can provide critical insights.
Analyzing Clusters of Suicide in Small Communities: A Qualitative and Ethnological Approach
Michel Tousignant, Geneviève Garneau
CRISE, University of Quebec in Montreal
Abstract: Clusters of suicide have been regularly reported (Niedzwiedz et al., 2014). Many originate in institutional settings
but a certain number of them have been observed in small communities, with an overrepresentation in Aboriginal
communities. There is no consensus on the definition of such clusters or on the factors involved. This study has been
ongoing between 2000 and 2009, collecting data on fifteen sites identified through the coroner's office or suicide
prevention teams. At the starting point, a cluster was defined as a series of three or more suicides, from a same
geographical territory, and separated by not more than a year. A stringent criteria was that suicides would have been in
close contact shortly before death. The method included interviews of community health employees, leaders as well as
members of the community and people closely related to the suicides.
Data showed that the representation of a cluster in the community was not necessarily based on objective facts. Few
informants had a clear idea of the number of suicides or of the connections between them. From a social sciences
perspective, it could be demonstrated that a cluster could be validated by the occurence in succession of suicides with
closed connections. In the population the factors contributing to conclude to an epidemics were the coverage by the
media, the inclusion of a very young suicide (11-12 year-old), or of a leader of the community, and the repetition of the
same method (judo belt, hanging in a closet).
Health agents are particularly vulnerable to such clusters because they are often related by kinship to the suicides or have
been called repeatedly to assist in the postvention operations. It is difficult to safeguard a private space and the panic
arising from the collective reaction bring community health agents to multiply interventions with little time and energy to
plan and evaluate their action. In conclusion, there is a need to build a protocole for suicide cluster situations and to help
the community to take action and become resilient.
The Seen and Unseen: Working towards Self Portraits of Suicidality and Healing
Mic Eales
Australia
People who have no lived experience of suicide often fail to recognize or accept the depth of pain (psychache)
experienced within a suicidal crisis. Suicide or more particularly its contemplation is seen as anything but conventional
thinking within today’s Western society and unfortunately is generally associated with some form of mental illness.
However, the extreme complexity of suicide is such that, I and many others, have found much solace in knowing that
suicide actually is an option. The integrated links between space and memory are inseparable when one seeks to
extricate the personal, social and cultural contents of memory. It is for this reason that in working and collaborating with
others who had similarly attempted suicide I decided to incorporate yarning as an essential method within my research.
Although generally considered an Indigenous research method for gathering stories, my approach to research has been
to partner the methodologies of dadirri (Deep Listening) and evocative research to act as a platform from which to create
a series of installation-based artifacts that respond imaginatively and poetically to original voice narratives of the lived
experience of suicide. Each narrative representation utilises specific combinations of media, through which meaning is
symbolically conveyed and expressed. This complex process of weaving together embedded layers of memory and
experience acts as a device to express and provide meaning to specific cultural and socio-cultural narratives. My role as
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storyteller/researcher attempts to express stories that are emotive, reflect on our humanity and provide insight into the
human condition. This paper will shed light on the benefits of empowering suicide attempt survivors in supporting and
collaborating with researchers to more fully understand various cultural and socio-cultural nuances of the suicidal mind.
Researching the Influence of Culture and Religiosity in Suicidal Behavior
Murad Khan
Aga Khan University, Pakistan
Religiosity is strongly influenced by culture, and religious, spiritual and cultural beliefs and practices are interwoven and
influence each other. Cultural factors have been found to buffer against suicide risk. Similarly, religious involvement and
spiritual well-being reduce the risk of suicide attempts. In studies on immigrants, religious well-being moderated the
relationship between acculturation and suicidality. Although culture and spirituality are seen as protective factors in
relation to suicidal behavior, the exact mechanisms by which culture influence spirituality and both protect from suicide
risk have not been established.
Research examining the role of cultural and spiritual factors in distinct populations is also limited. Research among these
populations, however, is vital for clinicians who need culturally appropriate therapies for the individuals they treat. In
addition, research comparing less vulnerable populations with higher risk populations may provide information that
improves treatment of the higher risk groups. For example, because religiosity is a factor primarily seen among certain
groups of population, studies may reveal that clinicians who encourage others to explore religiosity or an equivalent
protective factor are less likely to consider or attempt suicide.
By examining the cultural orientation, religiosity and worldview of populations at risk, we might uncover the protective
features of the beliefs, behaviors, and practices that reduce suicide risk in the population. This may also lead to an
understanding of the different suicide rates in different cultures and religions.
Future research should focus on cultural and spirituality protective factors that are found in some groups, and should also
examine whether these protective factors are unique to those populations. Research on cultural and spiritual protective
factors, however, must go further than simply correlating specific protective factors with lowered suicide risk. The
challenge would be to develop theories and empirically test how and why these cultural and spiritual protective factors
buffer suicide risk in different populations.
What Is Culture and How Can We Do Cultural Suicide Research?
Heidi Hjelmeland1, Birthe Loa Knizek2
Norwegian University of Science and Technology, 2Sør-Trøndelag University College, Norway
Cultural suicide research is crucial in order to develop our understanding of the meanings of suicidal behaviour in different
cultural contexts. But what exactly does it mean to conduct cultural suicide research? To be able to answer that question,
we first need to define what culture is. In the literature we meet a confusing mix of concepts, for instance, transcultural,
cross-cultural, inter-cultural or simply just cultural in relation to research. Each of these concepts has numerous different
definitions; sometimes used interchangeably, other times carrying different meanings. Often, culture simply is taken to be
the equivalent to countries or regions of the world and hence culture is viewed in an essentialist form as a static entity that
has been rendered explanatory power. That is, when differences across countries or regions are found, they are often
described as caused by culture or as cultural differences. However, our point of departure is that culture is not a static
variable but must be defined as the process of interaction between the person and his/her surroundings; as the dynamics
that arise in the interaction between the person and the environment. And, this dynamics cannot be explained in a linear
cause-and-effect relationship. Thus, culture cannot be treated as a causal or explanatory variable. Culture simply cannot
be operationalised into a variable to be measured in research projects since ‘culture’ is not a measurable variable. It
cannot be measured on a scale from 1-10 where we can say that some have a lot of culture and others have little, or, in
terms of presence or absence, where we can say that some have culture, others do not. Moreover, suicide is a complex
phenomenon. So, with culture as a process and suicide a complex phenomenon, how then can we do cultural suicide
research? In this presentation, we will argue that the only way to do that meaningfully is by means of qualitative research
since in such research it is possible to take more of the context and complexity into consideration in the analysis than
what is possible in quantitative research. With qualitative research we will be able to increase our understanding of the
meanings of suicide in different cultural contexts which in turn will contribute to a better understanding of suicide as such.
1
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OP17-2I: Symposium: Suicidal Behavior, Depression and Borderline
Personality Disorder in Adolescence, Clinical Research and Best Practice
Suicidal Behavior, Depression and Borderline Personality Disorder in Adolescence, Clinical
Research and Best Practice
Chair(s): Réal Labelle (Université du Québec à Montréal), Jean-Marc Guilé (Université de Picardie Jules-Verne, France)
This symposium will serve to report research data and experiences from clinical practice regarding major depression and
borderline personality disorder among suicidal adolescents.
Presentations of the Symposium
Protective Factors against Depression and Suicidal Behavior in Adolescence
Jean-Jacques Breton1, Réal Labelle2, Claude Berthiaume1, Chantal Royer3, Marie St-George1, Pascale Abadie1,
Priscille Gérardin4, David Cohen5, Jean-Marc Guilé6
1
Hôpital Rivière-des-Prairies, 2Université du Québec à Montréal, 3Université du Québec à Trois-Rivières, 4Université de
Rouen, France, 5Université Pierre et Marie Curie, France, 6Université de Picardie Jules-Verne, France
BACKGROUND: This study aims to: 1) finds out if protective factors moderate the impact of stressful events on
depression, and suicidal behavior in adolescence 2) examine the influence of sex and 3) discuss the clinical implications.
METHODS: Participants in the Protection for Adolescent Depression Study (PADS) were 402 adolescents from high
schools (n = 283) and in a Mood Disorder Clinic (n = 119) in Montreal. These were evaluated on six instruments
measuring risk and protective factors. Descriptive analyses, univariate and multiple logistic regression models were
carried out. RESULTS: Risk factors predicted higher levels of depression and presence of suicidal behaviour, and
protective factors lower levels of depression and absence of suicidal behaviour in both univariate and multivariate models.
Sex differences were observed in terms of the predictive power of risk factors (e.g., Hopelessness among girls and Keep
to self among boys) and protective factors (e.g., Focus on the positive among girls and Self-discovery among boys).
CONCLUSION: Protective factors moderate the impact of stressful events on depression and suicidal behaviour and
restoring protection appears especially relevant in chronic conditions such as depressive disorders in order to reduce the
likelihood of further episodes. The influence of sex makes it relevant to target different factors for boys and girls in
intervention and prevention.
Coping Strategies and Reasons for Living Associated with Suicidal Behavior in Adolescent
Inpatients with Borderline Personality Disorder
Jean-Marc Guilé1, Sébastien Garny de la Rivière2, Alexandra Knafo3, Nicolas Bodeau4, Jean-Jacques Breton5,
Réal Labelle6, Bojan Mirkovic7, Cornelia Pripis2, Nathalie Rey2, David Cohen8
1
Université de Picardie Jules-Verne, France, 2Service de psychiatrie de l’adolescent, CHU d’Amiens, France, 3Service de
psychopathologie de l\'adolescent, CHU Bernard, France, 4Service de psychiatrie de de l’adolescent, Salpêtrière, France,
5
Hôpital Rivière-des-Prairies, 6Université du Québec à Montréal, 7Université de Rouen, France., 8Université Pierre et
Marie Curie, France
BACKGROUND: To compare the coping strategies and the reasons for living of adolescents with borderline personality
disorder (BPD) to the coping strategies and the reasons for living of adolescents without BPD, and to explore their
association with suicidal ideation and attempts among BPD adolescents. METHODS: 243 adolescent inpatients aged 13
to 17 were admitted after suicide attempt and evaluated within 10 days, using 1) the Abbreviated version of the
Diagnostic Interview for Borderlines revised (Ab-DIB), 2) the Kiddie-Schedule for Affective Disorders and Schizophrenia
Present and Lifetime version (K-SADS-PL) supported by a team consensus best-estimate method for the primary
diagnosis, 3) the Columbia-Suicide Severity Rating Scale (C-SSRS), 4) the Adolescent Coping Scale (ACS), and 5) the
Reasons for Living-Adolescents. RESULTS: Compared with adolescents without BPD, BPD adolescents expressed fewer
reasons for living (RFL) and relied more on non productive coping strategies (CS), mostly avoidant strategies, and less on
productive coping strategies. Multivariate analyses performed on the association between RFL and CS, and suicidal
behaviors while controlling for age, gender and depression, will be detailed. CONCLUSION: BPD adolescents can be
discriminated from adolescents without BPD with respect to their RFL and CS profile.
Evaluation of Cognitive-Behavioral Treatments for Adolescents’ Self-Directed Violence: A
Systematic Review and Meta-Analysis
Réal Labelle, Alain Janelle, Louise Pouliot
Université du Québec à Montréal
BACKGROUD: Although cognitive-behavioral treatments are recognized as evidence-based interventions for depression
and other psychopatholgical conditions in adolescents, their efficacy remains equivocal in undermining self-directed
violence in this group. METHOD. This work first aimed to systematically and critically review the literature on cognitivebehavioral (CB) treatments for adolescents with self-directed violence (n = 25 studies). Second, a meta-analysis on data
from CB treatment studies based on a pre-post control group design (n = 14) was conducted. RESULTS: Overall studies
were run under non optimal scientific standards. For example, only two studies (8%) had sufficient statistical power to
detect a significant effect of the experimental treatment on self-directed violence. Meta-analysis of data from 13 studies
revealed a moderate significant treatment effect in reducing suicidal ideation (SI) (g = -.40, 95% CI = 0.30-0.49, z = 7.95,
p = 0.001). The standardized analysis of 8 studies for non-suicidal self-directed violent behavior (NSSDV) outcomes
indicated a significant effect (g = -.27, 95% CI = 0.17-0.38, z = 4.96, p = 0.00). Analysis of the suicidal self-directed
violent behavior (SSDVB) data did not yield a significant pooled effect (g = -.005, 95% CI = - 0.13-0.14, z = 0.07, p
= .99). CONCLUSIONS. CB therapies appear to have a clinically significant effect on both SI and NSSDVB. Low
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prevalence at baseline of SSDVB in most studies, because of active exclusion of adolescents at high risk of suicide, may
account of the poor observed effect of CB interventions on this behavioral problem.
Dialectical Behavior Therapy for Suicidal Adolescents: Implementation and Impact Study
Alain Janelle1, Réal Labelle1, Valentin Mbekou2, Johanne Renaud2
Université du Québec à Montréal, 2Institut en santé mentale Douglas, Université McGill
BACKGROUD: The link between suicidal behavior and major depression with borderline personality symptoms (BPS) is
well known. One of the best treatments in this field is dialectical behavior therapy (DBT). OBJECTIVES: To measure the
implementation of DBT in a clinical setting and to evaluate its Impact on BPS adolescents. METHODS: Fidelity of DBT
implementation was assessed by two independent raters reviewing the implemented program structure, material and
intervention protocols. The impact of this treatment was evaluated with 28 adolescent patients (M = 15.9 years; SD =
1.26) using a pretest-posttest design. Measures were taken before and after a 20-week program through assessment of
coping skills and borderline personality symptoms (BPS include suicidal behavior). RESULTS: High interrater agreement
(program structure = 90.1%, kappa = 1.00; material = 95%, kappa = 0.92; intervention protocol = 93.8%, kappa 0.82) was
found between actual and planned programs. Correlation analyses showed a significant relationship between decrease in
BPS and improvement in mindfulness (r = -0.43), emotional regulation (r = 0.55), and distress tolerance (r = 0.73). Linear
regression analyses showed improvement in distress tolerance alone contributed significantly to decrease in BPS (β = .67, p = 0.001). In addition, a hierarchical regression analysis showed that decrease in BPS could be achieved by
improving, first, mindfulness (β = 0.67, p = 0.01), second, emotional regulation (β = 0.75, p = 0.01) and, third, distress
tolerance (β = -0.67, p = 0.01). The model explained 56% of the variance. CONCLUSIONS: Results showed DBT was
properly implemented in Montreal and had an impact on reducing BPS by improving coping skills. Moreover, the order in
which skill are taught in DBT seems to be relevant.
1
Correlates, Stability and Predictors of Borderline Personality Disorder among Previously Suicidal
Youth
Brian Jeffrey Greenfield1, Melissa Henry2, Eric Lis1, Josh Slatkoff3, Jean-Marc Guile4, Geoffrey Dougherty1, Xun
Zhang5, Amir Raz1, L.Eugene Arnold6, Londa Daniel5
1
McGill University, Faculty of Medicine, Canada, 2Jewish General Hospital, Department of Psychology, 3British Columbia
Ministry of Children and Family Development, 4University de Montreal and Douglas Mental Health Institute, 5Montreal
Children\'s Hospital, 6Professor Emeritus of Psychiatry, Ohio State University
Objective: This article examines a large cohort of previously suicidal adolescents, identifying those that surpassed
threshold criteria for Borderline Personality Disorder (BPD), according to the Abbreviated Diagnostic Interview of
Borderlines (Ab-DIB), and determining the stability, correlates and predictors of BPD from early to late adolescence.
Method: Two hundred eighty-six youth (mean baseline age: 14.6; SD: 1.5), presenting consecutively to a metropolitan
pediatric hospital emergency department for evaluation of suicidality, were assessed at initial consultation for Axis I & II
disorders and demographic and clinical variables. Two hundred twenty nine (80%) were re-assessed for those variables
four years later and 204 (70.3%) had complete data sets at recruitment and follow-up.
Results: Previously suicidal youths who met BPD threshold on the Ab-DIB at recruitment were distinguishable at baseline
from those who did not in conduct disorder symptoms (p<0.003), lower levels of functioning (p<0.001), drug use
(p<0.001), stressful life events (p<0.003) and family relations (p<0.001). The BPD diagnosis was consistent, according to
this measure, at baseline and follow-up for 76% of participants. Four groups with respect to borderline pathology
(persisting, remitting, emerging and never) were identified (ICC = 0.603, 95% CI = 0.40-0.78). Persistent BPD status was
predictable by older age at presentation (p<0.01) and level of functioning (p<0.05). Eight percent were also suicidal at
four-year follow-up.
Conclusions: Using a self-report measure of BPD, we suggest that suicidal youth can potentially be diagnosed with the
disorder at 14 years old, given what appears to be its temporal stability, differentiation of those suffering with considerable
symptomatology or not, and predictors of its status in late adolescence. The low suicidality rate at follow-up indicates a
good short-term prognosis.
86
OP17-2J: Symposium: Life Experiences and Patterns of Distress in
Chinese and Chinese-Canadian Women with a History of Suicidal
Behaviour
Life Experiences and Patterns of Distress in Chinese and Chinese-Canadian Women with a History
of Suicidal Behaviour
Chair(s): Paul S. Links (Western University, London Ontario Canada), Juveria Zaheer (Centre for Addiction and Mental
Health, Toronto Ontario Canada), Xiaoqian Zhang (Tsinghua University, Beijing China)
China is the only country in the world where women have higher rates of suicide than men (Phillips et al, 2002). In the
Greater Toronto Area, 10.4% of the population identifies as ethnically Chinese (Statscan, 2006). Recent studies have
highlighted higher rates of suicidal behaviour and associated themes of gender role stress in Chinese women residing in
North America, including conflict between traditional and Western female roles (Chung, 2003).
This study explores the experiences, stressors and beliefs of Chinese-born women living in Canada with a history of
suicidal behaviour, and the impact of gender as a social and cultural construction on their experiences, including selfimage, relationships, ways of coping, and the communication of distress. Through qualitative interviewing and analysis,
the participants contribute to an understanding of the way in which these women construct their meanings and
experiences of gender, culture and suicidal behaviour through their interactions with their families, social structures and
with the investigators of this study. Our collaborators at Tsinghua University have explored the same questions in a
population of women living in Beijing, China, and a comparative analysis at the thematic level has also been conducted,
utilizing the process of asking reflexive questions to highlight the process of cross-cultural work and to compare
similarities and differences between the themes that emerged from both groups.
In the Canadian sample, women described restricted patterns of emotional communication, feelings of lack of agency,
experiences of victimization and oppression and stress related to both traditional gender expectations and expectations
related to rapid social change. Expectations of immigration often went unmet and stress arose from financial, educational
and family pressures. Stressors (marital stress, family/role stress, work/financial/educational stress mediated by
immigration/medical issues) lead to a build up of "stress" and "pressure". Restricted patterns of emotional communication,
lack of agency, recurrent patterns of victimization and oppression and gendered expectations lead to a coping style
focused on "endurance" of distress. However, enduring on one's own leads to negative view of self, physical
manifestations of distress, worsening depressive symptoms and feelings of hopelessness. Eventually, the women come to
a "breaking point" where they can no longer endure in this way, leading to suicidal behaviour that can be understood in
three ways 1) as an escape from pain and distress 2) as a way to communicate distress and 3) as a consequence of
pervasive hopelessness.
The analysis of the Chinese sample is in progress and will be available for presentation at the symposium. A crosscultural analysis focusing on both content and process will also be presented.
Presentations of the Symposium
Background and Statement of Problem
Juveria Zaheer1, Samuel Law2, Wes Shera3, Ka Tsang3, Alan Fung4, Paul S. Links5
1
Centre for Addiction and Mental Health, Toronto Ontario Canada, 2St. Michael\'s Hospital, Toronto Ontario Canada,
3
University of Toronto, Toronto Ontario Canada, 4North York General Hospital, Toronto ON, 5Western University, London
Ontario Canada
This presentation will review rates of suicidal ideation and behaviour and its relationship with gender internationally,
focusing on Canetto & Sakinofsky’s gender paradox of suicidal behaviour (1998), which describes how in almost every
country in the world, women have higher rates of suicidal ideation and behaviour, but lower rates of death by suicide than
men. We will contrast this pattern that which has been seen described in China, where national reports on suicide have
shown a strong reversal of the international trend: in those who are under age 60, female rates exceed male rates by an
average of 26%, with rural female rates exceeding rural male rates by 66% (Murray and Lopez 1996; Ji et al 2001).
Cultural conceptions of gender and suicide have been used to explain this discrepancy, and these will be discussed.
In this section, the importance of a qualitative analysis of the impact of social and cultural conceptions of gender on the
meanings and experiences of suicidal behaviour in Chinese-Canadian women will be outlined. While the impact of gender
role stress has been postulated as a risk factor for suicide, the need for further evidence, specifically an understanding
and appreciation of their experiences, has been stressed in the literature. While studies of suicide in women of Asian
descent in North America often recognize “psychosocial stressors” as a risk factor, empirical studies, specifically from the
perspectives of the women themselves, are scarce. Pearson et al (2002) suggest that further studies are needed to
address the impact of social stress and inequality on Chinese women, specifically those in rural areas, and the lack of
social and economic support to manage this stress. Joe et al (2008) have recommended qualitative ethnographic studies
in order to appreciate the complex experiences of ethnic minorities.
87
Methods
Juveria Zaheer1, Samuel Law2, Wes Shera3, Ka Tsang3, Alan Fung4, Pozi Liu5, Paul S. Links6
1
Centre for Addiction and Mental Health, Toronto Ontario Canada, 2St. Michael\'s Hospital, Toronto Ontario Canada,
3
University of Toronto, Toronto Ontario Canada, 4North York General Hospital, Toronto Ontario Canada, 5Tsinghua
University, Beijing China, 6Western University, London Ontario Canada
The methods used in this study and the rationale for same will be described in this presentation. The qualitative
interviews and analysis in the study were informed by constructivist grounded theory. Grounded theory is a systematic
qualitative research methodology that emphasizes the generation of theory rooted in data (Glaser and Strauss, 1977).
Constructivist grounded theory is a contemporary revision of grounded theory that assumes a relativist approach,
acknowledges multiple standpoints and realities of both the grounded theorist and the research participants, and takes a
reflexive stance towards actions, situations and participants, allowing the researchers to undertake a literature review and
form hypotheses to inform the qualitative interviewing and analysis (Charmaz, 2008). Constructivist grounded theory
guidelines assist in the examination of social psychological processes, direct data collection, manage data analysis and
develop an abstract theoretical framework that explains the studied process (Charmaz, 2003). Qualitative interviewing can
provide an in-depth exploration of an aspect of life about which the interviewee has substantial experience and can elicit
views of the person’s subjective world (Charmaz, 2003).
Canadian Findings
Juveria Zaheer1, Samuel Law2, Wes Shera3, Ka Tsang3, Alan Fung4, Catherine Cheng3, Rahel Eynan5, Paul S.
Links5
1
Centre for Addiction and Mental Health, Toronto Ontario Canada, 2St. Michael\'s Hospital, Toronto Ontario Canada,
3
University of Toronto, Toronto Ontario Canada, 4North York General Hospital, Toronto Ontario Canada, 5Western
University, London Ontario Canada
In the Canadian sample, women described restricted patterns of emotional communication, feelings of lack of agency,
experiences of victimization and oppression and stress related to both traditional gender expectations and expectations
related to rapid social change. Expectations of immigration often went unmet and stress arose from financial, educational
and family pressures. Stressors (marital stress, family/role stress, work/financial/educational stress mediated by
immigration/medical issues) lead to a build up of "stress" and "pressure". Restricted patterns of emotional
communication, lack of agency, recurrent patterns of victimization and oppression and gendered expectations lead to a
coping style focused on "endurance" of distress. However, enduring on one's own leads to negative view of self, physical
manifestations of distress, worsening depressive symptoms and feelings of hopelessness. Eventually, the women come to
a "breaking point" where they can no longer endure in this way, leading to suicidal behaviour that can be understood in
three ways 1) as an escape from pain and distress 2) as a way to communicate distress and 3) as a consequence of
pervasive hopelessness.
Chinese Findings
Xiaoqian Zhang1, Juveria Zaheer2, Paul S. Links3, Rahel Eynan3, Samuel Law4, Pozi Liu1
1
Tsinghua University, Beijing China, 2Centre for Addiction and Mental Health, Toronto Ontario Canada, 3Western
University, London Ontario Canada, 4St. Michael\'s Hospital, Toronto Ontario Canada
The analysis of the Chinese sample is in progress and will be available for presentation at the symposium.
Cross-Cultural Suicide Prevention Research – Process and Content
Juveria Zaheer1, Pozi Liu2, Samuel Law3, Xiaoqian Zhang4, Wes Shera5, Ka Tsang5, Catherine Cheng5, Paul S.
Links6
1
Centre for Addiction and Mental Health, 2Tshingua University, Beijing China, 3St. Michael\'s Hospital, Toronto Ontario
Canada, 4Tsinghua University, Beijing China, 5University of Toronto, Toronto Ontario Canada, 6Western University,
London Ontario Canada
A cross-cultural thematic analysis will be presented. Similarities in life experiences of victimization and oppression,
gender-based pressures and patterns of distress have been noted in the analysis thus far, while differences exist with
respect to immigration pressures, access to care and experiences of recovery. The process of conducting cross-cultural
suicide prevention research internationally will also be discussed, focusing on collaborators’ experiences and reflections
of facilitators and challenges.
Translating Results into Suicide Prevention Strategies
Juveria Zaheer1, Samuel Law2, Alan Fung3, Wes Shera4, Ka Tsang4, Paul S. Links5
1
Centre for Addiction and Mental Health, Toronto ON, 2St. Michael\'s Hospital, Toronto Ontario Canada, 3North York
General Hospital, Toronto Ontario Canada, 4University of Toronto, Toronto Ontario Canada, 5Western University, London
Ontario Canada
This section will present results-informed strategies that can be developed and evaluated in this population. Of particular
focus will be educational strategies for primary health care providers that focus on identifying suicide risk for these
women, building a therapeutic relationship focusing on providing an explanatory model, building agency, proper
assessment and management of mental health issues, and instrumental support.
88
OP17-2K: Gender and Suicide Risk and Behaviours
Gender Differences in Suicidal Behaviour in Patients with First-Episode Psychosis
Gudrun Austad1, Inge Joa2,3, Jan Olav Johannessen2,3, Tor Ketil Larsen2,4
RVTS Vest, Norway; 2Psychiatric Division, Regional Centre for Clinical Research in Psychosis, Stavanger University
Hospital; 3Faculty of Social Sciences, University of Stavanger, Stavanger; 4Institute of Psychiatry, University of Bergen,
Bergen, Norway; gnad@helse-bergen.no
Abstract
1
Aim: Patients with psychotic disorders represent a high-risk group for suicidal behaviour. Prior research shows
contradictory gender patterns in suicidal behaviour among patients with first-episode psychosis. Suicidal ideation has
been detected in 22–40% of patients at baseline and 8–32% have a history of suicide attempts, often prior to start of
treatment. Research on gender differences in suicidal ideation among patients with first-episode psychosis is limited. The
aim of this study was to investigate gender differences in the prevalence of suicidal behaviour (suicidal ideation, suicide
plans and suicide attempts) and to delineate risk factors for suicidal behaviour among consecutively included male and
female patients with first-episode psychosis in the TIPS II early detection study.
Methods: Patients with first-episode psychosis (n = 246) from a hospital catchment area with a system for early detection
were assessed and compared on baseline sociodemographical and clinical variables according to gender. Current (past 1
month) and lifetime prevalence of suicidal behaviour were assessed.
Results: Current and lifetime rates of suicidal behaviour were high (50.8% and 65.9%, respectively) and higher among
females (lifetime: 78.3 %, past month: 64.2 %) versus males (lifetime: 56.4 %, past month: 40.7 %). Depressive symptoms
and female gender were associated with both lifetime and current risk for suicidal behaviour. Lifetime prevalence was also
associated with a longer duration of untreated psychosis and young age after controlling for other risk factors.
Conclusions: Suicidal behaviour was frequent among patients with first-episode psychosis, with a higher prevalence of
suicidal behaviour in females. Depressive symptoms and female gender were significantly associated with suicidal
behaviour.
Strengths and limitations: The main limitation of this study is the potential for recall bias inherent in the retrospective
assessment of suicidal behaviour. We attempted to minimize potential bias by cross-checking reports of suicide attempts
with medical records and utilizing all available data sources. Additionally, we observed a relatively high refusal rate (40%),
which may have introduced potential selection bias. However, a comparison of participants versus non-participants
revealed no differences in sociodemographic characteristics. The age of females in our study was younger than typically
reported by FEP studies and may indicate a selection bias, or perhaps be attributable to the improved case detection by
the early detection teams. The risk of suicide in FEP is related to other risk factors, the measurement of which fell beyond
the scope of this study. The strength of this study is the large, representative, populationbased cohort of consecutively
enrolled FEP patients with a fairly equal gender distribution.
Risk Factors Associated with Suicide among Men: Comparison between Men Aged Under 40 Years
of Age and Those Who Are Older
Jacklyn McCarthy1, Amanda Wall1, Paul Corcoran1,2, McAuliffe Carmel3, Ella Arensman1,2
National Suicide Research Foundation, University College Cork, Ireland; 2Department of Epidemiology & Public Health,
University College Cork, Ireland; 3St. Patrick’s University Hospital, Dean Clinic, Cork, Ireland; jacklynmccarthy@ucc.ie
Introduction
1
The Suicide Support and Information System (SSIS) was established in Cork, Ireland in 2008. The SSIS outcomes
showed that men were over represented among those who died by suicide in Ireland (80.1%) (Arensman et al, 2013).
Although there are numerous studies that have addressed risk factors for suicide, less is known about the co-occurrence
of each of these risk factors and their impact on different subgroups. The objectives of the study were to identify cooccurring risk factors associated with suicide for men aged under 40 and over 40 years of age, and to recommend
appropriate strategies for suicide prevention and intervention initiatives for men in Ireland.
Method
Data were obtained via checklists completed on the basis of the coroners’ records for consecutive cases of suicide after
conclusion of the coroner’s inquest in Cork City and County from September 2008 to June 2012.
Results
The SSIS recorded 243 male deaths by suicide during September 2008 to June 2012. Of this group, 131 (54%) were
under 40 years of age, while 115 (47%) were over 40 years of age. The level of unemployment was significantly higher
among the younger men (<40: 39%, ≥40: 27%). Major life events varied across the two groups. Men under 40 years of
age experienced the following stressful life events prior to death: psychiatric illness (33%), physical illness (22%),
depression (20%) and legal trouble with the police (20%). Men aged over 40 years of age experienced psychiatric illness
(48%), physical illness (39%), depression (36%) and legal trouble with the police (12%).
89
For both age groups the most common method of suicide was hanging, although this was significantly more often
reported for men aged under 40 years of age (<40: 79%, ≥40: 57%). At time of death men aged over 40 more often had
drugs in their toxicology (≥40: 36%, <40: 24%). A greater proportion of those aged under 40 had alcohol only in their
toxicology (<40: 29%, ≥40: 18%). Men aged under 40 were significantly more likely to have engaged in previous acts of
self-harm (<40: 31%, ≥40: 16%). A higher percentage of the young men knew of a friend or family member who also had
engaged in self-harm (<40: 18%, ≥40: 7%). Those aged under 40 years were also three times more likely to know of a
suicide by a family member or close friend (<40: 30%, ≥40: 10%).
Conclusions
The different risk profiles for men aged under 40 and over 40 years have important implications for suicide prevention and
intervention initiatives. The impact of unemployment accompanied by other risk factors (e.g. history of self-harm, alcohol
or drug abuse) on suicide rates highlights the need to prioritise suicide prevention programmes during times of economic
recession, in particular among young men.
A Cross-National Study on Gender Differences in Suicidal Intent
Aislinne Theresa Freeman1, Christine Rummel-Kluge1, Roland Mergl1, Elisabeth Kohls1, András Székely2, Ricardo
Gusmao3, Ella Arensman4,5, Ulrich Hegerl1
1
2
University of Leipzig, Germany; Semmelweis University, Budapest, Hungary; 3New University of Lisbon, Portugal;
4
National Suicide Research Foundation, Ireland; 5University College Cork, Ireland; aislinne.freeman@medizin.unileipzig.de
Background: Suicide is among the ten leading causes of mortality which accounts for over 58,000 deaths in Europe per
annum. The rate of suicide attempts is estimated to be 10-20 times higher. Males have been found to have a
disproportionately lower rate of suicide attempts and an excessively higher rate of completed suicides compared to
females, and the gender differences in suicidal intent is posited to be a critical factor that contributes towards this gender
imbalance. The aim of this study is to assess gender differences in suicidal intent, and to determine whether these
differences are dependent on age and country.
Methods: The data utilized in the current study was from the EU-funded OSPI-Europe project, where data on suicidal
intent from 5212 patients was obtained from hospital emergency departments and categorized into ‘Non-habitual
Deliberate Self-Harm’, ‘Parasuicidal Pause’, ‘Parasuicidal Gesture’, and ‘Serious Suicide Attempt’. Gender differences in
intent were explored for significance by using χ²-tests, multivariate ANOVA and binary logistic regressions.
Results: A significant association of suicidal intent and gender was found, where Serious Suicide Attempts were rated
significantly more often in males than females (p<0.001). There was a significant difference in age and intent between the
genders (p<0.001), and gender differences in intent were also found between the countries (p<0.001).
Limitations: There was a large amount of missing data which led to many cases being excluded. Cases of non-fatal
suicidal acts were identified exclusively through emergency departments of hospitals
Conclusions: The findings have many clinical and practical implications which may guide future practice, and supports the
notion of targeted prevention and intervention strategies.
Gender Differences in Patterns of Deliberate Self-Harm in South Africa
Jason Bantjes1, Henri de Wet1, Ian Lewis2
University of Stellenbosch, South Africa; 2University of Cape Town; jbantjes@sun.ac.za
1
Background: Suicidal behaviour is a gendered phenomenon with consistent reports from developing countries showing
that self-harm is more prevalent among women while completed suicides is more frequent among men. However
comparatively little is known about gender differences in patterns of deliberate self-harm (DSH) in developing countries.
Objective: To analyse gender differences in patterns of DSH among a group of patients treated at a large urban hospital in
South Africa (SA).
Method: Detailed demographic, socio-economic, contextual and clinical data were collected from 100 consecutive cases
of DSH presenting at an emergency department of a large academic hospital in SA. Data were statistically analysed using
SPSS (statistical package for the social sciences) to determine if significant gender differences exist in the demographic
characteristics of patients (age, race, ethnicity, and religion), socio-economic variables (level of education and
employment status), contextual factors (method time and place of self-harm, stated reason for self-harm and evidence of
substance use), clinical features (presence of psychiatric illness, prior contact with mental health care services and past
suicidal behaviour) as well as the level of medical attention required.
Results: The proportion of men engaging in acts of DSH which require medical treatment was significantly higher among
this group than is typically reported in developing countries, with men constituting approximately 45% of patients. There
were also significant gender differences in the demographic features of DSH patients and the socio-cultural circumstances
in which this group of South Africans engage in acts of DSH. The clinical picture and level of medical intervention required
to treat the male patients was also distinctly different to that of the female patients.
90
Conclusion: The findings provide some insight into the epidemiology of DSH in SA and add to the growing body of data on
gender differences in patterns of suicidal behaviour in the developing world. More research is required in SA to
understand the reasons for these gender differences and to explore their clinical implications.
Suicidality among Latina Adolescents: The Relative Effects of Psychosocial Risk Factors and
Psychological Symptoms
Kiara Alvarez
Cambridge Health Alliance, United States of America; kalvarez@charesearch.org
In national surveys of U.S. adolescents, Latina females have been found to have higher rates of suicidal ideation and
attempts when compared to Latino males and to non-Latino White and Black males and females (Centers for Disease
Control, 2014). The reasons for these gender and racial disparities in suicidal behavior have not been definitively
established. Prior research indicates that suicidal behavior among adolescents is influenced by both individual-level
psychological symptoms and by psychosocial risk factors (Bridge, Goldstein, & Brent, 2006; King & Merchant, 2008;
Prinstein, Boergers, Spirito, Little, & Grapentine, 2000). Among Latina adolescents in particular, the interplay between
cultural processes and family relationships has been identified as a key influence on suicidal behavior (Zayas, 2011). The
purpose of this study was to build upon Zayas’s (2011) model of suicidality among adolescent Latinas by evaluating the
relative effects of individual, family, and peer factors on suicidality (ideation, plans, and attempts). A latent variable
structural equation model (SEM) was developed and tested using a sample that included 946 U.S. Latinas aged 13 to 18
who were interviewed for a national psychiatric epidemiological survey, the National Comorbidity Survey – Adolescent
Supplement (NCS-A; Kessler, 2013). The SEM model measured the direct and indirect effects of the latent variables of
generation status, peer support, negative peer influence, family relationships, and depression on suicidality. Results of the
study indicated that higher levels of depression, poorer family relationships, and higher levels of negative peer influence
were associated with higher levels of suicidality. The influence of family relationships and negative peer influence on
suicidality were partially mediated by depression; however, negative peer influence also had a substantial direct effect on
suicidality. Results of this study support a clinical focus on multisystemic interventions for Latina adolescents that address
functioning at individual, family, and peer levels, as well as further investigation into the pathways by which negative peer
influence impacts suicidality in this population.
91
OP17-2L: Self Harm and Deliberate Self Harm
Characteristics of Persons from a Population Study (the HUNT Study) Who Were Hospitalized
Because of Deliberate Self-Harm or Took Their Own Lives
Wibeke Stuen Leira1,2, Ottar Bjekeset2, Solveig Klaebo Reitan2,3, Eystein Stordal2, John Olav Roaldset1,2
Aalesund Hospital, Norway; 2University NTNU, Trondheim, Norway; 3St.Olav hospital; wibeke.stuen.leira@helse-mr.no
Background:
1
Studies of suicidal behavior mostly involve patients that have been treated in psychiatric settings: inpatient or outpatient.
Fewer studies have examined suicidal behavior in a general population. The Nord-Trøndelag Health Study 2 (HUNT 2)
and the HUNT 3 were conducted in 1995-97 and 2006-08, respectively. Of the nearly 100 000 adults in the region eligible
for participation, about 65000 (70%) participated in HUNT 2 and about 51000 (54%) in HUNT 3.
The aims of the study are
(i) to identify persons participating in HUNT 2 or HUNT 3 who were hospitalized because of deliberate self-harm (DSH) or
had taken their own lives in the period 1995-2013, and
(ii) to explore demographic and clinical characteristics of this group.
Methods:
The data are collected from three sources: (i) Hospital records from the three near-by hospitals of the region; Namsos
Hospital, Levanger Hospital and St Olav University Hospital, to identify the HUNT participants that had been hospitalized
because of deliberate self-harm in medical, surgical or psychiatric departments (Hospital registry). (ii) The National
registry of death and (iii) the HUNT 2 and HUNT 3 registers. Finally, the three sources (registers) were linked,
depersonalized and transferred to SPSS data file for further analyses.
Results:
Totaling 78 000 persons were included from the HUNT 2 and HUNT 3. Of these, 435 persons were recorded with DSH,
and 96 had taken their own lives. Further demographic and clinical results will be presented, and also characteristics of
persons with repeated hospitalizations with DSH.
A New Primary Care Approach to the Assessment and Care of those in Self-Harm/Suicide Crisis
Sean McCarthy
Health Service Executive, Ireland; sean.mccarthy@hse.ie
This presentation will outline the development of a Suicide Crisis Assessment Nursing (SCAN) service to primary care.
Over a five year period the National Office for Suicide Prevention in Ireland piloted the development and delivery of a
priority referral, rapid assessment and care service within primary care for individuals experiencing self-harm/suicide
distress. The service was established to offer to primary care an expert mental health nursing service that would.
1. Be available, accessible and speedy in responding to GP's requests for a timely assessment of those in distress
2. Carry out a comprehensive (bio-psycho-social) needs assessment of the client within the GP surgery
3. Work collaboratively with the GP and the wider specialist psychiatric services to institute a health/social care plan to
meet the risks and care needs of the duistressed client.
The pilot service was subsequently evaluated by the National University of Ireland Galway. The main findings of this
evaluation will be outlined in the presentation as well as an overview of the current position regarding the National roll out
of the service across Ireland. During 2014 an additional 8 sites were chosen to develop the service and these are
currently operational. Within the Health Service Executive service plan for 2015 the further development of the service is
planned.
Predicting Non-Suicidal Self-Injury at 12 months – A Place for Psychometric and Behavioural
Assessment of (Experiential) Avoidance?
Emma Nielsen, Kapil Sayal, Ellen Townsend
University of Nottingham, United Kingdom; lpxen@nottingham.ac.uk
Background
The Experiential Avoidance Model (EAM) considers non-suicidal self-injury (NSSI) as a form of experiential avoidance,
employed in response to a stimulus that elicits an intense aversive emotion. This conceptualisation is consistent with
research that views NSSI as a means of coping with distress; NSSI representing a means of escaping or altering the
nature or intensity of an otherwise intolerable emotion.
While there is a range of cross sectional work addressing NSSI, comparative little research has addressed the dynamics
92
of behaviour change. There is a dearth of understanding regarding the factors which prospectively predict NSSI
behaviour(s) and whether these are different to variables which can predict NSSI status at one time point. Given the high
risk of repetition in NSSI and negative outcomes associated with escalation, insight into temporal dynamics and
prospective research are paramount.
We investigated whether psychometric and behavioural assessments of (experiential) avoidance are able to distinguish
NSSI status cross-sectionally, including considerations of recency of engagement, and whether measures of avoidance
could predict self-injury outcome at 12 months.
Method
This prospective study recruited undergraduate students who, at baseline, completed standardised assessments of
(experiential) avoidance, wellbeing, momentary affect and history of NSSI. Half of the participants were randomised to
receive a negative mood induction, before participants in both conditions completed a behavioural approach/ avoidance
task. NSSI status, wellbeing and momentary affect were re-assessed at follow up (12 months).
Results
One hundred and forty participants (110 females) aged 18-29 years were recruited to the study, of whom 114 provided
recency information. At baseline 43% (N=49) of participants had no history of NSSI, 39% (N=45) had self-injured in their
lifetime, but not within the last month and 18% (N=20) had self-injured recently (within the previous month). Eighty-nine
participants (78%) completed follow-up, 47% (N=42) of whom had self-injured in the intervening 12 months. At baseline
assessment, between-groups differences were observed in both psychometric and behavioural measures. Moreover, both
psychometric and behavioural components predicted self-injury at 12 months (above baseline NSSI history, depression
and anxiety)
Conclusion
This preliminary longitudinal work suggests that behavioural approach/avoidance paradigms may have promising utility in
the prediction of future NSSI, which has important implications for clinical practice.
Systematic Review of Self-Harm and Suicide in Children and Young People in the Care of the State
Rhiannon Evans
Cardiff University, United Kingdom; EvansRE8@cf.ac.uk
Children and young people who have experience of being in the care of the state are a vulnerable population. Entry into
state care is associated with numerous adverse health, social, and economic outcomes across the life-course (Viner and
Taylor, 2005; Simkiss, 2012). There is evidence to suggest that status as a looked after child or young person (e.g.
residing in children’s homes; foster care; youth detention centres) predicts self-harm, suicide ideation and suicide (Meltzer
and Lader, 2005; Storey et al., 2005; Katz et al., 2011). However, there remains limited systematic synthesis of the
evidence in this area, in addition to a dearth of understanding around the causal pathways to self-harm and suicidality.
There is some evidence to suggest that this population are a higher risk by virtue of the fact that they have been subjected
to numerous adverse life events prior to entering care (Katz et al.,2011), whilst other research highlights the public care
system’s lack of ameliorative effect. This paper presents a systematic review of the prevalence of self-harm and suicide in
children and young people who have experience of being in the care of the state, along with associated risk and protective
factors.
Methods: A systematic review was conducted of international studies that empirically examine suicide ideation; self-harm
(with and without suicidal intent); para-suicide and suicide in children and young people who have experience of being in
the care of the state. The population was restricted to those aged 25 and under. All studies designs were included.
Appraisal and synthesis of the included papers is currently being finalised.
Results: The results of the systematic review will be presented in two sections: 1) meta-analysis of the prevalence of selfharm and suicide in children and young people who have experience of being in the care of the state 2) narrative
synthesis of the risk and protective factors associated with self-harm and suicide. These include: the stability of care
placements; age of entry into care; relationships with birth family.
Conclusion: Elicitation of the higher prevalence of suicide and self-harm in children and young people who have
experience of being in the care of the state compared to the general population highlights their vulnerability. Identification
of pertinent risk and protective factors is instructive in informing future theoretically informed prevention and intervention.
93
OP17-2N: Understanding Suicide and Suicidal Behaviours I
The Cross-Cultural Applicability of American-Based Theories of Suicide
Blaire Catherine Schembari, David Jobes
The Catholic University of America, United States of America; 95schembari@cardinalmail.cua.edu
Collaborative Assessment and Management of Suicidality (CAMS) is a suicide-specific intervention (Jobes, 2006). Central
to CAMS is the Suicide Status Form (SSF), a multiuse assessment, treatment planning, tracking, and outcome tool
(Jobes, 2006). The SSF has been used domestically and internationally and has strong psychometric properties (Jobes et
al., 1997). The present study will take a cultural perspective based on suicidal patients’ ratings and rankings of the first
five “SSF Core Assessment” (CA) constructs, which are American-based theories of suicide, across six different nations.
The CA is routinely used in the first session of CAMS; it demonstrates strong validity and reliability (Conrad et al., 2009).
Additionally, first session ratings of these scales describe and predict treatment outcomes and reductions of suicidal
ideation over treatment (Jobes et al., 1997). The CA is comprised of six constructs. These constructs have corresponding
rating scales. The first five constructs are derived from the work of Shneidman (1988), Beck and colleagues (1979), and
Baumeister (1990). After rating each construct, patients rank order constructs from most to least important. A recent US
study examined patients’ rankings of the CA constructs across different samples of suicidal patients; results revealed
significant differences indicating variations in construct importance (Martin & Jobes, 2014). There is strong evidence for
the impact culture has on the suicidal experience (Colucci, 2013). As highlighted by Mishara (2006), suicide research has
mainly focused on the universalities of suicide among different cultures. In addition, notwithstanding external issues that
may contribute to suicide, theories of suicide propose there are common internal motivations for suicide (Mishara, 2006).
The first five theory-based CA constructs are considered to be universally relatable. Since these constructs are derived
from American theorists, they may be tapping into important aspects of the suicidal experience other studies from different
cultures may not have previously investigated. Therefore, this study aims to further the current state of knowledge
regarding suicide and culture and cultivate insight into important potential cultural differences of patients’ suicidal
experience by investigating possible cross-cultural differences and/or similarities between suicidal patients’ rankings and
ratings of the CA. Data utilized in this study were derived from archival research conducted in their respective nations—
Denmark (n=54), Ireland (n=34), Norway (n=25), Switzerland (n=35), Taiwan (n=20), and the US (n=32). In order to
compare the ratings and rankings of CA constructs, frequencies will be calculated and One-Way Analyses of Variance will
be conducted. This study may enhance clinicians’ and researchers’ understanding of cultural differences among suicidal
persons, leading to the development of more precise and culturally informed suicide-specific clinical tools.
Pain, NSSI and Suicidal Behavior: A Systematic Review
Olivia J Kirtley1, Ronan E O'Carroll2, Rory C O'Connor1
University of Glasgow, United Kingdom; 2University of Stirling, United Kingdom; o.kirtley.1@research.gla.ac.uk
Introduction: There is a growing body of research exploring altered physical pain threshold and tolerance in nonsuicidal
self-injury (NSSI). Despite this recent attention, however, the evidence is inconsistent such that the nature of the
relationship is unclear. Additionally, whether or not this effect is also present in suicidal self-harm is equivocal. A further
question also exists as to what mechanisms may account for altered pain tolerance within these populations. This
systematic review, therefore, aimed to: 1) evaluate the strengths and limitations of the evidence for/against altered pain
threshold and tolerance in NSSI and suicidal self-harm; 2) identify psychological correlates of altered threshold and
tolerance for physical pain; and 3) identify candidate explanatory mechanisms for the phenomenon.
1
Methods: A keyword search of three major psychological and medical databases (PsycINFO, Medline and Web of
Knowledge) was conducted, yielding 1,338 records of which (following duplicate removal), 964 records were screened.
Following screening, the remaining 39 articles were read to determine if they met the inclusion criteria, yielding 25 that
were included in the final systematic review. All articles were quality assessed.
Results: There is strong evidence for increased pain tolerance in NSSI and some evidence for this in suicidal individuals.
There was a total absence of prospective research examining the relationship between NSSI and suicidal self-harm and
altered pain threshold and tolerance. No studies have explored pain threshold and tolerance in those with NSSI or suicidal
ideation, or in those who have not previously engaged in self-harm behavior. Furthermore, there was a marked lack of
research examining pain tolerance in suicidal individuals, compared to the number of studies focused on NSSI. The
review also highlighted the lack of substantive focus on psychological correlates of altered pain tolerance in this
population. Several candidate explanatory mechanisms were proposed within the reviewed studies, including offset
analgesia, endogenous opioid activity and opponent process theory.
Conclusions: Prospective research investigating altered pain tolerance in those who engage in NSSI and suicidal selfharm is a critically important area for future research, as this will help to determine if altered pain threshold and tolerance
are a cause or a consequence of the behavior. Similarly, future studies should also aim to include those with
NSSI/suicidal ideation, as this may provide further answers. Psychological correlates of increased pain tolerance has
been a neglected area of research and could provide opportunities for treatment/intervention development, if mediating or
moderating pathways can be identified. Too few studies have directly investigated candidate explanatory mechanisms to
draw definitive conclusions.
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Pain, Selflessness, and the Desire to Be Like Everyone Else: Examining Interpersonal Theory of
Suicide within Stories of Attempted Suicide
Kathy McKay1, Sarah Coker2, Samara Gray2, Myfanwy Maple1
University of New England, Australia; 2SANE Australia; kmckay8@une.edu.au
Aims: One of the first Australian studies including people with lived experience of suicide, the aim of this study was to
explore factors that helped or hindered people’s recovery after they had attempted suicide.
1
Methods: In total, 31 people who had previously attempted suicide were interviewed about their suicidal crises. Interviews
were semi-structured and conducted via telephone after a risk assessment was completed. These narratives were then
analysed thematically to explore how the stories told spoke to the experiences of Thwarted Belongingness, Perceived
Burdensomeness, and Acquired Capacity in Joiner’s Interpersonal Theory of Suicide.
Relevance: Suicide remains a tragedy on a global scale where every death means a life cut short and people left
bereaved. Various theories to understand suicide have been proposed, including Joiner’s Interpersonal Theory of Suicide.
However, little research around this theory has included people with lived experience when examining how a suicidal
crisis leads to a suicide attempt.
Results: Participants’ stories demonstrated Thwarted Belongingness within narratives of loneliness and being alone prior
to their suicide attempt. People told stories of social isolation and how attempts to connect were rejected, subsequently
leading to suicidal crisis. Perceived Burdensomeness was spoken in terms of suicide being the only way to release
participants’ beliefs that they were a burden on people around them. Here, suicide was described as a selfless act due to
the presumption that others would be better off without them. While Acquired Capacity was spoken about in terms of
method selection, suicide-bereaved participants tended to find that their grief experiences protected them from attempting
suicide on some occasions as they did not want to cause this same bereavement in others.
Conclusions: These findings demonstrate that Joiner’s Interpersonal Theory of Suicide is relevant to the experiences of
this sample of Australians who had previously attempted suicide, particularly the constructs of Thwarted Belongingness
and Perceived Burdensomeness. Findings from this study also illuminated the potentially protective nature of suicide
bereavement. These findings suggest that future suicide prevention initiatives need to find ways of identifying and
including socially isolated people. Strategies also need to be incorporated that provide varied and layered social and
healthcare supports for people struggling with suicidality so as to prevent their perceptions of burdensomeness.
From Saaz to Shneidman: Ethical Considerations in Suicide Prevention
Kenneth Norton
NAMI New Hampshire, United States of America; proberts@naminh.org
From the days of ancient Greece to modern times suicide has posed vexing philosophical and ethical questions. Despite
this historical philosophical tradition, it is rare these days for clinicians or professionals working in the field of suicide
prevention to openly address ethical issues related to this work. For instance, three US states now have physician
assisted suicide laws as do several European countries, yet this issue and the closely related end of life/quality of life
issues are infrequently addressed within our professional community.
Clinicians and suicide prevention professionals working with suicidal individuals or in the area of suicide prevention, face
ethical challenges which may vary for different age cohorts and cultures. Provision of effective suicide prevention or
clinical practice requires professionals to recognize and examine their own personal values and attitudes as well as
respecting and understanding those of their clients. Particularly for clinicians, response and service to at risk clients must
be provided in a competent manner, with recognition of the strengths and needs of the individual and within the context of
ethical codes and standards.
The workshop will touch on important ethical concepts such as dignity and worth of the individual, self-determination,
involuntary treatment, informed consent, confidentiality and assisted suicide. This program will examine ethical concerns
related to working with clients who are dealing with suicidal thoughts and behaviors, and will encourage clinicians to be
more cognizant of how their own values, experiences and belief system impact their work.
• Reflect on how our own personal, and professional values, experiences and belief system impact our work with clients
presenting with suicidal thoughts and behaviors
• Understand the important role informed consent plays in treating suicidal or potentially suicidal individuals
• Demonstrate a greater understanding of ethical concerns related to suicidality in clients.
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Accounting for Protective Factors Implicit in the Interpersonal Theory of Suicide: The Role of Zest
for Life
Sarah Elizabeth George, Werner G. K. Stritzke, Andrew C. Page, Khan Collins
University of Western Australia, Australia; sarah.george@research.uwa.edu.au
Research Aims
According to the Interpersonal Theory of Suicide (ITS), three proximal risk factors underlie suicidal behaviour. 'Thwarted
belongingness' and 'perceived burdensomeness' are life draining forces that drive suicide ideation, while 'acquired
capability' facilitates the transformation of desire into lethal suicidal behavior by overcoming the evolutionarily ingrained
desire to live (Joiner, 2005). To date, evidence in support of the interpersonal theory has been promising but is limited by
(a) not accounting for protective factors such as zest for life and (b) a lack of experimental manipulations to test the causal
role of the core components of the ITS. Although implicit in the ITS, strong zest for life provides a protective barrier to
engaging in suicidal behavior (Linehan et al., 1983; O’Connor & Nock, 2014) that may counteract the adverse effects of
the interpersonal variables, while its depletion or recent weakening may also signal heightened risk.
Prior to testing the theoretical predictions of the protective role of zest for life in the pathway to suicide risk, a new
measure, the Zest for Life Scale (ZLS) was first developed. A novel team-based task (Burdensomeness and
Belongingness Suicide Analogue Task; BABSAT) was also devised to manipulate the core constructs of the interpersonal
theory and to test the moderating influence of zest for life.
Methodology
The factor structure of the new ZLS was tested using exploratory and confirmatory factor analyses in Study 1 (n = 200)
and Study 2 (n = 417) respectively. In Study 3 (n = 237), prospective validity of zest for life in relation to markers of suicide
risk was tested using structural equation modelling. In Study 4 (n = 98), participants who were recruited based on ZLS
scores (high or low) played the BABSAT, to test the effects of induced burdensomeness and thwarted belongingness on
desire to disengage, a proxy for the desire to give up on life.
Conclusions
Consistent with the ITS, zest for life significantly partially mediated the relationships between the interpersonal variables
and suicide risk. Zest for life was significantly negatively associated with all markers of suicide risk, suggesting that it may
mitigate risk. In the final study, heightened levels of induced burdensomeness and thwarted belongingness caused
significant deficits in persistence on the BABSAT, while individual differences in zest for life partially buffered the adverse
effects of the interpersonal variables on desire to disengage from the task.
Findings suggest that zest for life protects against suicide risk and should be considered in theoretical models and in
clinical risk assessments. The new Zest for Life Scale is a reliable and valid measure to assess this concept.
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SP18: Plenary Session 2 [séance plénière 2]
1) Contributions of Art to (Mis) Understanding Suicide: Analysis of 1,750 Suicides in Feature Films / [Contribution de l’art à
la (mauvaise) compréhension du suicide : une analyse cinématographique de 1750 suicides], Steven Stack; 2) Predicting
Suicidality Using Blood Biomarkers and Clinical Data / [La prédiction des tendances suicidaires par l’utilisation de
marqueurs biologiques et de données cliniques], Alexander B. Niculescu, III; 3) Preventing Suicide among Young People.
Results of the Saving and Empowering Young Lives in Europe (SEYLE) Project / [Prévention du suicide chez les jeunes.
Résultats du projet Saving and Empowering Young Lives in Europe (SEYLE)], Vladimir Carli
Contributions of Art to (Mis) Understanding Suicide: Analysis of 1,750 Suicides in Feature Films /
[Contribution de l’art à la (mauvaise) compréhension du suicide : une analyse cinématographique
de 1750 suicides]
Steven Stack1, Barbara Bowman2
Wayne State University, United States of America; 2Center for Suicide Research; steven_stack@hotmail.com
Suicidology has neglected the arts. Film is an influential art form, being linked to public opinion on a variety of social
problems, emotions, and behaviors. Through its use of such artistic mechanisms as images, body language, facial
expressions, & tone of voice film can communicate effective, emotion-based messages about suicide in a way that cannot
be done in scientific articles and newspapers. Suicides embedded in stories acted out by loved film stars may be
especially effective in shaping a cultural definition of suicide.
1
The present discussion presents selected findings from an ongoing, decade long project on suicide films. Findings are
illustrated with brief film clips. The themes are suggestive of a cultural definition of suicide, which simultaneously helps &
hinders efforts at effective suicide prevention.
Intimate Partner Problems(IPP). Most films stress a social not psychiatric cause of suicide. 25.1% films link suicide to IPP
(close to 27% of 30,000 suicides in the Nat’l Violent Death Reporting System, NVDRS, but understudied). Film Clip: The
Great White Hope, 45 seconds, clip of domestic verbal violence scene before the off screen suicide.
Legal Problems. While 12.6% of real suicides in the NVDRS cite legal problems (e.g., custody issues)as a contributing
factor, only a handful of the 51,000 articles on suicide in Medline have this as a focus. Film Clip: Anna Karenina, Anna
disobeys a restraining order to visit Sergei on his birthday.
Death of a Loved One. Film clip: extreme grief expressed in House of Sand & Fog over a child’s sudden death.
Job Problems: 9.6% suicide in film, close to 10.0% in NVDRS. Film clip: Up in the Air.
Demonization of Suicide. 20% of film suicides are psychopaths- audience feels glad, not sad about suicides. Film Clip:
Mystery Ranch, kidnapper/serial killer suicides – final act of defiance.
Suicide Prevention: Love & Work prevent suicide attempts from transitioning to suicides. Film Clip: The Titanic.
Does Talk/Drug Therapy Help? An analysis of 130 suicide attempt movies found that those who receive treatment are
more likely to complete suicide than those who receive no treatment. Film Clip: The 6th Sense, patient breaks into the
home of film star Bruce Willis, a psychiatrist, murders him and then suicides.
Lethal Means: Gun suicides increased in film by .36%/year from 1910 to 2010, reflecting/contributing to an increase from
30% to 50% in gun suicides in society. Males are 3.9 times more apt than females to choose guns in film, contributing to
the suicide differential in society.
Conclusions: Cultural definitions of suicide in film (including French & British) are similar to those in 2,000 years of
literature, but their social emphasis is different from definitions in psychiatry. Films provide new ideas for research,
encourage suicide prevention through connectedness, but have dangerous qualities as well.
Predicting Suicidality Using Blood Biomarkers and Clinical Data / [La prédiction des tendances
suicidaires par l’utilisation de marqueurs biologiques et de données cliniques]
Alexander B. Niculescu. III
Indiana University, School of Med., dept Psych.; anicules@iupui.edu
Predicting suicidality using a combined genomic and clinical risk assessment approach Predicting suicidal behavior in
individuals is one of the hard problems in psychiatric clinical practice, and in society at large. What if we had better,
objective and quantitative ways to do it? We had previously provided proof of principle of how a first generation blood
biomarker test discovered in bipolar subjects, combined with some clinical symptoms data, could have predictive ability. I
will present comprehensive data for a next generation, broader-spectrum, blood biomarker and clinical predictor tests. Of
note, both these instruments (biomarker panels and new clinical scale) do not require asking the person assessed if they
have suicidal thoughts, as individuals who are truly suicidal often do not share that information with people close to them
or with clinicians. We propose that the widespread use of such risk prediction tests as part of routine or targeted
healthcare assessments will lead to early disease interception followed by preventive lifestyle modifications or treatment.
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Preventing Suicide among Young People. Results of the Saving and Empowering Young Lives in
Europe (SEYLE) Project / [Prévention du suicide chez les jeunes. Résultats du projet Saving and
Empowering Young Lives in Europe (SEYLE)]
Vladimir Carli1,2
National Centre for Suicide Research and Prevention of Mental Ill-Health at Karolinska Institutet, Stockholm, Sweden;
2
WHO Collaborating Centre for Research, Training and Methods Development in Suicide Prevention;
Vladimir.Carli@ki.se
Globally, among young adults 15-29 years of age, suicide accounts for 8.5% of all death and is ranked the second most
important cause of death after traffic accidents. Suicide attempt is the most important predictor of future suicide and,
among young people, is an important indicator for long-term health-care requirements and social burden. Saving and
Empowering Young Lives in Europe (SEYLE) is a research project that aimed at developing, implementing and evaluating
school-based suicide preventive interventions. The project involved 11,110 pupils recruited from randomly selected
schools in 10 European Union countries: Austria, Estonia, France, Germany, Hungary, Ireland, Italy, Romania, Slovenia
and Spain, with Sweden as the coordinating centre. The main objectives of SEYLE were to lead adolescents to better
mental health through decreased risk-taking and suicidal behaviours; to evaluate and compare the outcomes of three
preventive interventions based on different approaches; and to recommend culturally-adjusted intervention models that
effectively promote adolescent mental health and well-being in European countries.
1
Each country performed a RCT comprising three active interventions and one minimal intervention serving as a control.
The active interventions comprised gatekeeper training (QPR), mental health awareness training (YAM), and professional
screening for at-risk adolescents (ProfScreen). Structured questionnaires were developed and administered to pupils at
baseline, with 3-month and 12-month follow-ups to examine and compare the effects of the interventions.
No significant differences between intervention groups and controls were observed at 3 month follow-up. At 12-month
follow-up, a significant effect of the YAM programme, compared with controls was observed with reduction of incident
suicide attempts (OR: 0·45 [0·24 - 0·85]; p=0·014) and severe suicidal ideation (OR: 0·50 [0·27 – 0·92]; p=0·025). No
completed suicides among participants were observed during the study period.
YAM was shown to be effective in preventing suicide attempts and severe suicidal ideation. These findings underline the
benefit of universal suicide preventive interventions in schools.
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Poster Session B: June 18 / 18 juin - Poster Session [séance par affiche]
An Observational Study of Bullying as a Contributing Factor in Youth Suicide in Toronto
Mark Sinyor, Ayal Schaffer, Amy Cheung
University of Toronto / Sunnybrook Health Sciences Centre, Canada; mark.sinyor@sunnybrook.ca
Objective: Bullying has been identified as a potential contributing factor in youth suicide. This issue has been highlighted
in recent widely publicized media reports worldwide in which deceased youth were bullied. We report an observational
study conducted to determine the frequency of bullying as a contributing factor to youth suicide.
Method: Coroner records were reviewed for all suicide deaths in youth aged 10-19 in the city of Toronto from 1998-2011.
Data abstracted were recent stressors (including bullying), clinical variables such as the presence of mental illness,
demographics and methods of suicide.
Results: Ninety-four youth suicides were included in the study. Mean age was 16.8 years and 70.2% were male. Bullying
was present in 6 deaths (6.4%) and there were no deaths where online or “cyber” bullying was detected. Bullying was the
only identified contributing factor in fewer than 5 deaths. The most common stressors identified were conflict with parents
(21.3%), romantic partner problems (17.0%), academic problems (10.6%) and criminal/legal problems (10.6%). Any
stressor or mental and/or physical illness was detected in 78.7% of cases. Depression was detected in 40.4% of cases.
Conclusions: This study highlights the need to view suicide in youth as arising from a complex interplay of various
biological, psychological and social factors of which bullying is only one. It challenges simple cause and effect models that
might suggest that suicide arises from any one factor such as bullying.
Associated Risk Factors for Suicide Ideation among University Students in Wuhan, Centre of China
E-Sheng Zhou1, Ming Zhang2, Ping Qin3, Xu Yang2
University Hospital, Central China Normal University, China; 2School of Life Sciences, Central China Normal University,
China; 3National Centre for Register-based Research of University of Aarhus, Denmark; eshengzhou@163.com
Background: Depression is becoming a significant issue in university students, since depressive symptoms affect
academic performance, are associated with health compromising behaviors, and may in extreme cases contribute to
suicide. Reports of suicides and violent incidents on campus in the world have added urgency to the development of
effective prevention and intervention programs.
1
Objective: To explore the associated risk factors for suicide ideation among university students in Wuhan, central of
China.
Participants and Methods: Using a stratified random sampling method we selected 705 students from six universities in
Wuhan city and adopted the 19-item Beck Scale for Suicide Ideation (Beck Scale for Suicide Ideation, BSI) with recent
one year life events for assessment and data collection. By the online survey we received completed questionnaires from
385 male and 320 female students. We computed the contingency frequency of study variables and examined risk factors
for Suicide Ideation last week using Chi-square test and conditional logistic regression.
Results: The rate of suicide ideation within last week was 3.0%, but when the most depressed, most melancholy, the rate
of suicide ideation within last week was 10.8%. Recent one year life events of sampling students analyzed by Chi-square
show that negative life events induced suicide ideation, such us failed in an exam (p<0.000), broke up love (p<0.041),
conflict with classmates (p<0.002), lack of money (p<0.027), suffered an acute illness (p<0.001), no friend (p<0.001), and
no group activities at spare time (p<0.041) significantly. When modeling the data with logistic regression analysis, we fund
that two risks for suicide ideation for the most depressed and melancholy, is significantly more and more, failed in an
exam (OR=2.363, p<0.000), self suffered an acute illness (OR=2.306, p<0.000).
Conclusion: When the most depressed, most melancholy, the prevalence of suicide ideation among these students was
higher (10.8%). This result suggests the importance and necessity of promoting mental health care and psychological
consultation among universities in Wuhan, Centre of China.
E Ho`opili No Na Haumana (Meaning “to Come Together for the Students”) Project, Campus Wide
Suicide Prevention: Results and Lessons Learned
Darren H. Iwamoto, Dale R. Fryxell
Chaminade University of Honolulu, United States of America; diwamoto@chaminade.edu, dfryxell@chaminade.edu
This poster presentation provides an overview of a comprehensive, culturally appropriate, campus-wide suicide
prevention program which was developed and implemented at a four-year university. The goal of the project is to prevent
suicide attempts and completions and to enhance services for students with mental and behavioral health problems such
as depression and substance use/abuse. The project has accomplished its goals by improving and strengthening the
mental health and substance abuse prevention services and wellness programs at the university. This was done by
improving the assessment, identification, treatment capacity and infrastructure system at the university utilizing
evidenced-based strategies that are gender and culturally sensitive. The program provides mental health services to the
university’s students, faculty, staff, families and parents, including a special focus on several high-risk groups including
gay, lesbian, bisexual, and transgender students, as well as Native Hawaiian and military students.
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The poster provides: an overview of the various components of the campus-wide strategy that has been successful in
implementing the program; specific lessons learned that can be used by other schools that are interested in developing
suicide prevention programs; programming that was developed as part of the project in order to reach all stakeholders
(students, faculty, staff, and families); and data that has been collected to assess the effectiveness of the project.
This project was supported by the U.S. Department of Health and Human Services, Substance Abuse and Mental Health
Administration Services (SAMHSA) Grant 1U79SM060476-01.
Centre of Research Excellence in Suicide Prevention (CRESP): Promoting Research, Translation,
Education and Collaboration in Suicide Prevention
Karolina Krysinska1, Helen Christensen1, Philip Batterham2, James Butler3, Alison Calear2, Ian Hickie4, Andrew
Mackinnon5, Nicholas Martin6, Judy Proudfoot1, Maree Teesson7
1
Black Dog Institute, University of New South Wales, Australia; 2Centre for Mental Health Research, Australian National
University, Australia; 3Australian Centre for Economic Research on Health, Australian National University, Australia;
4
Brain & Mind Research Institute, University of Sydney, Australia; 5Centre for Youth Mental Health, University of
Melbourne, Australia; 6Queensland Institute of Medical Research, University of Queensland, Australia; 7National Drug
and Alcohol Research Centre, University of New South Wales, Australia; k.krysinska@unsw.edu.au
Centre of Research Excellence in Suicide Prevention (CRESP) is a research and translation centre funded by the
National Health and Medical Research Council, located at the Black Dog Institute, Sydney, Australia. CRESP brings
together leading Australian and international experts in suicide prevention to share expertise and resources and
undertake the necessary research to promote rapid advances in suicide prevention and to lower suicide rates in Australia
and internationally.
CRESP links the expertise of researchers, clinicians, suicide prevention organisations, consumers, carers and
government in order to bring gains in suicide prevention. CRESP Investigators include suicide researchers in Australia
and New Zealand, and suicide prevention experts from Europe, Asia and USA. Organisations delivering suicide
prevention services, such as crisis support services, helplines, online services, mental health promotion, and advocacy
organisations are collaborating with CRESP as Industry Partners.
CRESP aims to generate new research to increase the knowledge base regarding effective suicide prevention and
treatment via four research streams:
1) Better delivery of interventions: this stream involves testing the effectiveness of interventions delivered to risk groups
using the latest developments in eHealth technology through mobile phones, ipads or computers.
2) Better knowledge of causes and risks: investigating new models of suicide causation through a range of survey and
focus group projects.
3) Improved help-seeking: investigating the effectiveness of potentially useful methods to increase help seeking, including
self-screening, suicide literacy and lowering stigma around suicide and mental health issues.
4) Improved prioritising of suicide funds: within this stream CRESP aims to develop guidelines to assist policy makers in
determining priorities for funding suicide prevention programs. It involves modelling the effectiveness of interventions,
their costs and impacts.
In addition to conducting high quality innovative research, including application of e-health technologies, CRESP’s goal is
to disseminate evidence-based practice and policy. This is being achieved through scientific publications in Australia and
internationally, the Centre website (http://www.cresp.edu.au), contacts with the media, policy consultations and
conference workshops and presentations.
In September 2014 CRESP established a Consumer Committee to help guide research through engaging with those at
risk of suicide, suicide survivors, and families and friends of those who have died by suicide. Key aims of the Consumer
Subcommittee include the canvassing of priorities for research in suicide and promoting knowledge of and participation in
research. At the same time CRESP seeks to provide the Committee members with an opportunity to raise awareness and
knowledge of suicide and suicide prevention in Australia and engage with researchers.
Hopelessness as a Predictor of Suicidal Ideation in Depressed Youth after Acute Treatment with
Fluoxetine
Sarah Horton1,2, Jessica King1,2, Paul A. Nakonezny1, Jordan Gates3, Taryn L. Mayes1,2, Aleksandra Foxwell1,2,
Graham J. Emslie1,2, Beth D. Kennard1,2, Kristin Linette Wolfe1,2
1
University of Texas Southwestern Medical Center; 2Children's Medical Center Dallas; 3University of Texas at Austin;
sarah.ezzell@utsouthwestern.edu
Objectives: Several studies have suggested that hopelessness plays a key role in suicidality (Kuo, Gallo & Eaton, 2004;
Forman et al., 2004). Few have studied this relationship in youth (Steer, Kumar, & Beck, 1993) and the majority of these
have been retrospective examinations (Enns et al., 1997; McLaughlin et al., 1996). We examined hopelessness,
depression severity, and suicidal ideation at baseline as predictors of suicidality after 6 weeks of acute treatment.
Methods: Participants were enrolled in a randomized controlled trial which examined the impact of fluoxetine alone
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compared to medication plus therapy. Of the 200 enrolled in acute treatment, 147 were adolescents and administered the
Beck Hopelessness Scale (BHS) and the Children’s Depression Rating Scale-Revised (CDRS-R) as part of a larger
battery (n=147). The BHS and CDRS-R were evaluated at baseline and after 6 weeks of treatment with fluoxetine. All
statistical analyses were run using SAS software, version 9.4 (SAS Institute, Inc., Cary, NC). The level of significance was
set at α = .05 (two-tailed). Results: The mean age was 14.86 ± 1.69, 59.3% were female and 77.9% were Caucasian.
Depression severity was in the marked range (M= 59.10), and 51% reported having suicidal thoughts, plans or recent
attempts at baseline. The mean BHS score was in the moderate range (9.24 ± 5.49) at baseline. The multiple linear
regression (with both baseline BHS and baseline CDRS-R Total included in the same model, overall model R2=0.09) and
the Pearson partial correlation revealed that baseline hopelessness (BHS) was positively and significantly related to
suicidal ideation after 6 weeks of acute treatment with fluoxetine (based on week 6 CDRS item 13, which assesses
suicidal behaviors), while controlling for baseline depression severity (r=0.25, p=.04;b=0.05, 95% CI=0.002 to 0.09, p=.04,
Standardized B=0.27). Baseline depression severity was not significantly related to suicidal ideation after 6 weeks of
acute treatment with fluoxetine, while controlling for baseline hopelessness (r=0.04, p=.72; b2=0.005, 95% CI= -0.02 to
0.03, p=.72, Standardized B2=0.04). A separate multiple linear regression and the Pearson partial correlation revealed
that baseline suicidal ideation (CDRS item 13) alone was positively and significantly related to suicidal ideation after 6
weeks of treatment, while controlling for baseline depression severity (minus baseline CDRS item 13) as well as baseline
BHS (r=0.27, p=.02; b1=0.13, 95% CI=0.01 to 0.24, p=.02, R2=0.15). Conclusion: The findings suggest that the presence
of baseline hopelessness is independently associated with suicidal ideation after 6 weeks of acute treatment with
fluoxetine. The findings from the current study suggest that hopelessness may play a predictive role in suicidal ideation.
Future research should continue to examine this relationship longitudinally, looking specifically at the underlying
mechanisms of hopelessness and its impact on suicidality.
Together to Live
Sophia Briard, MaryAnn Notarianni
Children's Hospital of Eastern Ontario, Canada; sbriard@cheo.on.ca, mnotarianni@cheo.on.ca
Background
The mandate of the Ontario Centre of Excellence for Child and Youth Mental Health (the Centre) is to improve the quality
and effectiveness of child and youth mental health (CYMH) services in Ontario by supporting the implementation and
evaluation of evidence-informed practices among CYMH agencies. The Centre is currently leading initiatives under
Ontario’s youth suicide prevention plan, which targets Ontario communities, primarily service providers working with
children and youth. Specifically, this work includes the development of an online community mobilization toolkit, the
implementation of provincial coaching supports, and community mobilization forums hosted across the province.
Objectives
The Centre’s work in youth suicide prevention aims to: provide access to evidence related to youth suicide prevention, risk
management, and postvention; build community capacity to mobilize for youth suicide prevention; and support crosssectoral knowledge mobilization.
Methods
The Centre worked collaboratively with a cross-section of relevant stakeholders to develop
TogethertoLive.ca/Vivonsensemble.ca, an online evidence-informed toolkit supporting whole community approaches to
youth suicide prevention. This toolkit officially launched in May 2014, and the Centre is currently working to mobilize and
maintain it.
In September 2014, the Centre began to implement an evidence-informed coaching model aimed at supporting
communities to build capacity and work collectively to address youth suicide. Within this model, 5 highly skilled coaches
with specific expertise in youth suicide prevention/risk management/postvention work within a community mobilization
framework to support cross-sectoral collaboration to develop and implement action plans to address youth suicide, and
evaluate and sustain their efforts.
Finally, in February/March 2015, the Centre will deliver 6 community mobilization forums across Ontario, including one
focused specifically on youth suicide prevention (life promotion) in Aboriginal communities. The purpose of the forums is
to bring together service providers from across sectors, young people and families with lived experience, to build capacity,
foster relationships and share knowledge in the area of youth suicide prevention, risk management and postvention.
Findings
An evaluation framework is in place to measure the initiative's processes and outcomes, and is based on two approaches:
results-based accountability and collective impact. Specific areas of interest include reach, usefulness and impact.
Evaluation data should be ready to share by early summer 2015.
Conclusions
This initiative represents an innovative, multi-pronged approach to support community capacity to address youth suicide
and to mobilize knowledge both locally and provincially about youth suicide prevention efforts across the province. While
Ontario-focused, there is potential to scale up these activities for greater impact both nationally and beyond.
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Extension of the Register for Suicide Attempts – Why Do People Try to Commit Suicide?
Anne Katrine Thrue Mikkelsen, Christina Petrea Larsen
Centre for Suicide Research, Denmark; akm@cfsmail.dk, crpe@cfsmail.dk
Introduction:
Knowledge of the extent of attempted suicides in Denmark can be found in the Register for Suicide Attempts. The
purpose of this study is to extend the data collection area from the former County of Funen to cover nationwide in time.
The Register for Suicide Attempts includes the variable “Circumstances” and thus we are able to gain greater knowledge
of the potential triggering and underlying factors for the individual's suicide attempt that allows us to elucidate why people
try to commit suicide. The results of this study presented below are based on 1,143 registered suicide attempts (women
737) (men 406) during 2012 and 2013 collected from various Regions of Denmark -not the entire country.
Methods:
We received transcripts of all civil registration numbers that had been in contact with an emergency ward (somatic) due to
a suicide attempt in 2012 and 2013. From each registered patient’s medical record, we registered the following variables:
time, date, age, gender, place of registration, code for cause of contact 4 (suicide attempt), method, medicine,
circumstances in relation to the attempt: proximal- and distal factors defined in various triggering and underlying causes.
Results:
The most frequent proximal and distal circumstances in relation to registered suicide attempts by gender in 2012 & 13:
Proximal circumstances:
The most frequent proximal factor is “Unknown” for both women (161) and men (117). This includes cases where the
patient's medical record has been insufficient to collect data on the circumstances of the suicide attempt.
The following most frequent proximal factors for women in 2012 was “Argument / disagreement / conflict with a close
relation” (69). In 2013 it was “Mental illness” (71). For men in 2012 & 2013 it was “Life is hard” (65).
Distal circumstances:
For women (437) and men (195) in 2012 & 2013, we found that “Mental illness” was the most frequent distal factor. The
second most frequent distal factor for men (101) and women (157) in 2012 & 2013 is “Unknown”.
Discussion:
The number of registered attempted suicides is only the tip of the iceberg as not all suicide attempters have subsequent
contact with somatic emergency wards. The information in the patient’s medical record depends on what information the
attending doctor is able to gather, sometimes the patients are hesitant about sharing information about the circumstances
of the suicide attempt, which affects the results of this study. Thus conclusions based on the registered circumstances
must be made with caution and reservations.
Conclusion:
The answer of why people try to commit suicide is complex as there are often several circumstances that influence on that
decision. Results are consistent with existing research in this field. The variables proximal- and distal factors must be
further investigated during the ongoing data collection for the Register for Suicide Attempts.
Dispositional and Contextual Psychosocial Factors as Determinants of Adolescent Suicide Ideation
Ancel Andrew George
University of the Free State, South Africa; georgeaa@ufs.ac.za
The incidence of adolescent suicide has become a source of grave concern within our societies as suicide rates have
nearly trebled in some industrialised countries, with South Africa showing a similar increase. More recent statistics
indicate almost 11% of all non-natural deaths in South Africa are suicide related. Approximately one person commits
suicide every hour with adolescent suicide accounting 9.5% of all deaths registered by teenagers. .A number of
dispositional and contextual factors has been implicated in adolescent suicide behaviour. According to various
researchers psychosocial factors such as poor personal or internal strengths as well as negative social and environmental
experiences were found to significantly impair healthy development and increase the risk for self-destructive behaviour in
adolescents. The aim of this study is to investigate the influence of dispositional and contextual factors as determinants of
adolescent suicide ideation.
A quantitative research approach was utilized to undertake a non-experimental, cross sectional correlational study. This
study utilised an existing data set collected during 2012 by the Department of Psychology as part of a broader study on
adolescent risk and resilience in the Free State Province. A group of 985 Grade 10 learners were selected by means of
random sampling. Participants were selected from urban and rural areas and are distributed across race, gender and
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socio-economic groups. The Suicidal Ideation Questionnaire, Resilience Scale, Satisfaction with Life, South African
Substance Abuse Inventory, and the Stressful Life Events Scale were used to measure the required variables.
A hierarchical regression analysis was performed with results indicating that both dispositional and contextual factors
making a significant contribution (p ≤ 0.01) to the variance of adolescent suicide ideation. The strongest variance
contribution was however made by dispositional psychosocial factors made
In conclusion it can be seen that dispositional factors appear to have a strong determining influence of adolescent suicide
behaviour, implying that a large part of this phenomenon should be accounted to within individual control. It is however
suggested that other contextual factors such a family structure and perceived social supports systems be incorporate in a
follow-up study.
Keywords: Suicidal Ideation, resilience, satisfaction with life, traumatic life experience, dispositional and contextual
factors.
Discussion of Suicide Prevention Based on the Trends among Elderly in Japan: The Report
Including Considerations among Young and Middle-Aged Groups
Ken Inoue1,2, Tatsushige Fukunaga3, Yasuyuki Fujita1, Haruo Takeshita4, Mari Sampei5, Satoko Ezoe6, Tsuyoshi
Miyaoka7, Jun Horiguchi7, Yuji Okazaki8,9
1
Department of Public Health, Faculty of Medicine, Shimane University, Japan; 2The International Research Group on
Suicide in Older Adults; 3Tokyo Medical Examiner’s Office, Tokyo Metropolitan Government, Japan; 4Department of Legal
Medicine, Faculty of Medicine, Shimane University, Japan; 5Department of Clinical Nursing, Faculty of Medicine,
Shimane University, Japan; 6Shimane University Health Service Center Izumo, Japan; 7Department of Psychiatry, Faculty
of Medicine, Shimane University, Japan; 8Michinoo Hospital, Japan; 9Tokyo Metropolitan Matsuzawa Hospital, Japan; keinoue@fujita-hu.ac.jp
Introduction: There were approximately 21,000-22,000 annual suicides in Japan from 1990 to 1995, 23,104 suicides in
1996, 24,391 suicides in 1997 and over 30,000 annual suicides from 1998 to 2011. Therefore, effective suicide prevention
measures that can bring about the immediate decrease of suicides are needed in the present. The Cabinet meeting
approved guidelines on suicide prevention that the government should promote in accordance with the Basic Act on
Suicide Prevention; these guidelines took the form of an Outline of Comprehensive Measures to Prevent Suicides. The
Plan to Accelerate Suicide Prevention Measures was formulated in 2008. The suicide rate among elderly is high from the
past in Japan, and the rate in Japan is also higher than it in other countries in the present. We think the discussion should
center on specific suicide prevention measures for elderly based on the research into the detailed trends and causative
factors of suicide.
Methods: We researched the number of suicides and the proportion of causative factors in age 60 or over group in
comparison to the total number of suicides in Japan during 2000-2005 based on numerical data reported by the National
Police Agency in the Journal of Health and Welfare Statistics. It was classified into ‘suicide note left’ and ‘suicide note
none’, and ‘suicide note left’ was further divided into “family problems”, “health problems”, “economic and life problems”,
“work problems”, “problems of relations between the sexes”, “problems in schools”, “others”, and “unknown”. We focused
on the proportion of causative factors among men and women, and we discussed specific suicide prevention measures
among elderly in total age groups (young, middle-age, and elderly).
Results: During the test period, the proportion of the number of suicides in age 60 or over group to the total number of
suicides changed from 29.3% to 31.1% among men and from 42.5% to 45.9% among women. The most common
causative factor was “health problems” among both men and women, the second-most common cause was “economic
and life problems” and the third-most common cause was “family problems” among men. “Family problems” was the
second-most common cause among women.
Discussion and Conclusion: People committing suicide because of “health problems” may suffer from physical illness or
mental health problems. Especially, we think that “suffering from physical illness”, and “mental health problems” were
important factors among the elderly, and young and middle-aged women. Suicide prevention measures must be carried
out continuously and cooperatively by members of the relevant fields and organizations.
Understanding the Health Professional’s Experience Surrounding the Pediatric Suicidal
Assessment: A Milestone for Suicide Prevention
Nathalie Maltais, christine Genest, Caroline Larue
Student at Montreal University, Canada; maltaisnathalie@hotmail.com
A suicidal assessment is a challenge for any health care professional. According to Fowler (2012), it is one of the most
stressful tasks for clinicians, particularly when it is a pediatric suicidal risk assessment. Furthermore, the pediatric suicidal
risk assessment becomes more complex as it requires the clinician to evaluate, not only, if there is a mental health
problem, but also to assess the cognitive maturity, the interaction between the child and the family system and the school
system, the losses of loved ones and the possibility of sexual abuse or negligence (Renaud & Marquette, 2002,). The
complexity of this evaluation can also be explained by the concept of death that can differ from one child to another
(Greydanus, 2010). Moreover, In the U.S.A, 12 % of children between 6 and 12 have suicidal ideations and 8 to 10 % of
all the Americans stated that they attempted suicide during their childhood (Horowitz and coll. 2010). According to
Greydanus (2010) many adults including health care professional have a difficult time considering that children might want
to kill themselves. The clinician’s attitude towards suicide may negatively influence their suicide risk assessment and
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management skills (Talseth et Gilje , 2011). It is crucial to understand the clinician’s experience of the pediatric suicidal
assessment because suicide prevention is directly linked to suicidal assessment. Sakar & coll. (2013) and Berthod & coll
(2013) stated the importance of assessing and treating children suicidality before they reach adolescence, an age where
the risk of completing suicide is higher. To our knowledge there is no published research on the understanding of the
clinician’s experience of the pediatric suicide risk assessment. Therefore, it is necessary to present what is already known
about the clinician’s experience towards adult suicidal assessment prior to conducting a study about nurses’ experiences
assessing children under 12 in a mental care setting. A literature review presents studies on the experience surrounding
suicidal assessment of adult patients. Method: Research engine for instance: Pubmed, Web of Sciences, Embase,
CINHAL, PsyInfo and Google Scholar have been consulted for this review. The key words used alone and also combined
were, “suicidal risk assessment”, “suicidal risk evaluation”, “suicidality assessment”, “nurses’ suicidal risk assessment”.
The literature review was completed in French and in English. Articles from 2004 to 2014 were retained. 30 articles were
found and 15 were analysed in dept because of their relevance to our project. Results: psychosocial barriers such as
clinician’s emotions, beliefs, knowledge, or attitudes can impair risk management of adult patients (Valente, 2011).Since
no published study on the professional experience of a pediatric suicidal risk assessment has been found, it is imperative
to study this phenomena for new knowledge that will enhance clinical pratice
The Effects of Childhood versus Adolescent Sexual Victimization on Non-Suicidal Self-Injury
Characteristics
Margaret Eileen Fleming, Elise Kathleen Paul, Janis Whitlock
Cornell University, United States of America; mef247@cornell.edu
Background: Most literature on sexual victimization and non-suicidal self-injury (NSSI) has collapsed adolescent and
childhood sexual victimization into a single measure. Results from nationally representative studies suggest that
adolescents are particularly at risk for sexual victimization. However, there is a dearth of literature examining adolescent
onset of sexual victimization in relation to NSSI. Studies of suicidal thoughts and behaviors suggest differential
relationships of childhood and adolescent sexual victimization and suicidality.
Objective: The goal of this study is to examine characteristics of NSSI in college-aged participants who have experienced
childhood (ages 0-12), adolescent (ages 13-18), or both child and adolescent sexual victimization.
Methods: The sample (N = 11,349) is from a secure online survey conducted at 8 universities (5 private, 1 private and
public, 2 public) in the Northeast and Midwestern United States. Participants had complete data on all study variables and
were between the ages of 18 and 24 years (57.8% female, Mage = 20.13 years, SD = 1.59). Multivariate logistic
regressions controlled for sex, age, race, school, SES, sexual orientation, emotional abuse, and physical abuse histories
in childhood and adolescence.
Results: A total of 2.1% (n = 240), 3.9% (n = 448), and 0.3% (n = 37) had experienced unwanted sexual contact in
childhood, adolescence, and both childhood and adolescence, respectively. Sexual victimization was significantly more
common in females than in males in both childhood and adolescence. Results from multivariate logistic and ordinary least
squares regressions showed that sexual victimization at each time period and at both time periods were related to
significantly greater odds of ever having practiced NSSI and to greater NSSI frequency. Adolescent, but not childhood,
sexual victimization was related to more NSSI forms and functions. Notably, adolescent sexual victimization (AOR = 2.39;
β = 0.11) was more strongly related than childhood sexual victimization (AOR = 1.99; β = 0.05) to the presence of and
lifetime frequency of NSSI.
Conclusions: Our results underscore the importance of differentiating adolescent and childhood onset of sexual
victimization in research and clinical settings.
Keep Him Here - A Community Suicide Awareness and Prevention Campaign
Patti Stark, Kathy Belton
Injury Prevention Centre, Canada; patti.stark@ualberta.ca
Although many Alberta communities have recognized World Suicide Prevention Day, there has not been formal
recognition of the day at a provincial level. Given this lack of provincial engagement and the fact that suicides take more
than 500 Alberta lives every year, members of the Alberta Suicide Prevention Network proposed that a provincial
message/initiative be planned for World Suicide Prevention Day.
A planning committee comprised of injury prevention practitioners, health professionals, community suicide prevention
organizations and school representatives began planning in early 2014. Suicide data indicated that of the 513 deaths in
2010, 75 per cent were men. Of these, 48 per cent were between the ages of 30 – 69 years. The group also identified that
men are more likely to have poor coping mechanisms for mental health issues and may have reduced social/support
networks. Compounding this situation is the continued negative societal perceptions regarding mental health and suicide,
preventing individuals, particularly men from seeking help. Based on this information, the planning committee chose to
focus on a goal of reducing rates of suicide among middle aged men in Alberta. The target audience for the campaign
would be social networks of middle age men (significant others, family, friends).
Key messages for the campaign were: know the signs, start the conversation and reach out. Along with the key
messages, a tagline meant to emphasize the role every individual can play to support and help an individual who is
struggling was developed - Keep Him Here. A series of themed posters, postcards and banner were developed. Images
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were chosen that depicted places where a middle aged man could be found in Alberta to highlight the diversity of men
who may consider suicide and the “hole” created by the loss of a loved one. A video and supporting website were
developed to provide additional information and resources. Campaign resources were requested by 32 community
partners representing a variety of organizations and coalitions. A provincial event occurred on September 10 at a coffee
shop. This location was chosen as coffee shops are places where people naturally gather to discuss what is happening in
their lives – a place to “start the conversation” about suicide prevention. Community partners facilitated activities
supporting Keep Him Here and/or World Suicide Prevention day in over 20 locations across the province.
Seventeen partners responded to our feedback survey. Generally people received positive feedback from those attending
their activities and estimates of attendance at the events ranged from 15 to 100 participants. Feedback regarding the
resources was generally positive, the postcards were accessible and people liked the variety of images used. Additional
comments included requests for the campaign to continue next year and to keep the website active to support ongoing
suicide awareness and prevention activities.
Crisis Counseling and Suicide in China through the Eyes of University Counselors
Erin M. Ambrose
William Jessup University, United States of America, The Chicago School of Professional Psychology, United States of
America; eambrose@jessup.edu
Suicide is the leading cause of death in China for young adults aged 15-34. The issue of suicide among college students
has not received much attention by the research community but is well known by students, university personnel, and
families who have lost a loved one. University counselors are valuable resources for understanding the crisis of suicide on
campus and may provide information for how to combat this problem. Following a grounded theory approach to determine
the contributing factors of student suicidal crises and explore the process of crisis counseling at Chinese universities, indepth interviews were conducted with 28 university counselors from 18 different universities in Beijing, China. Major
contributing factors to student suicidal crises include: academic pressure, family issues and romantic problems. Results
showed support for the strain theory of suicide in a college population. The process of crisis counseling was also viewed
through the lens of cultural-historical activity theory and suggests a need for development of counseling practices which
are more specific to stressors experienced by university students.
Understanding Self-Harm in Young People in Foster or Residential Care: A Qualitative Interview
Study
Ruth Wadman1, Marie Armstrong2, David Clarke1, Caroline Harroe3, Kapil Sayal1, Panos Vostanis4, Ellen
Townsend1
1
The University of Nottingham, United Kingdom; 2Nottinghamshire Healthcare NHS Trust; 3Harmless; 4University of
Leicester; ruth.wadman@nottingham.ac.uk
Young people in foster or residential care (looked-after young people) are at high risk of self-harm and research with this
group is greatly needed. Looked-after young people who self-harm (11 -21 years old) participated in qualitative individual
interviews. The aim was to explore their ‘lived experience’ of self-harm in order to improve our understanding of self-harm
in this group and inform supports and services. This paper presents preliminary findings from an Interpretative
Phenomenological Analysis (IPA) of the participants’ accounts. IPA is a qualitative method suited to exploring how
individuals make sense of their experience with health problems or disability. Emerging themes related to psychological,
social and clinical aspects of self-harm are discussed. For example, what do young people think are the key factors that
led them to self-harm and maintain their self-harm? What might help them to stop self-harm? Implications for improving
support in community, health and social care settings will be considered. This is the first targeted qualitative study on selfharm in looked-after young people and is part of the Department of Health’s research initiative to support the
implementation of the National Suicide Prevention Strategy in England. The work here will give much needed insight into
the specific needs and concerns of looked-after young people who self-harm, which is missing from current policy.
The Role of Positive Affect Intensity among Treatment Seeking Adolescents at Risk for Suicide
Sasha Rojas1, Ellen Leen-Feldner1, Heidemarie Blumenthal2, Sarah Lewis3, Matthew Feldner1,4
Department of Psychological Sciences, University of Arkansas, United States of America; 2Department of Psychology,
University of North Texas, United States of America; 3Center for Research, Assessment, and Treatment Efficacy
(CReAte), United States of America; 4Laureate Institute for Brain Research, United States of America;
sasharojas5@gmail.com
Risk for suicidal behavior often emerges in adolescence. In fact, suicide is the 2nd leading cause of death among
adolescents. Despite the relevance of individual differences in affective experience to clinically relevant problems
generally, and risk for suicide more specifically, relatively little work has evaluated affect intensity in relation to adolescent
risk for suicide. To address this notable gap in the literature, the current study evaluated the unique associations between
dimensions of positive affect intensity and risk for suicide in a sample of 165 treatment-seeking adolescents ages 13 to 17
years. As predicted, low positive affectivity accounted for unique variance in adolescent suicide risk above and beyond the
effects of negative affect.
1
The Predictive Index of Parental Bonding Styles in Suicidality in Taiwanese Population
For-Wey Lung1,2,3, Ming-Been Lee2,4,5
105
1
Taipei City Hospital, Taiwan, Republic of China; 2Taiwanese Society of Suicidology; 3National Defense Medical
University; 4National Taiwan University College of Medicine; 5Taiwan Suicide Prevention Center; forwey@seed.net.tw
Suicidality has been concerned of one of serious public health issue worldwide. It may have a number of different
proximal precipitating and distal predisposing risk factors, that include genetic backgrounds, parental bonding, personal
characteristics, and mental health problems, are related to increased rates of suicidality. Particularly, poor parental
bonding seems most at risk for suicidality. Parental bonding has been reported to be associated with suicidality, however,
it is unknown paternal or maternal bonding has play an important role in suicidal behavior and ideation. Hence, this study
explored the association between different parental bonding styles and suicidality. Total of 422 participants with suicidal
attempts, 356 whose with suicidal ideation, and 299 controls were recruited in this study. Suicidality and psychiatric
symptoms were assessed using the five-item Brief-Symptom Rating Scale (BSRS-5), and the Parental Bonding
Instrument (PBI) was employed to measure the perceived quality of parental bonding. Parental bonding styles classified
into the four quadrants: affectionate constraint (high care and high control), affectionless control (low care and high
control), neglectful parenting (low care and low control), and optimal bonding (high care and low control). In the present
study, the optimal parenting style for suicidal ideation or attempt is defined as a combination of the highest care and
lowest overprotection of both parents. The results showed three components for the best fit in care dimension, with mean
score of paternal care of 13.13 (SD = 1.2), 21.7 (SD = 3.30), and 29.30.18 (SD = 4.46), respectively. Two cut-off points for
paternal care were >14 and >29 (<=14, >14<=29 and >29 in three groups). The mean scores of maternal care were 15.72
(SD = 1.90), 22.44 (SD = 2.71), and 29.81 (SD = 3.56), respectively. Two cut-off points of maternal care were >17
and >28 (<=17, >17<=28 and >28 in three groups). Moreover, the results showed two components for the best fit in
overprotection dimension, with mean score of paternal overprotection of 4.34 (SD = 1.35), and 13.39 (SD = 4.19). The
cut-off points of paternal overprotection were >6 (<=6, and >6 in two groups). The mean scores of maternal overprotection
were 3.77 (SD = 1.27), and 14.2 (SD = 4.79). The cut-off point of maternal overprotection were >6 (<=6, and >6 in two
groups). After adjustment for socio-demographics, both of paternal and maternal “affectionless control” have significant
associations with suicidality. When adjusted for the demographics and depression, only the paternal “affectionless control”
remained significantly associated with the outcome. In conclusion, this study find out the parenting styles of paternal and
maternal “affectionless control” are independent predictors of suicidality in our population in Taiwan. Also, this study
provides a reference of predictive index of suicidality in further preventive strategies and management of suicidality in
community.
Psychopathology and Suicide Risk in Patients Suffering from Psoriasis and Other Dermatological
Diseases
Maurizio Pompili
Sapienza University of Rome, Italy; maurizio.pompili@uniroma1.it
Introduction: Psoriasis has a significant impact on the mental and emotional functioning. It has been shown that the risk of
psychiatric comorbidity increases with the severity of the disorder and the most frequent associations appear to be with
depression and anxiety.
Objectives: To analyze the association between psoriasis, mental disorders and suicidal ideation in a sample of patients
affected by psoriasis.
Aims: To analyze the differences between patients affected by psoriasis and patients with other dermatologic diseases.
Methods: we enrolled 157 consecutive patients (90 women and 67 men), mean age 50,15 years (±16,21); 91 affected by
psoriasis (58.0 %), 35 by melanoma (22.3 %) and 31 with atopic dermatitis (19.7%). All participants completed a
structured sociodemographic interview. We also administered the following rating scale: Hamilton Rating Scale for
Depression (HAM- D) and the Hamilton Rating Scale for Anxiety (HAM -A). We assessed current and prior suicidal
ideation and the number of previous suicide attempts.
Results: Patients with psoriasis, more frequently had a comorbid psychiatric disorder (38.5% vs 16.7 %, p < 0.05), and
reported more frequently previous suicidal ideation ( 37.4% vs 16.7%) and history of one or more suicide attempts (6.6%
vs 0.0%, p < 0.05). Moreover, patients with psoriasis, have higher scores on the HAM -D (T155 = 3.09, p < 0.01). The
duration of illness of more than 8 years (beta = 1.51, p< 0.001) was the only factor independently associated with
psoriasis.
Conclusions: The clinical evaluation of patients with psoriasis should include the assessment of psychiatric comorbidities
and the routine assessment of suicide risk.
Peer Victimization Mediates the Impact of Maternal Depression on Risk for Suicidal Ideation in Girls
but not Boys: A Prospective Study
Aliona Tsypes, Brandon Gibb
Binghamton University (SUNY), United States of America; atsypes1@binghamton.edu
Although research consistently demonstrates that children of depressed mothers are at an increased risk for internalizing
and externalizing problems, less is known about the mechanisms by which suicidality occurs. Children’s sex might
constitute an important moderator of the relation between maternal depression history and the emergence of suicidal
thinking in children, where maternal depression might be more strongly associated with internalizing problems in girls than
in boys. There is also evidence that peer victimization might precipitate STBs, although there is a dearth of longitudinal
data on the effects of peer victimization on suicidal thinking. We sought to examine whether mothers’ histories of MDD
106
would predict time to emergence of suicidal ideation in children over the course of a 2-year follow-up and whether this
effect would be stronger among girls. We also examined whether overt and relational peer victimization would mediate the
relation between maternal history of major depressive disorder (MDD) and children’s thoughts of suicide.
Participants were 210 mother-child pairs recruited from the community. The mothers who met the criteria for MDD during
their child’s lifetime were included in the “depressed” group (n = 101). Those without lifetime diagnosis of any DSM-IV
mood disorder and no current Axis I disorder were included in the “nondepressed” group (n = 109). The average age of
the children at baseline was 10.92 years. The Structured Clinical Interview for DSM-IV and the Schedule for Affective
Disorders and Schizophrenia for School-Age Children were used to assess for current DSM-IV Axis I disorders in mothers
and their children, respectively. Children of mothers with or without MDD were assessed 5 times over 24 months. As part
of the K-SADS-PL interviews at each assessment, interviewers assessed for the presence of suicidal ideation in children.
Experiences of peer victimization were assessed at baseline via the Children’s Social Experiences Questionnaire-SelfReport.
We found that mother’s history of MDD significantly predicted time to suicidal ideation in girls, Wald = 10.64, p < .01, OR =
5.27, but not in boys, Wald = .003, p = .95, OR = .98. We also found that both relational and overt peer victimization
significantly mediated the relation between mother’s history of MDD and thoughts of suicide among girls, but not among
boys. The findings were maintained even when children with lifetime history of MDD at baseline were excluded from the
analyses.
Our findings contribute to the understanding of which children of depressed mothers are at greatest risk for STBs as well
as the potential mechanisms of this risk. The results suggest that girls whose mothers are depressed are at an increased
risk of the emergence of suicidal thinking and that the relation between maternal history of major depression and the
emergence of suicidal thinking in these at-risk girls might be partially explained by peer victimization experiences.
L’automutilation est-elle un signal d’alarme pour une crise suicidaire imminente chez les
adolescents délinquants?
Nicolas Plante1,2,3, Marc Daigle2,3,4
Université de Sherbrooke; UQTR; CRISE; 4Institut Philippe Pinel de Montréal; nicolas.plante@usherbrooke.ca
La présence d’automutilation et de comportement suicidaire est très élevée chez les délinquants recevant des services
des Centres jeunesse. Les recherches actuelles font état d’une relation entre l’automutilation et le comportement
suicidaire. Toutefois, les études ont rarement mesuré si la relation entre l’automutilation et les tentatives de suicide était la
même pour les adolescents et les adolescentes. La présente recherche vise donc à comparer l’association entre
l’automutilation et les tentatives de suicide auprès d’une population recevant des services d’un Centre Jeunesse pour
problèmes de délinquance. Méthode : 177 adolescentes et 167 adolescentes ont répondu à un questionnaire portant sur
les comportements d’automutilation et les tentatives de suicide au cours de leur vie, de la dernière année et des deux
dernières semaines. Résultat : une association significative est observée tant pour les adolescents que pour les
adolescentes au niveau des tentatives de suicide et de l’automutilation lorsqu’ils sont mesurés à vie et dans la dernière
année. Toutefois, lorsque ces comportements sont mesurés dans les deux dernières semaines, cette association est non
significative pour les adolescentes mais fortement significative (Chi carré = 78.35 p = 0.001) pour les adolescents et ce,
malgré le petit nombre d’adolescents rapportant une tentative de suicide dans les deux dernières semaines. Discussion :
l’automutilation chez les adolescents délinquants semble très fortement liée à une tentative de suicide récente ou
imminente. Ces résultats suggèrent que l’automutilation doit être prise très au sérieux, spécialement chez les adolescents
délinquants.
1
2
3
Pesticide Self-Poisoning in Japan: A Retrospective Study at the Department of Emergency Medicine
(2007-2014)
Katsumi Ikeshita1, Shigero Shimoda1, Naohiko Iguchi1, Kazunobu Norimoto2, Keisuke Arita1, Izumi Harada1,3,
Kazuo Okuchi2, Toshifumi Kishimoto1
1
Department of Psychiatry, Psychiatric Institute, Nara Medical University, 840 Shijo-cho, Kashihara city, Nara 634-8521,
Japan; 2Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara city,
Nara 634-8521, Japan; 3Department of Neuropsychiatry, Tenri Yorodu Soudansho Hospital, 200 Mishima-cho, Tenri
city, Nara 632-8522, Japan; ikeshita@naramed-u.ac.jp
Objectives:
Delineation of suicide attempters by pesticide poisoning at the Department of Emergency Medicine in Japan.
Methods:
We investigated the patients who had attempted suicide by pesticide poisoning and been treated at the Nara Medical
University Hospital Emergency Center between April 1, 2007 and December 31, 2014. Clinical data and sociodemographic characteristics, including age, sex, psychiatric diagnosis, motive for suicide attempt, previous history of
suicide attempt, living area, and outcome were collected from medical records retrospectively and statistical analyses
were performed in comparison to suicide attempters by drug overdose who had been treated during 2010.
Results：
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The total number of subjects with pesticide poisoning suicide attempt (PP group) was 56 (35 males and 21 females, 28-93
years, mean age 63.52±14.95). In comparison to those who attempt suicide by drug overdose (OD group: 15 males and
40 females, 15-86 years, mean age 37.42±14.83), 1. The ratio of male/female was higher (1.7 vs 0.38: p<0.001), 2. Mean
age was older (p<0.001), 3. The mean length of the emergency department stay was significantly longer (12.0±14.3 vs
2.24±2.13: p<0.001) in PP group. This study revealed that people living in the areas where a higher proportion of
household worked in agriculture tend to commit suicide attempts by pesticide poisoning compared with drug overdose
(p=0.05). PP group was less frequently diagnosed with borderline personality disorder than OD group (1.8% vs 18.2%:
p<0.01). Regarding motives for suicide attempts, in both groups, health problems were the most common and financial
problems were more frequent among PP group than OD group (28.6% vs 1.8%: p<0.001). The rate of suicide attempt in
daytime (6:00-18:00) was higher in PP group than that in OD group (73.2% vs 38.2%: p<0.001). Past/Present psychiatric
history (55.4% vs 92.7%: p<0.001) and past suicide attempt history (25.0% vs 81.8%: p<0.001) were less frequently noted
in PP group. The death rate was higher in PP group (14.3% vs 1.8%: p<0.01).
Conclusion：
This study indicates the necessity of intervention for the elderly living in agricultural areas and also shows their several
problems, health and financial troubles, inaccessibility to psychiatric treatment and easy availability of pesticides.
Treatment of Outpatients at Risk of Suicide. Experiences from a Danish Suicide Prevention Clinic
Hanne Frandsen, Lone Fogholm, Sebastian Vinther, Annette Erlangsen
Psychiatric Centre Copenhagen, Denmark; hanne.frandsen@regionh.dk, lone.fogholm@regionh.dk,
sebastian.mondrup.vinther@regionh.dk
Background: Previous findings show that risks of suicide are particularly high during the first weeks after discharge from
psychiatric hospital. Early intervention will for people at risk of suicide is important, yet, we have little indication what type
of intervention is effective.
The Competence Center for Suicide Prevention in the Capital Region of Denmark has since 2009 provided
psychotherapeutic help for people at risk of suicide under the premise that early intervention will help reduce risk of
suicide and prevent future suicidal attempts. The aim of the current study is to describe the properties and clinical
experiences of the support provided to persons who have attempted suicide or have suicidal thoughts.
Method:
The clinic covers a population of approx. 1 million citizens. Patients can be referred from doctors, hospitals etc., but can
also refer themselves. Patients are offered short term psychosocial therapy intervention consisting of approx. 6-10
sessions, offered by an interdisciplinary team consisting of 2 psychologists, 1 nurse, 1 psychiatrist and 1 social worker.
Patients are assigned to one primary team member, but can in principle receive treatment from all professions. In
addition, counseling is offered to relatives and those left behind after a suicide.
Results:
The clinic treats approx. 350 patients per year. During the time the clinic has existed, there has been no suicide among
active patients. The number of suicide attempts among active patients has not been registered. Experience shows that a
number of patients with a debuting mental disorder will carry out a suicide attempt. As a result further assessment and
support is needed for this patient group.
Conclusion:
These and other newly published findings indicate that Danish suicide prevention clinics help to significantly reduce the
risk of future suicide among patients. However more research is needed in regards to which specific interventions are
most effective.
The Effectiveness of Active Listening through Helpline in the Reduction of Suicidal Tendencies of
Youth
Swapnil Bhopi, Anil Sawarkar
Connecting...NGO, India; swapnilbhopi@gmail.com
The present study was conducted to study the effectiveness of active listening though helpline among college students
having suicidal tendencies. The age group for the present study was between 18 to 25. The Adult Suicidal Ideation
Questionnaire (ASIQ) by William Reynold was used to measure suicidal tendencies among youth. The test was
administered to 824 subjects from different colleges in Pune. 80 Subjects who scored high on suicidal tendencies were
randomly assigned to experimental and control group respectively. The experimental group was then exposed to active
listening by the experts from Connecting (NGO) Pune. After the intervention, Adult Suicidal Ideation Questionnaire was
administered again on both the experimental and control group to examine the significance difference.
Analysis of Covariance (ANCOVA) was used to analyze the obtained data. The results revealed that experimental group’s
scores on suicidal tendency after the intervention was significantly lower than the control group’s scores. This finding thus
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suggests that if people with suicide thought can get someone who can listen to them with empathy will not make suicide
attempt.
Associations between Perceived Criticism and Suicide Ideation and Attempts
Christopher Hagan, Thomas Joiner
Florida State University, United States of America; hagan@psy.fsu.edu
The effect of perceived criticism from others is one potentially important risk factor for suicide that has received scant
attention, despite decades of research on the role of criticism in the treatment and course of mental illnesses such as
schizophrenia, depression, bipolar disorder, and anxiety disorders. This study analyzed the unique effect of perceived
criticism’s association with suicidal ideation and attempts as well as its connection with the well-established suicide
related constructs of thwarted belongingness and perceived burdensomeness as described in the Interpersonal
Psychological Theory of Suicide. Results demonstrated that perceived criticism is a significant predictor of suicidal
ideation and attempts, above and beyond the role of mental illness. Further analyses demonstrated that the effect of
perceived criticism on suicide ideation and attempts is fully mediated by the constructs of thwarted belongingness and
perceived burdensomeness. These results may be useful in public and individual mental health treatment to help reduce
suicide ideation and attempts.
Adolescent Suicide in Chile: A Time-Series Study of 18 years (1994-2011)
Isidro Alejandro Gómez1, Cristobal Cuadrado2, Pedro Zitko3
Departamento de Psiquiatría y Salud Mental, Universidad de Chile.; 2Escuela de Salud Pública, Universidad de Chile.;
3
Unidad de Estudios Asistenciales. Complejo Asistencial Barros Luco.; algomezcham@gmail.com
Since the year 2000, Chile has evidenced a sustained increase in suicide rates, mostly marked among the adolescents. In
the period 2000-2010, rate increase in the 10-19 group amounted to 52%. Compared to other OECD members, Chile has
greater rates than the mean (13,3 per 100.000).
1
Up to date, no studies in Chile have explored sociodemographic and economic factors possibly related to adolescent
suicide increase.
We explored association of adolescent suicide rate (10 – 19 years old) and socio-demographic and economic variables
among 29 chilean health districts, along 18 years (1994-2011). Variables included were: poverty rate, mean percapita
income (each ~U$160), unemployment rate and uniparental home rate (percentage of homes with at least one minor (<18
y) living with only one adult (>18 y)). All rates are expressed as percentages. Income inequality was explored using GINI
index. Effect of changes in mean percapita income by 1, 3 and 5 time-lags was also assessed. Interaction terms were
explored.
Multiple sources of information were used: population data from the Chilean Institute of Statistics, deaths from the Ministry
of Health registry, and sociodemographic and economic data from periodical national representative surveys from the
Ministry of Social Development. Inter and extrapolations of some variables were calculated when required.
Analysis was made using multilevel poisson regression models applying generalized estimating equations with
exchangeable matrix of correlations. All estimations are reported as incidence relative rates (iRR) with its respective 95%
confidence intervals. Stratified results by sex and ages (10-14 and 15-19 years old) were also explored.
Multivariate analysis showed that unemployment rate (iRR 1.14), low education rate (iRR 1.03), and ‘year’ (iRR 1.12)
were risk factors for adolescent suicide rate. Uniparental rate (iRR 0.96), mean percapita income (0.83) and poverty (iRR
0.95) appeared as protective factors for suicide, although the first two seemed to be risk factors in univariate models (iRR
1.26 and 1.22 respectively). Interaction analysis showed significant effect modification between: ‘year’ and unemployment
rate, ‘year’ and uniparental rate, and mean percapita income and uniparental rate. Otherwise, changes in mean percapita
income exerted a protective effect, more pronounced in shorter time-lags since 3 years-lags. Stratified analysis showed
similar results across sex and ages group. GINI index did not show significance in final models.
Our research proves a trend for increase in adolescent suicide risk along the study period, in both sexes and ages
explored. Low educational level and unemployment were found to be risk factors at an ecological level. A complex
relationship with suicide was found for economic factors such as poverty and mean percapita income. Counterintuitively,
uniparental rates in health district level evidenced a protective effect. The reason for these findings cannot be ascertained
in this moment. Progress in this direction could be made through other research designs.
Evaluation of the Impact of a Mental Health Wellness Workshop on Prisoners’ Awareness of and
Attitudes towards Mental Health and Suicide
Brian Joseph Keogh, Louise Doyle, Marie O'Shea, Jan DeVries, Padraig McBennett, Agnes Higgins
Trinity College Dublin, Ireland; keoghbj@tcd.ie
Background: Prison is regarded as a high risk environment for self-harm and suicide. High levels of mental distress
coupled with low mental health literacy make prisoners vulnerable to suicidal behaviour and rates of suicide and self-harm
are higher in prison than in the general population. An organisation called ‘Suicide and Survive’ delivered a number of one
day wellness workshops in a medium secure men’s prison with a view to increasing attendees’ knowledge and awareness
of mental health and suicide. The authors of this presentation were commissioned to evaluate the workshop using mixed
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methods. This presentation will present the findings of that evaluation.
Aims: Evaluation of the impact of a mental health wellness workshop on prisoners’ awareness of and attitudes towards
mental health and suicide.
Method: Pre, post and follow up surveys were administered to the participants. These included an overall satisfaction with
the course survey, the Herth Hope Index, a Mental Health Self Efficacy scale and an Attitudes Towards Mental Health
scale. Qualitative data was collected using semi structured telephone interviews. Data were analysed using descriptive
and inferential statistics and the interviews were transcribed and subjected to a thematic analysis.
Findings: Sixty nine participants completed the initial survey and this reduced to 23 at follow up. Ten telephone interviews
were completed. In total 87.5% (n=42) of respondents were satisfied or very satisfied with the workshop. Over 95% of the
participants perceived the workshop to be useful or very useful (n=46). Almost 79% of prisoners reported that the
Wellness Workshop improved or greatly improved their wellbeing one week following the workshop and this improvement
persisted over time rising to just over 90% 3-months after the workshop. From the qualitative analysis, many participants
spoke about prison life as being stressful, and how stress was a major problem in prison. There was recognition that
suicide was a problem for people in prison and that suicidal feelings and thoughts were prevalent throughout the male
prison population. There was evidence to suggest that participants’ attitudes towards mental distress and suicide
improved following attendance at the workshops. The participants spoke about how they had an improved understanding
of why someone might want to consider suicide as an option and some participants identified how attendance provided
them with the language to help someone going through a suicidal crisis.
Conclusions: Through attending the Wellness Workshop, participants in the prison setting identified how they were in a
position to acquire strategies to use when feeling distressed which offered alternative ways of coping. The findings also
suggest improvements in the participants’ attitudes to suicide and the Wellness Workshop could be a viable approach to
suicide prevention in prisons.
Suicide Education: The Effectiveness of E-Learning for the Nurses in Taiwan
Chia-Yi Wu1, Ming-Been Lee2, Hen-Shun Chen3, Shih-Cheng Liao4
Department of Nursing, National Taiwan University, Taiwan, Republic of China; 2Department of Psychiatry, National
Taiwan University, Taiwan, Republic of China; 3Department of Family Medicine, National Taiwan University, Taiwan,
Republic of China; 4Department of Psychiatry, National Taiwan University, Taiwan, Republic of China;
mingbeen@ntu.edu.tw
BACKGROUND: As the nursing education in Taiwan has been generally upgraded to baccalaureate level and is viewed
as a requirement for general hospital recruitment, the majority of the nurses are not prepared with satisfying psychiatric
mental health experiences to care for patients with suicide risks. In addition, quite a few nursing studies in Taiwan showed
the need of the nurses to learn the knowledge and skills about suicide prevention. In order to provide a more efficient and
effective way of learning, the national suicide prevention center (SPC) has developed its first on-line suicide education
program since 2012, with updated courses on the website to present comprehensive teaching materials about suicide
prevention for nearly 120,000 nurses in Taiwan.
1
METHODS: The staffs and researchers in the SPC have designed twenty online courses during 2012-2014. These
teaching materials can be grouped into three major themes: (1) suicide and mental illnesses; (2) suicide risk assessment;
(3) treatment modalities of suicidal behavior. Each course lasts for about 40-50 minutes and follows by questions inquiring
the nurses’ satisfaction and perceptions toward the contents. In this study we performed initial analysis of these results.
Using the 5-point scale, the nurses assessed their most agreeable response as 5 point, and the least as 1 point for each
question.
RESULTS: There were at most 8863 nurses who attended the online courses in the SPC website. The top five courses
that were highly selected were as follows: skills in the gatekeeper suicide prevention, stress management and suicide
prevention, using a “mood thermometer”(i.e. the Brief Symptoms Rating Scale) to assess suicide risks, suicide survivors’
crisis and mental health, and elderly mental health care. The majority of the abovementioned courses received nearly
4.36-4.58 points, indicating most agreeable that they learned a lot from the contents online. Moreover, nearly 93% of the
nurses appeared to be satisfied with the courses they took.
DISCUSSION: The findings suggested that the e-learning suicide prevention program provided a promising way of
teaching for the nurses in Taiwan. The materials not only inspired their willingness in taking heterogeneous courses, but
also gave them a good sources of knowledge within short period of time.
CONCLUSION: Online courses of suicide prevention is highly recommendable for clinical nurses who practice in
scattered healthcare facilities in Taiwan and elsewhere places with similar background. Further assessment method is
needed to be developed for a better evaluation for the effectiveness of e-learning nursing education program.
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A Model Evaluation of Severe Mental Illness for Quality of Life: Based on Salutogenesis Theory
Essential Yeh
Taipei City Hospital, Psychiatric Center, Taiwan, Republic of China; essentialyeh@gmail.com
Introduction:
Salutogenesis theory is valuable for promoting health state under stress. It indicates how individuals combine idiosyncratic
factors(ex. motivation types) and life experiences from daily activities to produce sense of coherence(SOC).
SOC is a critical concept of salutogenesis theory to adjust individuals' health state. Studies have been proved that SOC is
related to quality of life(QOL) and depression. However, there are little researches represented the interactions between
activity participation, motivation, SOC, depression and QOL.
Objectives:
The purpose of this study was using Structural Equation Modeling to estimate the relationships between subjective
feelings of activity participation (sense of involvement, positive, negative affects, and self-worth), motivation
types(Autonomy, Control, Impersonal), depression, SOC and QOL in individuals with severe mental illness.
Methods:
This study was used cross-sectional design, and collected individuals with severe mental illness in Taiwan. The
instruments included Sense of Coherence Scale-13, General Causality Orientations Scale, World Health Organization
Quality of Life-brief version, Activity Participation and Restriction Questionnaire and Beck Depression Inventory second
version.
Results:
This study collected 228 individuals with severe mental illness. The results showed that BDI was the partial
mediator(R2=0.63) which predicted by SOC(β=-0.55), diagnosis(β=11.16),negative affects(β=3.93), impersonal(β=0.24),
autonomy(β=-0.18), and control(β=0.14). The QOL was the dependence(R2=0.61) predicted by BDI(β=-0.59), selfworth(β=1.80), and sense of involvement(β=1.78). The Goodness of Fit showed χ2=5.09(df=7,p=0.65), RMSEA=0.00,
CFI=1.00, RMSR=0.63.
Conclusion:
This study conformed salutogenesis theory indicated that SOC, negative affects and motivation predicted QOL through
depression state. However, self-worth and sense of involvement of activity participation could more directly predict QOL.
Contribution to the practice:
When using salutogenesis theory to improve QOL, therapists should not only think about ways to adjust SOC, but also
consider factors of the activity participation to decrease negative affects, increase self-worth and sense of involvement.
Neural Correlates of Suicidal Behavior in Bipolar Disorder
Humberto Correa, Dante Galileu, Maila Castro
Federal University of Minas Gerais, Brazil; correa@task.com.br
Objectives: The risk of complete suicide in Bipolar Disorder (BD) patients appears to be 20–30 times higher than that of
the general population. Several studies find morphological changes in suicidal related neural networks of adults who
attempt suicide. The aim of the present study is to investigate the possible neuroanatomical basis of vulnerability of
suicidal behaviour in euthymic type I BD patients (BD-I).
Methods: We assessed 38 euthymic BD-I patients. Voxel based morphometry (VBM) was performed comparing with and
without lifetime history suicidal behavior. Preprocessing of images used DARTEL (diffeomorphic anatomical registration
through exponentiated lie algebra) for voxel-based morphometry (VBM) in SPM8.
Results: The main findings of the present study is a significant positive correlation between Suicide Attempt (SA) and
superior frontal gyrus white matter volume (WMV) (p=0.015) and negative correlation between SA and anterior cingulate
gray matter volume (GMV) (0,031).
Conclusions: This results support our hypothesis that bipolar patients who attempt suicide present morphological
abnormalities in suicidal-related neural networks compared with those without SA.
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Characterization of Suicide Cases in the City of Teresina - Northeast of Brazil
Carlos Henrique de Aragão Neto1, Adriana da Cunha Menezes Parente2, Artur Acelino Francisco Luz Nunes
Queiroz2
1
University of Brasília, Brazil; 2Federal University of Piauí, Brazil; caragao.neto@gmail.com
Objective: to characterize the cases of suicide in the city of Teresina, Piauí capital, northeastern Brazil, between 2012 and
2013. Methodology: This is a quantitative, descriptive and retrospective study and the data were collected at the Institute
of Legal Medicine (IML) of this city. A instrument for structured data collection available in Death Certificates, filed in the
IML was used. The selected variables were gender, age, marital status, method used, neighborhood, month, occupation
and education. Data were entered in Excel 2010 program with double entry and validation, analyzed using the Statistical
Package for the Social Sciences software (SPSS), version 18.0. Results: Were identified 134 cases of suicides during the
period studied (2012: 70 and 2013: 64), distributed according to the following variables: gender (81.8% men and 18.2%
women); age (10-15: 0.7%; 16-19: 7.2%; 20-44: 59.4%; 45-60: 18.8%,> 60: 11.6%); marital status (married / common-law
marriage: 38.4%; singles: 37.7%; divorced: 5.1%; widows: 3.6%); method (poisoning: 12.3%; fire: 3.6%; precipitation
height: 0.7%; hanging: 67.4%; firearm: 8%; other: 3.6%); geographical area (south: 18.1%; SE: 12.3%; East: 13%; center:
20.3%; North: 15.9%; rural: 13.8%); education (no education: 10.9%; 1st to 4th series: 25.4%; 5th to 8th grade: 16.7%;
high school: 21.7%; incomplete higher: 10.9%; a college: 5 , 8%), professional occupation. Conclusion: The profile of the
individual who committed suicide more frequently in Teresina, in the period surveyed was: male, between 20 and 44 years
without stable relationship, resident of the countryside, with hanging being widely the method of choice. From these
results, one should seek to implement public policies aimed at preventing suicide, more specifically directed to the profile
highlighted by the survey.
Evaluating the Interpersonal Psychological Theory of Suicide in an Adolescent Clinical Sample
Sarah E. Horton1,2, Jessica King1,2, Jacquelyn Matney1,2, Jennifer L. Hughes1,2, Betsy D. Kennard1,2, Nicholas
Westers2, Taryn Mayes1,2, Graham Emslie1,2, Andrew Diederich1,2, Sunita Stewart1,2
1
University of Texas Southwestern Medical Center, United States of America; 2Children's Medical Center of Dallas,
United States of America; sarah.ezzell@utsouthwestern.edu
Background
Despite a large literature on risk factors in suicide, there has been no significant decrease in suicide rates in the last 50
years. Joiner’s (2005) Interpersonal Psychological Theory of Suicide (IPTS) is promising, as it provides a coherent
framework to organize scattered findings related to risk for suicide. The IPTS indicates that: 1) thwarted belongingness
(TB) and perceived burdensomeness (PB) play roles in the development of suicidal ideation; 2) acquired capability for
suicide (AC) is involved in progression from suicidal ideation to suicide attempt; and 3) the presence of all three IPTS
constructs results in greatest severity of suicidal behavior. IPTS constructs have only been tested using proxy variables in
adolescents. This study tests the three hypotheses that are central to the IPTS in an adolescent clinical sample using
direct measures of the constructs.
Method
This study was approved by the UT Southwestern IRB. Participants were 133 adolescents (Mean, SD for age = 14.72,
1.42 years) recruited soon after admission to an inpatient psychiatric unit. The sample was primarily Caucasian (70%) and
girls (75%). Participants completed the Interpersonal Needs Questionnaire assessing PB and TB, Acquired Capability for
Suicide-Fearlessness About Death (ACSS-FAD) assessing AC, the Quick Inventory of Depressive Symptomatology SelfReport (which includes a question about increasing suicide severity), the Hopelessness Scale for Children, and interview
questions regarding lifetime history of suicide attempts. Sex, age, depression severity, and hopelessness were controlled
in all analyses. Regression analyses were used to examine the relationship between the constructs and current and
lifetime suicidal phenomena.
Results
Logistic regression demonstrated that higher levels of TB [OR (95% CI)=3.56 (1.31, 9.65)] and PB [OR (95% CI)=7.36
(2.21, 24.45)] were significantly and independently associated with current suicidal ideation. In addition, AC [OR (95%
CI)=1.60 (1.07, 2.40)] distinguished between adolescents with and without lifetime history of suicide attempt. After entry of
covariates, a multiple regression model containing IPTS constructs and their interactions significantly predicted severity of
suicidal symptoms [F (11, 121) = 14.74, p<.001]. This model accounted for 15.1% of additional variance in suicidal
symptom severity. Main effects of IPTS constructs were significant predictors.
Conclusions
This study contributes to the literature by examining three hypotheses central to the IPTS and demonstrating the validity
of the theory in a clinical adolescent sample. By controlling for depression and hopelessness, two known predictors of
suicidal ideation and attempt, we have demonstrated the additive utility of the IPTS constructs. These findings have
clinical implications regarding suicide risk screening and intervention.
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A Policy Tools Analysis of National Suicide Prevention Strategies
Linda de Chenu
University of Hertfordshire, United Kingdom; l.dechenu.soc@outlook.com
This paper discusses analytic frameworks of ‘policy tools’ in a comparative case study of national suicide prevention
strategies and the importance of the identification of ‘policy tools’ to a critical analysis of policy . It is argued that different
types of policy tools can affect public participation by gaining support or alienating people and that different choices of
policy tools produce different interest groups (Schneider and Ingram, 1990). Types of policy tools include ‘authority tools’
of formal legal rules , informal and formal administrative rules and rules involving physical coercion. Information tools
include information spreading, training and education, symbolic information and information collection . Lastly
inducements and financial tools are analysed. These ‘tools’ can also be evaluated by their cost and also on the dimension
of coercion to non-coercion (Hood, 1983). The paper also discusses the style of the design of prevention strategies and
the different design processes identified (ad hoc, instrumentalist, contingentist, proceduralist and constitutivist ) and the
extent to which they promote public participation. The influence of the type of relationship between central government
and local services and the choice of policy tools is also considered.
Methodology and methods
The comparative case study methodology included methods of qualitative interviews with policy actors and analysis of
secondary literature. Through an ‘illustrative method’ (Neuman,2004) a framework of policy tools was applied to analyse
the data.
Discussion
In particular the analysis discusses the relevance of the analytic frameworks to comparative analysis .
Conclusion
From a comparative perspective the analysis of tools enables the reduction of complexity and the comparison of choices
by different governments which then helps thinking about how things could be done differently and perhaps in a better
way (Dodds,2013).
Rehospitalization among Suicidal Adolescents in Relation to Course of Suicidal Ideation and Future
Suicide Attempts
Ewa K. Czyz, Johnny Berona, Cheryl King
University of Michigan, United States of America; ewac@umich.edu
Description: Psychiatric hospitalization is essential in the clinical management of suicidal adolescents; however, empirical
data are lacking regarding its efficacy for suicidal individuals. A considerable number of hospitalized adolescents are
rehospitalized, yet little is known about the implications of this experience for the subsequent suicide-related outcomes,
such as suicidal ideation and suicide attempts.
Research Aims: This study examined the extent to which rehospitalization within 3 months of index hospitalization
predicts suicide attempts and a change in the course of suicidal ideation within a subsequent 9-month period. This
question warrants inquiry because psychiatric hospitalization, although often necessary, is expensive and restrictive while
the extent of its benefits, particularly in the absence of rigorous studies, is less clear.
Methods: The sample was drawn from data from a randomized clinical trial of a psychosocial intervention for adolescents
hospitalized due to suicide risk. Participants were 373 youths (13-17 years; 72% female) hospitalized due to suicide risk
and followed for one year. Using Cox regression, rehospitalization was examined as a predictor of time-to-suicide attempt
during subsequent nine months. Using latent class growth modeling, it was also examined if rehospitalization was
associated with change in the 9-month course of three previously published suicidal ideation trajectories (subclinical 32%
of sample, elevated-fast declining 57%, chronically elevated 11%).
Results: Twenty-one percent of adolescents were rehospitalized within the first three months of discharge.
Rehospitalization predicted distinct changes in suicidal ideation trajectories, while controlling for baseline depressive
symptoms, hopelessness, externalizing problems, sex, suicide attempt history as well as suicidal ideation severity at
baseline and follow-up (i.e. ideation trajectories). Specifically, for two of the suicidal ideation trajectories–the elevated-fast
declining and chronically elevated–rehospitalization predicted increases in suicidal ideation during the 9-month follow-up,
with larger magnitude for the chronic ideation group. In contrast, rehospitalization was associated with a decrease in
follow-up suicidal ideation among the subclinical group. Rehospitalization was also associated with greater risk of suicide
attempts, above the effects of key covariates. The pattern of these results was the same when previous number of
hospitalizations was controlled for.
Conclusions: Even when accounting for key covariates and previous number of hospitalizations, rehospitalization
predicted a more severe course of suicidal ideation for the majority of adolescents while it was protective for a smaller
subgroup with subclinical levels of ideation at index hospitalization. Our findings also suggest that rehospitalization is a
strong indicator of future suicide attempt risk, even when adjusting for the role of covariates.
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Does Recent Suicidal Desire Moderate Different Measures of Psychological Pain and its
Neurophysiologic Correlates?
Esther Meerwijk, Sandra Weiss
University of California San Francisco, United States of America; esther.meerwijk@gmail.com
Unbearable psychological pain is frequently noted as the reason for suicide and is a prominent symptom in people who
experience depression. Psychological pain scores on the Orbach & Mikulincer mental pain questionnaire (OMMP), but not
on the Psychache scale (PS), have been associated with objective measures of resting-state low-frequency heart rate
variability (HRV) and right frontal EEG delta power. As both instruments assess psychological pain, we explored whether
differences in recent suicidal desire could explain potential differences in what the PS and OMMP measure and in their
neurophysiologic correlates.
We collected resting-state EKG and EEG data in adults (N = 35) with a history of depression but were not necessarily
experiencing a depressive episode at the time of data collection. Neurophysiological data were recorded during 5-minute
sessions while subjects were sitting upright with their eyes closed. To test the moderating effect of recent suicidal desire,
we created two groups based on item 4 of the Beck Scale for Suicide Ideation (BSS), which indicates whether participants
had an active suicidal desire during the week that preceded the study. Depression level was assessed on the Beck
Depression Inventory II.
Strong positive correlations between PS and OMMP were observed, although considerably stronger in the group with
recent suicidal desire. (r = .75, p < .01, n = 11 vs. r = .50, p < .05, n = 24). Strikingly, the correlation between PS factor 2
and the OMMP score in the group with recent suicidal desire was very strong (r = .90, p < .001), but only a statistical trend
existed for a moderate correlation in the group who reported no recent suicidal desire (r = .35, p = .09). When PS scores
were regressed on right frontal delta power while controlling for depression, a significant interaction between suicidal
desire and delta power was observed (∆R2 = .07, p < .01). The model of PS regressed on low-frequency HRV showed a
trend toward a significant interaction between low-frequency HRV and recent suicidal desire (∆R2 = .02, p = .13). Results
obtained with the OMMP resembled results for the PS in subjects who reported recent suicidal desire, but indicated no
moderating effect of suicidal desire.
Findings suggest that recent suicidal desire is associated with higher current psychological pain and affects congruence of
different measures of psychological pain and their association with neurophysiologic correlates. Results have implications
for the utility of the PS and OMMP in assessment of suicide risk.
Risk Factors for Compassion Fatigue and Burnout among American Suicide Crisis Hotline Workers
Blaire Catherine Schembari1, Kevin Siegel2
The Catholic University of America, United States of America; 2University of California, Santa Barbara, United States of
America; 95schembari@cardinalmail.cua.edu
Compassion fatigue, often referred to as secondary traumatic stress, is defined as the presence of negative physical and
psychological symptoms resulting from providing care to distressed clients (Figley, 1995). Given that crisis hotline
counselors assist individuals in extreme distress, they may be at a high risk for developing compassion fatigue. According
to Taylor and Furloner (2011), the development of compassion fatigue among aides can hinder one’s ability to effectively
help. It is possible that because suicide hotline workers aim to assist those in suicidal (life and death) crises, they may be
exposed to a higher degree of conversations about death, hopelessness, and trauma compared to non-crisis talk line
workers. Relatively little research has examined compassion fatigue among suicide hotline counselors, specifically
(O’Sullivan & Whelan, 2011; Sanford & Cerel, 2014). Therefore, this study seeks to explore potential risk factors
associated with compassion fatigue and burnout among suicide crisis hotline workers, such as demographic variables
(e.g., education, ethnicity, gender, age, martial status, length of time working as a counselor, employment status). This
study’s data were derived from an online survey that combine three measures of compassion fatigue/burnout: The
Professional Quality of Life Scale-5 (ProQOL-5; Stamm, 2010), Compassion Satisfaction/Fatigue Self Test for Helpers
(Figley, 1995), and a general demographics sheet. These measures were completed by n=43 suicide crisis hotline
counselors from an American suicide hotline. A series of statistical analyses including, but not limited to, logistic
regressions, correlations, and independent t-tests will be conducted in order to identify significant risk factors for
compassion fatigue and burnout among suicide hotline workers. The ability to identify risk factors of compassion fatigue
may help increase self-care initiatives for suicide hotline workers. Upon completion of this presentation, participants will be
able to identify risk factors for compassion fatigue among suicide crisis hotline workers, acknowledge the significance of
self-care, and discuss aims for future research.
1
Interrupted Attempt, Actual Attempt and Acquired Capability for Suicide in a Clinical Adolescent
Sample
Sarita Patel1,2, Katherine V. Rial1,2, Kristin L. Wolfe1,2, Jennifer L. Hughes1,2, Sarah E. Horton1,2, Jessica King1,2,
Sunita M. Stewart1,2
1
UT Southwestern Medical Center, United States of America; 2Children’s Medical Center;
Sunita.Stewart@UTSouthwestern.edu
Objectives
Acquired capability for suicide (AC) is a central variable in the Interpersonal Psychological Theory of Suicide (IPTS) in
explaining suicide attempts (Christensen et al., 2014; Cukrowicz et al., 2013; Joiner, 2005). Research supports the
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empirical basis for this construct in relation to suicide attempts in adults (Ribeiro et al., 2014), though few studies have
examined adolescents (Czyk, Berona, & King, 2014). Even in adult literature, the focus has been primarily on the
association between AC and the presence or absence of an attempt, but little has been done to examine AC as a
dimension. For example, because AC is proposed to increase with desensitization to the fear of death, the IPTS would
predict that AC would also be enhanced with aborted and interrupted events, but would be most markedly increased
following actual attempts. This preliminary investigation examines this hypothesis in a clinical sample of adolescents.
Method
Participants were 133 adolescents (Mean, SD for age = 14.76, 1.41 years, range 12-17 years) recruited from an inpatient
psychiatric unit. The sample was primarily Caucasian (71%) and girls (75%). Participants completed the Acquired
Capability for Suicide Scale-Fearlessness About Death (ACSS-FAD) and the Columbia-Suicide Severity Rating Scale (CSSRS), which contains questions regarding lifetime history of interrupted, aborted, and actual suicide attempts.
Results
A univariate ANOVA was conducted to examine differences in ACSS-FAD scores among three groups of adolescents:
those with 1) no suicide attempt (n=39), 2) an aborted or interrupted attempt (n=12), and 3) an actual attempt (n=75).
There was a statistically significant difference between groups, F (2, 123)=6.97, p =.001. Post-hoc comparisons using the
Tukey HSD test indicated that the actual attempt group (M=2.53, SD=1.04) differed significantly from the no attempt group
(M=1.78, SD=.97). The aborted/interrupted attempt group (M=2.29, SD=1.11) did not vary significantly from either of the
other two groups, likely because of low power related to sample size. A subsequent Tukey HSD test showed that
individuals in the attempt group had the highest ACSS-FAD mean scores (M=2.53), followed by the aborted/interrupted
attempt (M=2.29), and the no attempt group had the lowest mean scores (M=1.78).
Conclusion
The current study illustrates the dimensional nature of AC. Adolescence, when ideation and attempts typically first
emerges, provides a window to examine the early development of suicidality. Our results suggest that when assessing
suicide risk, it is important to not only inquire about actual attempts, but to also inquire about aborted or interrupted
attempts. Further research is needed to examine other contributors to the AC dimension, including non-suicidal self-injury
and trauma. Also needed are studies that prospectively examine changes in AC and subsequent attempts.
The Possibility of Self-Efficacy as a Suicide Ideation Predictor: A Population Cohort Study in Rural
Japan
Koji Fujita1, Yoshio Kobayashi1, Yoshihiro Kaneko1, Yutaka Motohashi2
Akita University Graduate School of Medicine, Akita, Japan; 2Kyoto Prefectural University of Medicine, Kyoto, Japan;
kfujita@med.akita-u.ac.jp
Background: Self-efficacy has been widely studied in suicide, both in its causality and efficacy of treatment programs.
However, the evidence of causality is still ambiguous and there is a lack of generalizability. The aim of this study was to
examine the relationship between self-efficacy and suicide ideation through a population cohort study. Methods: The
community-based household survey using a self-administered questionnaire was conducted in a rural area of Japan,
Happo Town, in Akita Prefecture with community residents age 30 and over at two respective time points by local health
volunteers. The baseline survey was conducted in 2010 with a response rate of 88.9% (n = 6044). Among them, 3812
residents met the inclusion criteria for the follow-up survey in 2012 where the response rate was 75.3% (n = 2869).
Exposure variables to suicide ideation included demographic details, depression, and self-efficacy. The Institutional
Review Board and the Ethics Committee of Akita University approved the study protocol and all subjects signed informed
consent. Results: A total number of 2105 participants (76.4%) without suicidal ideation in the baseline study were enrolled
into the follow-up study, and 8.2% of them had developed suicide ideation. These participants with suicide ideation were
significantly less likely to be married/cohabitant; they had worse subjective health, poorer self-perceived economic status,
stronger depressive mood, and lower self-efficacy scores. The odds ratio of the self-efficacy scores at the follow-up
survey for participants who had developed suicide ideation were about 2 times lower than at baseline (95% confidence
interval = 1.42 – 2.91) after adjusting for all confounding factors. Conclusion: This result suggests that suicide ideation
may be prevented by increasing self-efficacy. We suggest that self-efficacy can be an effective tool for identifying people
with suicide ideation, and increasing self-efficacy can be strategically beneficial for larger suicide prevention.
1
Actigraphy and Agitation in the Assessment of Suicide Risk: A Validation Study
Adam J. Rossi, David A. Lynch, Daniel J. Flack, Randall Richardson-Vejlgaard
Teachers College, Columbia University, United States of America; ajr2171@tc.columbia.edu, dal2151@tc.columbia.edu,
djf2136@tc.columbia.edu, djf2136@tc.columbia.edu
Identifying individuals at imminent risk for suicidal behavior is a problem that continues to vex both clinicians and
researchers. Current approaches to suicide risk assessment rely on highly sensitive self-report inventories that fail to
adequately specify periods of heightened risk within a given individual. An association between an individual’s experience
of agitation and suicidal behavior has been demonstrated across both inpatient and outpatient clinical settings (Busch,
2003; Balázs et al, 2006; Olgiati et al., 2006). Actigraphy, a frequently used ecological momentary sampling technology,
allows researchers to capture the frequency and intensity of physical movement. This exploratory study examined the
relationship between self-reported levels of agitation (measured by the Brief Agitation Measure; Ribeiro et al., 2011) and
variables derived from actigraphy movement data within defined temporal intervals in 8 healthy individuals. A multi-modal
analytic strategy was used, incorporating multi-level modeling, within-subjects analyses, and additional exploratory
analyses, revealing a relationship between self-reported agitation and physical activity as measured with actigraphy. In
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gaining a deeper understanding of the experience of agitation, we propose a methodology with potential for making more
proximal predictions of suicidal behavior, and the phenomenology thereof, in the service of suicide prevention.
Organisation and Volunteer Building for Suicide Prevention and Survivor Support – A Human
Capacity for Response Approach
Bobby Zachariah1,2, Sandy Dias Andrade1, J.G.F Bunders2, Barbara J. Regeer2
Connecting...NGO, India; 2Athena Institute, VU, Amsterdam; bobbyzac@gmail.com
The Concern
1
Volunteer implemented suicide prevention and survivor support programs is a key factor in developing sustainable
activities. Attracting new volunteers, partnering with them in organisation building and preventing volunteer burn out is
crucial to achieving this goal. While attracting the right volunteers to the cause of suicide prevention is difficult, ensuring
volunteer satisfaction and preventing burnout is an ongoing challenge for suicide prevention organisations. Consequently,
the volunteers leave, necessitating additional efforts in volunteer recruitment and training.
Studies conducted on crisis line volunteers have found that expectations, perceptions of competence and support, and
other factors influence satisfaction, burnout and intention to quit, leading to significant wastage of volunteer recruitment
costs and training.
Methodology
A theoretical frame work to understand volunteer response and appropriate approaches for volunteer development is
provided by the Human Capacity for Response theory proposed by ‘Affirm Facilitators’ and ‘The Constellation’. It proposes
that human beings have the capacity to care, change, hope, be a community and initiateleadership. Organisations that
recognize this can initiate approaches to facilitate this capacity to respond to critical issues.
This framework was adopted in 2012 and implemented at ‘Connecting...NGO’, a suicide prevention and survivor support
organization based in Pune, India. Specific tools that were used include SALT (Support, Appreciate, Listen/Learn and
Team/Transfer), Dream Building Tool, Self-Assessment Tool, Participatory Action Research, Strength Based Mentoring,
Listening Approaches, Briefing / Debriefing and Volunteer Care/appreciation programs. Specific attention is given to
volunteers who are suicide survivors and volunteers who are undergoing personal crises.
Results
Over a three year period, the volunteers found the organisation to be a place where they belong to, emergence of
experienced volunteers mentoring new volunteers, initiation of new programs based on vision shared by volunteers,
improving work and documentation, presence in local / national / international media, double the number of helpline calls,
initiation of a suicide survivor support program that reaches out to hospitals / neighbourhoods and an organisation locally
recognized as a place of credible support related to distress and suicides. The number of volunteers has grown fivefold
over the three year period. The programs implemented have attracted donor grants. A research is further looking into
factors that has led to satisfaction and the factors that led to attrition among ex-volunteers.
Broader Implications
The results can be replicated by other organisations that work with populations under high distress to gain ownership,
build evolving initiatives and prevent burn out.
A Comparison of the Characteristics of Suicide Attempters with and without Admission to
Psychiatric Wards after Treatment in an Emergency Department
Shigero Shimoda1, Katsumi Ikeshita1, Kazunobu Norimoto2, Keisuke Arita1, Kazuo Okuchi2, Toshifumi Kishimoto1
1
Department of Psychiatry, Psychiatric Institute, Nara Medical University, Japan; 2Department of Emergency and Critical
Care Medicine, Nara Medical University; s-s@naramed-u.ac.jp
Objectives: The purpose of the present study was to compare the characteristics of suicide attempters who had been or
had not been admitted to psychiatric wards after treatment in an emergency department.
Methods: The subjects were suicide attempters who were admitted to Nara Medical University Hospital Emergency
Center between April 1, 2007 and March 31, 2014. We divided the subjects into two groups, 1. Patients who were
admitted to psychiatric wards after treatment in an emergency department (the admission group), 2. Patients who had not
been admitted to psychiatric wards after treatment in an emergency department (the non-admission group). Group
differences were analyzed with age, gender, psychiatric diagnosis, previous history of suicide attempt, past/present
psychiatric history and method of suicide attempt. Clinical data and socio-demographic characteristics were collected from
medical records retrospectively.
Results: The total number of subjects was 532 (119 in the admission group and 413 in the non-admission group). The
ratio of male/female was higher in the admission group (0.8 vs 0.5), mean age was older in the admission group
(45.4±19.3, 26.1-64.7 years) than the non-admission group (39.7±16.6, 23.1-56.3 years). The rate of subjects diagnosed
with affective disorders and schizophrenia spectrum disorders was significantly higher in the admission group while
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personality disorders and adjustment disorders were more frequently diagnosed in the non-admission group. Past/Present
psychiatric history and past history of suicide attempt were more frequently noted in the admission group. Regarding
methods of suicide attempt, ‘drug overdose’ was the most common in both groups and the proportion of ‘hanging’,
‘jumping from height’, ‘jumping in front of a moving vehicle’ and ‘stabbing’ were more frequent among the admission
group.
Conclusion: Significant differences were observed in age, psychiatric diagnosis, previous history of suicide attempt,
past/present psychiatric history and method of suicide attempt. When patient with affective disorders and schizophrenia
spectrum disorder suicide attempt using severe methods, psychiatric approach is particularly necessary.
C-Reactive Protein Associated with Suicidal Behavior in an Inpatient Population
Hunter Gibbs, Lauren Davis, Jeffrey Clothier, LouAnn Eads, Ricardo Caceda
University of Arkansas for Medical Sciences, United States of America; rcaceda@uams.edu
Growing evidence suggests a pro-inflammatory status associated with suicidal behavior. Most studies have focused on
rarefied samples that exclude patients with an array of inflammatory conditions. In order to examine the role of
inflammation in suicidal ideation and behavior in adult patients suffering from severe psychiatric conditions, we
retrospectively examined serum C-reactive protein (CRP) levels and erythrocyte sedimentation rates (ESR) in patients
admitted to the inpatient psychiatric units (N = 218) of the University of Arkansas for Medical Sciences following a suicide
attempt, with suicidal ideation, and inpatient psychiatric controls. Additionally, we recorded demographics, clinical data,
smoking status, white blood cell count, and fasting lipid panel. After controlling for demographic factors, CRP levels were
associated with status post suicide attempt compared with psychiatric controls [F(2,121) = 4.15, p < .01]. In patients
hospitalized with mood disorders, ESR emerged as an independent predictor [F(1,155) = 4.61, p = .043]. This research
builds on the growing body of evidence supporting a role for inflammation in the neurobiology of suicide by replicating the
association between pro-inflammatory status and suicidal behavior in a sample of ‘real world’ severely ill psychiatric
inpatients.
Incarcerated Women in Community: What Is the Impact on Suicidal Ideation?
Regina Trudy Praetorius, Laura Frank Terry, Anne Elizabeth Nordberg
University of Texas at Arlington, United States of America; annenordberg@uta.edu
Background: 29% of all jail deaths in the US are suicides. The rate of suicide in jails is 47 per 100,000. This is over 4
times higher than the national rate of 11.5 per 100,000. Purpose: To examine how one agency’s holistic services impact
suicidality of women in a jail setting.
Methodology: A mixed methods design was utilized in this study. For the quantitative portion, a pre-/post-test design
measured the effectiveness of holistic programming on mental health, empowerment, and readiness for change among 70
women. For the qualitative portion, open-ended evaluation questions and journals completed by the women were
collected to assess women’s satisfaction with programming and what they perceived to be the most impactful components
of programming. Results: Programming significantly decreased mental health symptomology including depression,
anxiety, and PTSD. Decreases in women endorsing suicidal ideation at posttest in comparison to pretest was noteworthy.
Suicide Prevention in Prison: An E-Learning Module to Increase Professionalization of Prison Staff
in Managing and Assessing Suicidal Patients
Julia Leong1,2,3, Erik Masthoff1, Derek de Beurs2,3, Ad Kerkhof2,3
Penitentiary Institution Vught, Netherlands, The; 2Department of Clinical Psychology, VU University, Amsterdam, The
Netherlands; 3EMGO Institute for Health and Care Research, Amsterdam, The Netherlands; leong.julia@gmail.com
Suicide is the most common cause of death in correctional settings. Compared to a normal population, sentenced
detainees have an increased suicide rate of 6 times and pretrial detainees have an even higher suicide rate of 7.7 times.
1
Currently, there’s no up-to date suicide prevention program for prison staff.
Therefore, a collaboration has been set up between the Penitentiary Institution Vught and the VU-University Amsterdam.
The aim is to develop and test an e-learning module designed to train prison staff to identify suicide risk factors in
detainees and subsequently to cope with those in a state of the art manner.
Setting: Penitentiary Psychiatric Centre of the Penitentiary Vught, the Netherlands
Design: cluster randomized controlled trial
Intervention: In the intervention group all staff members will study the e-learning module suicide prevention. This 60minute e-learning module contains theoretical information and additional vignettes on the management of suicidal
patients. The e-learning module aims to improve knowledge, attitude and skills of the prison staff in managing suicidal
prisoners. Changes at these points will be measured at baseline, directly after completing the module and at 3 months
follow-up. The control group will only fill out the preliminary questionnaire and the three month follow-up. After the
assessment at three months the control group will also participate in the e-learning module.
Matching and Randomization: Eligible wards will be matched in pairs on basis of the main diagnostic DSM-IV-TR category
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of residing inmates. Subsequently, both wards of every matched pair will be randomly allocated to either the control or the
intervention group. Binary randomization will be performed by an independent researcher of the EMGO+ research
institution who is not involved in the study.
Sample size calculcation: The number of professionals that needed to be included was set to 234. This number is
sufficient to find a small effect size (Cohen’s d) of 0.4, assuming an alpha of 0.05 and the statistical power of 1-Beta=0.80.
A correction of 5% for clustering of effects within departments was applied.
Outcome measures: Self-evaluation of knowledge will be measured by the Question, Persuade, Refer Questionnaire
(QPR). The ability to recognize the appropriate response will be measured by the Suicide Intervention Response
Inventory (SIRI-2) and the confidence of the staff members will be measured by the Confidence and Beliefs Questionnaire
(CB).
The theoretical knowledge will be measured with an exam.
Inclusion of professionals will start in October 2014. Last assessments will be completed in January 2015. At the congress
these results will be presented.
Preliminary Results: Preliminary results from the pilot study (pre N= 16 and post N=12) are promising. This study shows
that after the post measurement knowledge (p= .000) , CB (p = .033), QPR (.006) improved significantly. Only the SIRI
showed no significant result (p = .083).
Connaissances, stéréotypes et représentations sociales du suicide et des personnes suicidaires en
Bretagne
Celine Kopp Bigault1, Michel Walter2, Anne Thevenot1
Université de Strasbourg, France; 2Université de Bretagne Occidentale, Brest, France; michel.walter@chu-brest.fr
La Bretagne est la région de France la plus touchée par le suicide avec une mortalité de 28.9 décès pour 100 000
habitants (Observatoire National du Suicide, 2014). Depuis 50 ans, cette région est à la première place des régions
françaises concernant ce problème majeur de santé publique. Les chiffres décroissent lentement depuis le pic de 1986,
sans être jamais repassés en dessous de la moyenne française, malgré des politiques de santé publique régionales
axées sur la prévention du suicide existantes depuis les années 1990 (ORS Bretagne, décembre 2007).
1
Les actions de prévention sont entre autres basées sur la formation des acteurs de la vie locale au repérage et à
l'intervention en situation de crise suicidaire (Seguin, Terra). Ces formations ont été élaborées à partir des nombreux
travaux internationaux sur le suicide et de la conférence de consensus qui a eu lieu en 2000 en France.
Dans le cadre de ces formations, un chapitre est dédié aux "idées reçues" des participants face au suicide, avec une
hypothèse qui pourrait être que ces "idées reçues", ou encore stéréotypes (Mannoni, 2012), modifient les attitudes de la
population à l'égard du suicide et potentiellement freinent les motivations des personnes à intervenir et limitent l'impact
des messages de prévention (Morissette, 1985).
Ces stéréotypes sont-ils les mêmes partout sur le territoire français ? Y a-t-il des stéréotypes plus actifs en Bretagne ou
encore différents ? Une analyse des stéréotypes associés au suicide et aux suicidaires en Bretagne nous permettrait-elle
de comprendre les représentations sociales (Jodelet, 1989) et la pensée collective bretonne en rapport avec cet acte?
Renberg et Jacobsson (2003) ont mis en évidence qu'une personne touchée par un suicide était plus tolérante et
permissive qu'une personne qui ne l'avait pas été, tandis qu'au niveau collectif, dans les régions avec un fort taux de
suicide, ils ont retrouvé des attitudes plus intolérantes et hostiles. Il a par ailleurs été mis en évidence que les messages
de prévention devaient s'adapter aux populations cibles et à leurs caractéristiques (Chambers, Pearson and al., 2005)
A partir des "idées reçues " figurant dans le manuel du formateur au repérage et à l'intervention de crise suicidaire, de
certains items inspirés de différents questionnaires d'évaluation des attitudes à l'égard du suicide [SOQ (Domino, Moore,
Westlake & Gibson, 1982 ; Gonzalez Forestier, 1983 ; Rogers, DeShon, 1992 ; 1995), SEDAS (Jenner, Niesing, 2000),
ATTS (Renbers, Jacobsson, 2003)] ainsi que des facteurs de risque de suicide connus (Brown, Sheran, 1972 ; Leenars,
1996 ; Conférence de consensus, 2000 ; Manuel du formateur), nous avons élaboré un questionnaire d'étude des
connaissances et stéréotypes associés au suicide à destination de la population bretonne. Ce questionnaire a été diffusé
par internet, mailing et courrier.
Nous proposons ici de rendre compte des premiers résultats de cette étude.
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PP18-1: Parallel Plenary: Genetics and Neurobiology of Suicidal Behavior
[Plénière parallèle: Génétique et neurobiologie des comportements
suicidaires]
Genetics and Neurobiology of Suicidal Behavior / [Génétique et neurobiologie des comportements
suicidaires]
Chair(s): Teo Postolache (University of Maryland School of Medicine)
Suicide is a public health problem, causing more than 1 million deaths worldwide each year. The risk of suicide-related
behaviour is supposed to be determined by a complex interplay of sociocultural factors, stressful life events, psychiatric
history, personality traits and e.g. a genetic vulnerability among others.
This symposium will especially focus on genetic and neurobiological risk factors of suicidal behaviour including
interactions of genes and environment.
First, Gil Zalsman will give an update on Gene x Environment Interactions in suicidal behaviour. Especially he will focus
on the age-related and gender-related development of the brain including animal models.
Next, Vincenzo De Luca will talk about stress interaction and genes in suicidal behavior. In detail he will present data on
genome wide association studies and interactions with early Childhood Trauma.
Kees van Heeringen will give an update on imaging studies in suicidal behaviour and discuss that in relation to possible
biomarkers.
Teo Postolache will summarize newest research on neuroimmunology of suicidal behavior focusing on Toxoplasma gondii
(T. gondii) chronic “latent” infection, and molecules of the kynurenine pathways (kynurenine and quinolinic acid), which
have been previously independently associated with suicidal self-directed violence.
Finally, Alexander B. Niculescu III will introduce blood biomarkers which could help to predict suicidality. He will discuss
this in the light of other possible biomarkers and there interactions.
Presentations of the Symposium
Impulsivity, the 5-HTTLPR Polymorphism and Suicide Behavior in Euthymic Bipolar Patients /
[Impulsivité, polymorphisme 5-HTTLPR et comportement suicidaire chez les patients bipolaires en
phase euthymique]
Humberto Correa, Fernando Neves, Marco Aurelio Romano-Silva, Leandro Malloy
Federal University of Minas Gerais, Brazil
Suicide behavior is very frequent in Bipolar Disorder (BD) and they are both closely associated with impulsivity.
Furthermore they are, impulsivity, BD and suicide behavior, associated with serotonergic function, at least partially, under
genetic determinism and somewhat associated with the serotonin transporter gene polymorphism, the 5-HTTLPR. We
aimed to assess different impulsivity components in BD sub-grouped by suicidal attempt and healthy controls. We
hypothesized that the non-planning/cognitive impulsivity, could be more closely associated with suicidal behavior. We
further associated 5-HTTLPR genotypes with neuropsychological results to test the hypothesis that this polymorphism is
associated with cognitive impulsivity.
We assessed 95 euthymic bipolar patients sub-grouped by suicidal attempt history in comparison with 94 healthy controls.
All subjects underwent a laboratory assessment of impulsivity (Continuous Performance Test and Iowa Gambling Test).
Furthermore the genotyping of 5-HTTLPR was performed in all subjects.
We found that bipolar patients are more impulsive than healthy controls in all impulsivity dimensions we studied.
Furthermore bipolar patients with a suicide attempt history have a greater cognitive impulsivity when compared to both
bipolar patients without such a history as well when compared to healthy controls. No association was found between 5HTTLPR genotypes and neuropsychological measures of impulsive behavior.
The sample studied can be considered small and a potentially confounding variable - medication status - was not
controlled.A lifetime suicide attempt seems associated with cognitive impulsivity independently of the socio-demographic
and clinical variables studied as well with 5-HTTLPR genotype. Further studies in larger samples are necessary.
Suicide: Gene and Stress Interaction / [Suicide : interaction entre les gènes et le stress]
Vincenzo De Luca
Group for Suicide Studies, CAMH, Dept Psych., Un. of Toronto
Objectives: Suicide attempt in schizophrenia is an important clinical issue in its management. We performed a genomewide association study to identify genetic markers, which increase the risk for suicide attempt in schizophrenia.
Methods: Suicide attempt lifetime was assessed in 122 schizophrenia patients and defined by the means of the Columbia
Suicide Severity Rating Scale and the Beck Scale for Suicidal Ideation. Genotype distribution of 1,205,383 single
nucleotide polymorphisms (SNPs) in patients with suicide attempt lifetime (n=55) was compared to that in patients without
any suicide attempt lifetime (n=67). The same SNPs were analyzed in interaction with childhood trauma.
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Results: None of the variants reached genome-wide significance, the best marker in the main genetic model was the SNP
rs12895203 (p=0.00001) and the top SNP interacting with Childhood Trauma Questionnaire was the marker rs7897059
(p=0.00005). The odd-ratio of the top SNP in the main-genetic effect model was 3.91 and in the gene-early trauma
interaction model was 1.13.
Conclusions: Although our data need to be interpreted carefully owing to the small numbers in this cohort, they suggest
that a combination of genetic markers and early life stress might indeed be used to identify patients at risk for suicide
attempt.
State of the Art of Neuroimaging / [Imagerie cérébrale de pointe]
Kees van Heeringen
Univ. Dept Psychiatry & Med. Psychol., Institute for Neurosc.
Postmortem and neuropsychological studies have demonstrated the involvement of brain dysfunctions in the development
of suicidal behavior. Recently, neuroimaging techniques have become available to study brain functions in vivo, and these
techniques are increasingly applied to the study of the vulnerability to suicidal behavior. This talk will give a
comprehensive review of recent findings from imaging studies of suicidal behavior, combined with a review of selected
recent studies in depressed and healthy individuals. Recent findings from studies using divergent imaging techniques
confirm the association between changes in brain functions and the occurrence of suicidal behavior. Studies outside the
suicidological domain show that treatments may have an effect on these changes. It is now becoming clear where and
how decisions about the self are made relying on memory, the cognitive regulation of emotion, affective responses to
environmental stimuli including emotional pain, and the perception of the future. Studies of the effects of antidepressant
treatments show that underlying brain functions are influenced by such treatments.
Neuroimmunology of Suicidal Behavior: A Focus on the Upstream, the Downstream and the
Modifiable / [Neuroimmunologie des comportements suicidaires : Éléments proximaux, distaux et
modifiables]
Teo Postolache
University of Maryland School of Medicine
Certain changes in the environment are reflected in certain changes in physiology that have been associated with suicidal
behavior. For instance, reduced ultraviolet radiation and its Vitamin D metabolism, exposure to allergens and microbes, all
converge towards changes in immune function. Downstream, predisposing and precipitating factors tend to interact
additively, if not synergistically. For instance, both Toxoplasma gondii (T. gondii) chronic “latent” infection, and molecules
of the kynurenine pathways (kynurenine and quinolinic acid), have been previously independently associated with suicidal
self-directed violence. As infection with T. gondii is demonstrated to elevate kynurenine levels, and because high
kynurenine levels are in turn immunosuppressive, they may in turn contribute to reduced immune pressure and trigger
reactivation of T. gondii. We hypothesized that T. gondii association with suicide attempt history will be stronger in those
with high kynurenine levels. 950 patients with schizophrenia were evaluated clinically, anti-T.gondii IgG antibodies were
measured with using solid-enzyme immunoassay as well as kynurenine levels using with high performance liquid
chromatography. In T. gondii seropositive patients only, KYN levels in the upper 25th percentile were associated with
nonfatal suicidal self-directed violence. The results argue against a linear mediation of T. gondii effect by kynurenine and
its metabolites. We propose that the immunosuppressive effect of high levels of kynurenine, resulting from a dysregulated
kynurenine pathway, may contribute to T. gondii reactivation, and suicidal behavior. We will also present literature on
downstream mediation of other environmental factors, such as the immune dysregulation as a consequence of Vitamin D
deficiency and allergy. Ultimately, the presentation will focus on modifiable risk, and environmentally and
pharmacologically based innervations for risk management.
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PP18-2: Parallel Plenary: Qualitative Suicide Research [Plénière parallèle:
Recherche qualitative en suicidologie]
Qualitative Suicide Research / [Recherche qualitative en suicidologie]
Chair(s): Heidi Hjelmeland (Norwegian University of Science and Technology)
For far too long, suicidology has been dominated by quantitative research, mostly in the form of repetitive risk factor
studies. The risk factor mindset is based on the biomedical model and even though the notion of causality in itself is not
always made explicit, this model is based on an idea of a linear cause-and-effect relationship that explains suicidal
behaviour as the result of (caused by) various risk factors. From a philosophy of science perspective, however, speaking
of causal explanations of human behaviour is questionable. Irrespective of whether or not they are suicidal, human beings
neither behave according to the rules of causal determinism nor are they disconnected from their life history and context.
We argue that to move forward the suicidological field we need to increase studies focussing on understanding suicidal
behaviour in different socio-cultural contexts. In this, qualitative research is essential. By being able to take more of the
context and life history into consideration in the analysis, qualitative studies contribute knowledge about the complexity of
suicidal behaviour beyond what is possible in quantitative research.
However, qualitative research still is met with negative attitudes in the field; attitudes that clearly reflect lack of knowledge
about what qualitative research is and what this approach can contribute. As a result, qualitative studies are few and far
between in the international suicide research journals. Moreover, although many researchers realize the need for
qualitative research and really want to do such research, many do not seem to know what it is or how to do it well.
Qualitative data are either quantified or merely described with no real qualitative analysis conducted. There seems to be a
myth in some circles that "qualitative method equals no method". In other words, there seems to be a lack of knowledge in
the field about what qualitative research is, what it can contribute, how to do it well, and how to report it.
By means of a number of examples from recent qualitative research in different cultural contexts, the main goal of this
symposium is to demonstrate that qualitative studies can contribute to both a deeper as well as a different understanding
of suicidal behaviour compared with quantitative studies. Such research is an essential starting point in contexts where no
previous suicide research has been conducted. However, even in contexts where we already have plenty of suicide
research, qualitative research still has an important contribution to make in helping to build foundations for communitybased and context-sensitive prevention and postvention strategies. Hence, we argue that a change of direction in suicide
research is urgently needed in that we now need more ‘pure’ qualitative as well as mixed methods research.
Presentations of the Symposium
Qualitative Suicide Research: What Is It and What Can It Contribute beyond What Quantitative
Research Is Able To? [Qu’est-ce que la recherche qualitative en suicidologie et comment peut-elle
combler les lacunes de la recherche quantitative?]
Heidi Hjelmeland1, Birthe Loa Knizek2
Norwegian University of Science and Technology, 2Sør-Trøndelag University College
The suicide research field still is dominated by simplistic risk factor studies and qualitative studies are relatively few and
far between. On the one hand, negative attitudes towards qualitative research still are voiced by influential people like
editors, reviewers and research managers. On the other hand, there are signs that more and more researchers realize the
need for qualitative suicide research. However, conference presentations as well as journal submissions reveal that many
do not seem to know what it is or how to do it well. The qualitative data are either quantified or merely described with no
real/specific qualitative analysis conducted. Thus, there seems to be a lack of knowledge on what qualitative research is
and what it can contribute, as well as on how to do it well. Badly performed qualitative research contributes to maintain
negative attitudes towards it, which, in turn, hinders qualitative studies to be widely accepted.
1
In this presentation, we will argue that as for quantitative studies, also qualitative studies should collect and analyse data
systematically and rigorously by means of specific methods to be named in the article/presentation. Moreover, just as
issues of reliability and validity are important to discuss in a quantitative paper, the relevant equivalents credibility,
transferability, dependability and confirmability, are important to discuss in a qualitative one. In contrast to quantitative
studies where statistical generalization is important, analytical and/or theoretical generalization is emphasized in
qualitative studies. That is, it is the users of the knowledge produced that have to decide whether the findings are useful in
their setting.
By means of examples, we will highlight limitations of quantitative studies and demonstrate what qualitative research can
contribute beyond what qualitative research is able to do. For instance, in quantitative studies of risk factors, authors
usually launch a number of speculations as to how the various risk factors found might be related to the suicidal
behaviour. However, the vast majority displaying any risk factor do not (attempt to) kill themselves and quantitative studies
are unable to find out what it is with the risk factors, if anything, that contributes to suicide for a few, but not most people
displaying them. One example is that quantitative studies have found that almost all people who kill themselves suffered
from one or more mental disorders and then a causal link between the two is implied. However, qualitative studies have
now found that mental disorders do not seem to play a central role for most of the suicides studied. Thus, qualitative
studies not only contribute to a deeper, but also a different understanding of the suicidal process than what quantitative
studies are able to.
Sometimes, the risk factors are also put together into models aimed at predicting suicidal behavior. However, such
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models will always have a rather limited sensitivity and/or specificity since the outcome for an individual will always
depend on a number of (constantly changing) variables not included in the model. A major problem is that the models are
linear, whereas the suicidal process is not. To increase our understanding of the suicidal process, it must be analysed in
terms of a contextual and life history perspective, which is only possible to do meaningfully by means of qualitative
research. This will be demonstrated more in depth in the presentations to follow.
Rituals and Communication Styles Connected to Suicide among the Baganda: Qualitative Research
Where No Suicide Research Previously Has Been Conducted / [Rituels et styles de communication
associés au suicide chez les Baganda : une recherche qualitative réalisée où aucune recherche sur
le suicide n’a été menée]
James Mugisha1, Birthe Loa Knizek2, Eugene Kinyanda3, Heidi Hjelmeland4
Butabika National Referral Psychiatric Hospital, 2Sør-Trøndelag University College, 3MRC/UVRI Uganda Research Unit
on AIDS, 4Norwegian University of Science and Technology
Human experience and current behavior are historically, culturally and linguistically mediated. In Uganda, among the
Baganda suicide is the most feared cause of death and a great abomination to the community. Because of this fear, upon
a suicide, Baganda undertake an extended period of rituals to distance themselves from the suicide. Examples of such
rituals are practices conducted to liberate the children from the suicide spirit, detaching the family from a genealogical
spirit by denying a man who has killed himself an heir, destroying the house of the deceased, and planting traditional
signs to safeguard the community.
1
Baganda also belong to an indirect culture. They don’t communicate about death directly. They use their linguistic
resources to communicate indirectly about death in a way they deem not risky to society. Among the Baganda, talking
about suicide is inviting it to the family and the entire community and such behaviour should be condemned.
It therefore becomes essential that researching and understanding of the rituals performed on suicide among the
Baganda requires an in-depth understanding of their language. Since they don’t communicate directly about death, in this
study we use a deeper understanding of their language (talk and other intonations) as a cultural resource to gain a
sense/understanding of their cognitions (in terms of attitudes and likely consequent behavior) about death due to suicide.
The data were analysed by both grounded theory and discourse analysis. The words used by our informants are used to
develop two major linguistic/cognitive categories: the individual views on suicide, which were normally sympathizing to
suicide and, the communal view of suicide which was always dogmatic and condemnatory to suicide. In the majority of the
cases, both the individual and communal views on suicide were indirectly communicated to the researcher collecting data.
Conducting qualitative suicide research in this context is not only important, but even essential, for two reasons: First,
qualitative methodologies are flexible and hence culturally sensitive. Second, the findings described in this study would
have been completely impossible to obtain by means of quantitative research methodologies. Hence, qualitative research
contributes to the understanding of suicide in context beyond what is possible in quantitative research and is essential in
developing culture sensitive suicide prevention strategies.
Preventing Suicide at the Micro-Social Level: Understanding the Needs of Concerned Family
Members and Friends / [Prévenir le suicide au niveau microsocial : comprendre les besoins et les
inquiétudes des proches et amis]
Christabel Owens, Gareth Owen
University of Exeter Medical School
In this presentation, we will argue that suicide prevention needs to start at the level of the smallest social unit and work
upwards to achieve macro-level targets. The smallest social unit is an intimate partnership, family or friendship group. The
suicidal process unfolds within these micro-social contexts, but we know very little about what a suicidal crisis looks like
from the point of view of family members and friends, or the difficulties it poses for them.
Whilst the slogan ‘Suicide prevention is everyone's business’ has been widely used in awareness campaigns and national
strategies, research has remained largely focused on the role of health professionals in assessing and managing risk. The
process of lay judgement is much less well understood. We lack knowledge of how those closest to a suicidal individual
make sense of what is happening and decide what action, if any, they should take. Qualitative research was needed to
shed light on this neglected area and to inform the development of small-scale community-based prevention initiatives.
We investigated 14 cases of completed suicide, aged 18-34 and outside the care of mental health services. We
conducted in-depth interviews with members of the deceased’s family and social network, using snowballing techniques to
recruit as many informants as possible in each case, in order to examine different perspectives and build up detailed case
studies. Informants (n=31) were asked a single opening question, designed to elicit an extended free narrative about what
happened in the period leading up to the suicide. This allows informants to decide what information to include and how to
organise it, ensuring that the narrative is not influenced by the preconceptions of the researcher. The interviewer then
asked follow-up questions, clarifying and elaborating on aspects of the narrative that were most relevant to the study
aims.
Findings suggested that there had been few clear warning signs. Signs of distress were typically vague, oblique and open
to a range of interpretations, and were often offset by positive ‘countersigns’ or signs of ‘life as usual’, making it difficult for
relatives and friends to decide whether there was any cause for alarm. Even when they did recognise that something was
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seriously wrong, relatives and friends were often paralysed by fear, primarily fear of loss, which rendered them unable to
say or do anything to prevent the tragedy.
We concluded that one of the main challenges for suicide prevention is to help people to acknowledge and overcome their
fears about intervening. Most public health education messages are based on a simple SEE-DO or SEE-SAY-DO model
(‘See these signs, take this action’), which assumes that people are rational beings and fails to take account of the
personal risks involved in ‘saying’ or ‘doing’. Based on our findings, we are starting to develop a suite of simple public
education resources that address emotional as well as intellectual needs.
Qualitative Research in Suicide Bereavement / [Recherche qualitative sur le deuil par suicide]
Myfanwy Maple
University of New England
Qualitative methodologies, while being recognized for the ability to deeply interrogate the topic under study across health
and wellbeing research, is still rare in suicidology literature. Given the relative infancy of the field of postvention,
proportionally more research undertaken to understand the experience of individuals impacted by suicide has been
qualitative. This trend is not uncommon in emerging fields, as researchers determine the issues needy of further
investigation. However, with little leadership or fine examples of high quality qualitative research in suicide bereavement
and postvention, much of the research is poorly executed and analysed thus making publication difficult. This paper will
provide examples from qualitative research undertaken, identifying the epistemological, theoretical and methodological
issues requiring attention to ensure high qualitative research is undertaken with vulnerable communities and individuals.
These examples include using narrative inquiry with parents bereaved by suicide where using an indepth interview, a
three-tiered analytic frame was developed to understand the meaning the suicide death had on parents, a project using
thematic analysis with a community residing population exposed to suicide to contextual psychopathology reported within
a quantitative component of the study, and third, a photovoice project with young people with multiple and complex needs
reporting extraordinarily high levels of exposure to suicide death and attempt to understand concepts around mental
health and wellbeing. These three examples are used to illustrate the depth and breadth of qualitative methods in suicide
bereavement research.
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PP18-3: Parallel Plenary: Historical Trauma in Indigenous Societies:
Theoretical Approaches, and Implications for Youth Suicide Prevention
Historical Trauma in Indigenous Societies: Theoretical Approaches, and Implications for Youth
Suicide Prevention
Chair(s): Allison Crawford (Centre for Addictions and Mental Health & University of Toronto), Jack Hicks (Ilisimatusarfik
(Nuuk, Greenland) & Carleton University (Ottawa))
Rates of suicide behaviour vary widely between indigenous societies, between regions of indigenous societies, and
between communities in indigenous regions. The rates of variation are especially pronounced with regard to child and
youth suicide behaviour. One factor contributing to these variations may be differing levels of historical trauma between
and within these societies. The reality of high rates of historical trauma in these regions and communities has implications
for suicide prevention measures.
This symposium will include:
A. A review of epidemiological data on variations of rates of suicide behaviour between and within indigenous societies;
B. A theoretical overview of the concept of historical trauma, specifically as it is experienced by indigenous societies, and
evidence-informed hypotheses of the role that unresolved historical trauma may play in indigenous societies, regions and
communities with high rates of suicide behaviour; and,
C. Consideration of the implications of a historical trauma framework for the design of suicide prevention interventions in
indigenous communities.
Presentations of the Symposium
The Association between Intergenerational Trauma and Early Onset Suicidal Ideation and Attempts
Amy Bombay
Dalhousie University
Although rates of suicide vary appreciably across communities, the increased risk for suicidal ideation, behaviors, and
completed suicides are particularly evident in today’s generation of Aboriginal youth. Suicidal ideation and behaviors are
heterogeneous phenomena that result from complex interactions among distal factors that influence predisposition, and
proximal factors that can act as precipitants. Increasing evidence suggests that early-onset suicidal ideation and
behaviors are important risk factors for eventual completed suicide, highlighting the importance of identifying precursors to
early on-set suicidal behaviors among First Nations youth. It has been suggested that exposure to intergenerational
patterns of childhood adversity may be associated with an earlier onset of suicidal ideation and attempts, as well as more
frequent, severe, and violent attempts relative to those without this family history. Such intergenerational cycles of
childhood adversity characterize too many families from First Nations communities that were negatively affected by the
Indian Residential School (IRS) system. Indeed, intergenerational exposure to the consequences of familial IRS exposure
is a distal factor that has been associated with increased suicidal ideation and attempts among First Nations adults. In
order to begin to explore pathways by which intergenerational IRS exposure is related to suicide, age will be explored as a
moderator of the relationship between familial exposure to IRSs and suicidal ideation/attempts using data from the youth
sample of the 2008/10 First Nations Regional Health Survey (RHS). It is expected that the relationship between IRS
exposure and suicidal ideation/attempts will be stronger for younger youth (aged 12-14). Furthermore, using data from the
adult sample of the 2008/10 RHS, intergenerational exposure to familial IRS exposure is expected to be associated with a
lowered age of first suicidal ideation/attempt, which in turn is expected to be linked with an increased risk for a subsequent
suicidal attempt. Understanding how exposure to intergenerational adversity is associated with risk for suicide will inform
the development of evidence based and culturally informed prevention and intervention programs for First Nations youth.
Indigenizing National Suicide Prevention Strategies: Considering Culture, Historical Trauma and
Evidence
Allison Crawford1, Christina Viskum Lytken Larsen2, Jon Petter Stoor3
Centre for Addictions and Mental Health & University of Toronto, 2University of Southern Denmark and Min. of Health
(DK), 3Sámi National Centre on Mental Health and Substance Abuse (NO)
A strategy for suicide prevention is a purposeful set of integrated, multifaceted activities that are coordinated by
government. A strategy aims to promote, support and link inter-sectoral programs at local, regional and national levels.
The creation of national suicide prevention strategies (NSPS) is supported as a suicide prevention effort in its own right,
and guidelines for the creation of comprehensive and effective national strategies have been set out by the United Nations
(1996). The World Health Organization’s (WHO) recent Suicide Prevention guide highlights the need for an ecological
approach to suicide prevention, with consideration of cultural and community specificity. The WHO identifies risks for
suicide at the community level, including “disaster, war and conflict; stresses of acculturation and dislocation;
discrimination; trauma or abuse,” and links these with evidence-based approaches to prevention and intervention.
However, the evidence for interventions cited remains limited to approaches used globally, including means restriction,
gatekeeper training, and improved access to mental health services. There is a lack of specificity, and a lack of evidence
base for interventions specifically designed within transcultural and/ or Indigenous contexts. Similarly, while existing
guidelines for the creation of NSPSs highlight the importance of adopting a conceptual model of suicidal behaviour to
guide a coherent plan for which interventions are prioritized and supported, there is no consensus on whether suicide in
1
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Indigenous contexts is best explained using generic conceptual models, such as Hawton’s (2012) model, or whether novel
frameworks are necessary. Indigenous-specific frameworks may identify unique risk factors, such as disempowerment,
history of colonization, and intergenerational trauma, that guide the need for relevant interventions (see, for example,
Wexler and Gone 2013). This paper proposes to review NSPSs (e.g. Australia, New Zealand, Greenland, United States),
in addition to existing adaptations of suicide prevention strategies for and by Indigenous communities. Using Platt et. al.’s
(2006) comparative framework, which looks at origins, scope, adoption of a conceptual framework, evaluation, and
supporting structures, among other factors that contribute to a comprehensive strategy, the paper will consider how
Indigenous epistemologies, contexts, and unique social and historical circumstances are accounted for. This will be
discussed in relation to the author’s current engagement with Inuit Tapiriit Kanatami (ITK) in the development of a
National Inuit Suicide Prevention Strategy, and the ways that culture and community context guide the conceptual
framework, the process, and the content of the strategy.
Elevated Rates of Historical Trauma in Inuit Communities: The Evidence, an Explanatory
Hypothesis, and the Implications for Suicide Prevention
Jack Hicks
Ilisimatusarfik & Carleton University
A review of police files on deaths by suicide among Inuit in the Northwest Territories between 1920 and 1945 – before the
move into settled communities – reveals patterns of rates and risk factors which differ sharply from those contained in
Coronorial records on deaths by suicide by Inuit in Nunavut from 1967 to the present day. The 2010 Nunavut Suicide
Prevention Strategy “[confirmed] the belief of many Nunavummiut that elevated levels of social risk factors, rooted in
unresolved historical trauma, are a key factor underlying Nunavut’s high rate of death by suicide” in recent decades. An
analysis of suicide rates by community reveals a pattern which speaks to the range of historical traumas which have
impacted on Inuit society – the residential school experience being just one, and arguably not the most significant one in
this case. Nonetheless, the body of research on how the intergenerational transmission of historical trauma from
residential schools is associated with risk for suicide behaviour among children and youth offers important insights into the
role played by historical trauma resulting from other ‘disruptions’ to Inuit society in recent decades – and important
implications for suicide prevention measures targeting Inuit children and youth.
Understanding Intergenerational Embodiment to Aid in Suicide Prevention: A Public Health
Perspective
Gerald McKinley
Centre for Mental Health and Addictions
Suicide in First Nations communities is a significant public health problem. First Nations communities in Ontario
experience a disproportionate burden of suicide in their population under the age of 18. Despite accounting for
approximately 1% of the total population in that age group, First Nations youth represent over 20% of annual suicides.
The interaction of social, cultural, political and economic factors across generations contributes to the conditions of
possibility that enable the suicide epidemic to take place. Here, intergenerational transmission of experience, also known
as historical trauma, is considered to be a social determinant of health in First Nation’s communities. Using interviews with
First Nations youth this paper explores how First Nations youth embody community experience into their own concept of
Self. From this perspective I explore how protective factors against suicide are understood by youth within unique local
contexts. Based on this I argue that selected factors generally accepted as protective actually contribute to the
development of stress in youth.
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OP18-3A: Atelier: Mobiliser les communautés pour prévenir le suicide :
paradigmes et exemples québécois, dont l’engagement citoyen des
auteurs d’un téléroman à succès
Mobiliser les communautés pour prévenir le suicide : paradigmes et exemples québécois, dont
l’engagement citoyen des auteurs d’un téléroman à succès
Catherine Rioux1, Anne Boyer2, Luc Massicotte3
Association québécoise de prévention du suicide, Canada; 2Duo Productions; 3Centre de prévention du suicide Les
Deux Rives; crioux@aqps.info, aboyer@duoproductions.ca, luc.massicotte@prevention-suicide.qc.ca
Portées par la volonté d’engager les communautés dans le grand mouvement de la prévention du suicide et convaincues
de leur nécessité pour bâtir une société sans suicide, les organisations du Québec qui se consacrent à la prévention du
suicide ont modifié leur approche en matière de mobilisation sociale au cours des dernières années. Des paradigmes
nouveaux en matière de mobilisation et des pratiques inspirantes ont émergé.
1
Les présentateurs répondront à ces questions : comment l’AQPS et les organisations en prévention du suicide se sont
dotées d’un discours idéologique représenté par le slogan « Le suicide n’est pas une option »; pourquoi et comment ils
ont choisi d’adopter des pratiques inspirées des ONG; quelles sont l’évolution et l’ampleur de la mobilisation; quelles sont
les opportunités de mobilisation; en quoi cette approche est nécessaire et quels sont les résultats atteints et anticipés.
L’atelier fera une large place à une expérience unique au monde, soit celle de la collaboration audacieuse entre l’AQPS et
les auteurs d’un des téléromans les plus populaires au Québec. La représentation du suicide dans les œuvres de fiction
préoccupe celles et ceux qui travaillent en prévention. Elle rejoint aussi d’autres tranches de la population. Les auteurs et
producteurs de Yamaska, Anne Boyer et Michel d’Astous, ont choisi de traiter du sujet dans un téléroman grand public
tout en s’inspirant de bonnes pratiques en prévention du suicide. Leur engagement pour la cause a donné naissance à
une plateforme Web, à des événements de sensibilisation, dont une marche qui a réuni plus de 5 500 personnes, et plus
largement, à la mobilisation d’une communauté télévisuelle. Cette collaboration et ces projets ont permis à la cause
d’obtenir des retombées majeures en termes de visibilité. Ils ont aussi fait naître un modèle unique de mobilisation
citoyenne.
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OP18-3B: Symposium: Task Force Media & Suicide Symposium II: Suicide
Preventive Interventions via Online Media and Preventive Aspects of
Communication in Social Media [Groupe de travail Médias & Suicide II:
Prévention du suicide par internet et les médias sociaux]
Task Force Media & Suicide Symposium I: Suicide Preventive Interventions via Online Media and
Preventive Aspects of Communication in Social Media / [Groupe de travail Médias & Suicide II:
Prévention du suicide par internet et les médias sociaux]
Chair(s): Jane Pirkis (University of Melbourne, Centre for Mental Health), Thomas Niederkrotenthaler (Medical
University of Vienna, Center for Public Health)
This symposium hosted the IASP Media & Suicide Task Force aims at promoting the latest research findings in the areas
of suicide preventive interventions delivered via online media as well as aspects of communication in social media that are
relevant to suicide prevention. The symposium includes presentations from leading research groups from 5 countries and
3 continents. Specific presentations covered will focus on a content-analytic description of 35 English-speaking Public
Service Announcements for suicide prevention from around the world (Jane Pirkis), which can inform organizations
interested in the development of suicide-preventive PSAs. A recent experiment which tested the effect of three different
German-speaking suicide-educative professional websites on individuals in terms of knowledge, attitudes and suicide risk
factors will shed light on what works best when constructing educative websites (Benedikt Till). The online
memorialisation of those who have died by suicide as indicated by eleven qualitative interviews in the UK with individuals
who have experience of creating and maintaining Facebook sites dedicated to the memory of loved ones is the topic in
another presentation that will enhance our understanding of the use of Facebook in the aftermath of suicide (Jo Bell). A
qualitative discourse analysis of online communication patterns in a Swedish suicide bereavement forum adds another
perspective to the area of online representation of suicide bereavement, and indicates that a forum can serve as an
important place for the symbolic construction of a we-group (Michael Westerlund). The controversial topic of “pro-suicide”
message boards and their meaning for suicide prevention will be brought up in another talk that elaborates on similarities
and differences between postings in German-speaking “pro-suicide” and “anti-suicide” message boards based on a
content analysis of more than 1,200 online threads (Thomas Niederkrotenthaler). Finally, the timely topic of online bullying
and suicide will be addressed in an analysis of recent 2013 National Youth Risk Behavior Survey data from the United
States that comprises 13,000 students. This analysis suggests that online bullying may explain the transition from suicidal
ideation to suicide attempt behavior, with important potential implications for policy and prevention (Steven Stack).
Goals:
1) Provide an overview of examples of suicide-prevention PSAs as a basis for others who consider using PSAs in their
countries and regions.
2) Enhance our understanding of effective educative websites related to suicide prevention
3) Deepen our understanding of the preventive functions of social media in the aftermath of suicide
4) Deepen our understanding of “pro-suicide” message boards, with implications for policy and prevention
5) Highlight cyber-bullying as a potential factor on the pathway from suicidal ideation to suicide attempt
Presentations of the Symposium
Mass Media Campaign Material Designed to Prevent Youth Suicide: Examples from around the
World / [Exemples à travers le monde de campagnes médiatiques de prévention du suicide chez les
jeunes]
Maria Ftanou1, Georgina Cox2, Angelina Nicholas1, Jo Robinson2, Anna Machlin1, Jane Pirkis1
Centre for Mental Health, Melbourne School of Population Health, 2Orygen Youth Health Research Centre, The
University of Melbourne
An intervention that has been receiving increasing attention in recent times as a means of combatting suicide is the media
campaign. These typically take the form of public education campaigns (consisting of informative or persuasive
messages) rather than social marketing campaigns (which involve an exchange with the community) and have public
service announcements (PSAs) at their core. Suicide prevention campaigns involving PSAs have not been well described
and have been subject to minimal evaluation. We searched for short (≤90 seconds) English-language PSAs that had
been screened as part of a small- or large-scale suicide prevention campaigns around the world. We found 35 (12 from
the United States, six from Australia, seven from the United Kingdom, six from New Zealand, three from Canada, and one
from Israel). Most commonly, these PSAs focused on the general population and/or people who might be at risk of
suicide, and had a particular emphasis on young people. Almost 60% promoted open discussion about suicide, around
50% indicated that the life of a suicidal person was important, about 40% acknowledged the suffering associated with
suicidal thoughts and feelings, about 25% stressed that suicide is preventable, and about 20% focused on the devastating
impact of suicide for those left behind. Most PSAs promoted some sort of support for people at risk of suicide, usually a
helpline or website. All PSAs used a serious tone to get their message across, and the majority (around 70%) presented
realistic scenes and/or facts about suicide.
1
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The Use of Facebook in the Aftermath of a Suicide / [L’utilisation de Facebook après un suicide]
Jo Bell, David Kennedy, Louis Bailey
The University of Hull
There has been considerable concern in recent years about the use of social media in the aftermath of a suicide, in
particular how this may influence and contribute to ‘copycat’ suicides and suicide clusters. The instantaneous nature of
social networking platforms such as Facebook means that news about the death spreads rapidly to a very wide audience.
This paper presents findings from ongoing qualitative research in the UK which focuses on the online memorialisation of
those who have died by suicide. It draws on data from eleven interviews with individuals who have experience of creating
and maintaining Facebook sites dedicated to the memory of loved ones. These include those who lost a child, a sibling, or
a friend to suicide. Interviews were transcribed and the authors read the data, constructed a coding frame and examined
themes across the data set as well as within the context of each individual interview. Data were analysed using an
interpretive approach, combining constant comparison with thematic analysis.
Our analysis explores the various ways in which Facebook can be used in the aftermath of a suicide and examines in
particular the frequency of communication, what sentiments are expressed and how activity changes over time. It
highlights both the harmful and helpful potential of Facebook in the aftermath of a suicide across individual and
community levels. Examples of potential harm caused include: outpourings of grief that some felt were not genuine
(inauthentic requests for attention); fear of provoking copycat suicides; and the dangers of blurring private and personal
boundaries (anxieties about public private speech). Examples of protective potentials include using Facebook as a way of:
reaching out to others; bringing people together; staying connected; raising awareness; identifying and reaching those in
need of support. Implications for the role of Facebook in suicide prevention and postvention are critically discussed. Open
questions remain about the potential impact of exposure to intimate, sensitive suicide specific content via Facebook on
the wider community.
This research was funded by the Wellcome Trust UK.
Recent papers from this research:
Bailey, L., Bell, J., and Kennedy, D. (in press). Continuing Social Presence of the Dead: Exploring Suicide Bereavement
through Online Memorialisation. New Review of Hypermedia and Multimedia.
Suicidal Communication in 1,200 Suicide Method and Prevention Threads: What Can We Learn for
Suicide Prevention? / [Analyse de 1200 forums de discussion sur le suicide : Quelles leçons pour la
prévention?]
Thomas Niederkrotenthaler, Benedikt Till
Medical University of Vienna, Center for Public Health
Introduction
Suicide message boards are a controversial topic in public discourse, and prevention, policy. Little is known about the
contents of messages provided.
Methods
This study presents the results of an analysis of communication patterns in 1,200 threads randomly identified in 3 types of
German and Austrian message board types (categorized into “pro-suicide”” , “neutral”, and “anti-suicide” boards). We
assessed the primary concern of the initial (primary) posters, responses received, life stressors, and signs of suicidality in
primary posters and respondents, and we assessed differences across forum types. Intercoder-reliability was assessed
and satisfactory for all variables presented.
Results
Self-disclosed age and sex indicated a higher proportion of males and older individuals in “pro-suicide” boards, as
compared to other board types. The primary concern of the primary visitor (i.e., the individual opening the discussion) was
clearly constructive in 92% of threads in “anti-suicide” boards, in 72% of “neutral” boards and in 27% of “pro-suicide”
boards. Clearly destructive primary concerns were rare in “anti-suicide” boards (4%) and neutral boards (13%), but
common in pro-suicide boards (49%). Primary posters with constructive primary concerns received constructive
affirmation by respondents in over 70% of threads in all types of boards. However, primary posters with a destructive
primary concern received destructive affirmation in 75% of the respective threads in “pro-suicide boards”, while such
affirmation was less frequent in other board types. Types of life stressors presented by both primary posters and
respondents frequently involved relationship conflicts and isolation in “pro” and “neutral” boards, but stressors regarding
choice of methods were common in “pro-suicide” boards. More than 70% of primary posters across all types of
boards showed signs of suicidal constriction. The respondents ressembled the primary posters with regard to the amount
of suicidal constriction shown in “pro-suicide” threads, but less so in “neutral” threads. Most respondents in “anti-suicide”
threads showed no signs of suicidal constricition.
Discussion
The study indicates that the intent of primary posters and user type varies with regard to the type of message boards.
Respondents ressemble the primary posters in terms of problems and life stressors presented within each forum type. A
distinct difference between respondents in “anti-suicide” boards and “pro-suicide” boards is that respondents in the latter
type of board show a similar degree of suicidal ideation as the primary posters in these boards. Posters with constructive
concerns frequently receive affirming responses across all types of boards. However, in “pro-suicide-boards”, posters with
destructive intent also receive destructive affirmation. Users of “pro-suicide” boards are possibly a distinct target
population advanced in the suicidal process and hard to reach with professional intervention.
This work was funded by the Austrian Science Fund (FWF) (Grant Number P-23659-B11
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Internet Bullying Distinguishes Suicide Ideators from Attempters / [La cyber-intimidation distingue
ceux qui ont des idéations suicidaires de ceux qui font des tentatives de suicide]
Steven Stack1, Barbara Bowman2
Wayne State University / Center for Suicide Research / Troy, MI, 2Center for Suicide Research / Troy, MI
Cyber bullying refers to aggression perpetrated through the use of technology. The increasing use of communication
technologies including face book & chat rooms have provided an exponential increase in opportunities bullying on the
internet. While there has been substantial research on traditional bullying & suicidality, there is very little on cyber bullying.
The present study has two related aims (1) To provide national estimates of the incidence of cyber bullying & suicide, (2)
To see if cyber bullying victimization can be used as a tool to differentiate suicide attempters (SA) from ideators (SI). The
second aim is related to the theme of an SLTB special issue (Klonsky, 2014), the need to find risk factors that distinguish
suicide ideation from attempts. While most risk factors are able to predict SI and/or SA (e.g., 26/26 mental disorders), very
few (e.g., 4/26 mental disorders) reliably distinguish SA from SI. METHODS. Data are from the 2013 National Youth Risk
Behavior Survey of 13,583 high school students. SA & SI were measured using self reports spanning the last 12 months.
Cyber bullying is measured by a self report. Controls are included for involvement in violence (e.g., fighting, dating
violence), psychiatric morbidity (e.g., depression, substance abuse, eating disorder), & demographics. RESULTS. For the
entire sample of 13,583 students 14.8% reported cyber bullying victimization, but fully 52.2% of SA had been cyber
bullied. Taken separately, cyber bullying predicted both SI and SA. A logistic regression analysis was restricted to 2,136
youth ideators & attempters where the dependent variable was 1=SA & 0=SI. Controlling for the other independent
variables, suicide attempters were 1.50 times more likely to be cyber bullying victims than SI. Other leading predictors of
SA over SI included fighting (OR=1.91), dating violence (OR=1.36), major depression (OR=1.32), an eating disorder
(OR=1.83) and having a suicide plan (OR=3.35). The model explained 21.6% of the variation. CONCLUSION. Two
studies have suggested a link between cyber bullying & suicidality. However, none have raised the question regarding
whether or not cyber bullying may explain the transition from SI to SA. The present study addresses this issue. An
important difference between SI &SA is that the latter are more apt to be victims of cyber bullying. This finding can help
those engaged in risk assessment & suicide prevention in concentrating their resources on those most apt to make the
transition from SI to a SA. Future research using a longitudinal or cohort based research design is needed to address the
question of causality. The results suggest that there may be a need for greater social control of cyber bullying on the
internet.
1
Klonsky, E. (2014). Differentiating suicide attempters from suicide ideators: A critical frontier in suicidology research.
SLTB, 44,1-5.
The Role of Newspaper Coverage in the Initiation of Teenage Suicide Clusters / [Le rôle de la
couverture médiatique dans les suicides en série chez les adolescents]
Madelyn Gould1, Marjorie Kleinman2, Alison Lake2, Judith Forman2, Jennifer Basset Midle2
1
Columbia University / New York State Psychiatric Institute, 2New York State Psychiatric Institute
Introduction. We aimed to determine whether newspaper reports of suicide play a role in the emergence of suicide
clusters. Methods. Suicide clusters among youth aged 13 through 20 years in the U.S. from 1988 through 1996, a period
preceding the advent of social media, were identified using the Scan statistic. For each cluster community two matched
non-cluster control communities, where suicides of similarly aged youth occurred, were selected. Newspapers within
cluster communities were examined for suicide stories that occurred between the first and second suicide victims, a
period reflecting the initiation of the cluster. In non-cluster communities, a matched period following the death of the
control suicide victims was examined. Content analysis was conducted on 1,729 newspaper stories from 48 cluster
communities and 95 non-cluster communities.
Results. The average number of news stories about suicidal individuals after the index cluster suicide was significantly
greater than the average number of such stories after a non-cluster suicide. Several story characteristics, including frontpage placement, appeared more often in stories following the index cluster suicides than after non-cluster suicides.
Discussion. Our findings support the interpretation that media portrayals of suicide may play a role in the emergence of
teen suicide clusters. These portrayals may constitute a modifiable risk factor for clusters.
Conclusion. Our findings, from the largest series of youth suicide clusters examined to date, highlight the importance of
adherence to media guidelines in the wake of a suicide, and of heightened postvention efforts with vulnerable adolescents
following a suicide that receives media attention.
RELATED PAPER: Authors (see abstract). Newspaper coverage of suicide and initiation of suicide clusters in teenagers
in the USA, 1988—96: a retrospective, population-based, case-control study. Lancet Psychiatry, Volume 1, Issue 1,
Pages 34 - 43, June 2014
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OP18-3C: Symposium: Suicidal Behaviour in People with an Intellectual
Deficiency or an Autism Spectrum Disorder: Understand, Assess Risk and
Intervene [Le comportement suicidaire chez les personnes avec une DI ou
un TSA: comprendre, évaluer et intervenir]
Suicidal Behaviour in People with an Intellectual Deficiency or an Autism Spectrum Disorder:
Understand, Assess Risk and Intervene / [Le comportement suicidaire chez les personnes avec une
DI ou un TSA: comprendre, évaluer et intervenir]
Chair(s): Cécile Bardon (CRISE)
Objective: This symposium aims to gather experts on the topic of suicidal behaviour in people with an intellectual
deficiency (ID) or an autism spectrum disorder (ASD). There is growing concern regarding suicidal behaviours with ID or
ASD persons and there is not as much research on the topic as there should be. Our objectives are: to develop a better
understanding of the risk and protective factors for suicidal behaviour; to synthesise current knowledge and needs
regarding the development of strategies to assess suicide risk; and to offer guidelines for appropriate suicide risk
interventions with persons with ID or ASD. Finally this symposium presents a great opportunity to increase communication
and exchanges between the two fields of suicide prevention and ASD and ID research and aims to increase the potential
for collaboration between researchers and clinicians working in suicide prevention and in intervention with persons with ID
or ASD.
Content: The symposium will benefit from the involvement of specialists too rarely seen in suicide prevention forums and
conferences. Clinical and research experts working with groups of ID or ASD persons will present their research,
experience, concerns and questions about issues related to different aspects of suicidal behaviors, their identification and
management. Our first presenters work in an organisation that provides services to ID or ASD persons. They will present
their study of the incidence and characteristics of suicidal behaviour in their clientele and of the challenges the
organization faces in coping with them. Our second presenters are researchers who will present an overview of current
knowledge on suicidal behaviour in persons with ASD and identify needs for further research. Our third presenters are
clinicians in a psychiatrist setting who will discuss the various aspects of suicidality in their ASD patients and their
strategies for evaluating the risk and for intervening. Our final presentation will be made by researchers who have
analysed the incidence and characteristics of suicidal ideations in persons with ID. They will also address suicide
prevention needs with this population. A final discussion will aim to emphasise key findings and identify questions that
need to be addressed by researchers and clinicians in order to improve our understanding of suicidal crises, our ability to
assess risk and to intervene with persons with ID or ASD.
Format: The symposium will be organized to include: (1) a brief introduction to the topic and to the major issues related to
suicide behaviour in ID or ASD persons, (2) a series of four 15-minute presentations, (3) a 20-minute discussion between
presenters and participants to identify key questions that need to be explored in future research and collaborative work
with practice. To conclude, we will study the possibility for future contacts and collaborations between participants to
improve suicide prevention with persons with an ID or an ASD.
Presentations of the Symposium
Étude des manifestations suicidaires des personnes ayant une DI ou un TSA: constats et enjeux
d’identification / [Suicidal Behaviours in ID and ASD Populations: Findings and Challenges in
Evaluation and Intervention]
Chantal Mongeau, Anne-Marie Ouimet, Isabelle Jacques, Daphné Morin
CRDITED de Montréal
Contexte: Peu d’études a été réalisé sur les comportements suicidaires des personnes présentant une déficience
intellectuelle (DI) ou un trouble du spectre de l’autisme (TSA), mais les données récentes suggèrent une prévalence
égale et parfois supérieure à celle observée dans la population générale. À cet égard, il apparaît important d’améliorer
nos connaissances sur l’expression de la détresse suicidaire de ces populations, particulièrement en contexte de services
spécialisés de réadaptation, afin de permettre la mise en place de mesures de repérage et d’intervention adaptées.
L’objectif de cette étude consiste à identifier et décrire les manifestations suicidaires (MS) de personnes ayant une DI ou
un TSA bénéficiant de services spécialisés de réadaptation.
Méthodologie : Les intervenants d’un centre de réadaptation assurant le suivi de 4 351 usagers présentant une DI (n= 3
159) ou un TSA (n= 1 192) de l’enfance à l’âge adulte ont procédé à l’identification rétrospective des personnes ayant
présenté des MS au cours de l’année 2013. La notion de MS est définie au sens large, dans la mesure où elle inclut toute
verbalisation, comportement ou changement d’état pour lequel l’intervenant décelait l’expression d’un désir de mettre fin à
ses jours. Les informations relatives au profil sociodémographique, au type de service reçu ainsi qu’à la nature des MS
ont été extraites du dossier des personnes identifiées. Les données présentées sont tirées d’un plus vaste projet visant
l’étude des MS et des modalités de leur gestion dans un service spécialisé de réadaptation du réseau de la santé et des
services sociaux du Québec.
Résultats et discussion : Les résultats préliminaires indiquent que 126 personnes ont manifesté de 1 à 10 MS au cours de
l’année 2013. Autant les personnes ayant une DI que celles ayant un TSA ont été identifiées, mais les profils sont
distincts : les personnes ayant un TSA seraient davantage des hommes, à la fin de l’adolescence et vivant au domicile
de leurs parents tandis que les personne avec une DI seraient de jeunes adultes, autant homme que femme et vivant plus
fréquemment en milieux de vie substituts. Une description détaillée des types, de la fréquence et des caractéristiques des
MS seront présentés. Les enjeux suivants feront l’objet de discussion : 1) les défis à l’identification des MS auprès de
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cette population; 2) l’ombrage potentiel du diagnostic de DI ou de TSA sur l’identification de la détresse suicidaire; et 3)
l’importance de cibler les MS au sein même des services de réadaptation destinés à ces populations.
What Do We Know About Suicidality in Autism Spectrum Conditions? / [Que savons-nous des
comportements suicidaires chez les personnes ayant un Trouble du spectre de l’autisme?]
Sarah Cassidy1, Paul Bradley2, Janine Robinson2, Carrie Allison3, Meghan McHugh2, Lisanne Van Dongen4, Jan
Vandormael4, Simon Baron-Cohen5
1
Coventry U., Autism Research Centre, U. of Cambridge, 2Cambridge and Peterborough NHS Trust, 3U. of Cambridge,
4
Maastricht University, 5University of Cambridge
Autism Spectrum Conditions (ASC) are frequently associated with mental health problems such as depression, a known
risk factor for suicide in typical development. In addition, young people with ASC transitioning to adulthood often
experience a lack of support services, and poor outcomes in terms of health and social difficulties, occupational
attainment, social exclusion and isolation. These factors could all increase risk of suicidality in ASC, but few studies have
explored suicidality in this clinical group. Available studies show that suicidality is present in 7-66% of ASC samples, and
individuals with ASC represent a substantial subgroup (7-15%) of suicidal populations. However a majority of these
studies include small samples, lack of appropriate comparison groups, unconfirmed ASC diagnosis, and lack of validated
measures of risk, protective factors (e.g. quality of life), and suicidality in ASC populations. Thus there is still very little
understanding of the presentation, risk or protective factors for suicidality in ASC. This presentation will review recent
developments in the study of the prevalence, risk and protective factors for suicidality in ASC, and propose directions for
future research.
Conduites suicidaires et Troubles du spectre de l'autisme: Évaluation et spécificités / [Suicidality
and Autism Spectrum Disorder : Assessment and Specificities]
Pascale Abadie, Pascale Grégoire, Laurent Mottron, Caroline Simard
U de Montréal, HRDP
Les conduites suicidaires sont évoquées cliniquement chez les enfants et adolescents avec un trouble du spectre
autistique (TSA). Mais la recherche clinique dans ce domaine reste très limitée et le diagnostic n’est pas envisagé dans
les services d’urgence. Dans des populations cliniques d’adolescents ou d’adolescents avec un TSA, la suicidalité est
retrouvée avec une fréquence de 11 à 20%. Un des facteurs de risque individuels majeur à rechercher est le trouble
dépressif, or la présentation clinique rend le diagnostic de la dépression complexe et le clinicien doit souvent se fier aux
observations des parents et des intervenants afin d’affiner son raisonnement clinique tout en tenant compte du potentiel
intellectuel. L’autoévaluation de la suicidalité et de la dépression ou de l’anxiété reste de plus questionnable, ce qui
suggère la nécessité de faire appel à des observateurs extérieurs dans le contexte de l’évaluation. Sur le plan
environnemental, l’intimidation et les difficultés d’intégration sociale sont particulièrement préoccupantes dans cette
population, représentant alors des facteurs prédisposants au passage à l’acte suicidaire. La poursuite des recherches
cliniques concernant le compréhension et la phénoménologie de la suicidalité chez les patients avec un TSA avec ou
sans déficience intellectuelle s’avère donc fondamentale, afin de développer des interventions thérapeutiques ciblées.
Dans une 1ere partie de la présentation, nous rappellerons les principales données cliniques et épidémiologiques portant
sur les conduites suicidaires chez les patients avec un TSA ; nous distinguerons ainsi les patients selon leur potentiel
intellectuel.
Dans une 2eme partie, il s’agira d’aborder l’évaluation de ces conduites et la pertinence des outils cliniques disponibles.
Enfin, nous discuterons les interventions possibles et les pistes de recherche dans ce domaine.
Suicidal Ideation among Adults with Intellectual Impairment in Western Canada / [Idéations
suicidaires chez les adultes ayant une déficience intellectuelle dans l’Ouest canadien]
David McConnell, Amber Savage
Faculty of Rehabilitation Medicine, U of Alberta
Persons with intellectual impairment may be particularly vulnerable to suicidal ideation. Many known risk factors for
suicidal ideation cluster together with intellectual impairment. Persons with intellectual impairment are, for example, more
likely to be Aboriginal; to have experienced maltreatment in their own upbringing; to be exposed to chronic economic
hardship; and to suffer prolonged loneliness and psychiatric morbidity. However, there is a paucity of population-based
data on suicidal ideation among adults with intellectual impairment. Utilising the Canadian Community Health Survey
(2009/2010), we investigated the prevalence and predictors of lifetime and 12-month suicidal ideation among adults with
intellectual impairment in Western Canada. We found that adults with intellectual impairment were many times more likely
than non-disabled adults to report suicidal ideation, controlling for age, sex, ethnicity and reported psychiatric morbidity.
However, the prevalence of suicidal ideation was low among adults with intellectual impairment who reported low levels of
food insecurity and high levels of community belonging. Our conclusion is that reducing suicide risk among adults with
intellectual impairment will require appropriate and timely mental health care AND strategies redressing their social
marginalisation. Understanding the role that disablism plays in creating or exacerbating risk and vulnerability will be
essential to any effective suicide prevention effort.
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OP18-3D: Symposium: IASP Special Interest Group, Clusters and
Contagion: New Research and Practice
IASP Special Interest Group, Clusters and Contagion: New Research and Practice
Chair(s): Annette Louise Beautrais (University of Canterbury, Christchurch)
Internationally, there is growing interest in clusters and contagion in suicidal behaviour Clusters and contagion effects
appear to be more common, perhaps associated with the rise of modern communication systems. However, research in
this area is embryonic, and information on effective response procedures and prevention strategies has, to date, been
limited. This symposium will bring together academics and practitioners from five countries to share reports of empirical
research, innovative practice, and theoretical advancement. Topics to be discussed span: definitions of “contagion” and
the research utility of this concept; content analysis of media reports during a suicide cluster in Wales; an innovative
national programme in New Zealand designed to share details of suspected suicides in a timely way to assist postvention
responses and enable early identification of emerging clusters; evidence of gender-specific patterns in clustering of
suicide and self-harm in Ireland; practical strategies for addressing suicide clusters in indigenous young people, derived
from experiences with the SAMHSA-funded National Native Children’s Trauma Centre in the USA; and the New Zealanddriven development and dissemination of practical guidelines for communities facing suicide clusters and contagion. The
audience will be invited to discuss issues related to these presentations.
Presentations of the Symposium
Suicide Contagion: A Systematic Review of Definitions and Research Utility
Qijin Cheng
University of Hong Kong
Objectives: Despite the common use of contagion to analogize the spread of suicide, there is a lack of rigorous
assessment of the underlying concept or theory supporting the use of this term. The present study aims to examine the
varied definitions and potential utility of the term contagion in suicide-related research.
Methods: Following the PRIMSA procedures, a systematic literature screening was conducted based on three online
databases: PubMed, Web of Science, and Social Sciences abstracts and full-text (via EBSCO) in April, 2013. 100 initial
records and 240 reference records in English were identified as relevant with our research objectives, through systematic
literature screening. We then conducted narrative syntheses of various definitions and assessed their potential value for
generating new research.
Results: 20.3% of the 340 records used contagion as equivalent to clustering (contagion-as-cluster); 68.5% used it to refer
to various, often related mechanisms underlying the clustering phenomenon (contagion-as-mechanism); and 11.2%
without clear definition. Under the category of contagion-as-mechanism, four mechanisms have been proposed to explain
how suicide clusters occurred: transmission (contagion-as-transmission), imitation (contagion-as-imitation), contextual
influence (contagion-as-context), and affiliation (contagion-as-affiliation).Contagion-as-cluster both confounds and
constrains inquiry into suicide clustering by blending proposed mechanism with the phenomenon to be studied.
Contagion-as-transmission is, in essence, a double or internally redundant metaphor. Contagion-as-affiliation and
contagion-as-context involve mechanisms that are common mechanisms that often occur independently of apparent
contagion, or may serve as a facilitating background. When used indiscriminately, these terms may create research blind
spots. Contagion-as-imitation combines perspectives from psychology, sociology, and public health research and provides
the greatest heuristic utility for examining whether and how suicide and suicidal behaviors may spread among persons at
both individual and population levels.
Conclusion: Clarifying the concept of “suicide contagion” is an essential step for more thoroughly investigating its
mechanisms. Developing a clearer understanding of the apparent spread of suicide-promoting influences can, in turn,
offer insights necessary to build the scientific foundation for prevention and intervention strategies that can be applied at
both individual and community levels.
Thematic Content Analysis of Newspaper Reporting during a Suicide Cluster in South Wales
Ann John
University of Swansea
Introduction: In 2008 there was extensive international newspaper coverage of suicides in young people around Bridgend,
South Wales. Subsequent analysis revealed an apparent cluster smaller and of shorter duration than reported by the
media.
Aims: To explore the possible role and quality of newspaper reporting.
Method: Searches were conducted of Nexis, Newsbank, Google and individual newspapers for articles on suicide in
Bridgend for six months before and after the cluster. Quantity, quality (PRINTQUAL) and sensationalism were
examined. A qualitative thematic content analysis of the articles in the two peaks of reporting was conducted.
Results: 577 articles were identified. A high level of sensationalist reporting was found: 1 in 7 articles mentioned the
suicide method in the headline, and nearly two-thirds included photographs. Only 13% included sources of support and
advice. PRINTQUAL poor quality reporting scores showed only a small improvement over time (Spearman’s rs=-0.25),
accompanied by a similarly small deterioration in good quality scores (Spearman’s rs=-0.25). The relationship between
quantity of reporting and timing of individual deaths remains unclear. It may be that interventions instigated at the start of
the cluster were protective towards the end of the cluster and during the second peak of reporting. These results have
been reported previously, we will report here on the thematic content analysis of the two peaks
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Conclusions: There was a substantial volume of newspaper articles and high levels of sensationalism about the suicides
in Bridgend, with little change in either domain of quality over time. Adherence to reporting guidelines is likely to be poor
without supporting initiatives. We further report on the content analysis of these articles.
w.tcpdf.org)
Priming Postvention: Timely Transmission of Suspected Suicide Details to Government Health
Agencies (New Zealand)
Roger Shave1, Maree Inder2
CASA, 2Clinical Advisory Services Aotearoa (CASA)
This presentation describes the development of an innovative programme, the Coronial Suspected Suicide Data Sharing
Service (CDS), and discusses CDS relevance to suicide clusters and suicide contagion.
1
CDS is a nation-wide service delivered by Clinical Advisory Services Aotearoa (CASA) on behalf of the Ministry of Health
in New Zealand. CDS notifies regional government health agencies of suspected suicide deaths as they are notified to the
Coronial Service. Building on a project supported by New Zealand's Chief Coroner, CDS was implemented by the
Ministry of Health as part of the New Zealand Suicide Prevention Action Plan 2013–2016. This Action Plan requires the
Ministry of Health to “establish a function to analyse and share up to date provisional coronial data on suicide deaths with
agencies working in local areas to help prevent further suicides”.
CDS notifications provide a platform for the delivery of timely, well-coordinated postvention responses that may reduce
the incidence of suicide contagion and suicide cluster formation. Additionally, CDS works alongside the national
Community Postvention Response Service (CPRS; also delivered by CASA on behalf of the Ministry of Health). CPRS is
responsible for supporting any New Zealand community experiencing a suicide cluster or suicide contagion. The CDSCPRS interface allows for national oversight of suicide clusters and suicide contagion, and context dependent postvention
coordination. This presentation will outline the principles of the programme, describe how it is organised, operated and
delivered.
Clustering of Suicide and Self-Harm: Gender Specific Patterns
Ella Arensman
University of Cork
NTRODUCTION: Research has focused primarily on descriptive analysis of the factors influencing suicide clustering.
Therefore, in examining suicide clustering, it is important to verify both the statistical significance of emerging clusters
across space and time using geo-spatial techniques, and to examine the level of contagion among cases within clusters.
This study aimed to improve early identification of clustering and contagion of suicide and self-harm, and to identify arealevel and individual factors associated with clustering of suicide and self-harm.
METHODS: Geo-spatial analyses were conducted using real-time data obtained through the Irish Suicide Support and
Information System and the National Registry of Deliberate Self-Harm.
RESULTS: Over a period of two years (2010-2012), 9 statistically significant suicide clusters were identified. There was
overlap among these clusters, with 2 larger clusters emerging. Cluster 1 involved 13 cases of suicide (expected number:
1.86), which occurred in a small geographic area over a 3-month period. The self-harm rate in this area and period of time
was 416 per 100,000, which was twice the average national rate. Cluster 2 involved 7 cases of suicide (expected number:
0.52), which occurred over a 2-month period. In both clusters half of the suicide cases had a self-harm history. During the
same period, 3 self-harm clusters were identified. Self-harm clusters comprising of men occurred more often in the
proximity of male suicide clusters than self-harm and suicide clusters comprising of women.
CONCLUSIONS: Improved insight into the characteristics of individuals involved in self-harm clusters may inform required
interventions to prevent (on-going) suicide clustering, in particular among men. Considering the association between selfharm and suicide, it would be recommended to enhance surveillance systems of self-harm and suicide at national level.
Response, Resilience and Recovery in Northern Plains Tribes: Strengthening Community in
Response to Suicide Clusters
Matthew Taylor
Forefront, University of Washington
The National Native Children's Trauma Center (NNCTC) funded by the U.S. Substance Abuse and Mental Health
Services Administration (SAMHSA) is working in multiple reservation communities across the United States, including 3 in
Montana and South Dakota where suicide clusters or declared states of emergency have occurred due to suicide,
violence or loss. For example in one small, rural reservation, 5 middle school aged students (out of 123 students)
completed suicide recently. This presentation will overview how NNCTC worked with school officials to triage survivors
for risk and resilience factors, seek permissions from parents or caregivers for postvention services, and partnered
students at risk for self-harm with adult mentors. Impacts of these actions on further risk taking, disorderly conduct,
school absenteeism and academic achievement will be discussed. Similarly, this presentation will overview how, in
response to the cluster, NNCTC has been working closely with emergency department employees, the Tribal Health
Department, Indian Health Services and other area schools to revise crisis response procedures, clinical interventions,
community messaging, tribal justice and transportation policy, on-call services and follow up protocols. Mixed method
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evaluation procedures are being employed with patients screened during a 12-month 2012-2013 period (N=170) and
those receiving clinical services (N=86). Preliminary, quantitative data and qualitative information assessed during this
period will be provided. Results from using World Health Organization Brief Intervention and Contact (BIC) protocols,
strategies for improving fidelity to follow up treatments, and six overarching lessons relevant for working with suicide
clusters in Native communities will be outlined.
Practical Postvention Guidelines for Communities Facing Suicide Clusters and Contagion
Sandra Palmer
CASA
Suicide clusters generate widespread community concerns about the risk of contagious behaviour. These fears, and the
risk of further suicidal behaviour, may be mitigated by advice from people who can bring years of experience and
expertise in dealing with suicide clusters to local communities dealing with an often novel and frightening event. In New
Zealand a Ministry of Health- funded Community Postvention Response Service (CPRS) has operated nationally since
2007. This service developed a community development model of working in partnership with local communities combining CPRS experience of postvention with the community’s knowledge of their local community. This ensures that
every response to a cluster is appropriate to the specific civic, geographical and cultural needs of each community but is
informed by CPRS expertise.
Based on their extensive experience, the CPRS team, in partnership with Dr Annette Beautrais, have now developed
practical guidelines for providing support to communities facing suicide clusters and/or contagion. The development of
these guidelines is based on literature reviews of relevant publications, assessment of community needs, and
consideration of ethical, safety and cultural issues. Practical experience in a range of different communities has generated
guiding principles which can be applied to settings internationally. The overall goal of these best practice guidelines is to
provide practical guidance to help communities struggling with these issues minimise the risk of contagious suicidal
behaviour and to interrupt suicide clusters. Issues addressed will include:
Assessment of community risk (in conjunction with key community stakeholders);
The need for acute (mental health) and long term (public health) support;
Identification of key stakeholders to take part in interagency meetings
The challenges involved with working with multi-layered government and non – government agencies;
Identification and support of local leadership
Coordination and facilitation of interagency meetings
Privacy, confidentiality and management of community “at risk” lists
Guidance on management of postvention activities such as public community meetings, suicide walks, memorial
events, funerals and anniversaries
Appropriate training - when, to whom, and topics covered
Debriefing – after the crisis has passed
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OP18-3E: Current Research on Suicide Bereavement (Survivors)
Exploring Links between Suicide Bereavement, Suicidal Ideation and Attempts with Subsequent
Deaths by Suicide: Evidence from the Add Health Study
William Feigelman1, Thomas Joiner2
Nassau Community College, United States of America; 2Florida State University, United States of America;
feigelw@ncc.edu
Background: This exploratory study examines several leading hypotheses on suicide risk related to a family member’s
earlier suicide, a friend’s suicide and risks among those who had reported prior suicide thoughts and attempts with data
from National Longitudinal Survey of Adolescent Health (Add Health), n= 20,745. The Add Health study included high
school students between ages 13 and 19 in 1995, who were studied one year later and again six years later. Eighteen
years later death records of former respondents were matched to the National Death Index indicating their death causes
of 227 former respondents. At each survey wave respondents were presented with at least seven questions pertaining to
potential suicide risk.
1
Objectives: We compared and contrasted former Add Health respondents who subsequently were found to have died
from self-inflicted causes, n=22, with other respondents who were found to have died from others causes, n=205, and with
others who remained living, n=20,547.
Method. We employed crosstabulation, cross-tabulation controls by gender and logistic regression to test for statistically
significant differences between suicide decedents and those who were still living.
Results: Findings showed the Add Health suicide decedents were overwhelming male, 21 out of 22 cases. Suicide
decedents showed a significantly higher rate for having a family member’s prior suicide compared to deceased others and
the living, with 9% reporting another family member’s death at either Wave 1 or 2, compared to less than 2% for the other
two subgroups. Results showed no differences between a friend’s prior suicide and one’s own suicide risk. Nor did results
show suicide ideation and attempts related to completed suicides. There was only a single case among the 22 suicide
deaths when a previous attempt had been made. Previous attempters did not show any heightened risks of dying from
other causes. We discuss the implications of these surprising findings.
Conclusions: We believe these findings have much to do with the predominance of males in the sample of suicide
decedents, common to youth suicides, showing a 4:1 male to female risk ratio and findings are also consistent with other
studies showing high percentages of first attempt suicides among male youth. These findings, if confirmed in future
research, could call for new approaches to suicide prevention efforts.
Unresolved Grief and Bereavement Related Outcomes among Suicide-Bereaved Fathers and
Mothers. A Population-Based Survey
Rossana Pettersen, Pernilla Omerov, Ullakarin Nyberg
Karolinska Institute; rossana.pettersen@ki.se, Ullakarin.Nyberg@sll.se
Previous studies suggest that not having worked through grief is associated with long-term mental ill-health but little is
known about how this differs across gender. Using a mixed methodology we studied unresolved grief in 560 suicidebereaved fathers and mothers. Data was collected two to five years after the loss using a detailed questionnaire including
psychometric scales and qualitative analysis of free-hand comments. Participants were identified by nationwide registers.
We found that 34% of the parents reported “having unresolved grief.” We present associations of this finding with suicidebereavement related outcomes and qualitative findings using a gender perspective.
Suicide Versus Sudden Death: Differences in the Bereavement Process
Kairi Kolves, Katie Sillar, Diego De Leo
Australian Institute for Suicide Reserach and Prevention, Griffith University, Australia; k.kolves@griffith.edu.au
Background: People bereaved by suicide, similarly to other bereaved people, experience common bereavement reactions
(e.g. sadness). However, there are some reactions, which have been reported more frequently at the time of suicide grief
(e.g. shame, responsibility), even when compared to grief after accidental death. Nevertheless, previous studies have
several methodological limitations.
Aims: In the frames of the presentation results from the pilot study in Australia will be presented with the main focus on
differences in the grief reactions between suicide and sudden death bereavement will be presented.
Methodology: A longitudinal case-control psychological autopsy study design was applied. In the frames of the pilot 25
people bereaved by suicide and 15 bereaved by sudden death (control group) were interviewed by a trained clinical
interviewer. The first assessment was at 6 months (T1), two follow-up assessments were carried out at 12- and 24months (T2 & T3) after the critical event. Interviews were conducted in a semi-structured format and used validated
psychological scales/questionnaires including Grief Experience Questionnaire. Drop-out rate was only 10% (3 cases from
suicide bereaved group and 1 from control group).
Results and comments: Significant differences, higher in suicide bereaved group, were found in stigmatisation, rejection,
responsibility, unique reactions and overall in total score 6-months after death. There were fewer differences 12 months
and 24 months after death. However, responsibility and unique reactions remained significant.
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Men and Suicide Bereavement: Listening to Men’s Voices
Franklin Cook
Unified Community Solutions, United States of America; franklin@personalgriefcoach.com
The overwhelming majority of people engaged in survivors of suicide loss support networks are women. Research on
survivors’ needs and experiences is often conducted by accessing these networks, and thus, the results of these studies
may be skewed to represent women’s perspectives. To address the question of how men grieve after suicide, the Carson
J Spencer Foundation and Unified Community Solutions conducted a survey on men who had lost someone close to them
to suicide. The results of the survey will be presented, followed by a facilitated discussion.
Survey participants (n=191) came from all over the U.S. and abroad. The ages of the participants ranged from 19-70+
years old, and 58% were over 50 years old. The great majority of respondents were straight white men. Most of these
men lost adult men to suicide.
Men ranked the helpfulness of support systems and services, and many augmented their response with qualitative
remarks. Fairly consistently, friends and family were listed as most supportive, followed by external grief support.
Emergency responders were listed as least supportive. When asked about what type of interventions men found most
helpful, they tended to prefer face-to-face, intimate forms of support rather than electronic-based support like text support
or on-line chat (with the exception of getting information about grief from the Internet).
Many men reported to us (81%) that men and women grieve differently, and the majority felt strongly that men should
have special programs to deal with their grief (25% weren’t sure). They tended to strongly desired male peer support in
grieving process (79%) and 67% said they would be willing to help other men bereaved by suicide. Many who said they
couldn’t support other men were still to early in healing process to provide help for others. Those who were able to assist
others indicated that helping others helps themselves.
From our exploratory survey, the results clearly show the impact of suicide is profound and sustained for men. Men in our
survey tended to rely more on informal services like friends, family and peers and found emergency and medical service
providers least helpful in their grief journey. For more formal grief support services the men in our survey preferred peer
support groups, one-on-one peer assistance and Internet information. They found interactive technology least useful, but
that might be because this was an older sample of men that might not have been aware of the on-line resources, and
thus, unlikely to use them. Most men supported the idea that men and women grieve differently and that often male
stereotypes and self-criticism get in the way of a healthy grieving process. On a positive note, men would like male peers
to assist them with grief and would be willing to be a peer supporter if the opportunity arose. This practice of reciprocity in
male help seeking is fairly common in other areas of daily life and in distress situations.
Suicide-Bereaved Parents’ Experiences of Professional Encounters in the Aftermath of a SuicideLoss. A Population Based Survey
Pernilla Omerov, Ullakarin Nyberg
Karolinska Institute; Pernilla.Omerov@esh.se
Bringing the death notice to a parent that has lost a son or daughter through suicide is a delicate task. Professionals ask
for guidelines to assist them in their work but research on the subject is missing. We explored parents that had lost a son
or daughter through suicide experiences of professional encounters in the wake of the suicide loss. We used linkage of
nationwide registers and identified 915 suicide bereaved parents. Data was collected two to five years after the loss and
666 of the eligible parents participated in our population-based survey.
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OP18-3F: Workshop: Intersecting Indigenous Rainbows - International
LGBT First Nations and Two-Spirited People in Suicide Prevention
Intersecting Indigenous Rainbows - International LGBT First Nations and Two-Spirited People in
Suicide Prevention
Dameyon Bonson, Shawn Johnston
Indigenist, Australia; dameyonbonson@gmail.com, Shawn_Johnston@hotmail.ca
The lived experiences and the challenges faced by Indigenous (Aboriginal/First Nation/Native) Lesbian Gay, Bisexual and
Transgender (LGBT) people are diverse we are ourselves. For this population group racism and phobia faced by the
LGBT (LGBTphobia) community are not mutually exclusive. In isolation the affects of racism and LGBTphobia can be
crippling enough. However, the intersecting oppressions of racism and LGBTphobia overlaid with social and
environmental determinants of health largely experienced by the Indigenous LGBT people can have a devastating affect.
Preliminary planning for the workshop will be strongly influenced by an Indigenous Australian concept of Yarning Circles
(Bessarab & Ng’andu 2010). Yarning is defined as “an informal conversation that is culturally friendly and recognised by
Aboriginal people as meaning to talk about something, someone, or provide and receive information” (Bessarab 2012, p
5). A Yarning Circle will be used as a decolonizing method to assist in identifying both the shared and independent
stressors experienced by Indigenous LGBT people.
The Yarning Circle involves conversational styles in culturally appropriate ways (Towney 2005) and embraced the
community development approach when seeking face-to-face responses. As a recognized methodology of indigenous
research, Yarning provides safe space for Indigenous people to share stories of culture, place, experiences and
knowledge (Curtin, Dudgeon and Gibson 2013). Yarning in research is underpinned by a set of ethics and values. Curtin,
Dudgeon and Gibson highlight these as ”Spirit and Integrity, Reciprocity, Respect, Equality, Responsibility, and Survival
and Protection” (2013, p 5).
Aboriginal and Torres Strait Islander people view their health as holistic and through a whole-of-life view (Australian
Institute of Health and Welfare 2009). Social and Emotional Wellbeing (SEWB) is the term used to describe this view of
health. Social and Emotional Wellbeing is said to consider ‘the impact of other factors on emotional well being, such as life
stressors, removal from family, discrimination and cultural identification (Australian Institute of Health and Welfare 2009
p.x).
‘The concept of mental health comes more from an illness or clinical perspective and its focus is more on the individual
and their level of functioning in their environment.
The social and emotional wellbeing concept is broader than this and recognises the importance of connection to land,
culture, spirituality, ancestry, family and community, and how these affect the individual’ (SHRG 2004, p9)
Hart, Kitchener, Jorm and Kanowski (2010, p10) provide a definition within the day-to-day contexts of social and
emotional wellbeing:
• Social – participate in community life, justice, fairness and equity.
• Emotional – Feeling safe, good body touching, speak good words to each other.
• Physical – Looking after self when sick, being active, participate in recreational activities, eating good food.
• Cultural – Participate in community activities, including ceremony, included in policies supporting cultural practices,
knowing stories and songs
The concept of social and emotional wellbeing (SEWB) as explained by the Social Health Reference Group (SHRG) and
Hart, Kitchener, Jorm and Kanowski (2010, p10) underpin the approach to this discussion.
It is recognised that Two-spirited Aboriginal people face similarly face multiple intersecting oppressions and cumulative
traumatic experiences that placing great stress on coping strategies and protective factors. This too can lead to
exacerbated health disparities. Similarly, dispossession of traditional land and language, removal and placed in “care”
such as residential schools in Canada and the Stolen Generation in Australia. Much of these factors can be associated
with depression among Indigenous LGBT and Two-spirited people.
This workshop aims to bind our historic legacies to create opportunities for:
• Enhancing strengths and capacity Indigenous LGBT people populations.
• Enhancing strengths and resilience in individuals
• Targeted suicide prevention activities
• Building the evidence base and disseminating information
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• Standards and quality in suicide prevention, and perhaps most importantly
• To participate in the internationally recognise Indigenous act of reciprocity where we can intersect our rainbows to to
share and learn from each other.
This in an international Indigenous LGBT and Two-Spirit Collegiate activity.
An Indigenous Australian Gay man, and a First National Two-Spirit Canadian will LGBT co-facilitate this workshop.
International Indigenous LGBT people will be invited and encouraged to attend this workshop.
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OP18-3G: Atelier: S'entraider pour prévenir le suicide: les proches, de
précieux alliés
S’entraider pour prévenir le suicide: les proches, de précieux alliés
Philippe Angers, Josianne Beaumont
Suicide Action Montréal, Canada; pangers@suicideactionmontreal.qc.ca, jbeaumont@suicideactionmontreal.qc.ca
La famille et les proches sont de puissants facteurs de protection du suicide. Ils sont une source de soutien important,
mais aussi des intermédiaires souvent essentiels entre la personne suicidaire et les ressources du réseau de la santé et
des services sociaux. Par leur présence, ils procurent à la personne suicidaire des raisons de vivre donnant un sens à
leur existence et pouvant leur redonner goût à la vie. À l’ère des réseaux sociaux, ils sont également souvent les premiers
à observer de nouvelles façons d’exprimer la détresse suicidaire et à vouloir agir. Les proches jouent donc un rôle
absolument unique en prévention du suicide. En dépit de leur contribution déterminante, les proches demeurent
malheureusement rarement considérés dans les interventions auprès des personnes suicidaires.
Cet atelier permet d’identifier différents moyens pour mettre à profit l’énorme potentiel des proches et d’en explorer les
impacts positifs, tant pour les personnes en détresse que pour leurs proches. Il s’adresse aux intervenants, plus
particulièrement à ceux ayant déjà reçu la formation « Intervenir auprès de la personne suicidaire à l’aide de bonnes
pratiques », car nous verrons qu’il est possible d’utiliser avec les proches la grille d’estimation de la dangerosité d’un
passage à l’acte suicidaire.
Créée par Suicide Action Montréal (SAM) et le Centre de réadaptation en dépendance de Montréal – Institut universitaire
(CRDM-IU), la grille d’estimation de la dangerosité d’un passage à l’acte suicidaire permet à la fois d’estimer la situation,
de cibler des leviers d’intervention et d’éclairer la prise de décisions. Elle soutient donc le jugement clinique et favorise
une intervention orientée vers les solutions pour une meilleure prévention des décès par suicide.
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OP18-3H: Symposium: Suicide Prevention in Different Cultural Settings
Suicide Prevention in Different Cultural Settings
Chair(s): Frances Yik Wa Law (The University of Hong Kong), Gregory Armstrong (Nossal Institute, University of
Melbourne, Australia)
This symposium will include six papers that cover suicide prevention strategies in diverse cultural settings, from
Indigenous Canadian populations to people from immigrant and refugee backgrounds. Time will be left at the end of the
symposium for audience participants and panellist to discuss the presented strategies and propose ways to go forward in
our ability to develop and implement efficient culturally-responsive suicide prevention strategies.
Presentations of the Symposium
Care Pathway of Patients Surviving Self-Harm Episodes in Hong Kong
Yik Wa Law
The University of Hong Kong
Suicide is one of the leading causes of death in Hong Kong and many other parts of the world. Self-harm is a strong risk
factor for suicide, and non-fatal suicide attempts may be 40 times more common than completed suicides. Although selfharm is a broad category that includes both suicidal and non-suicidal injuries, research suggests that regardless of intent,
self-harm presents an increased risk of suicide. Effective suicide prevention that can significantly reduce the suicide rate
requires improving the help offered to those at risk of suicide, provided that they can be identified, and consent to receive
appropriate care in a timely manner.
Drawing on the Network-Episode Model, this study examines the subjective experience of self-harm patients in Hong
Kong during their contact with healthcare and psychosocial services along the pathway to care and how patients'
networks interplay with their care experiences in either facilitating treatment compliance or sustaining avoidance of care.
Self-harm patients aged 18-59 (n = 20) who survived from intentional self-harm episodes, gave consent and were
assessed as physically well enough to participate in the study by physicians of three public hospitals in Hong Kong. The
study adopted purposive sampling method, with particular emphasis on a variation in case background features. Their
experiences of care were explored in depth through semi-structured interviews, including their perceptions of the care
given, unmet needs, perceived barriers to or facilitators of care, and their account of the relationship between the care
received and self-harm acts. A thematic approach using open, axial, and selective coding and core themes was used for
data analysis.
Self-harm patients often experienced a fragmented and circular pathway to care before the self-harm episode. Major
themes associated with self-harm patients’ experience of service use were irrelevancy, non-usefulness and selfreliance. Those who had low intent to die reported higher frequency of service use and appeared to be more receptive in
attending follow-up mental health services and less avoidant to receiving their networks’ help.
Awareness and basic skills on detecting warning signs of suicide risk are suggested to be included in mental health
programs, particularly in post-self-harm care targeting patients’ networks, such as families and friends. Social work
professionals play a crucial role in the care management of patients with mental illness, and could be effective agents in
navigating services for self-harm patients.
Formulating Community-Based Suicide Prevention Initiatives for People Who Inject Opioids in Delhi,
India
Gregory Armstrong
Nossal Institute, University of Melbourne, Australia
People who inject drugs (PWID) in Delhi, India are an impoverished and marginalised sub-population estimated to number
35,000, and they are an important target group receiving comprehensive HIV prevention interventions. There is an
alarmingly high suicide risk in this community and there are some important psychosocial and culturally distinct risk
factors that distinguish suicidal PWID from non-suicidal PWID. Community-based suicide prevention initiatives are needed
to ameliorate the drivers of suicidality in this sub-population, which could appropriately be integrated into HIV prevention
interventions such as needle syringe programs.
An Exploratory RCT of Culturally Adapted Manual Assisted Problem-Solving Training (C MAP): A
Post Intervention Qualitative Study
Nusrat Husain
University of Manchester (UK)
Self-harm is the most important predictor for future suicide attempt and there are 10-20 self-harm acts for every suicide. In
Pakistan suicide and attempted suicide are illegal acts, and are socially as well as religiously condemned therefore there
is limited data on suicide. There is evidence that care of patients who attempt self-harm can be improved by
understanding self-harm and by offering appropriate interventions. The present study in urban Pakistan aimed to explore
the experience of self-harm and also the experience of participation in a culturally adapted psychological intervention trial.
Semi-structured in-depth interviews were conducted with 19 participants. All interviews were recorded, transcribed
verbatim and analysed using the stages of a framework analysis; familiarisation, identification of a theoretical framework,
indexing, charting and mapping and interpretation.
Three keys themes emerged: (1) precipitating factors for self harm (with four sub-themes; difficult family relationships and
domestic violence, isolation, stressful gender roles and poverty), (2) traditional explanatory models of mental illness (with
two sub-themes; role of devils/possessions, faith healers), (3) effects of culturally adapted intervention (with two subthemes; positive impact on emotional well-being, improvement in problem solving skills).
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There are various psychosocial factors that can contribute to self harm behaviour in Pakistan. Interventions that are
culturally adapted and tailored according to need of population can lead to improvement in psychological well being of that
population.
Religiosity, Culture and Suicidal Behavior: An Islamic Perspective
Murad Khan
Dept. of Psychiatry, Aga Khan University, Karachi, Pakistan
The Islamic religion strongly condemns suicide as an unforgivable sin. Spirituality and religious beliefs have a significant
role in suicide prevention in Islam. Muslims who commit or attempt suicide are seen as those who have rejected Islam
and interfered with the work of God. Yet, suicidal behavior is reported from almost all countries with majority Muslim
populations. In some countries such as Turkey, Iran, Pakistan and Bangladesh, there is evidence that suicide rates may
be increasing in recent years.
It is postulated that religiosity is strongly influenced by culture, and religious, spiritual and cultural beliefs and practices are
interwoven and influence each other. This is evidenced by the relatively high rates in Islamic countries of central Asian
republics (Kazakhstan, Uzbekistan) and low rates in Islamic countries of Middle East & North Africa (Syria, Morocco).
When planning suicide prevention programs measures of religion/spirituality should reflect greater sensitivity of ethnocultural factors, as the magnitude and direction of the effect of spirituality on health may vary across ethnic groups, which
differ with regard to the cultural centrality of religion. There is need to examine ways in which culture influences religion’s
expression of the spiritual and viceversa.
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OP18-3I: Suicide and the Elderly
Suicide Contagion among Older Adults: A Systematic Review
Gina Bhullar1, Marnin Heisel1,2,3
Western University, London, Canada; Lawson Health Research Institute, London, Canada; 3University of Rochester
Center for the Study and Prevention of Suicide, Rochester, N.Y., USA; gina.bhullar@gmail.com
INTRODUCTION AND AIMS: The prevalence of suicide among older adults is increasing, coincident with the aging of the
baby-boom cohort, and yet public awareness of this issue is limited. Whereas increasing media coverage could raise
public awareness about late-life suicide and its prevention, insufficiently sensitive reporting might inadvertently contribute
to a suicide contagion effect. Few empirical studies exist that investigate media-reporting and suicide contagion among
older adults. We thus conducted a systematic review of the literature on this topic.
1
2
METHODS: We conducted a systematic search of MEDLINE, EMBASE, PsycINFO, CINAHL, and WEB OF SCIENCE
electronic databases from their inception until 2014 for the following combinations of terms: suicide contagion, copycat
suicide, imitation, Werther effect, late-life suicide, elderly, geriatric, aged, seniors, and older adults. We included: empirical
articles; published in English; presenting findings of studies investigating associations between media accounts of suicide
and subsequent deaths by suicide; in which at least 10% of the sample was 65 years or older. We limited the search to
English language publications and studies involving human beings. We followed the principles of the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
RESULTS: We initially identified 79 unique articles that appeared to meet our search criteria. However, upon further
investigation of the content of those articles, only six met our inclusion criteria. Four of those articles reported an
association between media accounts of suicide or assisted suicide and subsequent deaths by suicide among older adults.
Findings from the other articles were inconclusive regarding the potential impact of media reporting on late-life suicide.
CONCLUSIONS: Our findings suggest an apparent association between media reports of suicide and subsequent suicide
behaviour among older adults. Journalists are encouraged to familiarize themselves with media resources for reporting on
suicide when covering these stories, given the potential public health impact of media accounts on suicide-related
behaviour among at-risk demographics. Our findings were limited to a small number of articles, necessitating additional
investigation of potential media-related late-life suicide contagion. Research is also needed investigating potential benefits
of media reporting on mental health and well-being and the potential transmission of suicide contagion by way of social
media.
Risk and Protective Factors Associated with Intentional Self-Harm among Older CommunityResiding Home Care Clients in Ontario, Canada
Eva Louise Neufeld1, John P Hirdes2, Christopher M Perlman2, Terry Rabinowitz3
Laurentian University, Canada; 2University of Waterloo, Canada; 3University of Vermont Medical Center, USA;
eneufeld@laurentian.ca
This study concurrently examined risk and protective factors associated with intentional self-harm among communityresiding older adults receiving home care services in Ontario, Canada. Administrative health data from the home care
sector were linked to hospital administrative data to carry out the analyses. Home care data are collected in Ontario using
the Resident Assessment Instrument–Home Care (RAI-HC), an assessment tool that identifies strengths, preferences and
needs of long-stay home care clients. The sample included Ontario home care clients aged 60 years or older assessed
with the RAI-HC between 2007-2010 (N = 222,149). Multivariable analyses were performed using SAS. Hospital records
of intentional self-harm (ISH) were present in 9.3 cases per 1000 home care clients. Risks of ISH included younger age
(60-74 years), psychiatric diagnosis, alcohol use and dependence, psychotropic medication, and depressive symptoms.
Protective effects were found for marital status and positive social relationships, yet these effects were more pronounced
for men. Cognitive performance measures showed the odds of ISH approximately two times higher for older adults with
moderate to severe cognitive impairment. This study based on provincial data points to tangible areas for preventative
assessment by frontline home care professionals. Of interest were the risk and protective factors that differed by sex. As
demand for home care in Canada is expected to increase, these findings may inform home care professionals’ appraisal
and approach to suicide prevention among community-residing older adults.
1
Meaning-Centered Men’s Groups for Men Facing Retirement: An Innovative Approach to Preventing
the Onset of Suicide Risk in Later Life
Marnin J. Heisel1, Gordon L. Flett2, Paul S. Links1, Ross M.G. Norman1, Sisira Sarma1, Sharon L. Moore3, Norm
O'Rourke4, Rahel Eynan1, Kim Wilson5, Paul Fairlie2, Beverly Farrel6, Kristan Harris6, Michelle Kerr7, Bonnie
Schroeder8
1
Western University, Canada; 2York University, Canada; 3Athabasca University, Canada; 4Simon Fraser University,
Canada; 5University of Guelph, Canada; 6Third Age Outreach-St. Joseph's Health Care London, Canada; 7Kiwanis and
Hamilton Road Seniors and Community Centre City of London, Canada; 8Canadian Coalition for Seniors' Mental Health;
Marnin.Heisel@lhsc.on.ca
Older men have high suicide rates and employ lethal means of self-harm (Heisel, 2006). Few intervention studies have
investigated suicide risk reduction among older adults (Links, Heisel, & Quastel, 2005), and nearly none has aimed
explicitly to reduce risk among older men (Lapierre et al., 2011). Men’s suicide rates increase at retirement age (Statistics
Canada, 2014); retirement may thus be a key life transition that can trigger increasing suicide risk and a critical period for
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effective intervention. With funding from Movember Canada, we are recruiting 100 community-residing older men facing
retirement into 12-session courses of a Meaning-Centered Men’s Group (MCMG), focusing on transitions associated with
retirement in the context of discussions about the meaning of work, retirement, leisure, relationships, and generativity.
Eligible participants will include cognitively-intact men over 60 who are vulnerable to the onset of depression and suicide
risk due to recent or impending retirement, and by virtue of low perceived Meaning in Life (MIL) and/or concerns about
finding meaning in the context of retirement. We will iteratively evaluate the efficacy of this intervention in preventing the
onset or reducing the severity of symptoms of depression, hopelessness, and suicide ideation, and in enhancing
perceptions of MIL and satisfaction with retirement. Initial groups will be offered in London, Ontario; subsequent groups
will be offered in B.C. and Alberta. The initial phase of the study involves finalizing the MCMG group intervention and
evaluating its impact on study outcomes, employing a pre-post design. The second phase of the study involves
comparison of the finalized intervention with a current-events discussion group control. The final phase of the study
involves dissemination of Meaning-Centered Men's Groups and training co-investigators in B.C. and Alberta to each
coordinate a course of MCMG. This meaning-centered group will be delivered in community centres and co-facilitated by
a social service worker, in order to enhance uptake and ensure sustainability. This project responds to a critical need to
translate research findings on resiliency and healthy aging into innovative interventions for potentially vulnerable groups.
Internal Migration and Suicide in South Korea from 1992-2012
Geoff Chee-Hon Chan1, Eric Caine2, Sungeun You3, Paul Yip1
The University of Hong Kong, Hong Kong S.A.R. (China); 2The Injury Control Research Center for Suicide Prevention,
Department of Psychiatry, University of Rochester Medical Center, United States; 3Chungbuk National University;
gefchan@hku.hk
Background
1
Cross-sectional studies have highlighted the spatial inequality in suicide in South Korea, as it is in many nations. This
study explores the spatial trends of suicide in South Korea from 1992 to 2012, and its relation with change of the
population distribution and structure.
Method
We categorized South Korea into five equal quintile groups based on population density index. Change of the population
distribution and structure in the five quintile groups from 1992-1996 to 2008-2012 was explored. Also, the annual suicide
rate increase of the five areas were estimated based on quasi-Poisson time-trend regression.
Results
Our results show that, over the 21-year study period, the nation’s population diffused from the most-urbanized urban
region (1st-quintile) and its rural regions (4th- and 5th-quintile) to the less-urbanized regions (2nd- and 3rd-quintile). In that
context, rural regions (4th- and 5th-quintile) aged more considerably than the urban counterparts. The suicide rate for
older men and women during the period of 1992-1996 were greater in the urban- than the rural-area. However, as the
increase of suicide rate among the rural dwelled elderly was greater than their urban counterparts, the suicide rate of
elderly dwelling in the rural area has surpassed its counterpart in the period of 2008-2012. On the other hand, the suicide
rates of the working-age men and women were greater in the rural- than the urban-area over the 21-year study period.
However, we found the increase of suicide rates among the working-age groups were greater among urban dwellers than
its counterparts, resulting with a reduced urban-rural difference. Time-trend regressions ascertained the differential trend
of suicide rates across urbanicity and age-groups.
Conclusions
Increase of elderly poverty particularly among those dwelled in the rural area along with the diminishing role of elderly
within the family may have substantially contributed to the rapid increase of elderly suicide in South Korea.
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OP18-3J: Suicide and Self-Harm in Students
Resilient, Narcissistic, or Scared: Lessons on Help-Seeking Behavior Learned from 30+ Law School
Talks & a National Survey on Law Student Well-Being
Katherine M. Bender
Dave Nee Foundation, United States of America; kbender@daveneefoundation.org
Lawyers and law students experience suicide, depression, anxiety and substance abuse at rates substantially higher than
the general population. The presentation will highlight key results of the 2014 Survey of Law Student Well-Being, the first
national, multi-school study of alcohol and substance use among law students in two decades and the first ever national,
multi-school study of mental health issues among law students. Results of the study will not only provide an overview of
the scope of the mental health issues faced by today's law students in the United States but also the reasons given by
students for not seeking help.In addition to the empirical data what will be discussed, the presenter will share her personal
experience from giving talks at over 30 law schools within the United States including some of the US News and World
Reports top ranked law schools.
This oral presentation will discuss the unique mental health needs of law students. Law students may be academically
successful but silently struggling with depression, anxiety, or substance use issues, all of which put law students at a
greater risk for suicide. However, given some of the legal profession's character and fitness requirements which attorneys
are required to meet in order to practice law, law students and lawyers are often deterred from seeking help. In addition to
the professional barriers, there is a social stigma that people who are well well-educated and high functioning can't
possibly have problems or be perceived as having mental health issues which also prevents law students from seeking
help.
Attendees will:
•Understand the differences and similarities of law student substance use and mental health as compared with other
graduate students
•Understand factors that prevent law students from seeking help
•Gain insight into the law student “perfectionist” and perhaps narcissistic mindset
•Understand the challenges that Bar admission process related to Character and Fitness present to help-seeking
behaviors
• See how the theories of suicide are applicable to the field of law.
• Learn strategies and best practices to attempt to change the law school culture and apply those to other high pressure
work environments
•Recognize the need for destigmatization of mental illness and the role all stakeholders, including universities, employers,
communities and government can play in that process
Relative Age and Suicide among Young Individuals: Evidence from Japan
Tetsuya Matsubayashi1, Michiko Ueda2
Osaka University, Japan; Syracuse University, United States of America; matsubayashi@osipp.osaka-u.ac.jp,
michiko.uedaballmer@gmail.com
This study presents evidence that children's relative age within a grade affects the rates of mortality by suicide later in
their lives using vital statistic data from Japan. We take advantage of the school entry cutoff date to implement a
regression discontinuity (RD) design, assuming that the timing of births around the school entry cut-off date is randomly
determined and therefore that individuals who were born just before and after the cut-off date have similar baseline
characteristics. Our analysis shows that those who were born right before the school cutoff day and thus youngest in their
cohort have higher mortality rates by suicide, at ages between 15 and 25 years old, compared to their peers who were
born right after the cutoff date and thus relatively older. We also find that individuals who were born in March (the
youngest in a grade) are less likely to have a college degree compared to those who were born in April. These findings
suggest that children's relative age might have affected their socioeconomic status and occupation, which subsequently
influenced their likelihood to engage in the acts of deliberate self-harm.
1
2
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The Interplay of Stressful Life Event and Coping Skills on Risk for Suicidal Behavior among Young
Students in Contemporary China
Fang Tang1, Fuzhong Xue1, Ping Qin2
School of Public Health, Shandong University,China; 2National Center for Suicide Research and Prevention, University
of Oslo, Norway; ping.qin@medisin.uio.no
Background: Stressful life events are common in youth students and may induce psychological problems and even
suicidal ideation in those with poor coping skills. This study aims to assess the influence of stressful life events and coping
skills on risk for suicidal ideation and elucidate the underlying mechanism using a large sample of university students from
China.
1
Methods: 5972 students, randomly selected from 6 universities, completed the questionnaire survey. Logistic regression
analysis was performed to estimate the effect of stressful life events and coping skills on risk for suicidal ideation.
Bayesian network was further adopted to probe their probabilistic relationship.
Results: Of the 5972 students, 16.39% reported the presence of suicidal ideation. Stressful life events constituted a strong
risk factor for suicidal ideation. The influence of coping skills varied according to the strategies adapted toward problems
with a high score of approach coping skill significantly associated with a reduced risk of suicidal ideation. Bayesian
network indicated the probability of suicidal ideation associated with specific life stressors was to a large extent conditional
on coping skills. For instance, exposure to conflicts with classmates could result in a probability of suicidal ideation of
35.22% and 27.13% respectively, for female and male students with approach coping skills under the average.
Conclusions: Stressful life events and deficient coping skills are strong risk factors for suicidal ideation in young students.
The results indicate the importance of prevention effort to improve coping skills towards stressful life events.
New Findings on Suicide Risk among Medical Students and Those in Other Health Professions
Matthew B Wintersteen1, Jonathan B Singer2
Thomas Jefferson University, United States of America; 2Temple University, United States of America;
matthew.wintersteen@jefferson.edu
Background: A handful of large-scale studies of medical students (MS) suggest that they appear to be greater at greater
risk for suicide than college students in general. To date, no large scale studies of students in other health professions
(OHP) have asked about suicide risk precluding similar comparisons. The aims of the current study are to establish
estimates of suicidal ideation and attempt among medical students and students in other health professions and identify
risk factors associated with each group. Similarities and differences between the two groups will be discussed.
1
Methods: 3,841 students (1,247 male; 2,725 female) enrolled at a six colleges and universities across the United States in
medicine and OHP (nursing, pharmacy, physical therapy, etc.) who completed an online, anonymous survey containing
questions regarding their personal and family mental health history, suicide risk factors, current and past suicidal ideation
and attempts, mental health service utilization and barriers to use. All students across the sites were contacted via email
giving a brief explanation of the study and a link to the survey. Two reminder e-mails were sent during the three week
survey period.
Results: In all, 11.4% reported NSSI, 19.3% a history of suicidal ideation (72% rated as serious or greater), and 7.1%
current suicidal ideation. 3.9% made a prior suicide attempt. Logistic regression models were used to calculate
differences between MS and OHP students (p < .005 as cutoff). OHP students were more likely to report that life was not
worth living and that they had serious or very serious suicidal ideation. They also reported a greater prevalence of
previous suicide attempts and family member suicide deaths than MS. However, MS reported higher prevalence of family
support. In all cases, females demonstrated higher risk.
Conclusions: Despite prior evidence that MS are a significantly high risk student population for suicide, data reveal that
students in OHP not only exhibit similar levels of risk across a number of domains, but they also demonstrate greater risk
in a number of key warning signs and risk factors for suicide. Further, they may not perceive as much family support as
MS in managing depression or anxiety. This is the first multi-site study of college students that has documented estimates
of suicidal ideation and attempts in MS and students in OHP. Medical school and OHP faculty should be aware of
students’ personal experiences with suicide and NSSI. Faculty in medical schools and OHP departments should consider
ways in which school climate might reinforce students’ concerns about help-seeking.
Non-Suicidal Self-Harm in a Sample of Mexican University Students
Everardo Castro Silva1, Corina Benjet1,2
Universidad Nacional Autonoma de Mexico; 2Instituto Nacional de Psiquiatria Ramon de la Fuente Muñiz;
curgos@hotmail.com
Introduction. Non-Suicidal Self-Harm (NSSH) has been defined as deliberate, direct physical self-harm (NSSH) without
conscious suicidal intent that does not lead to evidently life-threatening wound (Sarno et al., 2010, Klonsky, 2007). . In
adolescents and university students the percentages are between 9% to 46% in countries like Canada, UK, Australia and
USA (Brown, 2009; Muehlenkamp et al., 2012). Estimations from developing countries are scarce and greatly needed to
obtain a more comprehensive picture of NSSH throughout the world.Our objective, therefore, was to estimate frequency
of NSSH, possible gender differences and the motives for such behavior in a sample of Mexican university students.
Material and methods. The sample consisted of 579 university students, recruited among those studying different careers
1
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(psychology, medicine, nursery and pedagogy) in universities of the Mexico City metropolitan area. Most were female
(74%, n=428) and ranged in age from 17 to 26 years. Frequency and functions of NSSH were assessed with the
Inventory of Statements About Self Injury (ISAS; Klonsky & Glenn, 2009), a measure designed to comprehensively
assess 12 NSSI behaviors and 39 reasons those who engage in this behavior give for doing so, deemed to evaluate the
intra and interpersonal functions of NSSH. Procedure. All participants provided written informed consent following a
complete description of the study. Participants completed the questionnaires anonymously during regular classes and the
investigator was always present to provide clarification when necessary. Frequency analysis was performed for each
NSSH behavior and reason for engaging in the behavior, and to classify participants into three groups: no self-harm,
experimental (one to four occasions), and recurrent (five or more occasions). Chi-square tests were used to determine
gender differences. Results. 58.1% of participants reported having engaged in NSSH at least once in their lifetime.
Results indicated no significant gender differences in the three groups of NSSH (no self-harm, experimental or recurrent).
As for the specific forms of self-harm, the most frequently reported behavior was cutting (27.9%), carving words (26.1%),
self-hitting (22.7%) and severe scratching (22.6%). Gender differences were found in the rates of one specific NSSH
behavior only: women were more likely to report “cutting” than men (p<0.05). The most frequent motives for engaging in
NSSH were: reducing anxiety and frustration (59.8%), releasing emotional pressure (54.3%) and calming myself down
(44.3%).Discussion. Lifetime NSSH behaviors were reported in this sample of Mexican university students in higher rates
compared with other samples in other countries nor do they appear to be a problem for women only. Most of the motives
can be described as intrapersonal, and are not related with attention seeking. It is necessary to conduct further research
with a more diverse and representative university sample
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OP18-3K: Understanding Suicide from Epidemiological Research II
Childhood Residential Mobility and Risks of Attempted Suicide, Psychiatric Illness, Premature
Death, Substance Misuse and Criminality in Later Life
Roger T. Webb1, Carsten Bøcker Pedersen2,3, Pearl L.H. Mok1
Centre for Mental Health and Risk, University of Manchester, United Kingdom; 2Centre for Integrated Register-based
Research, CIRRAU, Aarhus University, Denmark; 3National Centre for Register-Based Research, Aarhus University,
Denmark; pearl.mok@manchester.ac.uk
Background
1
Previous studies have reported links between frequent residential movement during childhood and subsequent risks of
attempted suicide and suicide. These studies, however, rarely examined these outcomes beyond adolescence or young
adulthood. In addition, although suicidal behavior is correlated with a range of other adverse events, these were rarely
investigated in relation to residential mobility and in the same population.
Objectives
We examined the associations between childhood residential mobility and subsequent suicide attempt as well as a range
of other correlated adverse outcomes occurring between mid-adolescence and mid-adulthood in the same population.
Outcomes in three domains were investigated: 1) Psychiatric Morbidity (suicide attempt, alcohol or drug misuse disorder,
any secondary care treated mental illness); 2) Criminality (violent offending, receiving a custodial sentence, driving under
the influence of alcohol or drugs); 3) Premature death (all causes, natural causes, unnatural causes). Relative risks by
age of exposure to residential changes, and by frequency of moves during each year of their development, were
estimated compared to persons with no moves at the same age.
Method
A population-based cohort was constructed which included all persons born in Denmark between 1971 and 1997 and
whose parents were born in the country. Individuals were followed from their 15th birthday until end of 2012. Residential
mobility was measured each year from birth to age 14 years. Incidence rate ratios were estimated by log-linear Poisson
regression, adjusted for calendar year, age, and age and sex interaction.
Results
Residential mobility at all ages during childhood was associated with significantly increased risk for attempted suicide
between mid-adolescence and mid-adulthood. Risks were higher for those who moved two or more times compared to
those who moved only once, and there was a general rise in relative risks with older age at moving. The patterns and
magnitudes of risks were similar for males and females. The associations between elevated risks with higher frequency of
moves and older age at moving were also observed for the other adverse outcomes. For outcomes such as death by
unnatural causes, alcohol or drug misuse disorder, and violent offending, there was a clear pattern of relative risks rising
exponentially for residential changes during early adolescence.
Conclusions
The range of adverse outcomes associated with childhood residential mobility is wide and not confined to suicidal
behavior. Children may be particularly vulnerable to adverse effects associated with multiple residential changes during
adolescence.
Incidence and Presentation Rates of Self-Harm in a Nationally Representative UK Primary Care
Cohort, 2001-2013
Matthew Carr1, Darren Ashcroft2,3, Evangelos Kontopantelis4,5, Yvonne Awenat6, Jayne Cooper1, Carolyn ChewGraham7, Navneet Kapur1, Roger Webb1
1
Centre for Mental Health and Risk, Institute of Brain, Behaviour and Mental Health, University of Manchester, UK;
2
Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, University of Manchester, UK;
3
NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre; 4Centre for Health Informatics,
Institute of Population Health, University of Manchester, UK; 5NIHR School for Primary Care research, University of
Manchester, UK; 6School of Psychological Sciences, University of Manchester, UK; 7Research Institute of Primary Care
and Health Sciences, Keele University, UK; matthew.carr@manchester.ac.uk
Background: Most of the research conducted on self-harm has been undertaken in secondary healthcare settings. Little is
known about the frequency of occurrence in primary care.
Methods: Using the Clinical Practice Research Datalink (CPRD), we calculated directly standardised incidence and rates
of presentation during 2001-2013. Rates were compared across age bands, the nations of the UK, and levels of
socioeconomic deprivation.
Findings: We found significantly higher rates for females in terms of incidence (RR 1.45 [95% CI 1.42, 1.47]) and
presentations (RR 1.56 [1.54, 1.58]). An increasing trend in incidence was apparent for males (P<0.001) but not females
(P=0.083). However, both genders exhibited trends in increasing presentation rates (P<0.001). We observed a decreasing
147
gradient of risk with increasing age and markedly elevated risk for females in the youngest age group (15-24 years versus
all other females: RR 3.75 [3.67, 3.83]). Increasing presentation rates were observed for males across all age bands
(P<0.001). We found higher rates when comparing Northern Ireland, Scotland, and Wales with England, and increasing
rates of presentation for all four nations. We also observed higher rates with increasing levels of deprivation: most versus
least deprived male patients, RR 2.17 [2.10, 2.25].
Interpretation: Due to the lack of a national self-harm database, these temporal patterns and relative risks have not
previously been reported. Our findings can inform the targeting of high-risk groups in primary care toward the ultimate
goal of lowering risk of self-harm repetition and suicide.
Funding: Department of Health: Policy Research Programme.
Suicide among Immigrants in Norway: A Registry-Based Analysis, 1995-2009
Anne Reneflot, Karoline Tufte Lien, Ingri Myklestad, Lars Johan Hauge, Kim Stene-Larsen
Norwegian Institute of Public Health, Norway; anne.reneflot@fhi.no
Introduction
Norway has seen an increase in immigration in the recent decades, with immigrants now making up 14.9% of the
population. So far knowledge about immigrants’ population health is scarce and unclear, especially in the case of mental
illness and suicide (Abebe et al, 2014).
Research has often portrayed immigration populations as one large homogenous group, overlooking the heterogeneity
and complexity of backgrounds and experiences (Straiton et al, 2014). This analysis seeks to group the sample so it best
showcases these diversities, without sacrificing power or ethical concerns.
In this study we seek to examine risk factors and patterns of suicide among immigrants in Norway and if these differ
between different regions of origin, and whether immigrants’ family size in Norway has an effect on suicide risk.
Methods
The analysis is conducted on a large dataset with linkages to some of Norway’s health and personal registries. Using
registry data has the benefit of including all those registered as living in Norway, including immigrants with a personal ID
number.
Explanatory variables will include information on demography and socio-economic status while the response variable is
suicide mortality.
The analysis will be undertaken in STATA 13 with descriptive, survival and multivariate analysis. Sub-analyses will be
conducted separately for men and women.
Results
387 immigrants committed suicide between 1995 and 2009, 368 by first-generation and 19 by second-generation
immigrants. The distribution by gender differs between the general Norwegian population, where about 1 in 4 suicides are
committed by women while in the immigrant population 1 in 3 suicides are women. Gender distribution in the total
immigrant population is approximately equal.
Trends in suicide 1995-2009
In this analysis we separate between immigrants coming from Nordic countries and the remaining immigrant population.
Immigrants from Nordic countries have higher suicide rates than the general Norwegian population in every 5-year period,
while the rates of the group including the rest of the immigrant population is lower than the rates of general Norwegian
population.
Other results will include sections on the socio-demographic profile of immigrants in Norway, suicide risks by immigrant
groups, the impact of pre- and post-migration variables on suicide risk and the impact of registered family size on suicide
risks. Here, we present some initial descriptive statistics and rates, while the full paper will include the multivariate
analysis which will be completed in the beginning of 2015.
References
Abebe, D. S., Lien, L., & Hjelde, K. H. (2014). What we know and don't know about mental health problems among
immigrants in Norway. Journal of Immigrant & Minority Health, 16(1), 60-67.
Straiton, M., Reneflot, A., & Diaz, E. (2014). Immigrants' use of primary health care services for mental health problems.
BMC Health Services Research, 14(1), 341.
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Impact of Economic Fluctuations on Suicide Mortality in Canada (1926-2008): Testing Durkheim,
Ginsberg and Henry and Short Theories
Lise Thibodeau
Université de Montréal, Department of Demography, Canada; lise.thibodeau@umontreal.ca
Three classical theories have tried to explain the relation between economic fluctuations and suicide mortality. Each of
them proposed opposite perspective. First, Durkheim (1897): non-linear, in periods of both prosperity and economic
depression there is less social integration and regulation therefore suicide rates should increase. Ginsberg (1966):
procyclical, suicide rates should decreases during economic contraction, and increases during periods of expansion.
Finally, Henry and Short (1954): countercyclical, suicide rates should increases during economic contraction and
decreases during periods of economic expansion.
Empirical researches conducted in both cross-sectional and time series analyses explored the link between suicide and
economic conditions, often measured by unemployment rates, GDP, real income, and have mixed evidences found:
positive, negative and none (Boor 1980; Statistics Canada and Adams 1981; Wasserman 1984; Breault 1986; Leenaars
and Lester 1994; Trovato 1986). While previous studies captured part of the association, no studies have considered
lengthy time periods that incorporate Canadian economic time stage of the Great Depression, the Glorious thirties, and
the oil chocks to the fluctuations of the beginning of 21st century. In other words, using vital statistic starting in 1926 to the
latest data publicly available.Also, previous analysis in Canada has not specifically tested for the presence of the three
classical theories. Most fundamentally, numerous economic indicators possibly have long-term impact, and researchers
have neglected to consider unemployment rate as a lagging indicator in time-series of lengthy period in explaining suicide
rate.
The present study provides empirical assessment of the relationship between economy and suicide rates in Canada for
the period of 1926 to 2008. We seek to determine which of the three classical theories of suicide and economic
fluctuations is observed over 83 years. Unemployment rate is used as a contextual variable for Canada economic
fluctuations (contraction and expansion). Further, this analysis tests the impact of economic on suicide by age and sex to
evaluate in which group the effect is the most important. Box–Jenkins autoregressive integrated moving average (ARIMA)
on time series analyses that consider lag effect was used to model the relationship.
A significant relationship with unemployment rates was observed; positive during contraction period (1926-1950) and
negative in time of expansion (1951-1973). Males and females showed different relationship in period of moderate
unemployment (1974-2008). Suicide rate by age shown mid-adult (45-64) are the most impacted by unemployment rate
fluctuations. Overall, our findings indicate a significant nonlinear relationship of male suicide mortality with economic
fluctuations in Canada; Durkheim theory observed. It suggests public health responses are necessary in both time of
economic contraction and expansion.
Younger or Older Parental Age and Risk of Suicide, Attempted Suicide and Other Correlated
Adverse Outcomes in Offspring
Pearl L.H. Mok1, Sussie Antonsen2, Carsten Bøcker Pedersen2,3, Roger T. Webb1
Centre for Mental Health and Risk, University of Manchester, United Kingdom; 2Centre for Integrated Register-based
Research, CIRRAU, Aarhus University, Denmark; 3National Centre for Register-Based Research, Aarhus University,
Denmark; pearl.mok@manchester.ac.uk
Background
1
Younger or older parental age has been linked with a range of adverse offspring outcomes including suicide and
attempted suicide. However, much of this research has focused on either maternal or paternal age or on suicidality up to
young adulthood only. Suicidal behavior is also strongly correlated with other adverse outcomes, but studies of multiple
adverse events associated with parental age have rarely been conducted in the same cohort at risk.
Objectives
In a national birth cohort we investigated associations between maternal and paternal age at birth with offspring suicidality
and other correlated adverse outcomes occurring between mid-adolescence and mid-adulthood. Nine adverse outcomes
across three domains were investigated: (i) Premature Death: suicide, unnatural death, natural death; (ii) Psychiatric
Morbidity: suicide attempt, any mental illness, alcohol or drug misuse disorders; (iii) Criminality: violent offending,
receiving a custodial sentence; convicted of driving under the influence of alcohol or drugs.
Method
A population-based study of all persons born in Denmark between 1966 and 1996. A total of 2,033,944 persons were
followed up from their 15th birthday until December 31st 2011. Incidence rate ratios (IRRs) were estimated by log-linear
Poisson regression, adjusted for offspring age and sex, calendar year and the other parent's age. The parental age
category 25-29 years was used as the reference.
Results
Offspring of teenage mothers showed significantly elevated risks for suicide and attempted suicide, while those born to
teenage fathers had increased risk for attempted suicide but not for suicide. Paternal age 45 years and over was
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associated with raised risks for both suicide and attempted suicide, but neither outcome was linked with older maternal
age. Teenage motherhood was associated with increased risks for all of the other adverse offspring outcomes we
examined. Risks were particularly raised for custodial sentencing, violent offending, alcohol or drug misuse disorder, as
well as attempted suicide. Offspring of teenage fathers also showed elevated risks for all psychiatric and criminality
outcomes, but not for premature death. Similarly, offspring of fathers aged 45 years or over showed elevated risks for all
adverse outcomes, and a U-shaped pattern of IRRs was observed for psychiatric and criminality outcomes. In contrast,
risks tended to decrease with increasing maternal age, with the exception of those born to mothers aged 35-39 years who
showed a higher suicide risk than those born to mothers aged 30-34 and 40-44 years.
Conclusions
Parental age, in particular teenage maternal and advancing paternal age, is associated with elevated risks of suicide and
attempted suicide as well as other causes of premature death, substance misuse and criminality between midadolescence and mid-adulthood. Increased risk across a broad array of adverse outcomes suggests that multiple causal
mechanisms are implicated.
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OP18-3M: Symposium: Preventing Pesticide Suicide - Restricting Access
to the Means of Suicide
Preventing Pesticide Suicide - Restricting Access to the Means of Suicide
Chair(s): Morton Silverman (EDC)
Restricting access to means of suicide and reducing the lethality of methods of suicide provide key opportunities for
suicide prevention in all countries. A large body of evidence now addresses the extent to which reducing access and
lethality to means of suicide may reduce mortality and morbidity associated with suicidal behaviours. Restricting access to
the means of suicide may be one of the most cost-effective approaches to suicide prevention worldwide.
Emerging evidence from low- and middle-income countries (LAMIC), where over 80% of global suicides occur, suggests
that access to agricultural pesticides – the most common method of suicide globally – may be a more important
determinant of suicide rates than the prevalence and treatment rates for mental disorders. Of the estimated one million
suicides in the world each year, at least 30% involve ingestion of pesticides. Ready access to pesticides by members of
households where they are used, together with the impulsive nature of these self-poisoning acts, appear to be major
contributory factors. Therefore encouraging safer storage may be a significant means of reducing suicidal behaviours in
these households. There is growing evidence that different methods of restricting access to pesticides can effectively
reduce suicide rates, perhaps more effectively than conventional suicide screening programs and mental health
interventions.
This symposium will present the outcomes from community-based means restriction interventions in 4 LAMICs, and
highlight different methods of restricting access to pesticides.
The topics in the symposium will include:
- An international overview of restriction of access to methods of pesticide suicide as a means for suicide prevention.
- China – Recent initiatives to reduce pesticide suicides
- Suriname – Current approaches to preventing rural suicide
- India – Secure storage of pesticides in Andhra Pradesh: Establishing a feasibility study
- Sri Lanka – Results of a large-scale trial of secure storage of pesticides
Educational objectives
1 To learn about means restriction as a viable suicide preventive intervention;
2 To review the current status of secure storage studies and projects that focus on restricting access to pesticides in 4
countries;
3 To compare and contrast different methods of restricting access to pesticides;
4 To add new knowledge to this field by sharing experiences, discussing findings and innovative approaches.
Presentations of the Symposium
Large-scale trial to determine the effectiveness of safer storage to prevent self- poisoning with
pesticides in Sri Lanka: update of study progress and challenges
Keith Hawton
Oxford University, UK
Pesticide ingestion is a common method of suicide in lower and middle income countries in which there are large rural
areas with many small farms. This presentation will provide an update on progress of a large Wellcome Trust-funded
community cluster-randomized trial of a lockable device for safer storage of pesticides in 162 villages (more than 50,000
households) in Sri Lanka. This is a large effectiveness study of a community intervention in a developing country to
address the burden of suicide related to pesticide ingestion. Results of the trial will not be available until later in
2016. Undertaking such a large-scale trial has been built on a strong partnership between local and international
researchers, and also provincial health services. The trial has been faced with a number of challenges due to the scale
and context of the study, including collection of data on the main outcome (intentional self-harm involving pesticides and
also other methods) and changing patterns of self-harm nationally. The presentation will include a summary of the design
of the study, some of the challenges of conducting such an investigation, and an update on the current status of the trial.
Suicide by ingestion of agriculture poisons and using lockboxes to restrict access to these poisons:
the China experience
Michael R. Phillips
Shanghai Mental Health Center, Shanghai, China
China has experienced a remarkable 50% drop in its suicide rate over the last two decades. The drop has been more
rapid in rural communities than in urban communities, so the previous 3-to-1 ratio of rural to urban suicide rates has now
dropped to 2-to-1. Despite this change, ingestion of agricultural poisons (primarily pesticides) remains the most common
method of suicide in the country, particularly in rural areas. Unfortunately, there is no nationally representative monitoring
system that collects data on suicide methods so there may be important unrecognized changes in the types of poisons
151
being employed and in the profile of individuals who choose this method. This report describes the limited available
information on the characteristics of agricultural poisoning suicides in China and reports the results of a six-year project
that installed pesticide lockboxes in 10,000 homes in Mei Xian County in Shaanxi Province.
Current approaches to preventing rural suicide in Suriname
Toby Graafsma
Anton de Kom Universiteit van Suriname
In the Caribbean region, the suicide rates of both Guyana and Suriname are alarmingly high. Guyana reports a suicide
rate of 26 and Suriname reports a rate of 25 per 100 000 inhabitants (2012). Some areas report even higher rates and in
both countries those areas are the more rural, agricultural ones. Suriname reports for the most western district Nickerie,
over a ten year period an average rate of 47 suicides per 100 000 inhabitants, the highest in the country.
Agricultural activities prevail in Nickerie and most inhabitants stem originally from India. Ingesting a lethal dosis of
pesticides - mostly paraquat - is the main method of attempting suicide. Pesticides are needed in tropical agriculture, they
are used widely but, as was shown in earlier research, also rather carelessly. Access to pesticides is easy, storage is
unsafe and users tend to neglect the inherent dangers.
Suriname is in the process of developing a national strategy on suicide prevention in which a Public Health approach will
be central.
For the district of Nickerie, some initiatives are developed already, partly focussing on mental health promotion and partly
on public health activities. Regarding the latter: in a joint effort of several parties (local, national and international), the
attitude towards access, storage and use of pesticides is targeted. A three-phase integrated pesticide management
intervention program (IPMIP) was developed. First, a needs assessment was conducted through focusgroups and
questionnaires, to characterize community perceptions. Based on the results from this phase, a public health curriculum
was developed. The curriculum was implemented as an educational program, informing a group of key persons in the
community who are trained to function as Community Health Workers with the primary task to promote safe pesticide use.
In the third phase, the effectiveness of - mobile health technology enabled - CHW-activities will be examined.
This presentation will report the approaches Suriname tends to take in efforts to prevent suicide, in particular related to
restriction of access, use and storage of pesticides.
India – Secure storage of pesticides in Andhra Pradesh: Establishing a feasibility study
Sateesh Babu
Mamata Medical College
A large study undertaken in three villages in Andhra Pradesh state of India, in August 2010 with first phase of the
feasibility and subsequent pilot project started in October 2011 and ended in September 2013 for a total of 24 months.
The three study villages were given a secured and locked storage box in every household involved in farming and buying
pesticides. The suicides and deliberate self harm data was compared with three other control villages in same area
(district) having similar kind of rates of suicide.
The attitudes of the people towards suicide, deliberate self harm (DSH), the idea of secured storage box and its benefits
and whole idea of keeping the pesticides secured to prevent suicide and DSH was assessed three times during the pilot
phase – before the box being installed in the house, after one year and at the end of the study period 24months later.
Total number of the households that were studied for the above was 921. The results of the promising trends from the
study will be presented in the IASP Congress at Montreal.
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OP18-3N: New Technologies and Suicide Prevention II
ReachOut.com Ireland – Bridging Barriers; Exploring Five Years of ReachOut.com Ireland User
Survey Data
Fenella Murphy, Derek Chambers
Inspire Ireland, Ireland; fenella@inspireireland.ie, derek@inspireireland.ie
Background
Many young people experiencing mental health problems will delay seeking help or not seek help at all*. The online
service ReachOut.com aims to engage young people and provide mental health information and support where and when
they need it. Originally established in Australia, ReachOut.com now also operates in Ireland and the USA.
To evaluate and inform service delivery, ReachOut.com Ireland adapted an online 'user survey' originally designed by
ReachOut.com Australia and in 2011 began collecting annual cross-sectional data from self-selected samples.The survey
explores visitor demographics, help-seeking knowledge, preferences and behaviours, mental health literacy and
psychological distress.
This presentation explores data collected by ReachOut.com Ireland through five annual user surveys.
Method
During data collection periods, all visitors to ReachOut.com Ireland were invited to participate in the survey via a ‘pop-up’
notification. This presentation focuses on ‘young’ survey respondents only, i.e. those aged 12 to 25 years.
Data collection for the 2015 and fifth annual user survey began in January 2015 and will be completed in February 2015.
This data collection time frame is in keeping with that of previous surveys.
Results
Results from five annual user surveys, 2011 to 2015, will be compared and discussed during this presentation. The 2015
results will be presented for the first time.
An encouraging increase in the understanding of ‘help-seeking’ was observed across the four years of user survey data
currently available. A sustained willingness to use online supports was also recorded emphasising the potential of online
services to engage and support young people.
High levels of psychological distress were recorded using the Kessler-10**, with an average of 59% of respondents
scoring ‘severe’ on the scale. However, proportionate to these high distress levels, engagement with health professionals
was quite low.
With high levels of visitors in distress and not seeking professional help, it appears that ReachOut.com may be supporting
young people in Ireland in need and unwilling or unable to seek help elsewhere.
This presentation provides an insight into young ReachOut.com visitors, compares selected findings based on data
collected through five annual user surveys and will discuss how ReachOut.com is engaging young people and
encouraging help-seeking.
*Rickwood D, Deane FP, Wilson CJ, Ciarrochi J (2005). Young people’s help-seeking for mental health problems.
Australian e-Journal for the Advancement of Mental Health 4(3), Supplement.
**Kessler RC, Barker PR, Colpe LJ, Epstein JF, Gfroerer JC, Hiripi E, Howes MJ, Normand S-LT, Manderscheid RW,
Walters EE, Zaslavsky AM (2003). Screening for serious mental illness in the general population. Archives of General
Psychiatry 60(2), 184-189.
“Connecting Canada”: A Virtual Conference on Suicide Prevention, Postvention and Intervention
and Its Impact as a Knowledge Exchange Mechanism
Meg Schellenberg1, Jennifer Ward2
Mental Health Commission of Canada, Canada; 2Hope Talks; mschellenberg@mentalhealthcommission.ca,
jenn.ward@hopetalks.ca
“Necessity is the mother of invention.” Plato
1
With funding constraints across Canada for individuals and organizations, the Canadian Association for Suicide
Prevention (CASP) partnered with the Mental Health Commission of Canada (MHCC) to host Canada’s first ever 3 day
virtual conference – a world’s first on the topic of suicide prevention, intervention and postvention.
Building on the 2014 theme for World Suicide Prevention Day – “One World Connected” – the virtual conference was built
on the themes of communities, collaboration and hope. In an effort to use high quality, low cost and “effective delivery
channels” (Dobbins et. al. 2009) the conference was delivered through the use of WebEx – an online webinar platform.
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The conference showcased innovative approaches and initiatives that promote meaningful collaboration and dialogue.
The conference also explored how technology is being used to promote ‘suicide safer’ communities, exchange knowledge
and share promising practices.
Keynote speakers and themes addressed high priority topics related to Suicide in the Canadian landscape including,
Military suicide prevention, media reporting and engagement and National Collaboration. High quality presentations and
the “use of opinion leaders” (Boaz, 2011), including audio, visual and “interactive educational outreach” (Gordon et. al.,
2006) resulted in an innovative and effective technology-based knowledge exchange mechanism for participants and
delegates. The virtual nature of the conference allowed for increased engagement with populations such as Survivors of
Suicide Loss, People with Lived Experience, Students, Seniors, and rural and remote communities that have previously
been underrepresented at traditional in person conferences.
This presentation will provide an overview of the conference including its strengths and challenges, lessons learned,
evaluation results and the effectiveness of an online conference as a knowledge exchange tool. In addition, we will outline
the social media engagement surrounding the conference, which supports the notion of social marketing to facilitate social
connections (Luxton et. al. 2012).
Use of Technology to Build and Maintain an Effective Postvention Workforce across a Vast Country:
24/7 Community Based Support in Australia
Jill Fisher
United Synergies Ltd., Australia; jfisher@unitedsynergies.com.au
There is an increasing emphasis on the importance of timely individual, family and community support for the suicide
bereaved (Moore, Maple, Mitchell & Cerel, 2013). Professional, timely, coordinated assistance that enables survivors to
access the types of support they need has been shown to reduce adverse health reactions, including: chronic or
complicated grief; an increased rate of depression, anxiety and other mental health issues; and, a higher risk of suicidal
thoughts and/or behaviors (Jordan & McIntosh 2011, Comans et al 2012). Providing suicide postvention support is a
relatively new area of health service and only recently has the need for defined practice guidelines, standards and quality
frameworks been recognized to support the growing numbers who work in this vital area.
The National StandBy Response Service currently trains and supports Australia’s largest dedicated postvention workforce
with more than 200 staff employed in the delivery of a community based 24 hour response after suicide and an additional
250+ local representatives steering the program at regional levels. These include those with Lived Experience, local
Indigenous community members and emergency services staff who also provide peer support and training assistance.
This presentation will discuss training and maintenance of this unique workforce and provide examples of StandBy’s use
of technologies to ensure high quality person-centred postvention support across a vast country. The presentation will
conclude with an open discussion about emerging postvention workforce experiences and encourage suggestions for a
platform to share learning and knowledge amongst those undertaking this critical area of practice.
iCare Packages: Outcomes and New Directions for Active Postvention
Jess Stohlmann-Rainey
Carson J. Spencer Foundation, United States of America; jess@carsonjspencer.org
iCare is a postvention program for people bereaved by suicide. When a family loses a loved one to suicide, they often feel
alone in their grief as they try to make sense out of the unimaginable. Many times the communities that care about them
are at a loss of what to say or do, but know their friends need an embrace of care during this very challenging time. The
purpose of the iCare Packages is to prevent suicide in of bereaved families by engaging them in healing and connecting
them to supportive communities. While most organizations focus on suicide prevention, there is a great need for
postvention initiatives. Survivors of the deceased experience a different grief from those who have lost loved ones to
alternate causes of death. When a suicide occurs, it often leaves survivors feeling unprepared. They are faced with the
social stigma of death by suicide and may not be able to find the support they need. There is a need for increased efforts
in active postvention to provide loss survivors tools to grieve in healthy ways.
After many years of operating as a grassroots program, the Carson J Spencer Foundation has begun to structure and
formalize the program for the purpose of scaling it to benefit a wider audience. As a beginning step in this process, a
preliminary evaluation of the program was conducted in the summer of 2014. The evaluation aimed to identify the postloss grieving behaviors of iCare recipients and determine how the package has supported help-seeking behaviors leading
to a normal and healthy grieving process.
A majority of evaluation participants (75%) connected with multiple support systems they found through the iCare
Packages. 72.22% sought professional support following the loss of their loved one. The time span of active help spanned
from 3 months to 5 years, with a mean of 1.32 years. Only 6.25% of survey participants had regularly received any
psychological before the loss. With their own mental health in jeopardy and a decrease in social acceptance, active
postvention is a critical step in the healing process for people bereaved by suicide.
This presentation will discuss the iCare findings in depth, make a case for the inclusion of active postvention in prevention
models, and make recommendations for universal strategies for active postvention programs.
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The (Cost-)Effectiveness of an E-Learning Supported Train-the-Trainer Program to Implement a
National Suicide Practice Guideline
Derek de Beurs1, Marieke de Groot2, Jos de Keijser3, Ad Kerkhof2
Netherlands Institute of Health Services Research (NIVEL), Utrecht, the Netherlands; 2VU Amsterdam, Netherlands,
The; 3GGZ Friesland; dp.de.beurs@vu.nl
Background
1
Evidence based guidelines are important instruments to improve patient care but are seldom implemented. Interventions
that support the adherence of professionals to guidelines might lead to a quicker recovery of suicidal patients, and hence
be cost-effective. The current study examines the (cost )effectiveness of an e-learning supported Train-the-Trainer
program aimed to improve adherence to the multidisciplinary practice guideline on the assessment and treatment of
suicidal behavior.
Method
In the experimental condition, full staff of psychiatric departments was trained via an e-learning supported Train-theTrainer program on guideline adherence. Outcome measures on the patient level were suicide ideation, self reported
suicide attempts and treatment satisfaction. Missing cost and effect data were imputed using multiple imputations.
Bootstrapping was used to estimate uncertainty around cost-differences and the incremental cost-effectiveness ratio
(ICER). Cost-effectiveness planes were plotted, and cost-effectiveness curves estimated.
Results
After 3 months, psychiatrists, psychologists and nurses showed significantly more confidence and knowledge. Nurses
showed an increase in guideline adherence. On the patient level, no effect was found when anlayzing all suicidal patients
(n = 566). We did find an effect for the largest group of suicidal patients: suicidal patients with a diagnosis of
depression.Depressed suicidal patients in the experimental condition (n = 75) showed more recovery from suicide
ideation when compared to similar patients in the control condition (n = 79). No significant differences in costs between
groups were found. We did find that for depressed suicidal patients, TtT-e may be considered cost-effective in comparison
with usual implementation for some ceiling ratios (if society is willing to pay ≥ € 6100 per patient).
Conclusion
Our intervention resulted in improved outcomes at the professional level and resulted in improved clinical outcomes for
the largest group of patients in our sample, suicidal patients with a diagnosis of depression. The intervention was not
effective for all suicidal patients, and cannot be considered a cost-effective intervention strategy in comparison with
implementation as usual.
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OP18-4A: Atelier: Décloisonnement des pratiques et réseaux - Atelier en
coopération UNPS-GEPS
Décloisonnement des pratiques et réseaux - Atelier en coopération UNPS-GEPS
Marc Fillatre1, Benjamin Chkroun2, Guillaume Vaiva3, Philippe Carette4, Michel Walter5
UNPS, France; 2EMÉVIA, France; 3CHRU Lille, France; 4Centre Popincourt; 5CHRU Brest, France; m.fillatre@chutours.fr, travailleur@emevia.com, Guillaume.VAIVA@CHRU-LILLE.FR, philcarette@yahoo.fr
1- Bien-être des étudiants français en 2015
1
Actions de prévention par les mutuelles étudiantes du réseau EMEVIA
Benjamin Chkroun, Béatrice Travailleur
EMÉVIA, 250 rue St Jacques Paris 75000
chkroun@emevia.com
travailleur@emevia.com
Résumé : EmeVia mène depuis 16 ans une enquête sur la santé des étudiants. Le bien-être des étudiants est un axe
phare de cette enquête.
L’intervention portera sur l’évolution du bien-être des étudiants français depuis 2007, en lien avec leur consommation de
produits psycho-actifs et leur situation face aux nouvelles technologies pour les deux dernières années.
- Présentation des données de l’enquête santé sur 5 ans concernant le mal-être / bien-être des étudiants (évolutions,
commentaires)
- Lien entre l’utilisation des nouvelles technologies d’information et l’isolement, le mal-être des étudiants.
- Lien entre la consommation de produits psychoactifs et le mal-être des étudiants.
- Actions de prévention mises en place par les mutuelles étudiantes du réseau emeVia face aux constats précédents.
2- Programme ALGOS - suivi des suicidants - Protocole et résultats. G. Vaiva (GEPS, CHRU Lille), P. Courtet, F.
Ducrocq, S. Duhem, AL Demarty, A. Duhamel, P. Goldstein, M. Walter.
Guillaume Vaiva
CHRU Lille, rue André Verhaeghe
59037 Lille
Guillaume.VAIVA@CHRU-LILLE.FR
Résumé : Quand la combinaison de plusieurs médias de veille des suicidants se potentialisent et allient efficacité sur les
récidives de conduites suicidaires et faisabilité médico-économique dans notre période de crise actuelle.
3-Réseau et base régionale de l’UNPS
Marc Fillatre, Jean-Yves Tromeur
UNPS 33, rue Linné
75005 Paris
m.fillatre@chu-tours.fr
jytromeur@orange.fr
Résumé : L’UNPS tire sa légitimité des associations, collectifs et réseaux qui la composent. Elle facilite la circulation des
idées entre les structures proches des personnes en risque suicidaire et avec les organismes de décision. L’UNPS s’est
fixé comme objectif de réaliser un annuaire des structures nationales oeuvrant en prévention du suicide. L’expérience
commence avec la région parisienne...
4-Des pratiques à médiation artistique en prévention du suicide
Philippe Carette, Clémence Lucien, Vincent Lapierre
Centre Popincourt
6 rue de l’asile Popincourt
75011 Paris
philcarette@yahoo.fr
centrepopincourt@orange.fr
Résumé : Le détour par le support artistique ou culturel révèle ce que les procédés habituels de la psychothérapie sont
parfois impuissants à mettre en évidence. La complémentarité de ce travail en lien avec des approches
psychothérapeutiques plus individuelles favorise l’émergence d’intuitions. Elles interrogent la production artistique ou
culturelle, comme elles interrogent la thérapie, explorent leurs points communs comme leurs enrichissements réciproques
dans une complémentarité parfois étonnante.
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OP18-4B: Symposium: Psychosocial Treatment for People at Risk of
Suicide [Traitement psychosocial pour les personnes à risque de se
suicider]
Psychosocial Treatment for People at Risk of Suicide / [Traitement psychosocial pour les personnes
à risque de se suicider]
Chair(s): Annette Erlangsen (Mental Health Centre Copenhagen, Denmark), Kate Andreasson Aamund (Mental
Health Centre Copenhagen, Denmark)
People with a recent suicide attempt or severe suicidal ideation are considered at risk of suicide. It is well established that
this group has an elevated risk of (repeated) suicide attempt and death by suicide. While we are quite aware that these
people need support, it is less clear what kind of support will be effective. Numerous RCT studies have been conducted
but few have been able to document a protective effect. Recently several studies have emerged showing positive effects
of psychotherapeutic interventions aimed at specific as well as on wider groups of patients.
The proposed symposium will bring a state of the art regarding the evidence of psychotherapeutic interventions as well as
present findings from the most recent studies within the field. The symposium consists of five individual presentations with
a summarizing general discussion of where we are now and how to advance the field.
Presentations of the Symposium
Effectiveness of Psychosocial and Pharmacological Treatments for Self-Harm: Evidence from
Cochrane Collaboration Systematic Reviews / [Efficacité des traitements psychosociaux et
pharmacologiques en cas d’automutilation : les preuves avancées par les revues systématiques de
l’organisation Cochrane Collaboration]
Keith Hawton
Centre for Suicide Research, University of Oxford, UK
INTRODUCTION: Self-harm (SH) is common in most countries (e.g. more than 200,000 presentation to hospitals each
year in the UK), is often repeated and is one of the strongest risk factors for suicide. It is important therefore to establish
effect treatments for patients who present to clinical services following SH.
METHODS: Searches of the CENTRAL, EMBASE, MEDLINE, PsycInfo, PsycLit, and PROQUEST databases were
undertaken, supplemented by earlier hand-searching of several specialist journals. Reference lists of relevant reviews
were also hand-searched. Eligibility criteria was: (a) randomised allocation to intervention and control arms; (b)
comparison between any psychological and/or pharmacological intervention and a control treatment (e.g., standard care,
placebo); and (c) all participants had engaged in SH (including attempted suicide) in the six months prior to
randomisation. The outcome measures were repetition of SH, depression, hopelessness, problem solving, suicidal
ideation and suicide.
RESULTS: Presently, a total of 73 completed studies have been identified (56 of psychosocial treatments for adults, 7 of
pharmacological treatments for adults and 10 trials in adolescents) Preliminary results from 17 trials suggest a benefit for
psychological therapies in adults on the repetition of SH, suicidal ideation, hopelessness, and problem-solving abilities.
Evidence is not strong, indeed largely equivocal, for other psychosocial treatments in adults, such as dialectical behaviour
therapy and low intensity interventions (e.g. sending regular postcards). Several treatments have only been evaluated in
single trials. There is little evidence of beneficial effects for pharmacological interventions in this population. In
adolescents there are some promising results for therapeutic assessment, DBT and mentalisation therapy, but only from
single trials.
CONCLUSIONS: While in recent years an increasing number of treatments for self-harm patients have been conducted,
we are still far from having strong evidence to guide clinical practice. Evidence is strongest for brief psychological
treatments in adults. Some promising results from largely single studies need further evaluation.
Dialectical Behavior Therapy vs. Cams for Patients with Borderline Personality Disorder Traits and
Suicide Attempt: A Randomized Clinical Trial
Kate Andreasson Aamund1, Jesper Krogh1, Christina Wenneberg1, Helle Karkov Lindberg Jessen1, Kristine
Krakauer1, Rasmus Risager Thomsen2, Lasse Randers1
1
Mental Health Centre Copenhagen, Denmark, 2Mental Health Centre Amager, Denmark
BACKGROUND: Suicide is a major public health problem in the world. A recent report from World Health Organization
states that 800.000 individuals die by suicide each year. In Denmark, suicide behavior is also a problem where
approximately 600 individuals will die by suicide, and 8000-10.000 will attempt suicide each year. One of the national
strategies to prevent suicide is the Excellence Centers for Suicide Prevention, where patients are offered
psychotherapeutical treatment and social counseling. A recent survey showed that 30 % of these patients were suffering
from borderline personality disorder. Borderline personality disorder affects approximately 1%-2% of the general
population. 60%-70% of these individuals will attempt suicide, and the lifetime risk of death by suicide is 10%. Therefore
many treatments have been developed to reduce self-harm and prevent suicide in this population. One of the most
investigated treatments is dialectical behavior therapy and it has shown effect in reducing self-harm. Collaborative
assessment and management of suicidality is an evidence-based suicide-specific therapeutical framework, with a short
training period and it has shown effect in reducing suicide behavior.
157
OBJECTIVE: To compare two brief psychotherapeutical interventions for suicide prevention and reduction in deliberate
self-harm in patients with borderline personality traits, and a suicide attempt.
METHODS/DESIGN: The DiaS trial was designed as a single-center, two-armed, parallel-group observer-blinded
randomized clinical superiority trial. In the two years recruitment period from 2012-2014, we included 108 participants with
at least two criteria from borderline personality disorder diagnosis (DSM-IV) and a suicide attempt. The participants were
offered either 1) 16 weeks of modified dialectical behavior therapy or 2) collaborative assessment and management of
suicidality informed supportive psychotherapy. The treatment duration varied according to the established methods of
treatment. The outcome measure was the ratio of deliberate self-harm including suicide attempts at week 28 after the
initiation of the treatment.
RESULTS AND CONCLUSION: The characteristics of study sample, the efficacy of the treatments and other exploratory
outcomes such as severity of symptoms, suicide ideation, depression, hopelessness and impulsivity will be presented at
the symposium. Finally, the conclusion and future clinical implications will be discussed.
Dialectical Behavior Therapy for Adolescents with Repeated Suicidal and Self-Harming Behavior – A
RCT / [Thérapie comportementale dialectique vs évaluation et gestion collaboratives du risque
suicidaire pour les patients ayant des traits de personnalité limite ayant fait une tentative de
suicide : un essai clinique randomisé]
Lars Mehlum
National Centre for Suicide Research and Prevention, Faculty of
BACKGROUND: Self-harming behavior (non-fatal self-poisoning or self-injury with or without suicide intent) in adolescents
is a serious public health problem in many countries. According to population studies, between 5% and 10% of
adolescents report past year self-harm, with cutting as the most commonly reported method and relief from intensely
unpleasant emotions or to die as the most common functions reported.
OBJECTIVE: We examined whether a shortened form of dialectical behavior therapy, dialectical behavior therapy for
adolescents (DBT-A) is more effective than enhanced usual
care (EUC) to reduce self-harm in adolescents.
METHODS: This was a randomized study of 77 adolescents with recent and repetitive self-harm treated at community
child and adolescent psychiatric outpatient clinics who were randomly allocated to either DBT-A or EUC. Assessments of
self-harm, suicidal ideation, depression, hopelessness, and symptoms of borderline personality disorder were made at
baseline and after 9, 15, and 19 weeks (end of trial period), and frequency of hospitalizations and emergency department
visits over the trial period were recorded.
RESULTS: Treatment retention was generally good in both treatment conditions, and the use of emergency services was
low. DBT-A was superior to EUC in reducing self-harm, suicidal
ideation, and depressive symptoms. Effect sizes were large for treatment outcomes in patients
who received DBT-A, whereas effect sizes were small for outcomes in patients receiving EUC.
CONCLUSION: DBT-A may be an effective intervention to reduce self-harm, suicidal ideation, and depression in
adolescents with repetitive self-harming behavior.
Cams as an Intervention for Suicidal Risk / [Évaluation et gestion collaboratives du risque suicidaire
comme méthode d’intervention]
David Jobes
Suicide Prevention Lab, Catholic University of America, USA
The Collaborative Assessment and Management of Suicidality (CAMS) is an evidence-based suicide-specific therapeutic
framework that is used to identify, assess, treat, and track suicidal risk to clinical outcomes. CAMS is both a philosophy of
care and a specific series of clinical interventions that are designed to modify provider behaviors through the use of a
multi-purpose clinical tool called the “Suicide Status Form” (SSF). The SSF serves as a therapeutic roadmap in CAMS,
guiding a suicide-specific course of care that focuses on outpatient stabilization planning and the identification and
problem-focused treatment of patient-defined suicidal “drivers” (those issues or concerns that compel the patient to take
their life). CAMS is fundamentally designed to enhance the therapeutic alliance and increase patient motivation; the
patient functions as a “co-author” of their own suicide-specific treatment plan. Routine use of the SSF over the course of
CAMS care also creates an extensive and thorough medical record of assessment and treatment oriented documentation
that should significantly reduce the risk of malpractice liability. CAMS and the related use of the SSF are supported by
over 25 years of “real world” clinical research with a variety of suicidal populations in a range of clinical treatment settings
(Ellis et al., 2012; Jobes, 1995; 2000; 2006; 2012; Jobes et al., 1997; 2004; 2005; 2009). There are six published
correlational studies and one published randomized clinical trial of CAMS all of which show favorable and superior
outcomes in support of the intervention (e.g., Jobes et al., 2005; Comtois et al., 2011). Three well-powered randomized
clinical trials of CAMS are currently under way in the United States, Denmark, and Norway that will be able to investigate
the potential impact of CAMS on suicide attempt behaviors; a smaller randomized clinical trial of CAMS using a SMART
design is now being pursued as well. Results across these clinical studies show that CAMS reliably and rapidly
decreases suicidal ideation and overall symptom distress while increasing hope and reasons for living; patients prefer it to
treatment as usual and it also enhances retention in care. There is also some evidence that CAMS is associated with
decreased use of primary care and emergency departments (Jobes et al., 2005). CAMS is relatively easy to train and
practice adherence to the key domains of CAMS care is relatively easy to achieve. As a flexible suicide-specific
therapeutic framework, CAMS has been adapted to inpatient use (Ellis et al., 2012), a group format (Johnson et al., in
158
press), and as a brief intervention (Jobes, 2012). Research on CAMS training and adherence is on-going (e.g., Marshall
et al., 2014) and various electronic adaptations pertaining to CAMS-guided clinical care are also being investigated.
Impact of Psychotherapeutic Treatment after Suicide Attempt on Social Outcomes: A RegisterBased, Multicenter Study Using Propensity Score Matching / [L’effet des interventions psychothérapeutiques après une tentative de suicide sur les conséquences sociales : une étude
multicentrique des registres avec pairage des scores]
Annette Erlangsen
Mental Health Centre Copenhagen, Denmark
INTRODUCTION
Although deliberate self-harm is a strong predictor of suicide, documentation on effective interventions is missing. The aim
of the study was to examine whether psychosocial therapy (PT) after self-harm was linked to lower risks of adverse social
outcomes, such as unemployment, unfinished educational pathway, and partnership break-ups.
METHODS
All persons receiving PT intervention after deliberate self-harm (n=5,678) at seven of eight suicide prevention clinics in
Denmark during 1992-2010 were compared to persons who did not receive the PT intervention after deliberate self-harm
(n=58,282). Clinical data on the PT group was obtained from the suicide preventive clinics and information on sociodemographics and examined outcomes were obtained from nationwide register data.
The PT intervention consisted of 8-10 individual sessions provided in an outpatient care setting. The intervention focused
on suicide prevention using different psychotherapeutic elements, such as cognitive therapy and enhancement of
problem-solving skills. Standard aftercare after deliberate self-harm for the no PT group consisted of psychiatric
hospitalisation, referral to outpatient treatment or general practitioner, or discharge with no referral. The examined
outcomes were incomplete higher education, unemployment, partnership break-up, child placed out of home by
authorities, as well as other social events. Propensity score matching was applied to adjust for differences in observed
characteristics between the PT and no PT group. Using a 1:3 ratio, participants were matched on socio-demographic
characteristics, clinical profile and previous suicidal behaviour; resulting 31 matching factors.
Incidence rates and odds ratios were calculated for each outcome over short term (one year of follow-up) and long term
(5, 10, and 20 years of follow-up).
RESULTS
In all 5,678 PT recipients were included. The no PT group consisted of 58,282 individuals recorded with a first episode of
self-harm. Using a 1:3 ratio, 17,034 persons from the no PT group were matched to the PT group on the observed
characteristics. Thus, a total of 42,828 person-years was observed for the PT recipients while 544,602 and 133,306
person-years were observed for the unmatched and matched no PT group, respectively. The analysis is on-going and
findings for the examined outcomes will be reported at conference.
INTERPRETATION – This is the largest assessment of psychosocial intervention after self-harm. Although data does not
allow for random assignment, the propensity score matching was selected as a means of compensation. Given the lack of
concise information on effective treatments for people at risk of suicide, the findings of large-size study populations are
likely to provide results needed for advancement of the field.
ASSIP - Attempted Suicide Short Intervention Program. Results of a 24 Months Follow-up RCT /
[Programme court d’intervention après une tentative de suicide. Résultats d’un essai clinique
randomisé avec suivi sur 24 mois]
Konrad Michel, Anja Gysin-Maillart, Leila Soravia
University Psychiatric Hospital Bern, Switzerland
Background: ASSIP is a manualized brief therapy based on a model of suicide as goal-directed action, aimed at
establishing a therapeutic alliance in a patient-oriented, collaborative approach. The main goals of the three-session
program ASSIP are for patients to understand, from an observer’s position, patterns leading to a suicidal crisis, recognize
triggers and warning signs, and to establish individual safety strategies for future suicidal crises. An ongoing therapeutic
support is provided with regular letters over 24 months.
Method: The study was conducted in a naturalistic setting. 120 Patients were randomly assigned to an intervention group
(60 participants) treated with ASSIP combined with follow-up contact through letters, and a control group (60 participants)
receiving a single session of clinical assessment. Both groups had treatment as usual. Patients completed a set of
psychosocial and clinical questionnaires every six months over a period of 24 months.
Results: In the ASSIP group 5 patients made a total of 5 reattempts, compared to 15 patients with 41 reattempts in the
control group. The survival analysis yielded a significant difference with a Wald Chi2 of .000003. The ASSIP group had
significantly lower suicidal ideation and fewer days of inpatient treatment compared to the control group. Higher scores in
the Penn Helping Alliance Questionnaire were associated with lower suicidal ideation during follow-up.
Conclusions: ASSIP is a highly effective brief therapy for patients with recent suicide attempts. Forming a strong
therapeutic alliance is considered to be a major factor for outcome. ASSIP can be used with minimal training by
experienced therapists. An English version of the manual will be published in May 2015.
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OP18-4C: Evaluating Individuals and Evaluating Programmes [Évaluation
des individus et évaluation de programmes]
Mieux comprendre le risque suicidaire chez les personnes ayant une déficience intellectuelle (DI) ou
un trouble du spectre autistique (TSA) / [Assessing Suicide Risk in Persons with an Intellectual
Deficiency (ID) or an Autism Spectrum Disorder (ASD)]
Cécile Bardon, Xénia Halmov
CRISE, Canada; tron-bardon.cecile@uqam.ca, halmov.xenia.2@uqam.ca
Contexte – Les dispensateurs de services aux personnes ayant une DI ou un TSA sont de plus plus préoccupés par
l’incidence des comportements suicidaires chez leurs usagers, qui dénotent aussi une importante détresse. Afin de mieux
répondre aux besoins de ces personnes, il est important de se pencher sur la compréhension des processus en jeu dans
le développement des comportements suicidaires, afin d’améliorer l’estimation du risque suicidaire et de cibler les
interventions appropriées.
Objectifs – Cette présentation a pour but de décrire les facteurs de risque et de protection spécifiques, distaux et
proximaux, ainsi que présenter un modèle de compréhension du risque suicidaire chez les personnes ayant une DI ou un
TSA.
Méthodologie – Cette présentation est basée sur une recension des écrits et sur les conclusions d’un forum d’experts
composé de chercheurs et cliniciens œuvrant en prévention du suicide et en DI/TSA.
Résultats – L’incidence des comportements suicidaires varie grandement selon le niveau de DI et le type de TSA,
cependant, les personnes avec une DI légère à modérée et avec un TSA ont autant d’idéations et de comportements
suicidaires que la population générale. Dans l’état des connaissances actuelles, il est difficile de les repérer et de les
identifier à cause, entre autres, de limites dans le langage parlé et dans la capacité d’expression des émotions chez ces
personnes. Les indicateurs de risque suicidaire reconnus comme étant des facteurs de risque dans la population générale
sont des indicateurs moins significatifs pour les personnes avec une DI ou un TSA (comme l’impulsivité), alors que
d’autres facteurs en apparence anodins pour la population générale peuvent être importants pour elles (comme les
changements de routine).
Il est aussi important de considérer des facteurs-clés pour comprendre et estimer le risque suicidaire chez les personnes
ayant une DI ou un TSA, comme le développement cognitif et émotionnel, la compréhension du concept de mort, la
notion du temps, l’adaptation sociale, les notions d’espoir et de désespoir ainsi que l’automutilation et l’intention
suicidaire.
Nous proposons un modèle d’estimation du risque suicidaire pour les personnes ayant une DI ou un TSA et une
comparaison avec des modèles existants pour la population générale.
Conclusion – Les personnes ayant une DI ou un TSA partagent certaines caractéristiques avec la population générale,
mais il y a des variations selon le niveau de DI et le type de TSA. Il n’est donc pas recommandé d’estimer le risque
suicidaire en se basant sur les critères et indicateurs utilisés pour la population générale.
Implications pour la prévention du suicide : une modélisation adéquate du risque suicidaire chez les personnes ayant une
DI ou un TSA permettra de mieux prendre en compte leurs besoins et de développer des outils d’estimation du risque
appropriés.
Grille d'estimation de la dangerosité d'un passage à l'acte suicidaire / [Scale for Estimating the
Danger of a Suicidal Behaviour]
Sharon Casey1, Marie Lecavalier2, Brigitte Lavoie3, Janie Houle4
Suicide Action Montréal, Canada; 2Centre de réadaptation en dépendances de Montréal-Institut universitaire; 3Lavoie
Solutions; 4Université du Québec à Montréal; scasey@suicideactionmontreal.qc.ca, marie.lecavalier@ssss.gouv.qc.ca,
lavoie.solutions@bell.net, houle.janie@uqam.ca
Créée par Suicide Action Montréal et le Centre de réadaptation en dépendance de Montréal – Institut universitaire, la
Grille d’estimation de la dangerosité d’un passage à l’acte suicidaire vise à soutenir le jugement clinique des intervenants,
à cibler rapidement des leviers d’intervention incontournables et à prendre des décisions. Elle comporte sept critères :
planification du suicide, tentative, la capacité à espérer un changement, l'usage de substances, la présence des proches,
et la capacité à prendre soin de soi. Elle a été élaborée à partir des connaissances scientifiques dans le domaine ainsi
qu’à partir d’un consensus d’experts. La Grille est indissociable de la pondération qui précise les variables à considérer
dans l’évaluation. Son utilisation s’inscrit à l’intérieur d’une alliance thérapeutique, car l’intervenant aide la personne
suicidaire à retrouver l’espoir en même temps qu’il estime la dangerosité.
1
La Grille peut être utilisée de façon ponctuelle et en suivi. Elle permet une lecture rapide et dynamique des éléments de
danger et de protection et elle offre une attention particulière aux troubles mentaux et à l’abus de substances. La Grille
favorise le recours à des leviers d’intervention et permet de mesurer l’effet immédiat sur la personne. Elle oriente les
actions à poser en facilitant la création de protocoles harmonisés pour assurer la sécurité. Elle facilite également
l’instauration d’un langage commun entre les intervenants engagés auprès de la personne suicidaire et a été
recommandée dans le Guide de bonnes pratiques en prévention du suicide produit par le ministère de la Santé et des
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Services sociaux du Québec (MSSS) (Lane, Archambault, Collins-Poulette et Camirand, 2010).
Jusqu’à aujourd’hui, plus de 13 000 intervenants ont été formé à son utilisation dans presque tous les secteurs du
système de santé du Québec et du réseau local des services en santé mentale.
Cette présentation abordera les sujets suivants : le contexte d’origine de l’outil, les principes directeurs, la démarche de
validation, une exploration brève de l’outil, et un résumé de l’impact de son implantation dans le réseau de services en
santé mentale au Québec.
Suicide Postvention in Schools: Evaluation of the Headspace School Support Service / [Postvention
dans les écoles : Évaluation du service de soutien dans les écoles, Headspace]
Jo Robinson2,1, Vanessa Kennedy2, Nic Telford2, Jane Pirkis3, Gill Green4, Matt Spittal3
Orygen the National Centre of Excellence for Youth Mental Health, Australia; 2headspace National Youth Mental Health
Foundation; 3Melbourne School of Population and Global Health, Australia; 4STORM® Project, University of Manchester,
UK; jr@unimelb.edu.au
Suicide postvention in schools: evaluation of the headspace School Support service
1
Background
An estimated two to three high school aged young people die by suicide each week in Australia. The impacts of suicide
are not limited to the individual and in many cases the impact of a suicide extends beyond close family members and
friends, affecting the broader community. This is particularly true in a school context.
headspace, Australia’s National Youth Mental Health Foundation has developed a national service designed to assist
schools affected by suicide. Staff are located in each state and territory and work closely with schools to provide
resources, ‘preparedness’ workshops, a gatekeeper training program and support following a suicide.
The service has been subject to a rigorous evaluation and has an integrated research agenda. The aims of this
presentation are to describe the School Support service and to present findings from the evaluation.
Methods
The evaluation was conducted between 2012 and 2014. Two surveys were administered. The first was sent to schools
that had used the service and was designed to assess satisfaction. The second was sent to a random sample of 188
school wellbeing staff from across the country. This survey assessed awareness of the service and perceived capacity
and need with regard to suicide prevention programs in schools. Participants in the gatekeeper training program were
asked to complete a series of surveys before and after the training plus a filmed role play designed to assess skill
development.
Results
Between 2012 and 2014 School Support staff had contact with over 250 schools that had experienced a student suicide
and had more general contact with 1900 Australian schools.
Overall the evaluation demonstrated a clear need for the service, and early data collected about its impact indicated
potential to increase the skills, capacity and confidence of school staff with regard to managing suicide and students at
risk of suicide. 96% of schools who had used the service following a suicide reported high levels of satisfaction, and 97%
stated that they would recommend the service to others.
The evaluation of the gatekeeper training program demonstrated increased confidence and perceived capacity, plus
improvements in practical skills when conducting risk assessments following the training.
Discussion
Overall this study highlights that school staff have not, to date, felt fully equipped to deal with suicide-related behaviour
among students. The headspace School Support service is going some way to meeting this need. The program has been
well utilised and well received by stakeholders.
Evaluating suicide postvention services presents a range of methodological and ethical challenges, however further
research into the continued impact of the service is required and will be a central component of future activity.
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The Implementation of the Swiss ASSIP-Model (Attempted Suicide Short Intervention Program) in
Finland / [Implantation du modèle suisse ASSIP (Attempted Suicide Short Intervention Program /
Programme court d’intervention en cas de tentative de suicide) en Finlande]
Outi Ruishalme, Reija Narumo
The Finnish Association for Mental Health, Finland; outi.ruishalme@famh.fi, reija.narumo@famh.fi
In Finland, there are about 1000 suicides each year (population 5,5 million). Suicide attempts are estimated to be ten
times higher. It is known that the most effective means of preventing suicide is aftercare for persons with suicide attempt.
The Finnish Association for Mental Health (FAMH) has brought the Swiss ASSIP model (Attempted Suicide Short
Intervention Program) to Finland. ASSIP- model has been developed in psychiatric outpatient clinic in the University of
Bern, in Switzerland under the leadership of Dr. Konrad Michel. Work with clients is based on the view that the suicide
attempt is not automatically a symptom of mental illness, but a difficult life situation can cause a strong dead-end feeling
causing suicide attempt. It is known that even a short intervention can prevent new suicide attempt. The Swiss ASSIPmodel is based on increase and capacity on client life reading, identification of suicidal predisposition and triggering
factors. Objectives of the Finnish LINITY –project 2013-2017:- Reduction and prevention of suicide attempts and suicides
in Finland - Import and implement Swiss ASSIP -short intervention program in Finland - Develop a model for suicide
attempt aftercare which fits to the Finnish system - Intensive cooperation with hospitals and health centers to guide
patients to this service - Implementation: SOS-Crisis Centre of FAMH in Helsinki is the the first to pilot this model. 2-3
regional Crisis Centers will pilot the model at a later stage of this project. The aim is that in the end of the project this
intervention model would be in use and permanently working in different parts of Finland. The main challenge is to create
effective connections to the health care facing patients who have attempted suicide, so that they could guide clients to this
intervention. Methods: Therapeutic concepts include narrative interviewing, video-playback, a homework task, work-up of
individual vulnerabilities and suicide triggers, individual safety planning including a personalized emergency card, protocol
rehearsal, and regular outreach contacts as reminders and as provision of a minimal long-term therapeutic relationship.
The model can be used for inpatients and outpatients and is usually provided to suicide attempters in addition to standard
follow-up care. It does not replace any treatment or care. Evaluation: Feedback is collected from the clients and from the
co-operating organizations. There is also a Steering Committee and evaluator which follow the results. There will be also
two dissertations coming. Discussion and conclusions: The experience so far has shown that many suicide attempters
has not any or enough support available concerning their suicidal crisis so that they could talk and analyze what
happened and why. The conclusion is that there is a need for this type of low threshold intervention, where clients can
come without a referral.
Démarche globale d’implantation des bonnes pratiques cliniques et de gestion en prévention du
suicide au Québec : bilan de l’implantation / [Update on the Implementation of Best Clinical
Practices and Prevention Activities in Quebec]
Julie Lane1, Normande Hébert1, Kim Basque2, Dominique Gagnon3, Françoise Roy2
CSSS-IUGS, Canada; 2AQPS, Canada; 3ASSS Montérégie, Canada; jlane.csss-iugs@ssss.gouv.qc.ca, nhebert.csssiugs@ssss.gouv.qc.ca, kbasque@aqps.info, dominique.gagnon.agence16@ssss.gouv.qc.ca,
consultationsfranco@hotmail.com
Chaque année, environ 1100 personnes s’enlèvent la vie au Québec (Légaré et coll. 2014). À la demande du Ministère de
la Santé et des Services sociaux (MSSS), le Centre de santé et de services sociaux--Institut universitaire de gériatrie de
Sherbrooke (CSSS-IUGS) pilote depuis quelques années une démarche globale qui vise à implanter de bonnes pratiques
cliniques et de gestion en prévention du suicide. À la suite d'une analyse des besoins dans sept régions du Québec, le
CSSS-IUGS a réalisé des guides de bonnes pratiques pour les intervenants et des gestionnaires (MSSS, 2010). Ces
guides proposent des stratégies d’intervention et de gestion issues de la recherche et de l’expérience de praticiens
chevronnés. Ils encouragent aussi le travail en partenariat. Une démarche d’implantation a ensuite permis de rejoindre
l’ensemble des régions du Québec grâce à la collaboration de l’Association québécoise de prévention du suicide (AQPS),
de Suicide Action Montréal, de relayeurs régionaux dans chacune des Agences de la santé et de services sociaux et des
relayeurs locaux dans chacun des CSSS. Des ateliers d’une journée offerts dans chacun des territoires des CSSS ont
permis de mobiliser 1240 gestionnaires afin d’élaborer des plans d’action locaux et concertés. Une formation pour les
intervenants, formation offerte par les formateurs accrédités de l’AQPS, a permis de favoriser le développement des
compétences de 12 000 intervenants. Des arrimages stratégiques ont aussi été effectués afin que la formation soit une
priorité ministérielle et que les exigences des démarches d’agrément des établissements s’inscrivent en cohérence avec
les bonnes pratiques proposées dans la démarche.
1
Cette démarche s’inscrit directement en cohérence avec les récentes recommandations de l’Organisation mondiale de la
santé (2014) invite les pays à mettre en place une approche globale en prévention du suicide par différentes actions
stratégiques (ex. : engager les parties prenantes, sensibiliser, mobiliser le système de santé et former les agents de
santé, etc.).
Différentes données ont été recueillies au fil de la démarche (ex. : formulaire d’appréciation complété par les
gestionnaires à la suite de chaque atelier et par les intervenants à la suite de chaque formation) et un récent sondage en
ligne a permis de recueillir les commentaires de 173 gestionnaires et 1901 intervenants au regard des retombées qu’ils
perçoivent plusieurs mois après avoir participé à l’atelier et à la formation. Ces données permettent de faire un bilan de
l’implantation. La conférence permettra de dresser ce bilan et de répondre aux questions suivantes :
•Quelles ont été les différentes étapes de cette démarche?
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•De quelle façon l’atelier pour les gestionnaires sert-il de tremplin à des collaborations fructueuses en matière de
prévention du suicide?
•En quoi la formation des intervenants permet-elle de bonifier leur pratique?
•Quelles sont les retombées de la démarche?
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OP18-4D: Symposium: Media Recommendations: A Review of Their Use
and Impact Internationally
Media Recommendations: A Review of Their Use and Impact Internationally
Chair(s): Daniel Reidenberg (SAVE)
The Media Recommendations for Suicide have been widely used and adopted by many countries around the world. The
used of these Recommendations, and those disseminated by the WHO, have made a positive impact on how the media
reports on suicide and suicide related behaviors. In this panel presentation multiple nations will share experiences with a
celebrity or high profile suicide, in particular the death of Robin Williams, and the impact the Media Recommendations
have made in their country. Additional information to be shared by panelists include survey and evaluation data from
journalists on their experiences with the Media Recommendations and/or reporting tools used in their countries.
Presentations of the Symposium
A Case Study of Media Helping to Prevent Suicide Following Robin Williams Suicide
John Draper
National Lifeline
The suicide of internationally recognized actor/comedian Robin Williams on August 11, 2014 was perhaps the first major
test of national and local U.S. media since the release of U.S. recommendations to media on the safe reporting of suicide.
The recommendations released by the Suicide Prevention Resource Center in 2005 suggested that media refer the
public to the SAMHSA-funded National Suicide Prevention Lifeline (800-273-TALK). Following subsequent reports of Mr.
Williams’ suicide, the Lifeline’s national network received an unprecedented surge in calls, and Lifeline’s social media and
web-based resources experienced exponential increases in activity. Relative to user trends prior to Mr. Williams’ suicide,
the hotline and online services continued to receive significantly more activity in the weeks and months thereafter. These
data and their implications for both future media reporting on suicide and public health will be discussed.
Responding to the Spread of Helium Suicides by Engaging Media: A Hong Kong Experience
Paul Yip
The University of Hong Kong
There is an increase of the method of use of helium suicides in Hong Kong. It leads to suffocation of death and has been
reported in newspaper and its animation in social media. It is mainly found among males of aged 15-29.
It is suspected that the contagious effect arising from the sensational and graphical representation in the media.
Discussions with various responsible media professionals were held and encouraging response has been received.
It provides many valuable experiences how we could engage the media professional constructively.
The Media Recommendations: Experiences in Austria
Thomas Niederkrotenthaler
Medical University of Vienna
Working with media recommendations to prevent imitation effects and educate the public has had a long tradition in
Austria. Austria was among the first countries worldwide to develop recommendations and implemented them in 1987,
when a sudden increase of subway suicides raised concerns about that newly emerging suicide method. Following their
implementation, an immediate drop in subway suicides in Vienna was widely noted in the literature. The recommendations
have been repeatedly updated, revised and redistributed to journalists and editors in the decades that followed. Research
suggests that the quality of suicide reporting in general has improved, and the recommendations seem to have
contributed to the decline in total suicide rates in Austria. The Austrian approach favors voluntary collaboration with
editors and journalists and relationship-building based on active outreach by mental health and interested media
professionals as the main ingredients of successful implementation work. Sensationalist reporting of suicide is nowadays
rare but occurred at some instances after the implementation of the recommendations. These reports were always related
to celebrity suicides or to suicides that affected many individuals and occurred in public. Some but not all of the celebrity
suicide reporting instances were followed by imitation effects;an increase in suicides was particularly seen after the
suicide of the famous local authority , Peter Gürtler, a Viennese hotel boss and TV star, in 1998. However, several
celebrity suicides in the years that followed the implementation of the media recommendations were reported in nonsensationalist ways and did not seem to trigger additional suicides. This presentation will review the Austrian experiences
with working with the recommendations over several decades in a changing media, social and scientific environment. An
additional emphasis will be placed on the experience of an improved acceptance of media recommendations by Austrian
media professionals following the description of a potentially suicide-protective Papageno effect of media reporting. This
latest experience highlights what is probably a general fact in suicide prevention and health promotion: In order to get
other professional groups support a preventive cause, the work of that group needs to be appreciated by prevention
experts.
The Mindframe Media Initiative in Australia
Jaelea Skehan
Hunter Institute of Mental Health
Australia has arguably the longest running active strategy to engage journalists about the reporting of suicide under the
Mindframe National Media Initiative. Under Mindframe, guidelines are promoted to media through face-to-face training,
active engagement, integration of the guidelines into journalism curricula and most recently through a strategic social
media strategy and the development of online tools. In Australia, our work with journalists is supported by complementary
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work with the mental health and suicide prevention sector and with police to ensure that those working with journalists on
stories are also informed about best-practice communication and are more open to working with journalists on what are
challenging stories. In Australia, research evidence indicates the media are generally aware of their responsibilities when
reporting suicide, the rise of digital media and social media can turn a local issue into a national story and a national story
into an international story. The speed of news and the race to be ‘first’ with breaking news creates many challenges for
reporting generally, and specifically when we are dealing with sensitive issues like suicide and the interface between
social media and traditional media poses challenges on a national and international scale. This paper will use the death
of Robin Williams to highlight how reporting practices of international journalists affected the quality of Australian news
and the response from Mindframe, the health sector and the media in the rush to be first and then the rush to be first to
correct. It will also use a local grass-roots social media campaign generated by a family bereaved by suicide to highlight
the challenges of managing the interface between social media and traditional media and managing potential contagion.
The Association of Trends in Charcoal-Burning Suicide with Google Search and Newspaper
Reporting in Taiwan: A Time Series Analysis
Ying-Yeh Chen1, Shu-Sen Chang2, Simon Sai Man Kwok3, Qijin Cheng2, Paul Yip2
Taipei City Psychiatric Center and National Yang-Ming U. Taiwan, 2The University of Hong Kong, 3The University of
Sydney, Australia
Background: Some East/Southeast Asian countries experienced a rapid increase in suicide by burning barbecue charcoal
over the past decade. Media reporting and internet use were thought to contribute to the epidemic. We investigated the
association of method-specific suicide incidence with internet searches and newspaper reporting related to specific
suicide methods in Taiwan.
Methods: We obtained weekly data for suicide, internet searches on Google using terms related to suicide methods, and
the numbers of articles reporting suicide in four major newspapers in Taiwan, 2008-2011. Poisson autoregressive
regression models were used to examine the associations between suicide incidence, internet search, and newspaper
reporting, separately for charcoal-burning and non-charcoal-burning suicide.
Results: In the fully adjusted models, every 10% increase in Google search was associated with a 4.3% (95% confidence
interval [CI] 1.1-7.6%) increase in charcoal-burning suicide incidence in the same week and a 3.8% (95% CI 0.4-7.2%)
increase in the following week, whilst one article increase in United Daily was associated with a 3.6% (95% CI 1.5-5.8%)
increase in the same week. By contrast, trend in non-charcoal-burning suicide was not associated with Google search but
was associated with Apple Daily’s reporting in the previous week.
Conclusions: Increased internet search for charcoal-burning suicide appeared to be associated with a subsequent
increase in suicide by this method. The prevention of suicide using emerging methods may include monitoring and
regulating online information that provides details of these methods. Proactive approaches to engaging internet service
providers by providing help-seeking information on the internet could also be considered.
1
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OP18-4E: Attempt Survivors as Allies in Suicide Prevention
Lived-Experiences of Suicidal Behaviours through Film
Mic Eales, Erminia Colucci
The University of Melbourne, Australia; littlecreek@aapt.net.au
Art/film can act as a vehicle for expressing what words too often fail to do.
The Arts have the ability to contribute to knowledge and understanding through engagement with the imagination. Since
many suicide attempt survivors feel uncomfortable in speaking publicly (or privately) about their attempt, using art/film as
an alternative language makes it possible to use alternative storytelling techniques as a means of gathering and
disseminating knowledge in a way that can bridge and enhance cultural diversity and understanding. By recognizing the
power of art/film to transform, insight can be gained into experiences and knowledge that would otherwise remain hidden.
During this presentation, Erminia will share some of her own film documentary work and collaborative projects with people
with lived experience of suicide, such as the film Different Voice Different Perspective: The art of healing and
understanding suicide examines the original voice documenting about the life and work of Australian
installation/performance artist Mic Eales, which was part of the exhibition Inspired lives
(http://www.toofewladders.com/apps/documents).
Erminia will also draw on her experience in ethnographic photo/film-documentary and present her recent work such as the
digital storytelling project Finding our way (http://www.mhima.org.au/finding-our-way) and Song of memory, Songs of
Loss, a personal visual ethnography about her grandfather (http://movie-ment.org/personal-visual-ethnography).
My passion for the storytelling process is well known but in creating the film I felt that I was providing another, deeper
layer of understanding upon which the audience could reflect. Mic Eales
Together We’re Better: Suicide Attempt Survivors and Suicide Loss Survivors as Allies in the
Suicide Prevention Movement – A Discussion
Sally Spencer-Thomas1, Eduardo Vega2
Carson J Spencer Foundation, United States of America; 2Mental Health Association of San Francisco, United States of
America; sally@carsonjspencer.org, eduardo@mentalhealthsf.org
Allies are groups or individuals that have pulled together in a coordinated way for mutual benefit or to achieve some
common purpose. Because suicide and suicidal behavior is often so hidden, allies play a critical role in bringing attention
to the suicide prevention movement. The voices of lived experience – both of loss and of surviving attempts represent
some of the important allies at the heart of the cause. Survivors of loss often bring forth tremendous passion for change
as they make meaning out of the loss of their loved one. The recovery experiences of suicide attempt survivors provide
critical insights from which the whole field could learn about what actually works in prevention and intervention. This brief
facilitated discussion will provide participants a chance to discuss the opportunities and challenges in bringing together
these two different groups with a coordinated effort and an overlapping vision. After a brief overview of some initiatives
that have successfully demonstrated partnerships among the two groups (e.g., Man Therapy, The Way Forward launch,
the US/Canada Forum on Workplace Suicide Prevention) the following questions will be explored:
1
1) What does it mean to be an ally in suicide prevention work? Why are allies needed?
2) What opportunities exist to coordinate efforts among suicide attempt survivors and suicide bereaved? What are the
benefits of collaboration?
3) What are the perceived challenges in bringing these groups together and how can we work through any potential
barriers?
4) What are some action steps that might increase strategic partnerships among the different groups? Examples of
success and lessons learned?
Finding a Way Forward: How Attempt Survivors Engage with Suicide Prevention
DeQuincy A Lezine
Prevention Communities, United States of America; drlezine@gmail.com
In 2011 the National Action Alliance for Suicide Prevention supported launching the Suicide Attempt Survivors Task Force
to focus on resources and supports for a population at elevated risk for death by suicide. The final work product, The Way
Forward, was just released in 2014 as a resource and guide for a broad range of suicide prevention activities with the
perspective gained through living through a suicidal crisis. Because the imminent threat of death often forces an
examination of what is most important to life, many of the resulting ideas and recommendations have potential application
for a broad spectrum of people and services. While the specific elements that contribute to a person feeling the painful
urge to end life vary by location, there are common experiences and realizations that form the basis for many of the
viewpoints and recommendations presented in The Way Forward. The workshop will also discuss the process of writing
the resource while balancing multiple (and at times competing) viewpoints as well as community-based promotion after
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the resource was completed.
The Task Force started by developing a set of Core Values which describe in human terms the outcomes of suicide
prevention activities that attempt survivors would find most helpful. The process for developing those Core Values as well
as the results can help jump-start similar efforts that can be made by persons with lived experience from suicidal crises in
other countries. The following Core Values were identified by the Suicide Attempt Survivor Task Force:
Inspire hope, meaning and purpose
Preserve dignity, counter stigma, stereotypes, discrimination
Connect people to peer supports
Promote community connectedness
Engage and support family and friends
Respect and support cultural, spiritual beliefs and traditions
Promote choice and collaboration
Provide timely access to care and support
What followed was a process of examining suicide prevention activities that were initially generated by looking for
programs, practices, and policies. It was key to examine what was already in existence, what the evidence base was, and
what types of supports might be useful to develop. Those approaches were compared against the Core Values and then
sorted and categorized into the six sections in the final resource: Self-Help and Peer Supports, Family and Friend
Supports, Medical and Behavioral Health Systems, Crisis Services, Continuity of care, and Community engagement.
Several areas of recommendations may be particularly applicable to an international audience:
Engagement and meaningful inclusion of persons with lived experience from a suicidal crisis into volunteer, staff,
leadership and advisory positions.
Self-help and peer-help as ways to empower atempt survivors and expand the reach and impact of support.
Ideas and needs for engaging and helping family and friends of persons who have lived through a suicidal crisis.
What We Missed - A Personal Story of Misdiagnosis, Loss, and Grief
Nic Newling
Black Dog Institute, Australia; nic@nicnewling.com
My name is Nic Newling and I work for the Black Dog Institute in Sydney, Australia. My life and career are travelling along
nicely now but the way I found myself here is quite unusual. My past has put me in the fortunate position of being perhaps
the least officially qualified person in the field but one with perhaps the closest insight.
Before these most recent 5 years of working on and now managing the Black Dog Institute's adolescent online positive
psychology program, I was a patient of the Institute from the age of 15. It was around that time that I'd dropped out of high
school, been institutionalised for over a year in total, lost my brother to suicide, and despite receiving ECT and taking
heavy medication I was unable to feel anything positive. Or anything at all sometimes.
The strange thing is that to look at me now, no one would know any of this.
So maybe I'm a little quirky. I own a total of one suit (which in an academic research institute is like not owning a jacket in
the Canadian winter). But on the whole the people in my life who have met me in more recent times cannot see what a
mess I once was when I was suffering through many adolescent years of minsdiagnosises and ineffective treatments.
They can't see from the outside how hiding my mood disorder in school only served to isolate me more instead of helping
me fit in. They can't see the cracks that have since been sealed over. Most of them never met my brother who was silently
suffering behind me.
This is why I talk about it. About what we missed.
I spend a lot of my time speaking publicly in schools, workplaces, events, and conferences about mental health from my
personal perspective. My aim is to help stimulate the kinds of conversations that I was unable to have in school. The
conversations that hopefully have a lasting impact in the broader community and ultimately can help to preserve life.
My presenting style is off the cuff. I don't have notes, slides, or a rehearsed script. I speak from the heart as it comes to
me as I feel this conveys the genuine emotion as I'm recalling it. I do however tailor my presentation to fit the type of
audience whether they are school students, the bereaved, or people working in mental healthcare.
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For the IASP I'd like to speak primarily to the hearts of the professionals who work in the area of suicide prevention. I'd
like to use my personal story as a means of recalibrating and reminding us why we're all here trying to achieve what we
can in suicide prevention. I've found that in conversations following presentations I've made to university med school
students that it's all too easy to focus so much on the theory, the academic pursuits, grant funding applications, and ethics
approvals that we sometimes need a reminder of what the whole point is of our direction and intentions in our work on
suicide prevention.
Circles of Support: Cultivating Resources for Friends and Family of Suicide Attempt Survivors
Elaine de Mello1, Deb DiMasi2, Sally Spencer-Thomas3
NAMI New Hampshire; 2Samaritans, Inc.; 3Carson J Spencer Foundation, United States of America;
edemello@naminh.org, ddimasi@samaritanshope.org
The experience of attempting and surviving a suicide attempt can be very solitary and lonely. Often those contemplating
suicide do not realize, in part due to their great distress at the time, how others would be profoundly impacted by their
attempt and devastated if they should die by suicide; others who are contemplating suicide may believe that they are such
a burden that taking their lives, in their mind, would be doing their loved ones a favor. Both perceptions in the mind of the
suicidal person rarely match the reality that there are loved ones who would wish to be a part of an effort towards keeping
them safe and moving them towards recovery-just as they would if the person at risk were diagnosed with cancer and
going through radiation and chemo or some other preventative or restorative process. This workshop will explore the
challenges and benefits of engaging with the suicidal person and the kinds of tools, technology and strategies that might
be implemented for friends and family of a youth or young adult at risk. Barriers such as confidentiality, empowerment
engagement in safety planning will be explored.
1
PRESENTATION DESCRIPTION
.The Circles of Support Task Force is a group of suicide prevention specialists, loss and attempt survivors and other
interested partners working together nationally to knit a global safety net for youth at risk comprised of peers, caring
adults, and mental health providers by connecting them tools for advocacy and empowerment.
Members of this national committee will discuss the relationships, best practices and documents/tools that have been
incorporated into a dialogue to enhance the safety and smooth return to stability, recovery and a healthful life for youth
and young adults who have attempted suicide.
Presentation To Include:
- -Best Practice Documents
- -Sample tools for safety planning and continuity of care
- -Presentation including oral report and visuals (i.e. power point)
- -Testimonials
- -Group discussion around challenges and opportunities
Educational Objective:
At the conclusion of the workshop, participants should be able to:
1. Understand the research and experience which supports positive outcomes for attempt survivors
2. Define key components of a support system for persons who are/have been at risk for suicide
3. Describe various tools and options for assuring the safety and a healthy recovery for individuals after an attempt.
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OP18-4F: Workshop: The Waka Hourua Programme: Insights into
Indigenous Suicide Prevention in Aotearoa - New Zealand
The Waka Hourua Programme: Insights into Indigenous Suicide Prevention in Aotearoa - New
Zealand
Marama Parore1, Monique Faleafa2
Te Rau Matatini; Le Va; marama.parore@matatini.co.nz, monique.faleafa@matatini.co.nz
While the prevention of suicide is a global imperative, the diversity of the initiatives needed to preserve human life should
not be underestimated. For instance, suicide affects indigenous populations the world over at higher rates than nonindigenous populations. Culturally responsive suicide prevention initiatives are key to addressing this disparity. This
workshop capitalises on the learnings of Waka Hourua, a national Māori and Pasifika suicide prevention programme
currently being delivered in Aotearoa – New Zealand. Attendees will leave this workshop with knowledge of pioneering
developments in indigenous suicide prevention currently taking place in the South Pacific.
1
2
Workshop Goals
1. Attendees gain new knowledge of pioneering developments in indigenous suicide prevention.
2. Attendees appreciate the importance of suicide prevention initiatives for indigenous peoples being indigenously owned,
designed and delivered.
3. Attendees understand how the Waka Hourua approach could be adopted, adapted and implemented by indigenous
peoples in other nations.
Workshop Description
Every 40 seconds, a person somewhere in the world dies by suicide. While the prevention of suicide is a global
imperative, the diversity of the initiatives needed to preserve human life should not be underestimated. For instance,
suicide affects indigenous populations the world over at higher rates than non-indigenous populations. In Aotearoa – New
Zealand, Māori die by suicide at two-and-a-half times the rate of non-Māori, and Pasifika peoples have higher rates of
suicidal ideation and planning than the general population. Culturally responsive suicide prevention initiatives are key to
addressing this disparity.
This workshop capitalises on the learnings of Waka Hourua, a national Māori and Pasifika suicide prevention programme
in Aotearoa – New Zealand delivered between 2014 and 2017. Waka Hourua is the Māori name for a double hulled canoe
developed by the Polynesians, and represents the joint partnership formed between these two indigenous populations on
their journey towards the prevention of suicide. The objectives of the programme include:
1. Building the capacity and capability of Māori whānau (families), hapū (subtribes), iwi (tribes), Pasifika families and
communities to prevent suicide and to respond safely and effectively when suicide occurs.
2. Ensuring that culturally relevant suicide prevention education and training are available to Māori whānau, hapū, iwi,
Pasifika families and communities.
3. Building the evidence base of what works for Māori whānau, hapū, iwi, Pasifika families and communities to prevent
suicide.
4. Building the leadership for suicide prevention.
Facilitated by the Chief Executives of the two organisations Te Rau Matatini (Māori) and Le Va (Pasifika) delivering the
programme, attendees will leave this workshop with knowledge of pioneering developments in indigenous suicide
prevention currently taking place in the South Pacific. The workshop will explore three of the programme’s five
workstreams:
1. A one-off fund that supported 64 Māori and Pasifika communities to develop and deliver their own solutions to suicide
prevention. Initiatives range from a creative arts intervention that explores cultural disconnection in youth and their search
for cultural identity, the development of suicide prevention resources for kaumātua (Māori elders), and a whānau wānanga
(family gathering) that focuses on the culturally protective factors of whakapapa (genealogy), tīkanga (customs) and
tōhunga (traditional healers).
2. Ko Au, Ko Koe, Ko Tātou, a suicide prevention and community development programme that empowers community
change agents to develop local Suicide Prevention Action Plans. Focus will be given to the culturally tailored suicide
prevention gatekeeper training developed by the programme as an alternative to mainstream methods, and the roles of
cultural supervision and kaumātua (elders) in the prevention of suicide in Māori.
3. FLO: Pasifika for Life, the first suicide prevention programme for Pasifika peoples in Aotearoa – New Zealand and on
an international scale. The programme develops innovative suicide prevention and postvention resources and training for
Pasifika families and communities, including specialised initiatives for ethnic-specific, youth and LGBTIQ (Lesbian, Gay,
Bisexual, Transgender, Intersex, Queer) groups. Focus will be given to community perspectives on suicide prevention and
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FLO Talanoa, a new toolkit that equips Pasifika communities to build resilience and leadership in suicide prevention.
Using Waka Hourua as a point of origin, this workshop will take attendees on an engaging and thought-provoking journey
into the waters of indigenous suicide prevention. Resolving the ethnically disproportionate nature of suicide is the
responsibility of all of us. While the route remains unclear, the destination is one we must all work towards.
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OP18-4G: Opportunities and Priorities in Research and Stakeholder
Engagement
Research Opportunities in Suicide Prevention: Views from North American Funders
Joel Sherrill1, Jill Harkavy-Friedman2, Cynthia Stirbys3
National Institute of Mental Health, United States of America; 2American Foundation for Suicide Prevention; 3Canadian
Institutes of Health; jsherril@mail.nih.gov, jharkavyfriedman@afsp.org, cynthia_stirbys@sfu.ca
Summary: Relative to other diseases and conditions, research support for suicide prevention is limited. Within this tight
funding climate, government and private foundation funders of suicide research must make decisions regarding research
priorities, and also consider how to optimize their investments. This presentation includes information from three
organizations that fund suicide research located in North America: The American Foundation for Suicide Prevention
(AFSP); the National Institute of Mental Health (NIMH) as a part of the US National Institutes of Health; and the Canadian
Institutes of Health – Institute of Aboriginal Peoples Health (CIHR-IAPH). These funders support international research
efforts outside the U.S. and Canada. Presenters will describe funding priorities and opportunities, and what preparation
and processes that can improve funding success.
1
Goal: To facilitate information dissemination about these funding programs.
Content: The American Foundation for Suicide Prevention (AFSP) is the largest private U.S.-based funders of suicide
research. Some areas AFSP specializes in include: start-up grants for innovative studies; early-career scientist support
with the guidance of a mentor; and the Focus Grant that is directed toward funding to an understudied and potentially
impactful area of suicide research. In addition, AFSP supplements studies funded by other sources so that investigators
are able to include meaningful number of individuals who are suicidal or who have been touched by suicide. Over 90% of
AFSP funded investigators go on to obtain larger grants from other sources to further the innovative research they
initiated with their AFSP grant.
NIMH is one of the largest government funders of U.S. suicide prevention research. NIMH’s current approach to suicide
research funding is guided by the Prioritized Agenda for Suicide Prevention (www.suicide-research-agenda.org). New
policies and initiatives relevant to suicide prevention research affect submissions of clinical and services research;
attention to the relevance of the Research Domain Criteria efforts (RDoC) should also be considered. As emphasized by
both the Agenda and NIMH policy, the use of common data elements, and plans for data sharing, are also encouraged.
The Canadian Institutes of Health Research (CIHR) funds research to create new scientific knowledge and to enable its
translation into improved health. CIHR launched a signature initiative called Pathways to Health Equity for Aboriginal
Peoples, which is led by the Institute of Aboriginal Peoples’ Health. The Pathways initiative funds research to better
understanding of how to design, launch and scale-up interventions in four exemplar areas one of which includes suicide
prevention. Teams funded under this exemplar should explore effective interventions that promote resilience, strengthen
mental health outcomes and prevent suicide.
Research Priority Setting and the Cochrane Satellite for Suicide and Self Harm Research
Lloyd Keith1, Ann John1, Simon Hatcher2, Rachel Churchill3
Swansea University, United Kingdom; 2University of Ottawa; 3Bristol University; k.r.lloyd@swansea.ac.uk
Suicide prevention, means restriction and post-vention initiatives require a rigorous evidence base to inform policy and
practice decisions.
1
The Cochrane satellite for suicide and self-harm research at Swansea University has been set up as part of the Cochrane
Depression, Anxiety and Neurosis Group (CCDAM). Working with colleagues in Bristol UK and Ottawa Canada, a priority
setting process for suicide and self-harm research is underway to inform policy, research funders and future Cochrane
systematic reviews.
Much of the evidence in suicide and self harm research is not in the form of trials. The inclusion of non trial and qualitative
data in reviews and meta analyses will also be discussed.
Often research priorities are set and projects are funded without a high level of involvement from all relevant stakeholders
– important patient, carer, family and clinician input is frequently limited or missing. The James Lind Alliance (JLA) has
established a process for developing research priorities that are more democratic and reflect the views of people affected
by the condition under consideration and those who care for them and these are brought together in the UK Database of
Uncertainties about the Effects of Treatments (DUETS) hosted by the UK National Institute of Clinical Excellence.
The team has considerable experience of the JLA prioritization process and of Cochrane systematic reviews in the
context of suicide and self harm research.
The presentation will cover
1.The objectives of the Cochrane Satellite for suicide and self harm
2. How to become involved in future Cochrane Collaboration activity in this area
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4. The inclusion in reviews of non trial and qualitative research on suicide and self harm.
5. The principles of a James Lind Alliance Research Priority setting process
6. Progress to data in the Cochrane satellite for suicide and self harm priority setting process
7. A discussion of using the prioritized list to influence research funders to support priority areas
Suicide Prevention Community Conversations: #308Conversations, Canadian Members of
Parliament and insight from suicide prevention stakeholders
Meg Schellenberg, Meaghan Huet
Mental Health Commission of Canada, Canada; mschellenberg@mentalhealthcommission.ca,
mhuet@mentalhealthcommission.ca
In May 2014, the Mental Health Commission of Canada launched a campaign inviting Canadian Members of Parliament
to host community conversations on suicide prevention and mental health in their ridings. The conversations were
significant on 3 levels: 1) At the federal level, #308conversations brought together – for the first time – community best
practices from coast-to-coast-to-coast to inform decision making and strategy to address the urgent issue of suicide; 2)
Locally, #308conversations provided citizens with information on the actions and initiatives taking place in their own
communities; 3) Online, social media surrounding #308conversations was mobilized by suicide prevention stakeholders to
draw attention to suicide prevention related tweets, community resources and other suicide prevention events.
This presentation will outline the initiative that was undertaken, its development and approach. In addition, drawing from
the interim report (released in January 2015) and preliminary findings from the completion of the initiative (May 2015), this
presentation will identify and discuss the data gathered throughout the #308conversations campaign. Spanning multiple
regions of Canada, the data, information and stories gathered from each community conversation represent the diverse
concerns and common challenges of Canadian suicide prevention stakeholders from coast to coast to coast.
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OP18-4H: National Strategies and Approaches II
Current Status of Suicide Prevention Internationally: Outcomes of the IASP-WHO Global Survey
Ella Arensman1,2,3, Alexandra Fleischmann4, Vanda Scott3, Lorraine Barnaby3,5
National Suicide Research Foundation, University College Cork, Ireland; 2Department of Epidemiology & Public Health,
University College Cork, Ireland; 3International Association for Suicide Prevention; 4Department of Mental Health &
Substance Abuse, World Health Organisation; 5Cayman Islands Health Service Executive; earensman@ucc.ie
Introduction
1
In 2013, the International Association for Suicide Prevention (IASP) and the Department of Mental Health of the World
health Organisation (WHO) initiated a global survey on suicide prevention to ascertain what information exists on national
strategies and activities in this area.
Methods
Semi-structured self-report questionnaires were sent predominantly to members of IASP in 157 countries, with 90
countries responding (response: 57%). Information was obtained on the presence, development (plans) and evaluations
of suicide prevention strategies, funding and other resources, specific suicide prevention activities, surveillance of suicide
and attempted suicide, and legal status of suicide.
Results
According to WHO regions, the highest proportion of completed questionnaires was 64% in the South East Asian Region,
and the lowest proportion was 38% in the African Region. In nearly two thirds (61%) of the responding countries, suicide
was perceived to be a significant public health concern. In 31% of the countries a comprehensive national strategy or
action plan was adopted by the government. Among the countries that did not have a national strategy, a number of
suicide prevention activities were carried out in just over half (52%) of the countries. Among these were training on suicide
risk assessment and intervention (38%), training for general practitioners (26%), suicide prevention training for non-health
professionals including first responders, teachers and journalists (37%). In 42% of the countries self-help groups were
available for people bereaved by suicide. A unique contribution of this survey was that for some regions across the world,
such as the Eastern Mediterranean and African Region, where previously information on suicide prevention activities was
limited or absent, new information was obtained. For example, in 40% of the responding countries in the Eastern
Mediterranean Region a training programme on suicide assessment and intervention for GPs was available, and in 20%
of the countries in this region, training programmes were available on suicide prevention for non-health professionals.
Reported challenges in developing and implementing national suicide prevention programmes included criminalisation of
suicide (25 countries), insufficient resources, ineffective co-ordination, lack of enforcement of guidelines, limited access to
surveillance data on suicide and attempted suicide, and lack of independent evaluations.
Conclusions
Even though a growing a number of countries have implemented (fully or partly) a national suicide prevention programme,
in many countries the area of suicide prevention requires to be prioritised by Health Ministers, policy makers and relevant
stakeholders. The survey outcomes support the recommendations of the WHO Comprehensive Mental Health Action Plan
2013-2010 and the WHO Report - Preventing Suicide: A Global Imperative.
How Japan Reduced Suicides ~ behind the Scene of Its 25% Reduction
Yasuyuki Shimizu
NGO LIFELINK, Japan; shimizu@lifelink.or.jp
1)Reduction of suicides in Japan
National Police Agency just announced the number of Japanese suicides in 2014. It was the smallest number since 1998
when it rose remarkably to 32,863 from 24,391. The number had stayed over 30,000 since 1998 for 14 years, and it
looked the number would never go down. But three years after Japan’s Basic Act for Suicide Prevention was implemented
(2006), the number started to decline year by year. It was 32,845 in 2009, 27,858 in 2012, and 25,374 in 2014. The
number was reduced more than 25% from its peak.
2)Paradigm shift on suicide issue
In 2006, Japan’s Basic Act for Suicide Prevention was implemented and brought the paradigm shift on suicide issue.
Suicide had long been a social taboo in Japan. It was considered a personal problem and was not widely or publicly
discussed. But Basic Act realized the socialization of suicide. It defined suicide is a social problem. Underlying it was the
philosophy that a suicide prevention policy would help build a society in which citizens live purposeful lives, and various
responsibilities were attributed to the state. It also gave the legal basis to the national and local government to promote
suicide prevention.
3) 5 key concrete movements realized the shift
Based on Basic Act for Suicide Prevention, 5 key concrete movements were realized. First, the “General principles of
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suicide prevention” policy was enacted in 2007, providing the various menus of suicide prevention to the local
governments. Secondly, the Japanese government secured funding in 2009 through the “Regional comprehensive suicide
prevention emergency strengthening fund”. The Fund was mainly directed at reinforcing local suicide prevention activities.
Thirdly, the government designated March as National Suicide Prevention Month to strengthen public awareness.
Fourthly, it also introduced reforms to data collection, mandating the National Police Agency to release detailed municipallevel suicide statistics monthly. This facilitated the promotion of suicide prevention measures aligned with local needs.
Lastly, nationwide networks were formed. NGO’s network for suicide prevention was formed in 2010. Another network
was formed by local governments (more than 280 local governments are joining now) in 2011. These 5 key concrete
movements are combined together and backing up the paradigm shift getting done right.
4)Struggles behind the scene
This paradigm shift did not happen automatically. There were tough battles against the stigma behind the scene, starting
in 2000 when children who had lost their parents to suicide began to break the taboo by speaking out in the media about
their experiences. In 2005, the NGO LIFELINK started to push members of the parliament and mass media to make
suicide prevention legislation. Buoyed by a petition with more than 100 000 signatories calling for suicide prevention
legislation, Japan’s Basic Act for Suicide Prevention was finally signed into law in June 2006.
National Strategies for Suicide Prevention: How to Work for Impact!
Jerry Reed1, David Covington2, Richard McKeon3, Merete Nordentoft4, Steve Platt5
1
Education Development Center, Washington, DC, United States of America; 2Recovery Innovations, Phoenix, Arizona;
3
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Administration; 4Psychiatric
Center Copenhagen, University of Copenhagen; 5University of Edinburgh; jreed@edc.org,
david.covington@recoveryinnovations.org, Richard.McKeon@samhsa.hhs.gov, merete.nordentoft@dadlnet.dk,
steve.platt@ed.ac.uk
In September 2014, The WHO released its first suicide report entitled “Preventing suicide: a global imperative. “ Included
in the report is information on what is known about suicide across the world, groups at particular risk of suicide, and what
can be done at both societal and individual level to reduce the number of deaths from suicide. Through this report, we are
informed that over 800,000 people die by suicide every year across the globe and that breaks down to one person every
40 seconds and countless others make a suicide attempt. These deaths are preventable and we have evidence informed
approaches which have shown promise such as reducing access to lethal means, incorporating suicide prevention as a
core component of health care delivery, promoting early intervention and addressing the role of substance abuse in
suicide prevention to name a few. The report encourages WHO member nations to work towards the global target of
reducing the suicide rate in countries by 10% across the world by 2020.
Many nations currently have national and regional strategies for suicide prevention in place. Some have been evaluated
and others have set goals in terms of expected reductions in morbidity and mortality. In response to the charge in the
WHO report, this oral presentation will use the recently released WHO Global Report on Suicide as a foundation for
discussion and explore selected national strategies for suicide prevention and share specific approaches and initiatives
that are designed to demonstrate impact and yield reductions in morbidity and mortality. This session will feature
discussion of the state of several selected national strategies, results achieved, and rationale for setting goals for national
strategies such as implementing initiatives that reach high risk populations with a goal of saving lives to include restricting
access to lethal means, strengthening a systems capacity to deliver optimal suicide care, pursuing both health and public
health approaches. The concept of Zero Suicide will be presented as one approach as will other initiatives which focus on
impacting change at the population level.
Learning Objectives:
• Attendees will become familiar with the WHO Preventing Suicide Global Report and the call to reduce rates by 10% by
2020
• We will include examples of the approach of several nations who are executing their national strategies with the goal of
impact
• This workshop will address shifting our focus from merely having national strategies to having strategies designed to
achieve impact
Implementation and Results from an Action Plan for the Prevention of Suicide in Flanders (Belgium)
Marjolijn van den Berg1, Eva Dumon2,3, Cornelis van Heeringen2, Gwendolyn Portzky2,3
Agency for Care and Health, Belgium; 2Unit for suicide research, university of Ghent; 3Flemish center of expertise on
suicide prevention; marjolijn.vandenberg@zorg-en-gezondheid.be
Introduction and aims
1
Key strategies in a targeted action plan for suicide prevention in Flanders (Belgium) are presented in terms of
implementation and preliminary results in containing the number of deaths by suicide. In 2011, the Flemish Minister of
Welfare, Care and Health organized a health conference on suicide prevention. A targeted action plan was developed
with all stakeholders involved. Key strategies were subjected to a health economic evaluation. The health goal of this plan
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is to “decrease the mortality by suicide with 20% in the year 2020 compared with the baseline year 2000”.
Method
The new action plan for suicide prevention identifies key strategies on the level of universal, selective and indicated
prevention. For each strategy a range of actions were defined. The action plan makes use of current developments in the
field of technology based suicide prevention. Implementation is organized at both centralized and de-centralized level.
Results
Flanders (Belgium) ranks high in number of deaths by suicide. Recent reporting shows stabilization in the number of
deaths over 2012, and a small, but not significant decrease in the number of suicide attempts in 2013. Due to the
economic crisis and the developments in suicide rates in surrounding countries, a stabilization was unexpected.
Conclusion
Further implementation is necessary, but short term results of a target action plan for the prevention of suicide are
promising. This may encourage nation states and regional authorities to invest in targeted action plans. The need for more
knowledge in the field of implementation is recognized.
Suicide Prevention in Israel
Avshalom Aderet1,2, Lior Carmel1
1
Kibbutzim College, Israel; 2Path-to-Life, Israel; adereta@netvision.net.il
14 years ago, the first author's son, Eran, committed suicide during his military service. He had very much wanted to work
with computers but was assigned to a routine job in which he was unable to use his talents, making him deeply troubled.
This led us to be active in the public arena for preventing suicide in Israel.
Despite the number of suicides in Israel, until recently there was no official treatment and the funds allocated by the
government for the prevention of suicide were negligible. Suicide survivors and professionals got together about 14 years
ago and formed an association called "Path-to-Life" in order to take steps to prevent suicides as well as support the
families affected.
The main challenge the association faces is removing the wall of silence surrounding suicide in Israel, and increasing the
awareness of parents, teachers and principals of this phenomenon and its magnitude: 400-500 people in Israel commit
suicide every year. About 6,000 people who try to commit suicide end up in the Emergency Room.
The association's activities include:
1. Lectures given by suicide survivors in army bases in order to alert the soldiers and officers to soldiers' distress during
their military service.
2. Talks between suicide survivors and professionals and pupils at ages of 15-18 in order to get across the important
message of "mutual responsibility", alertness to and awareness of distress signals, and looking out for their friends when
they are troubled.
3. Instruction for parents and school staff in order to make them aware of this phenomenon and the need to talk about it.
4. Organizing conferences on the subject. The conferences are called "Hush – we don't talk about things like that" and, in
recent years, dealt with the media's disregard of the subject, marginalization of the subject in the educational system,
coping with the social stigma in Israeli society and with the question of whether it is really possible to prevent suicide.
5. Creating and managing support groups of suicide survivors: Spouses of, sons and daughters of, brothers and sisters of,
parents of.
6. Creating public pressure on the Israeli government to initiate national program of suicide prevention in the country.
We confront many obstacles:
a. Absence of openness and willingness of schools in the educational system to listen to lectures on suicide and stress.
b. Unwillingness of the media to deal with the subject responsibly. We still see, from time to time, articles where the
person who has committed suicide is seen as a hero.
c. The inability to directly approach the suicide survivors because of the privacy laws in Israel, thereby preventing us from
offering them assistance and support.
d. Lack of government awareness on this subject means that no resources are allocated to the Path of Life resulting in a
curtailment of our activities and the limiting our ability to influence the public agenda in Israel on this issue.
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OP18-4I: Symposium: Advances in Understanding Suicide in the US
Military
Advances in Understanding Suicide in the US Military
Chair(s): Craig Joseph Bryan (National Center for Veterans Studies)
The suicide rate among US military personnel and veterans has more than doubled during the past decade and remains
at its highest point in history. Although considerable research has identified risk and protective factors for suicide in this
population and recent clinical developments have identified effective therapies for reducing the risk for suicide attempts,
there nonetheless remain several important unanswered questions about military suicide that could lead to even greater
advances. For example, debate continues regarding the potential role of deployments and combat exposure as risk
factors for suicide, and no studies have examined the roles of military sexual trauma and nonsuicidal self-injury. In
addition, there has been little progress in detecting risk in a population that is generally reluctant to self-disclose emotional
distress and/or suicidal urges. The current presentation will provide the results of several lines of research designed to fill
these knowledge gaps.
Presentations of the Symposium
Clarifying the Relationship of Combat Exposure and Risk for Suicidal Thoughts and Behaviors
among Military Personnel and Veterans
Craig J. Bryan1, James Griffith1, Bryan T. Pace2, Kent Hinkson3, AnnaBelle O. Bryan1, Tracy A. Clemans1, Zac
Imel2
1
National Center for Veterans Studies, 2University of Utah, 3Utah Valley University
In light of rising suicide rates among military personnel and veterans, questions have been raised about the possible role
of deployments and combat exposure. Most studies to date have not been based on empirically-supported models of
suicide and have yielded mixed results, fueling professional and public debate and confusion. In the present study, we
conducted a narrative review and meta-analysis of 21 published studies to integrate findings relevant to the relationship of
deployment-related predictors (i.e., deployment, deployment to a combat zone, combat experience, and exposure to
specific combat events) with suicide-related outcomes (i.e., suicide ideation, attempt, and death). Across all predictors
and outcomes, the combined effect was small and positive, r = 0.08 [0.03, 0.13], and marked by significant heterogeneity,
I2 = 99.9%, Q (20) = 4879.77, p < .0001. This corresponds to a 25% increased risk for suicide-related outcomes among
those who have some type of deployment experience. Studies examining the relationship of exposure to killing and
atrocities in particular (k = 5) showed the largest combined effect, r = 0.13 [0.08, 0.17], and less, although still significant,
heterogeneity, I2 = 84.4%, Q (4) = 34.96, p < .0001. This corresponds to a 43% increased risk for suicide-related
outcomes among those exposed to killing or atrocity. Results align with the fluid vulnerability theory of suicide and suggest
that deployment history may be insufficiently specific as reliable predictor of suicide-related outcomes.
Sexual Assault Before and During Military Service: Gender Differences in the Association with
Suicide Risk
AnnaBelle O. Bryan, Craig J. Bryan
National Center for Veterans Studies
Objective: Military sexual trauma (MST) is a strong predictor of psychiatric disorders and negative health outcomes, but
less is known about the relationship of MST with self-injurious thoughts and behaviors (SITB) among military personnel
and veterans. The current study investigates the association of MST with SITB in a sample of military personnel and
veterans.
Method: 422 U.S. military personnel and veterans enrolled in college classes completed standardized self-report
measures of sexual trauma history, depression, posttraumatic stress disorder (PTSD), and SITB.
Results: The relationship of MST with SITB differed for male and female participants. Among men, MST was associated
with significantly increased risk for suicide ideation, plans, and attempts. Among women, MST was associated with
significantly increased risk for NSSI but not suicide ideation, plans, and attempts. Nonmilitary sexual trauma (NMST) was
associated with increased rates of suicide ideation, plan, attempts, and NSSI for both men and women. Results were no
longer significant when adjusting for age, depression, and PTSD symptoms.
Conclusions: MST is associated with increased risk for SITB among male but not female military personnel and veterans,
and is explained by concurrent emotional distress.
Vocally Encoded Emotional Arousal and Its Relation to Agitation and Hopelessness in Acutely
Suicidal Military Personnel
Alexander O. Crenshaw1, Craig J. Bryan2, Brian R. Baucom1
1
University of Utah, 2National Center for Veterans Studies
The majority of patients who ultimately die by suicide will not tell their therapist about their suicidal thoughts (Isometsa et
al., 1995). Given that approximately 33-40% of soldiers who die by suicide had met with a military mental health
profession within 30 days preceding their deaths (Hall et al., 1999), it is critical to find ways to improve suicide prevention
in clinical care even in the absence of patient-provided information regarding suicidal ideation. One such approach could
entail the analysis of vocally encoded emotional arousal. Prior research has shown an individual’s vocal pitch to be a
reliable and objective indicator of emotional arousal (e.g., Baucom, 2010; Owren & Bachorowski, 2007), and one that can
176
also predict clinical outcomes (Baucom, Atkins, Simpson, & Christensen, 2009; Baucom, Weusthoff, Atkins, & Hahlweg,
2012). The primary aim of the study is to test the association of vocally encoded emotional arousal with self-reported
emotional state in a clinical sample of acutely suicidal U.S. military personnel. Measures of patient vocal pitch were
created from previously-recorded crisis interventions of acutely suicidal soldiers using cutting-edge signal processing
methods. Regression analyses indicated that a suicidal patient's voice pitch is most strongly correlated with self-rated
agitation and absence of hope, two robust indicators of suicide risk. Results suggest that voice pitch may be a useful
clinical indicator of risk, which may lay the foundation for future advances in clinician training.
Non-Suicidal Self-Injury as Prospective Predictor of Suicide Attempts among US Military Personnel
Craig J. Bryan, M. David Rudd
National Center for Veterans Studies
Background: Nonsuicidal self-injury (NSSI) is a risk factor for suicide attempts, but it has received little attention in military
populations, for whom suicide rates have doubled over the past decade. In the current study, the relationship of NSSI with
future suicide attempts was prospectively examined in a sample of active duty Soldiers receiving outpatient psychiatric
treatment for suicide ideation and/or a recent suicide attempt.
Methods: Data were collected as part of a two-year prospective study of 152 active duty Soldiers (87% male, 71%
Caucasian, mean age = 27.53) in outpatient mental health care who reported current suicide ideation and/or a suicide
attempt during the month preceding intake. Suicide attempts and NSSI were assessed using the Suicide Attempt Self
Injury Interview.
Results: Forty percent of Soldiers with a history of nonsuicidal self-injury and 25% of Soldiers with a history of suicide
attempt made a suicide attempt during the 2-year follow-up. Soldiers with a history of nonsuicidal self-injury were more
than twice as likely to make a subsequent suicide attempt (hazard ration [HR] = 2.25, P = .045). Soldiers with a history of
suicide attempt were no more likely to make a subsequent suicide attempt than Soldiers without a previous suicide
attempt (HR = .88, P = .787). Thirty percent of Soldiers with a history of suicide attempt had also engaged in nonsuicidal
self-injury. Forty-two percent of Soldiers with histories of both nonsuicidal self-injury and suicide attempt made a
subsequent suicide attempt and were more likely to make a suicide attempt during follow-up than Soldiers with a history of
suicide attempt only. Number of NSSI episodes, but not number of suicide attempts, was significantly associated with
increased risk for future suicide attempt. Results were unchanged when adjusting for baseline symptom severity.
Assessing Suicide Risk in U.S. Military Veterans: Lessons Learned from the Current Conflicts
Peter M. Gutierrez
Denver VA Medical Center, United States of America
Suicide risk among Veterans of the United States military has been of concern to the Department of Veterans Affairs for
many years. As more troops were deployed to Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and
Operation New Dawn (OND) then rotate home and separated from military service suicide rates among Veterans began
to rise. In particular VA began to see dramatic increases in self-directed violence among the youngest cohorts of
Veterans. Recognition of the scope of the problem led to historic changes in the approach taken to suicide prevention
within VA, significantly facilitated by passage of The Joshua Omvig Veterans Suicide Prevention Act of 2007. There are
now full time suicide prevention coordinators in every VA medical center and larger community based outpatient clinics
tasked with overseeing a range of staff trainings, patient monitoring systems, and community outreach efforts. VA
partnered with the National Lifeline (suicide crisis line) to provide an option for military members and Veterans to reach
highly skilled crisis line callers with full access to VA medical records, if the callers choose to identify as Veterans
receiving care from VA. All of these efforts have been informed by extensive scientific research conducted by VA scholars
and their collaborators. This presentation will summarize the state-of-the-art in suicide assessment from a VA perspective,
with particular emphasis on what we have learned from the experiences of our youngest OIF/OEF/OND Veterans. The
presentation is informed by multiple studies conducted by the author (e.g., Gutierrez et al., 2013; Rings, Alexander,
Silvers, & Gutierrez, 2012; Breshears, Brenner, Harwood, & Gutierrez, 2010) as well as work done by his colleagues and
collaborators in VA and academia.
References
Gutierrez, P. M., Brenner, L. A., Rings, J. A., Devore, M. D., Kelly, P. J., Staves, P. J., Kelly, C. M., & Kaplan, M. S.
(2013). A qualitative description of female veterans’ deployment-related experiences and potential suicide risk factors.
Journal of Clinical Psychology, 69(3), 923-935.
Rings, J. A., Alexander, P. A, Silvers, V. N., & Gutierrez, P. M. (2012). Adapting the safety planning intervention for use in
a Veteran psychiatric inpatient group setting. Journal of Mental Health Counseling, 34(2), 95-110.
Breshears, R. E., Brenner, L. A., Harwood, J. E. F., & Gutierrez, P. M. (2010). Predicting suicidal behavior in veterans with
traumatic brain injury: The utility of the Personality Assessment Inventory. Journal of Personality Assessment, 92(4), 349355.
177
OP18-4J: Effective Prevention Programmes
Systematic Review and Meta-Regression to Identify the Most Effective Methods of Crisis
Intervention for Deliberate Self-Harm
Sarah Hetrick1, Jo Robinson1, Gregory Carter2
University of Melbourne, Australia; 2University of Newcastle, Australia; shetrick@unimelb.edu.au
Background
1
Hospital-treated deliberate self-harm (DSH) is common and problematic. Despite this, limited evidence exists to guide
clinical decisions about what treatment should be delivered to those who have recently engaged in DSH.
Methods
A systematic review using a comprehensive search of Medline, PsycInfo and EMBASE (from 1999 to June 2014), as well
as ancestry searching and contact with international experts was done. Eligible for inclusion were randomised controlled
trials testing the efficacy of psychological or psychosocial interventions for adults who had recently (as defined in the trial
report) engaged in DSH regardless of intent, including self-harm, self-poisoning or suicide attempt (SA). Studies that
stated their aim was to examine non-suicidal self-injury (NSSI) specifically were excluded as this is generally considered
to be a different phenomenon. Two independent authors extracted data from the trials and an assessment of the risk of
bias across the domains of selection, performance, detection and attrition bias was undertaken. Meta-regression was
used to enable a thorough investigation of the impact of various treatment approaches on the overall effectiveness of
interventions to prevent repeat DSH. Specifically, we examined whether any of the following characteristics were
associated with the magnitude of the intervention effects: 1. The type of intervention (complex/outreach, problem solving,
CBT, psychodynamic, other); 2. The intensity of intervention 3. Whether home visits were included; 4. Whether follow-up
and/or between session contact were included; 5. Whether there was a focus on motivating the patient to attend sessions;
6. Whether there was a focus on continuity of care; 7. Whether access to a clinician during a crisis was included; 8.
Whether inpatient admission was included.
Results
Thirty-three trials were included that tested a range of psychological and psychosocial interventions. Most of the trials
were small and the risk of bias was high in at least one domain in the majority of studies. Overall, psychological and
psychosocial interventions were more effective than a control comparison, of which most were treatment as usual. There
were no significant modifiers of this overall treatment effect, except for intensity whereby those interventions that were
more intense had a greater effect.
Discussion
The review significantly updates the evidence base and has highlighted that the field is in its infancy in terms of
understanding which, of a range of interventions and aspects of treatment delivery, are most effective in preventing repeat
DSH. What is clear is that more intensive interventions are likely to be more effective in reducing DSH, and that more
active approaches to management than simply ‘treatment as usual’ are required.
An Exploration of Attrition among Clients Attending a Therapeutic Suicide Intervention Programme
in Ireland
Amy Louise Moore1, Dr Paul William George Surgenor1, Dr Marelise Spies2
Pieta House, Centre for the Prevention of Suicide and Self-harm, Ireland; 2Department of Psychology, Trinity College
Dublin, Ireland; amymoore@pieta.ie
Background: A key barrier to effective crisis services concerns the high rates of client attrition (drop-out), which
detrimentally effects service accessibility and client outcomes. Efforts to reduce attrition have been hindered by a lack of
consensus regarding predictive factors within this population. While limited research has been conducted into attrition in
general therapy populations using regression techniques, no research to date has attempted to predict non-completion in
a multidimensional manner using Structural Equation Modelling techniques. In line with this, a dearth of exploratory
research exists on suicidal populations attending crisis intervention services. This study aimed to comprehensively
examine attrition within a suicide intervention programme, in order to better predict clients at risk of non-completion of
therapy.
1
Methodology: Secondary analyses were conducted on a range of demographic and clinical variables from 856
anonymised files of clients attending a suicide intervention charity in Ireland. Data consisted primarily of demographic
information gathered at intake, and using the Patient Health Questionnaire (PHQ-9), the Single-Item Self-Esteem Scale
(SISE), and the Positive and Negative Suicide Inventory (PANSI). Non-parametric analyses were used to analyse the
effect of demographic, clinical, health service utilisation and service variables on continuous and dichotomous outcome
variables. Correlational analysis was used to inform Structural Equation Modelling (SEM), in which significant predictors of
drop-out were analysed using multivariate analysis.
Results: Attrition rates of 22.4% were reported in the present study, with a median number of 15 sessions attended. Two
well-fitting models of client attrition were identified: one predicting the number of sessions attended (involving depression,
suicidal ideation, social support, previous attendance at therapy and GP engagement); and one predicting client drop-out
178
(suicidal ideation, deliberate self-harm and GP engagement).
Conclusions: Based on the interaction of factors identified in this study, crisis intervention services have the opportunity to
adapt the therapeutic programmes of clients that match a particular profile to provide additional support or resources to
reduce potential non-adherence. Given the demonstrated positive psychological effects of crisis intervention and the
importance of maintaining optimum service accessibility for at-risk clients, an awareness of the factors linked to attrition
can be used to tailor service protocols to provide improved crisis services. The identification of the GP as a significant
predictor can further be used to bolster efforts to improve channels of referral and ease of access to crisis services. Crisis
intervention services can utilise these findings to promote optimum service provision by targeting the key limitation of
client attrition.
Experiences of Skills For Safer Living in the Irish Context
Evelyn Gordon1, Maeve Kenny2
Dublin City University, Ireland; 2St Vincent's Hospital, Fairview, Ireland; evelyn.gordon@dcu.ie, maeveken@gmail.com
Skills for Safer Living (SFSL), formerly known as PISA, is a group psychotherapeutic intervention specifically designed in
Canada for those who make recurrent suicide attempts. A mixed methods approach was utilized to investigate the
effectiveness and acceptability of the intervention in an Irish context. This government-funded study was conducted in four
public mental health service sites. The quantitative element of the study comprised pre, post and follow-up psychometric
measures with clients. The qualitative element, which is the focus of this paper, involved in-depth interviews with clients
(n=16) and facilitators (n=8). These data were analyzed using thematic analysis. This presentation will focus on the
experiences of those delivering (facilitators) and receiving (clients) the intervention during the trial period. Participants
identified aspects of the model that positively impacted their engagement with it and highlighted challenges associated
with the delivery of a non-traditional intervention model within mental health settings in Ireland. Outcomes experienced by
clients included positive changes in their capacity for growth and recovery. Outcomes experienced by facilitators included
positive shifts in their views of and approach to working with people experiencing recurrent suicidality. The findings
suggest that the model was experienced as acceptable and beneficial in working with this population beyond the cultural
context in which it originated and as such it has international relevance.
1
Ambivalence towards Help from Others before a Suicide Attempt
Said Dadašev, Paulius Skruibis, Danutė Gailienė
Vilnius University, Lithuania; said.dadasev@fsf.vu.lt
Social support is considered one of the most important factors related to decreased suicide risk, but studies show that
people who have suicidal thoughts or have attempted suicide may avoid seeking help from others. Therefore the aim of
this research is to more deeply understand social support needs and help seeking before the suicide attempt in the
sample of suicide attempters in Lithuania – the country with one of the highest suicide rates in the world.
Twenty one adult (7 men and 14 women, their age ranging from 18 to 62 years (mean age - 31.5 years)) hospitalized after
attempted suicide participated in the study. Data were collected from each participant by semi-structured interview during
the first month after the suicide attempt. Thematic analysis according to principles suggested by Boyatzis (1998) was
used to analyze the interviews.
Results of this study showed strong ambivalence among research participants in relation to others‘ help. First, almost all
study participants (n = 20) expressed various reasons not to seek social support. However, while 10 of them did not seek
any help from others at all, another 10 participants mentioned that they did seek others’ help at some point as well.
Second, nearly half of research participants (n = 10) mentioned that they did not need help from other people before
suicide attempt. Yet 13 participants also expressed need for various forms of help from others: emotional support, such as
a) realistic encouragement in accordance to what they feel competent to do (unrealistic encouragement leads to feeling
even more powerless) b) understanding and accepting their feelings and situation c) calming their emotions; tangible
support, such as a) assistance with work b) financial help c) admittance to psychiatric hospital; cognitive guidance or
informational support, such as a) receiving advice which could help them solve their problem or b) feedback about their
thoughts or behaviour (some of research participants wanted others to directly persuade them not to commit suicide);
positive social interaction, such as engaging in communication or common activities for fun and relaxation. It is also worth
to mention that most of those who did not express need for others‘ help (n = 6) nevertheless received support (e.g.,
reassurance that research participant is cared for by others and may share his or her burdens; direct actions such as
arranging meeting with mental health specialist; constructive feedback about current problematic situation) either before
or after suicide attempt which changed their previous lack of expectations towards others.
It seems that our research participants need kinds of help which are not extraordinary for people in stressful situation.
However, it is important for those who are willing to help to acknowledge ambivalence of those in suicidal crisis - they may
not be eager to seek social support or even recognize the need for help, thus more active support appears to be relevant.
Suicide Prevention of Medically Serious Suicide Attempts
Marcelo Tavares1, Larissa Vasques Tavira1, Wenddie Cassimiro Dutra2, Laura Campos Moura1, Lara Percílio
Santos1, Arthur Henrique D'Almeida Vitor1, Mariana Amado Cordeiro1
1
Universidade de Brasília, Brazil; 2Secretaria de Estado da Saude, Diretoria de Saude Mental, Distrito Federal, Brazil;
marcelo.tavares.unb@gmail.com
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Medically serious suicide attempts (MSSA) require immediate attention regarding life-threatening situations due to suicide
attempts (SA). METHOD: Content analyses of patient records were performed on 42 cases of MSSA. Selection criteria
were: having been admitted because of a SA for at least a full day; having been seen by either the Psychiatric or the
Psychology Units and having information on method of SA. RESULTS: Of the 42 patients, 36% were seen once; 52% had
4 or more encounters with the psychological or psychiatric teams. Age average was 31 years (SD=11), 45% were males.
Nineteen patients were first time attempters, 11 had made 2 and 12 made 3 or more SA. Method of SA were: use of
medications (13 cases), jumping from heights (9), hanging (8), jumping in front of moving vehicles (5), poisoning (4) and
stabbing or cutting (3). Nine records presented no psychodiagnostic information; 3 only had psychodiagnostic hypotheses
and 28 had a diagnostic decision: 5 psychotic disorders, 13 mood disorders, 8 anxiety disorders and one dissociative
disorder. There were 8 personality, 2 cognitive disabilities, 5 substance use disorders, some of which were comorbid. Men
had more problems with substance use (r=.43). Alcohol use correlated with recent adverse life events (ALE; r=.41). The 2
suicide related variables coded from the records were number of attempts and attitude towards suicide. They correlated:
more SA related to expressed regret for not having a fatal outcome (r=.49). The number of SA correlated with the
diagnosis of personality disorder (r=.48), and serious family conflicts or loss of someone close (r=.45). Attitude towards
suicide (wish to die) correlated with childhood and recent ALE, such as being a victim of physical or sexual abuse in
childhood (r=.43), and serious family conflicts or loss of someone close (r=.43). Combining these childhood and recent
ALE yielded a stronger correlation (r=.56). CONCLUSION: Despite the positive findings, serious flaws in recording
relevant information were observed. No suicide risk assessment or treatment protocols were in place. As a result, the
records were unstructured, incomplete and dependent on the personal knowledge and style. Information on standard risk
and protective factors were not registered most of the time. For example, religion and sexual orientation were only noted
when explicitly reported by patients as being directly related to the SA; ALE were only entered when patients made direct
reference to them. Considering that 16 cases (41%) indicated problematic use of substance, only 5 related diagnoses or
diagnostic hypotheses were made. At least 12 cases allow for an argument in favor of a substance abuse or dependency
diagnosis. Limitations of this study include: different background and levels of training of staff members and possible
recording biases. Suggestion is made for the adoption of suicide assessment and treatment protocols and training the in
their use.
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OP18-4K: Understanding Suicide: Biology, Air Pollution and Distress
Tolerance
Neuroanatomy of a Suicide
maria paola bonasoni1, alberto ferrari2, manuela licata3, giorgio gardini1
1
Santa Maria Nuova Hospital, Reggio Emilia, Italy; 2Centro di Salute Mentale, Guastalla, Reggio Emilia, Italy; 3Toxicology
Laboratory, Modena, Italy; paolabonasoni@yahoo.it
A 28 year-old-boy was admitted to a psychiatric hospital after complaining of kinesthetic hallucinations: he claimed that his
abdominal organs were either moving inside the belly or getting out from the body and back in. He had had no previous
history of mental illness, and this event was recorded as the first psychotic episode. He was treated with oral olanzapine
10 mg/die and then discharged after 3 weeks. Maintenance therapy also included oral lorazepam. Therapeutic
compliance was high and the patient always attended the scheduled medical appointments. No other dysmorphophobic
symptoms or delusions were further reported. Nevertheless, after 3 months since the psychosis and apparently in good
health conditions, he suddenly committed suicide jumping out of the window from the 4th floor of his building. He was a
tissue donor (corneas, skin, bones and great vessels) and a full autopsy ruled out occult diseases.
However, postmortem examination was paramount in discovering unknown cerebral and systemic anomalies, not
detected or even suspected in life.
Grossly, the brain showed asymmetric hemispheres with a smaller right occipital pole. Brain gyration was abnormal with
hypotrophy of postcentral gyri and marked asymmetry of parietal lobes. The “simple” lobe of the cerebellum was
hypoplastic.
Histological examination revealed patchy cortical dysplasia in both parietal lobes with irregularity of microcolumns and big
neurons in layers II and III.
Hypothalamic infundibulum evidenced multinucleated neurons suggestive of dysplasia or early hamartoma. Pituitary gland
had abundant basophil cells (ACTH secreting cells).
The left adrenal gland was hypoplastic weighing 3 g, while the right weighed 5 g. Both adrenals showed expansion of the
cortex, especially the zona fasciculata. No other systemic anomalies were found.Tox screen showed olanzapine and
lorazepam within therapeutic range. No other substances were detected.
On the whole, this case was fairly singular as the parietal lobes anomalies may explain the dysmorphic body sensations.
In fact, parietal lobes play a role in mediating proprioception, such as awareness of the position of body parts and visceral
perception. Moreover, suicidal behavior might be the consequence of an anomalous activity of the hypothalamic-pituitaryadrenal (HPA) axis because of hypothalamic dysplastic neurons and marked expansion of the zona fasciculata in the
adrenals (cortisol secreting zone).
In conclusion, autopsy should be mandatory in any case of suicide, even though the cause of death is clear, since it may
disclose unknown anomalies contributory to the last lethal action. A possible explanation for suicidal behavior may be a
relief for survivors in reducing and overcoming the feelings of guilt.
Neural Substrates of Impulsive Choice in Recent Suicide Attempters
Ricardo Caceda, Andrew James, Zachary Stowe, Bettina Knight, Clint Kilts
University of Arkansas for Medical Sciences, United States of America; rcaceda@uams.edu
Documented suicide took the lives of almost 40,000 people in 2011 in the US and over one million worldwide. It is still
singularly difficult to predict who is going to commit suicide and establish adequate interventions. Suicide is usually
triggered by stressful situations that create overwhelming psychological pain in an individual who chooses to terminate
his/her own life, disregarding all future consequences. We have previously demonstrated marked impulsive choice
common to both recent suicide attempters, which tends to normalize within one week. We used functional magnetic
resonance imaging (fMRI) and a delay discounting task to identify the neural substrates of impulsive choice during acute
suicidal behavior. In this ongoing study we have acquired fMRI data for adult depressed patients hospitalized following a
recent (within 72 hours) suicide attempt and inpatient depressed controls (7 per group). Behaviorally, delay discounting
rates were higher in the suicide attempter group [t(2,12) = 2.61, p =0.02]. There was a differential pattern of activation in
the right posterior parietal cortex and parahippocampus and deactivation in the right ventromedial prefrontal cortex during
immediate choices, and activation in bilateral insula, right dorsolateral prefrontal cortex and bilateral caudate deactivation
during delayed choices in suicide attempters compared with depressed controls with k>10 voxels, p < 0.001 before
correction. These preliminary results suggest a specific imbalance between frontostriatal cognitive control and limbic
networks during intertemporal choice in acutely suicidal behavior independent from depression.
Aeroallergens, Air Pollution Exposures and Suicide Rates in Hungary, 2005-2011
Thomas Bradley Cook1, Péter Döme2, Xénia Gonda2, Zoltán Rihmer2, Teodor T Postolache3
Mercyhurst University, Department of Public Health, Erie, PA, United States of America; 2Department of Clinical and
Theoretical Mental Health, Semmelweis University, Budapest, Hungary; 3University of Maryland School of Medicine,
Baltimore, Maryland, USA; tcook@mercyhurst.edu
1
181
Background: Asthma, allergy and exposure to aeroallergens and air pollution have been identified as risk factors for
suicidal self-directed-violence. Hungary has among the highest suicide rates in the world, with locally higher rates in the
Great Hungarian Plain. Due to distinct ecological features of the Carpathian basin, Hungary is a global hotspot for highly
allergenic ragweed pollen along with high air pollution concentrations, with particulate matter responsible for 16,000
premature deaths annually. No previous study has addressed links among Hungary’s relatively high burden of
aeroallergens, air pollution, allergic disease and suicide. We sought to account for geographic and temporal variability of
suicide rates across Hungary in relation to peak periods of multiple aeroallergen and air pollution exposures. Methods: All
suicides during 2005-2011 (N=11,454) among 9 counties of Hungary spanning diverse geographic regions with both daily
air quality monitoring stations and standardized pollen traps were included in the sample. Variability in local rates of
suicide were assessed using multi-level Poisson regression models (Stata 11.0) including random effects for geographic
location. Weekly total counts of suicide per location (9 counties, and Budapest) were modeled as a function of the weekly
average of daily pollen counts, air pollution (NO2, CO, Ozone) and particulate matter (PM10) concentration measured
daily at monitoring stations within each county. Models were adjusted for climatological factors (temperature, humidity,
wind, changes in day length) and county-level socio-demographic factors (unemployment, age distribution, urban/rural).
Parallel models predicting weekly counts of acute myocardial infarction (MI) deaths were used to determine if associations
were specific to suicide risk. Results: Suicide counts were significantly elevated during weekly periods of relatively high
pollen exposure >30 u/g3, the level at which symptoms typically appear among allergy-sensitized individuals (RR = 1.09,
95%CI 1.02-1.16), adjusting for other air pollutants, weather and socio-demographic factors. Moreover, this relationship
exhibited a dose-response at higher exposure thresholds and was more pronounced in counties with higher annual pollen
counts. Among the air pollutants, only particulate matter (PM10 > 50 μg/m3) was associated with weekly suicide rates
(RR = 1.05, 95% CI 1.01-1.10). By comparison, variability in weekly rates of acute MI rates were not related to pollen
counts but were significantly related to all air pollution exposures. Conclusions: As an ecological study, individual-level
exposure assessment is needed to determine if pollen exposure contributes to risk of suicide. Though effect sizes were
modest compared to previous ecological studies on aeroallergens, this study adjusted for a wider range of climatological
factors and concurrent exposure to air pollution as well as a direct comparison to another inflammatory condition.
Positive Predictive Value of Psychological and Biological Scales for Binary Prediction of Later
Suicidal Behavior: Systematic Review and Meta-Analyses
Gregory Leigh Carter1,2, Allison Joiy Milner3, McGill Katherine2, Woodford Rachel2, Pirkis Jane3, Spittal John
Mathew3
1
2
Calvary Mater Newcastle, Australia; University of Newcastle, Australia; 3University of Melbourne, Australia;
gregory.carter@newcastle.edu.au
Background: Mental Health clinicians wish to be able to predict with acceptable accuracy, which individuals will
subsequently die by suicide or have non-fatal self harm (SH); so that interventions are directed to those identified as “high
risk”. The key measure of accuracy for this is the Positive Predictive Value (PPV). At the policy level the (US) National
Action Alliance for Suicide Prevention’s Research Prioritization Task Force aims to “find ways to assess who is at risk for
attempting suicide in the immediate future.”
Aim: Establish pooled estimates for PPV using psychological or biological scales in clinical populations.
Methods: We identified papers using PRISMA. We searched Medline, PsychInfo, EMBASE, CINHAL, Web of Science,
Cochrane trials and Scopus from Jan 1990 to Jan 2014; and hand searched key journals, reviewed the reference lists of
each paper and used the ‘find similar’ and ‘find citing’ functions for seminal papers in Web of Science and PubMed. We
used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool to assess study quality. We used random
effects meta-analysis with study-specific weights for estimating the pooled PPV calculated using the Mantel-Haenszel
method.
Results: For all studies combined (n=125 studies) the pooled estimates were: suicide (n=54) PPV 6.0 (CI95%: 4.3-8.4),
SH (n=59) 28.3 (23.9-33.2), and SH or suicide (n=12) 35.1 (25.2-46.6); for psychological scales (n=96), suicide (n=33) 3.6
(2.5-5.2), SH (n=53) 29.7 (25.2-34.6) and SH or suicide (n=10) 38.7 (27.5-51.2); and for biological tests, suicide (n=21)
14.3 (9.9-20.3) and SH (n=6) 14.8 (6.2-31.5). The best individual scales for the prediction of suicide was the CSF 5-HIAA
levels (n=6) 20.9 (14.7 to 28.8); and for SH was the “Buglass and Horton” scale (n=5) 28.8 (23.2-35.1). Studies rated as
being of high quality yielded lower PPV estimates.
Conclusions: No scale used to classify individuals as “high risk” has sufficient accuracy for the clinical use of determining
eligibility for intervention to reduce subsequent suicide or SH; because existing instruments identify many more individuals
who do not go on to have the outcome of interest and so could not benefit from the expensive, intrusive and potentially
harmful interventions (e.g. hospitalisation, psychological therapy). All such predictive instruments have a limitation on their
PPV brought about by the low prevalence rate of the outcomes of interest, which imposes an absolute ceiling on the PPV
for a given prevalence. For clinical practice we favour the “needs assessment” rather than any “risk assessment”
approach in order to determine individual interventions, as recommended by the NICE, or the deployment of inexpensive,
possibly effective, low potential harm interventions (e.g. brief contact interventions) to unselected clinical populations, or
the deployment of effective interventions for clinical sub-groups (e.g. DBT or mentalization for Borderline Personality
Disorder).
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Issues in Neuro-Cognitive Testing in Acute Poisoning Cases
Adarsh Kohli, Tarun Mittal, Baljinder Singh, Ashish Bhalla, Surjit Singh
Department of Psychiatry, Internal Medicine and Nuclear Medicine, PGIMER, Chandigarh, India;
doc_adarsh@hotmail.com
Introduction: Acute poisoning is an important cause of both morbidity and mortality in developing countries including India.
According to WHO, I million accidental and 2 million suicidal poisonings occur due to pesticides worldwide every year, of
which 20,000 patients die with most of these deaths occurring in developing countries. However these figures are old and
are debated. Anticholinesterase compounds include organophosphorous compounds (OPC) and carbamates. Acute
Anticholinesterase poisoning mostly occurs following ingestion with suicidal intent as they are easily available in
developing countries. Accidental exposure to anticholinesterase compounds occurs following exposure to aerosol during
agricultural spray or by ingestion of food recently sprayed with these compounds as they are easily absorbed through
unbroken or unabraided skin, respiratory tract, conjuctiva, gastrointestinal tract etc. A number of studies in literature
describe the acute effects of anticholinesterase poisoning, however, information regarding the difficulties encountered in
neuro-cognitive testing following acute anticholinesterase poisoning are lacking. Aim and objectives: To discuss the
issues related to neuro-cognitive testing in patients following acute anticholinesterage poisoning at the Emergency in
acute phase. Sample: Twenty eight patients admitted to the Medical Emergency of the Postgraduate Institute of Medical
Education & Research Chandigarh, India with acute anticholinesterae poisoning were taken. Neuro-cognitive Tests
administered were: Trail Making Test, PGI Memory scale, Verbal Fluency test, The Bender Visual Motor Gestalt test. The
tests used in our study were chosen to assess memory, attention, concentrating, executive functions and perceptual
motor-skills. Results and Discussion: These cases are all from the emergency OPD therefore the admission; the
evaluation and the discharge, involvement of other departments, issues related to poisoning, the physical state of the
individual, the suicidal intent, administrative issues, assessment of neuropsychological deficits and management issues
will be discussed.
183
OP18-4L: Medication, Firearms and Railways: Specificities of Means
Self-Poisoning with Medication: A Nationwide Investigation on Incidences, Comorbidities and
Repetitions in Norway
Ping Qin, Lars Mehlum
National Center for Suicide Research and Prevention, University of Oslo, Norway; ping.qin@medisin.uio.no
Background: Medication poisoning is the most common method for deliberate self-harm in the adult population. A better
understanding of this problem is essential in suicide prevention and in management of the patients and relevant
medications. In this study, we want to use rich data from Norwegian national registries to gain firm insights on poisonings
with medication in the population.
Methods: We obtained all records on acute incidence contacts to public hospitals and emergency centers because of
medication poisoning from the year 2008 through 2011 in Norway, and profiled the incidences of medication poisoning
according to sex, age and comorbid diagnoses in the first-recorded (index) contacts and in repetitions of the poisoning.
Results: We identified an average of 4114 persons who were seen in a hospital or emergency center because of
poisoning with medications each year, corresponding to a rate of 97.3 (95% CI: 94.2-100.4) per 100 000 population in
Norway. Of all 19 685 incidence contacts by 14 542 persons during the study period, 62.4% were from women and 35.8%
were from young adults of 20-34 years old. 16.5% of the patients (18.6% of females and 13.6% of males) repeated
poisoning with medication during the study period. Repetition rates were highest in children under 20 years old (19.0%)
and in 20-34 years old young adults (18.7%), and decreased with age to the lowest in the very old (3.7%). At the same
time, a comorbid diagnosis of psychiatric illness was present in 45.9% of incidence contacts, including 17.2% for affective
disorders and 14.3% for substance misuses. A supplemental diagnose of suicide attempt (X6n) was given in 33.3% of the
incidence contacts. Moreover, psychiatric illness and a diagnosis of suicide attempt at the index contact were strong risk
factors for repetition of medication poisoning regardless of sex and age of the patients. The comorbidities were also
associated with increased likelihood of having comorbid diagnoses of psychiatric illness and suicide attempt in repetitions
of medication poisoning.
Conclusion: Medication poisoning is an important health problem, especially in female and young populations.
Assessment of psychiatric illness and suicidal intention is crucial in treatment of patients with medication poisoning and in
efforts of preventing repetitions of the poisoning.
Psychotropic Medication Involved in Intentional Drug Overdose: Implications for Treatment
Eve Griffin1, Paul Corcoran1,2, Breda Heavey3, Ivan J Perry2, Ella Arensman1,2
National Suicide Research Foundation, Ireland; 2Department of Epidemiology and Public Health, University College
Cork, Ireland; 3Institute of Technology, Waterford, Ireland; evegriffin@ucc.ie
Introduction
1
Intentional drug overdose (IDO) is the most common form of hospital-treated deliberate self-harm. In Ireland, psychotropic
drugs such as minor and major tranquillisers, SSRIs and barbiturates are over-represented in intentional drugs overdoses.
However limited information is available on the source of medications taken in IDOs. This study examined the proportion
of IDO patients with current prescriptions and the proportion of those that used their medication in IDOs, as well as factors
associated with these patients.
Methods
The registration systems of three hospital emergency departments participating in the Irish National Registry of Deliberate
Self-Harm were screened over a continuous six-month period and a consecutive series of 299 IDO presentations were
identified. Of these, information as to whether the patient had a prescription for psychotropic medication was available for
288 cases. Details on the drugs taken in the IDO act, as well as background information on psychiatric treatment and
current prescriptions were recorded.
Results
Most of the 288 IDO presentations involved female patients (59.9%) and half (50.4%) had a previous history of self-harm.
Almost half (45.8%) of these involved a minor tranquilliser, with one in four (24.7%) involving a paracetamol-only
medication. One in five male IDOs involved a minor tranquilliser, compared with just 5.8% of female acts (X2[1]: 14.35;
p<0.001). One-third of IDO patients were known to be in contact with psychiatric services at the time of the act. These
patients were generally older (X2 for trend[1]: 26.14; p<0.001), more likely to have a medical card (X2[1]: 16.19; p<0.001),
and more likely to have a history of self-harm (X2[1]: 25.24; p<0.001). All patients with psychiatric contact had a current
prescription and in general were prescribed more medications (X2 for trend[1]: 117.56; p<0.001). 196 of patients had a
current prescription for psychotropic medication at the time of the act. The majority of these patients had psychotropic
medication on their prescription, and more than half of these were in current contact with psychiatric services. The
prescription of psychotropic drugs was associated with the use of these drugs in IDOs, in particular minor tranquillisers.
Having a prescription of a minor tranquilliser increased the risk of using prescribed psychotropic drugs in IDO’s
independent of any other factor (OR=4.27, CI: 1.49-12.25).
184
Conclusions
This study showed an association between prescription of psychotropic medication and the use of these drugs in IDOs.
The findings highlight the importance of considering risk of IDO among patients prescribed minor tranquillisers. Among
intentional drug overdose patients with a history of previous self-harm, a high proportion were in contact with psychiatric
services, which underlines the need for careful monitoring of medication in this setting.
Mixed Impact of Firearm Legislations on Firearm Deaths in Males: Norway
Finn Gjertsen1, Antoon Leenaars2, Margarete E. Vollrath1
Norwegian Institute of Public Health, Oslo, Norway; 2Psycologist in private practice, Windsor, Canada;
finn.gjertsen@fhi.no
Introduction: Laws have played a prominent role in public health and injury prevention. Public health organizations have
recommended restricted access and safe storage practices as a means of reducing firearm injuries and deaths, and more
restrictive firearm laws may be one reasonable approach of reducing firearm injuries and deaths. However, this is a
politically controversial topic and literature on gun control and firearm deaths shows conflicting results. The aim of this
study was to assess the impact of stricter firearms legislation on trends in male firearm deaths (unintentional, suicide and
homicide) in Norway from 1969 to 2009. Four different legislations were introduced during these years.
1
Method: All deaths due to firearm discharge, and explosive materials, were included (5,660 deaths, both sexes). The
method used to measure impact of gun legislations on accidental (unintentional) and intentional firearm deaths was to
subdivide the study period 1969-2009 into five time periods, defined by the years in which the four gun regulations were
implemented: 1986 (mandatory examination of hunters); 1990 (shotgun acquisition); 2000 (weapon cabinet if five or more
long guns); 2003 (removal of Home Guard guns, private stored). We used piecewise Poisson regression. The model
tested whether the trend changed between two successive periods i.e., if the slope of the estimated regression line
changed significantly from the previous period. Trends in male non-firearm homicide and suicide were used as
references.
Results: In the total sample (both sexes), 89% of all firearm deaths were classified due to suicide, 8% due to homicide,
and 3% as unintentional deaths (accidents). Male unintentional firearm fatality rates decreased significantly by 90% (95%
CI 95-82) during the period 1969-2009. Male firearm suicide increased by 166% (95% CI 135-201) from 1969 to 1988,
and decreased by 62% (95% CI 67-56) from 1988 to 2009. Despite of the great reduction in male accidental firearm
mortality, this study was unable to demonstrate any effect of the 1986 introduction of mandatory training of hunters with a
focus on safety, and the three other laws, on accidental deaths. However, on male firearm suicides the data suggested
that the 1990 regulation, requiring a police permit before acquiring a shotgun, had a beneficial impact on suicide in the
total sample and in those aged 15-34 years. Regarding male firearm homicides, the statistical model showed that male
homicide firearm rates decreased significantly post the 2003 regulation regarding storing home guard weapons in private
homes.
Discussion: European studies of the impact of firearm legislations are still rare. This study with data from Norway
suggested that two laws contributed to reduce male firearm mortality. It was, however, a challenge to measure the role of
the four firearm restrictions. The null findings were inconclusive, as they may reflect no true impact or study limitations.
Reduction of Suicides after Implementation of Visibility Measures on 30 Railway Locations in The
Netherlands
Bart Bouwe Hoogcarspel1, Paul Banens2, Roland J Blaauw3
ProRail, The Netherlands; 2retired from CQM, The Netherlands; 3Transparant IMC, The Netherlands;
bart.hoogcarspel@prorail.nl
Objective:
1
In 2005 a pilot project was started to reduce suicides on the railways in the Netherlands. The project consisted of 30
locations (train stations and level crossings) where multiple suicides took place in the past. In 2006 and 2007 a
combination of measures was taken: removing hiding places (through fencing or removing of vegetation), increasing
visibility (better lighting), detection (installation of cameras) and communication with the local authorities.
Materials:
A database containing over 6000 railway suicides in the Netherlands over the period 1980-2010, with information on date,
time of day and location of every incident.
Method:
For the 30 locations all relevant suicides were selected over the period 1997-2010. As a next step, the number of suicides
per year was analyzed by the CUSUM-method to detect possible significant changes in the number of suicides over time.
Results:
A significant reduction of 40% in the number of suicides was found after the measures were taken.
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Conclusions:
The use of level crossings and train stations for committing suicide can be reduced significantly by removing hiding
places, increasing visibility an installation of cameras.
What Neighbourhood Factors Are Associated with Railway Suicide in Victoria, Australia?
Lay San Too1, Matthew J. Spittal2, Lyndal Bugeja1, Allison Milner3, Mark Stevenson1, Roderick McClure4
1
Monash Injury Research Institute, Monash University; 2Centre for Mental Health, Melbourne School of Population and
Global Health, The University of Melbourne; 3McCaughey VicHealth Centre for Community Wellbeing, Melbourne School
of Population and Global Health, The University of Melbourne; 4Harvard Injury Control Research Center, Harvard School
of Public Health, Boston; tiffany.too@monash.edu
Background: There is a paucity of research on the relationship between neighbourhood factors and railway suicide. This
study investigates the associations between railway suicide and social, economic, and physical determinants in a
neighbourhood area using postcode-level data.
Methods: Railway suicide cases from Victoria, Australia for the period of 2001-2012, their age, sex, usual residential
postcode and year of death were obtained from the National Coronial Information System. Univariate negative binomial
regression models were used to estimate the association between railway suicide and area-level social, economic and
physical factors. Variables which were significant in these univariate models were then assessed in a multivariate model,
controlling for age and sex of the deceased.
Results: Younger males aged 14-34 years had the highest risk of railway suicide and their risk was threefold compared
with females in the same age group (incidence rate ratio (IRR) = 3.45, 95% confidence interval (CI) = 2.43–4.90).
Multivariate model shows that an elevated rate of railway suicide was weakly associated with area-level exposure of
higher social fragmentation (IRR = 1.05 95% CI = 1.00–1.11). Significant area-level risk predictors included the number of
railway stations (IRR = 1.33, 95% CI = 1.18–1.49), volume of station patronage (IRR = 1.05, 95% CI = 1.01–1.10), and
train frequency (IRR = 1.02, 95% CI = 1.01–1.04). An increased number of video surveillance systems at stations was
significantly associated with a modest reduction in railway suicide risk (IRR = 0.93, 95% CI = 0.88–0.98).
Conclusions: To prevent railway suicide, interventions should target areas of high station density, patronage volume and
train frequency.
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OP18-4M: Workshop: Suicide Prevention among Older Adults: Enhancing
Risk Assessment and Care Provision Incorporating Older Adult Suicide
Prevention Knowledge Translation
Suicide Prevention among Older Adults: Enhancing Risk Assessment and Care Provision
Incorporating Older Adult Suicide Prevention Knowledge Translation
Marnin J. Heisel
The University of Western Ontario; Lawson Health Research Institute; University of Rochester Center for the Study and
Prevention of Suicide; Marnin.Heisel@lhsc.on.ca
Older adults are at elevated risk for suicide in Canada and worldwide. Older adults often use violent means of selfdestruction and are more likely than younger adults to die from their injuries. At-risk older adults often access healthcare
services in weeks to months prior to death by suicide, creating an opportunity for risk detection and timely intervention.
Clinicians and social service providers typically receive little formal training in working with suicidal older adults. There are
relative fewer assessment tools and clinical interventions that have been developed and/or tested with at-risk older adults
as compared with other at-risk populations. Continuing professional education and knowledge translation efforts are
needed to help enhance the care of at-risk individuals.
The issue of suicide and its prevention among older adults is rapidly gaining prominence among healthcare providers,
researchers, policy analysts, and advocates, coincident with the tremendous growth in the North American older adult
population and high rates of suicide in later life. Responding to a need for older adult specific recommendations and tools
for enhancing healthcare and social support for at-risk older adults, the Canadian Coalition for Seniors' Mental Health
(CCSMH) has developed and broadly disseminated a late-life suicide prevention knowledge translation toolkit for frontline
providers. This toolkit consists of a guideline for the assessment of suicide risk and prevention of suicide, a clinician
pocket-sized quick reference card, a training DVD, a powerpoint presentation, a facilitator’s guide, and a guide for family
members of at-risk older adults.
This interactive training workshop will focus on enhancing participant knowledge and understanding of the epidemiology
of suicide among older adults, associated risk and resiliency factors, and assessment tools and approaches to risk
detection, intervention and outreach, employing the CCSMH toolkit and using presentation, group discussion, and casebased didactic methods. Findings will be presented from a Federally-funded knowledge translation study, evaluating halfday training workshops on older adult suicide risk assessment and intervention for healthcare and social service
providers. Discussion will focus on incorporating these, and other tools, into the sensitive care of at-risk older adults into
community and clinical settings.
Workshop Learning Objectives:
By the end of this workshop, participants will be able to demonstrate:
1) familiarity with the epidemiology and risk and resiliency factors associated with suicide among older adults;
2) awareness of the available empirical evidence for suicide risk assessment and interventions with at-risk older adults;
3) understanding of knowledge translation tools designed to enhance detection of suicide risk and interventions for older
adults at-risk for suicide;
4) an enhanced understanding of methods for working sensitively and effectively with at-risk older adults
This workshop is intended for researchers, health professionals and frontline providers, community members, family
members of older adults at-risk for suicide, and survivors.
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OP18-4N: Understanding and Helping Suicide Attempters I
Spirituality as Part of the Growing Flower Model of Reintegration after Suicide – A Qualitative Study
Vita Postuvan1, Onja Grad2
University of Primorska; University Psychiatric Hospital Ljubljana; vita.postuvan@gmail.com, onja.grad@psih-klinika.si
Suicide represents one of major public-health problems in Slovenia. Survivors of suicide loss experience the biggest
burden of each death that happens. In the wide spectrum of the consequences research rarely focusses on spirituality.
1
2
According to the grounded theory (a qualitative research method) we analyzed sixteen semi-structured in-depth interviews
with suicide survivors, who differed in the demographic data, their relationship with the deceased, time since death and
coping with the experience. We merged the 2631 quotations, 263 direct codes and 30 supercodes in 15 main concepts.
We developed a common model to explain them called Growing flower model (GFM).
One of the eight important concepts in the GFM is the spirituality. It is implemented on four levels: on level of the
bereaved person, family level, level of society and level of systems of services. Some suicide survivors see spirituality as
beneficial in their reintegration process. Others perceive it as connected to religion and as a part of traditional values,
which is often connected to clichés and unhelpful behaviors. Each of the levels involved play important role in whether
spirituality will serve a role as protective or risk factor in the process of reintegration of suicide survivors.
The Experiences of People Who Attempt Suicide: What Helps or Hinders Recovery?
Sarah Kate Coker1, Myfanwy Maple2, Katherine McKay2, Samara Gray1
SANE Australia, Australia; 2University of New England, Australia; sarah.coker@sane.org
The aim of this research was to examine the experiences of people who have attempted suicide to explore what helped or
hindered them at the time of the suicide attempt and since. It is hoped that this information can be used to inform suicide
prevention and intervention programs and give voice to an often disenfranchised group of people – those with lived
experience of suicide.
1
The researchers undertook a qualitative methodology, carrying out 31 semi-structured interviews over the telephone with
people from around Australia (6 men, 25 women). Participants were over 18 years old (range 19 -72 years) and their most
recent suicide attempt was more than six months ago (range 6 months - 40 years). Participants were recruited through
UNE and SANE Australia’s online and media channels.
Preliminary results indicate numerous themes that impact on a person’s motivation for attempting suicide. These included;
relationship breakdown, family dysfunction, disconnectedness, the experience of untreated mental illness, and the
challenge of finding suitable treatment and support. Many people spoke about the difficulty in communicating their feelings
of suicide to people around them either because of their state of mind at the time causing them to feel “unreachable”, or
because of stigmatising attitudes.
Being hospitalised was often mentioned as a negative experience, and a common hindrance to recovery was
disrespectful or uncaring comments experienced from professionals, families and friends. A strong supportive relationship
with a friend, family member or a trusted professional were crucial to getting through the attempt and to their subsequent
recovery, as was accurate diagnosis and treatment for mental illness.
There has been little exploration of the personal experience of those who attempt suicide in Australia to date, creating a
large gap in the current literature. These individuals are in a unique position to inform and influence the development of
interventions programs that can assist recovery after suicide attempts.
In the 2005-2007 timeframe over 97% of studies published in reputable suicidological journals were quantitative studies.
Hjelmeland and Knizek (2010) propose that this is driven by a fundamental emphasis on explaining suicidality and
highlighting correlations and causes. They suggest that more qualitative research is needed that aims to understand
suicide from an individual perspective. The current research aim to address this gap within Australian literature.
Hjelmeland, H., & Knizek, B. L. (2010). Why we need qualitative research in suicidology. Suicide & Life-Threatening
Behaviour, 40, 74-80.
Eviction as a Risk Factor for Non-Lethal and Lethal Suicide Attempts – a Follow Up Study of Almost
100 000 Swedish Households
Yerko Rojas, Sten-Åke Stenberg
Stockholm University, Sweden; yerko.rojas@sofi.su.se, Sten-Ake.Stenberg@sofi.su.se
The West has gone through a severe economic crisis, of which we still have not seen the end, with a strong connection to
the housing market. Hundreds of thousands have lost their homes and suicide is in an unprecedented way being directly
connected with foreclosures and evictions (cf. Fowler, Gladden, Vagi, Barnes, & Frazier, 2014; Serby, Brody, Amin, &
Yanowitch, 2006). However, given that home evictions has been neglected within suicidology, and is only recently being
acknowledged as a new mode of economic strain that may have suicidogenic effects, we know exceptionally little about
this relation (Stack & Wasserman, 2007).
This study will be based on a unique data that has been made available for us by the Swedish Enforcement Authority.
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Containing all applications for debt collection proceedings and assistance in connection with rent arrears and anti-social
behavior during the period 2008-2012, it allow us to explore the extent to which lethal and non-lethal suicide attempts can
be related to the sequence of events leading to an eviction notice, the actual course of events from the notification to the
execution of the eviction and the short and long term consequences of having being evicted. In all, almost 100 000
households are included in the data material. This information makes it possible, for the first time ever, to follow up
households with housing problems across time and for the whole country. Quantitative analysis will be made against a
control group consisting of a 10 percent sample of the Swedish population aged 16+ for the same year and with the same
background information as in the Enforcement Authority’s register.
References
Fowler, K. A., Gladden, R. M., Vagi, K. J., Barnes, J., & Frazier, L. (2014). Increase in Suicides Associated With Home
Eviction and Foreclosure During the US Housing Crisis: Findings From 16 National Violent Death Reporting System
States, 2005–2010. American Journal of Public Health, Published online ahead of print July 17, 2014: e1–e6.
doi:10.2105/AJPH.2014.301945
Serby, M. J., Brody, D., Amin, S., & Yanowitch, P. (2006). Eviction as a risk factor for suicide. Psychiatric services, 57(2),
273-b-274.
Stack, S., & Wasserman, I. (2007). Economic strain and suicide risk: a qualitative analysis. Suicide and Life-Threatening
Behavior, 37(1), 103-112.
Life after Suicide: Practitioners Speak about Their Experiences of Working with Suicidal Clients and
the Impact It Has on Them If Their Client Dies
Susan Scupham
Talking Therapies, United Kingdom; susan@scupham.net
The subjects of suicide and attempted suicide continue to receive attention through the media and government
interventions to reduce the rate of deaths by suicide. Those in the fields of psychotherapy and mental health have
responded to this challenge by producing articles, guidelines and procedures on the subject. However, what do
practitioners working with suicidal clients require to support them in their work with this client group?
The purpose of this research was to explore the question ‘working with suicidal clients: what are the effects on the
practitioner’? The study used a mixed method approach to examine practitioners’ experiences. The first phase of the
research was a quantitative survey in which practitioners’ (n=110) provided information on their experiences of working
with suicidal clients. The second phase of the study was qualitative and explored via interviews the effects of client suicide
on practitioners (n=15). A narrative thematic analysis approach was used to analyse the interview transcripts.
The findings identified that practitioners experienced strong feelings in response to the death of their clients including
sadness, shock, fear, anger, guilt and shame. Thoughts such as failure, self-blame, disillusionment, a collapse of
confidence and concerns for the clients’ family were prominent. Practitioners identified changes in their behaviour such as
noticing they were more cautious or avoidant about working with suicidal clients and being more careful in note taking.
Practitioners reported the impact of the manner in which they had been informed about the death of their client. Some
practitioners had been taken aside and spoken to in a sensitive and caring way, while others had been left a note on their
desk or found out in a team meeting. Those who thought the way they were informed was insensitive experienced
frustration, anger and a lack of support from their organisations.
While some practitioners felt let down by their organisations the majority felt adequately supported by their clinical
supervisors and colleagues they worked alongside.
Practitioners struggled to recall significant preparation in their core training to prepare them to work with suicidal clients.
Recommendations with regard to training would include that trainees may benefit from having discussions around
personal beliefs, a need for openness about their fears of working with suicidal clients, vigilance in relation to transference
and countertransference responses and demystifying the process of investigation into serious incidents such as suicide
within organisations.
Research indicates the death of a client is the greatest fear that practitioners experience. Yet it is a hazard of the job and
has to be survived in order to provide robust clinical care and support for other clients who may be struggling. Within the
context of organisations, guidelines for managers should be made available to support their practitioners following client
suicide.
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SP19: Plenary Session 3 [séance plénière 3]
1) The Durkheim Project: Opt-In Big Data for Risk Reduction / [Le projet Durkheim : Engager les méga-données pour la
réduction du risque], Chris Poulin; 2) Madness, Taedium Vitae or What? The Paradox of Suicide at the Sunset of Life /
[Folie, taedium vitae ou autre? Le paradoxe du suicide au crépuscule de la vie], Diego De Leo; 3) Economic Recession,
Unemployment and Suicide: Ecological Studies May Not Reflect True Associations from Individual Level Studies /
[Récession, chômage et suicide : les études écologiques ne reflètent peut-être pas les véritables associations rapportées
par les études des individus], Ad Kerkhof.
The Durkheim Project: Opt-In Big Data for Risk Reduction / [Le projet Durkheim : Engager les mégadonnées pour la réduction du risque]
Chris Poulin
The Durkheim Project, United States of America; chris@durkheimproject.org
The Durkheim Project was a successful DARPA sponsored research program that recently established both validated risk
metrics for suicidality, and a capability to scale this risk detection technology to larger opt-in social and mobile networks.
These various indicators are then fed into a real-time predictive analytics environment that enables both accurate and
timely interventions by clinicians via a secure communications network. Our original research road-map included three
phases: During the first phase, a US Veterans Affairs (VA) predictive risk medical records study was completed, based on
an analysis of the narrative text portions of medical records. During the second phase, still underway, opt-in social media
postings are collected and analyzed. During the third phase, a pilot program will isolate serious suicide risk for individuals
in real-time, and implement a prediction triage model for improved suicide intervention. For this session, we will update
the research community on the project status.
Madness, Taedium Vitae or What? The Paradox of Suicide at the Sunset of Life / [Folie, taedium
vitae ou autre? Le paradoxe du suicide au crépuscule de la vie]
Diego DeLeo
Griffith University, Australia; d.deleo@griffith.edu.au
Although data are often under-reported in their suicide figures, and despite the recent declines recorded in many
countries, suicide rates among the elderly continue to remain the highest in the world. In this particular age range, there
are some peculiarities (for example, risk and protective factors specific for age and gender differences), which must be
considered in the prevention and treatment of suicidality in this age group. This presentation provides an overview of
existing practices, examining the specific impact of the most common conditions that may be present in late-life, such as
loss of role, retirement, change of home, but also depression, physical illness, transfer to a nursing home, the fear of
physical suffering and death. Several types of prevention methods have been proposed for the elderly; however, very few
programs have been evaluated in the context of controlled trials. In addition, their results cannot be generalized
worldwide. This calls for further research and evidence-based investigations across different cultures, in order to establish
a convincing level of effectiveness of preventive interventions for older people at risk of suicide. This presentation also
illustrates the possibility of prevention and intervention offered by telemedicine and online assistance.
Economic Recession, Unemployment and Suicide: Ecological Studies May Not Reflect True
Associations from Individual Level Studies / [Récession, chômage et suicide : les études
écologiques ne reflètent peut-être pas les véritables associations rapportées par les études des
individus]
Ad Kerkhof, Renske Gilissen, Albert van Hemert, Jan Hoogenboezem, Kim de Bruijn
VU University Amsterdam, Netherlands, The; ajfm.kerkhof@gmail.com
Rising suicide rates and increases in unemployment have been related in a number of studies with ecological designs.
These studies suggest excess suicide mortality due to economic recession and in particular due to increasing
unemployment. However, not all studies found significant associations in all countries, and some even found weak or
absent associations or significant delays in associations over aggregated regions in the world. The amplitude and the
sensitivity to the crisis effect vary across countries. This provides caution against causal interpretation. Ecological studies
have to be followed by individual level analyses in order to demonstrate causality. The ecological fallacy cannot be ruled
out in ecological studies. In The Netherlands we conducted a direct individual level analysis of suicide trends in the
working-age population, in order to investigate whether increasing suicide rates can be explained by increasing
unemployment or other type of benefit. Results: although a significant correlation between increase in unemployment and
rising suicide rates at the ecological level is seemingly obvious, at the individual level analysis no direct association
between increasing unemployment and rising suicide rates can be determined whatsoever. On the contrary, the rise in
suicide rates in individual level analysis is marked in persons who are (still) employed, and particularly among those on
incapacity benefit. Suggesting that the most vulnerable are hit the hardest by economic recession, but not through the
mechanism of increasing unemployment. This changes the interpretation of ecological studies comparing suicide mortality
internationally.
190
Poster Session C: June 19 / 19 juin - Poster Session [séance par affiche]
Mexican Migration and Suicidal Ideation: What's the Connection?
Steven Hoffman
University of Texas at San Antonio, United States of America; steven.hoffman@utsa.edu
While many nations grapple with the challenges of high suicide mortality, Mexico has experienced a comparatively low
suicide rate of 3.72/100,000. While international comparisons of suicide rates may lead to the belief that suicide in Mexico
is not a pressing problem, a closer investigation into the country’s historical suicide rates shows a concerning trend.
Between 1970 and 1994 the suicide rate in Mexico rose from 1.13/100,000 to 2.89/100,000. Furthermore, in 1994, the
rate increased an unprecedented 156%, and from 1970 to 2007 it has increased 275%. When compared to 28 other
countries between 1990 and 2000, Mexico’s suicide rate increase was one of the highest. Of particular concern were
Mexican adolescent suicide trends between 1990 and 2001, during which time the suicide rate for youth ages 11-19
increased from 0.8/100,000 - 2.27/100,000 among girls, and 2.6/100,000 - 4.5/100,000 among boys. Among the various
states in Mexico, Guanajuato has struggled perhaps more than any other to control their rapidly increasing suicide rates.
Over the past 100 years the state of Guanajuato has consistently been one of the highest migrant-sending states in
Mexico. Youth living in high migratory states such as Guanajuato are heavily influenced by the expectation that they will
travel to the US, and research has shown that those who do not migrate may be looked down upon by members of their
community.
This presentation will focus on a secondary analysis looking at the connection between suicidal ideation and migration
aspirations among a group of adolescents living in Guanajuato, Mexico. Data were originally collected in 2007 as part of a
comprehensive health survey of youth attending an alternative high schooling program. Regression analyses show that
suicidal ideation predicts intentions to migrate among both males and females, while other factors differentially influence
the adolescents by gender. The findings from this study have potential implications for social workers, public health
professionals, policy makers, and researchers, and will be discussed in light of the cultural norms and expectations in both
the US and Mexico.
Psychological and Social Risk Factors for Suicidal Ideation and Attempts among Men Who Inject
Opioids in Delhi, India
Gregory Damon Armstrong1, Anthony F Jorm2, Luke Samons3, Michelle Kermode1
Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne,
Australia; 2Population Mental Health Group, Melbourne School of Population and Global Health, University of Melbourne,
Australia; 3The Society for Service to Urban Poverty (SHARAN), Delhi, India; g.armstrong@unimelb.edu.au
Background: Suicide is a major public health challenge in India, and the relative contributions of psychopathology and
social stressors as suicide risk factors are contested in this cultural setting. The psychological and social correlates of
suicidal ideation and attempts among people who inject drugs (PWID) in India, a high-risk group for suicide, have not
been explored. This paper reports on a cross-sectional survey of adult males who inject opioids in Delhi.
1
Methodology: Participants (n = 420) were recruited from needle and syringe programs using time location sampling (TLS)
and were interviewed using an interviewer-administered questionnaire. Self-report symptom scales were used to measure
the severity of recent symptoms of depression (PHQ-9) and anxiety (GAD-2). We assessed the presence of suicidal
thoughts and attempts within the past 12 months. An ‘ideation to action’ framework was adopted for the analyses so as to
identify those risk factors associated with suicidal ideation and those that are associated with suicide attempts among
ideators. Group discussions with PWID and local community workers were held to validate the survey findings and to offer
stakeholders a chance to interpret the findings.
Results: Suicidal ideation and attempts during the preceding 12 months were common. Fifty-three percent thought about
killing themselves and a substantial proportion had attempted to kill themselves (36 %); almost two-thirds (65 %) of
participants experiencing suicidal ideation had attempted suicide. Recent depressive and anxiety symptoms were
associated with suicidal ideation, as were a range of social stressors including poor physical health, length of injecting
drug use, housing insecurity, and experiences of violence and sexual abuse. However, depressive and anxiety symptoms
were not associated with suicide attempts. Factors associated with suicide attempts among ideators were housing
insecurity and relational dynamics including a poor relationship with family and, interestingly, being married.
Conclusions: Poor mental health was associated with suicidal ideation and could be contributing to an increased
vulnerability and poorer coping capacity in relation to stress and adverse life events. However, it is primarily relational
factors (poor family relationships and being married) that were providing the stimulus behind suicide attempts. When
understood in the Indian context, it is likely that poor family and marital relationships and the ensuing role strain/failure
and shame experienced by many of those dependent on illicit opioids play a causal role in relation to suicide attempts
among PWID in Delhi. Suicide prevention interventions among this population should address not only individual mental
health and addiction support needs but also the overwhelmingly poor psychosocial circumstances of this group, most
predominantly disrupted family and marital relationships.
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Association of Suicide Rates with Temperature in Two Cities
P. Grady Dixon1, Mark Sinyor2, Ayal Schaffer2, Anthony Levitt2, Christa R. Haney3, Kelsey N. Ellis4, Scott C.
Sheridan5
1
Fort Hays State University; 2University of Toronto / Sunnybrook Health Sciences Centre, Canada; 3Mississippi State
University; 4University of Tennessee; 5Kent State University; mark.sinyor@sunnybrook.ca
Background: Many studies have shown that higher temperatures (mean, maximum and minimum) on or around a specific
date are associated with increased suicide deaths although others have failed to find this pattern. These conflicting results
are likely in part due to their use of different and sometimes suboptimal methodologies. Suicide is obviously a complex
behavioral endpoint, and a simple cause-and-effect model with weather is implausible, but relationships with weather
could yield important insight into the biological mechanisms involved in suicide deaths. This study, a joint effort between
psychiatry and climatology departments, is designed to test for a relationship between air temperature and suicide rates
consistent enough to offer some predictive abilities.
Methods: “High-end” and “low-end” suicide weeks* and temperature anomalies** were examined for two cities - Toronto,
Ontario (1985–2009) and Jackson, Mississippi (1980–2006) to identify possible relationships between temperature and
suicide death. The Distributed Lag Nonlinear Model (DLNM) was then used to further characterize these relationships.
Results: Classifying weeks as anomalously “cool,” “normal,” or anomalously “warm,” there were no warm weeks with
small numbers of suicide deaths while nearly 10% of warm weeks were associated with peaks in suicide deaths. A similar
pattern in the opposite direction was seen for cold weeks. In general, for both Toronto and Jackson, suicide risk was lower
at below-average temperatures and higher at above-average temperatures although that trend reverses for the warmest
(i.e., the top 1%) weeks in which no peaks in suicide deaths were observed. Weekly suicide totals demonstrate a
sufficient association with temperature anomalies to allow some prediction of weeks with or without increased suicide
rates.
Conclusion: This study demonstrates a more nuanced understanding of the relationship between temperature and suicide
death. In general, suicide is increased with above-average temperature. The fact that a consistent relationship between
temperature and suicide results was found for two cities, Toronto and Jackson, with very different climates lends weight to
the results. While these findings alone are unlikely to have immediate clinical implications, they allow us a better and more
definitive understanding of how the weather can impact suicide.
*Weeks with large and small numbers of suicide deaths according to the 5th and 95th percentiles.
**Temperature deviations +/-5ºC from the norm.
Suicide in Kabuki Plays
Karolina Krysinska
Black Dog Institute, Australia; k.krysinska@unsw.edu.au
Kabuki plays are highly conventionalized and its scenes, including those depicting murder and suicide (two very popular
themes), follow established forms and patterns of action. Although often brutal and violent, the scenes of suicide and
murder are highly stylized, and are a part of the visual art of Kabuki performance, referred to as the “aesthetics of cruelty”.
Self-inflicted death is a crucial dramatic device in the Kabuki theatre, and although seppuku (ritual disembowelment), and
shinju (double suicide) are the two most frequent types of suicide, Kabuki characters take their lives in many other
circumstances and using a variety of methods. Some of the Kabuki plays were written specifically for the Kabuki theatre,
while others have been adopted from the Nō theatre or the doll theatre.
Reflecting the real-life complexity of seppuku, which was allowed only to the samurai and their superiors, and which exact
method depended on the rank of the samurai and the nature of his offence, there are many ways of performing seppuku
on stage. Some scenes of seppuku are accompanied by “wounded memories” acting technique, which is a variation of
“reminiscences”, in which a dying character delivers a long speech in which he repents for the (seemingly) villainous
deeds perpetrated in his life. The plots of plays involving double suicide are based upon a conflict between obligations
and personal feelings, involving a couple, usually a middle-class merchant and a prostitute, whose love can never
succeed. The suicide scene is often “grotesquely beautiful”, and the actors play both sadness and hope for a better future
after death. The scene of the suicide self is generally preceded by a “traveling on the way” dance-mime: the lovers sadly
walk together, while grieving for their misfortunes or recalling the past, and after arriving on the stage they dance and
strike melancholy postures.
The government became concerned about the suicides supposedly triggered by the Kabuki shinju plays and banned their
performance in 1723. Funerals for those who died in suicide pacts were prohibited, the bodies were left in public view at
Nihonbashi Bridge for 3 days and, if one of the lovers survived, he or she was tried for murder. Despite these measures,
within a few years the plays were written and performed again, and have remained a favourite theme of Kabuki and doll
theatre repertoire. Lovers’ suicides have remained a relatively popular phenomenon in Japan across the centuries, and
may be related to the recent spike in Internet-based suicide pacts in Japan.
Brandon, J. R., & Leiter, S. L. (Eds.) (2002). Kabuki plays on stage (Vol. 1-4). Honolulu: University of Hawaii Press.
Krysinska, K., & Lester, D. (2006). Comment on the Werther effect. Crisis, 27(2), 100.
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Leiter, S. L. (1969). The depiction of violence on the Kabuki stage. Educational Theatre Journal, 21(2), 147-155.
Suicide and Prevention – the Most Popular Publications and Most Sought Out Information
Trine Banke d'Andrade
Centre for Suicide Research, Denmark, Denmark; tbk@cfsmail.dk
Introduction
Since 2011, the Centre for Suicide Research has invited users of our website to participate in a questionnaire survey that
provides us with background information about our users. Participation is voluntary. Also, website statistics provide
information on each subpage and each publication.
Objective
The objective is to analyse the users of the website in relation to the most sought out information and the most popular
publications in order to determine if we meet their demands.
Methods
Electronic pop-up questionnaire and website statistics.
Results
Results from the questionnaire survey show that most do not state their profession. Students and the educational sector
are strongly represented followed by the various professions within the social and health sectors. In the category ‘Others’,
there are many unemployed, disability pensioners, pupils of the primary and lower secondary levels, and those affected
by suicidal behaviour.
The Centre for Suicide Research keeps two public Registers for Suicide and Suicide Attempts, and a unique Pool of
Statistics, that allow users to generate data on attempted and completed suicides. The Pool of Statistics is the most
visited page; other popular pages are Help and Support, Prevention, and Publications.
The Centre publishes at three levels aimed at the general population, professionals and decision makers. The most
popular publications aimed at professionals deal with adolescents. Recently, publications for the general population that
deal with Unemployment, Being bereaved after suicide, and Euthanasia, have been in great demand.
Conclusion
The Centre meets the most pressing demands, as we continuously conduct the project SAYLE - Adolescents’ selfharming behaviour, and extend the Register for Suicide Attempts. Future projects could focus on vulnerable groups, or
those affected by suicide or self-harming behaviour.
Furthermore, we are in the process of updating our website, and short-cuts to the most popular pages will be placed
prominently.
Risk of Suicide and Attempted Suicide and Use of Non-psychotropic Medication: A Systematic
Review
Hayley Christine Gorton1,2, Roger T Webb3, Navneet Kapur3, Darren M Ashcroft1,2
Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, The University of Manchester;
2
NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, The University of Manchester;
3
Centre for Suicide Prevention, Centre for Mental Health and Risk, Institute of Brain, Behaviour and Mental Health, The
University of Manchester; hayley.gorton@postgrad.manchester.ac.uk
Background and Aims
1
A growing literature documents the elevated risk of suicide and suicidal behaviour in individuals with physical illnesses.
Medicines used to treat these illnesses may contribute to this elevated risk, but this is difficult to discern due to the
confounding effect of co-morbid mental illness. Some observational epidemiological studies have considered the risk of
suicide and attempted suicide associated with non-psychotropic medications, but no systematic review has to date been
published. Our systematic review therefore aimed to (i) identify which non-psychotropic medications have been examined
in observational studies, in relation to suicide and attempted suicide; (ii) document the associations which have been
observed; and (iii) consider strengths and limitations of included studies.
Method
Embase, Medline, PsycINFO and International Pharmaceutical Abstracts were searched from 1990 to June 2014 for
articles with ‘suicide’ or ‘suicidal’ in the title or abstract, with combinations of medication-related terms. Articles were
assessed against inclusion criteria and observational studies which pertained to any non-psychotropic medication were
193
eligible, if outcomes of suicide or attempted suicide were reported. Key results were collated and studies critiqued.
Results
A total of eighteen studies satisfied our inclusion criteria. Five studies each considered cardiovascular medication and
antiepileptics; two studies each explored medication for asthma, acne and glucocorticoids and one examined antibiotics.
Another study compared various medications used by people who died by suicide versus living control subjects. There
was marked heterogeneity between study designs, outcome classification, choice of comparison group and control for
confounding factors, most importantly co-morbid mental and physical illnesses. No increased risk was associated with
cardiovascular medications but the associations with other medications remained inconclusive. There was particular
inconsistency regarding the risk associated with antiepileptic medications, both as a class and individually. Furthermore, a
striking increase in risk of suicide and attempted suicide was associated with glucocorticoid use in one study, but no
increased risk of suicide was found in another.
Conclusion
Whether non-psychotropic medications contribute to increased risk of suicide or attempted suicide remains unknown.
Robust observational studies are therefore imperative to accurately and precisely quantify suicide risk and subsequently
inform risk management. Any independent risk associated with non-psychotropic medication use must be recognised
beyond that conferred by the illness itself, and any co-morbid mental illness.
Religion, Spirituality, Faith, and Philosophy of Life – a Protective or Straining Factor for Soldiers?
Lilian Zoellner
Centre for Suicide Research, Denmark; lz@cfsmail.dk
Introduction and aims
Increasingly, the fields of suicide research and medical science have taken an interest in studying how subjects and
themes from religious studies can contribute to the understanding of suicidal behaviour.
This presentation will examine how religion, spirituality, faith, and philosophy of life have been applied to health research
and how religious studies can be applied.
Religious studies is an extremely complex science which through interdisciplinary collaboration provides us with
completely new possibilities to examine risk and protective factors for suicidal ideation, attempted and completed suicides.
Across cultures, political systems, borders, and languages we can incorporate religious studies into suicide research to
the benefit of both patients and research.
The aim is to examine if soldiers have a faith or philosophy of life that protects or strains them in relation to suicidal
ideation or suicidal behaviour.
Method
Interviews with 100 soldiers. The interviews were conducted at the soldier’s own home, at the Centre for Suicide
Research, or somewhere where the interviewee felt secure and free to open up. Each interview is recorded and
subsequently transcribed and analysed. Each soldier has been promised anonymity.
Participants
100 Danish soldiers who have been deployed once or more times to Balkan, Iraq or Afghanistan from 1990-2013. Some
have experienced suicidal ideation and attempted suicide prior to deployment.
Results
Rituals and social fellowship during deployment is protective for suicidal ideation and suicidal behaviour. While deployed,
the soldiers participate in the rituals and the social fellowship that arises when a chaplain also is deployed. The soldiers
can confide in chaplains, who are under duty of secrecy and who are not part of the military. Soldiers participate in
prayers and unite in the fellowship that arises from camp services or ceremonies in relations to death while deployed.
Ethics may be a risk for suicidal ideation and suicidal behaviour during and after deployment, as soldiers have difficulties
in accepting that they stood by and witnessed rape or civilian killings. They may feel guilt and shame of obeying an order
not to take action while witnessing atrocities against civilians, adults, and children.
Conclusion
Depending on circumstances, religious themes may have a protective or straining effect. To the soldiers, their philosophy
of life, religion, or faith in combination with their cultural background may have a protective effect for suicidal ideation and
attempted suicide prior to and during deployment, while ethics may have a straining effect during and after deployment.
The soldiers may feel guilt and shame. Furthermore, they may feel that their beliefs are not in keeping with their actions
during deployment.
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A Longitudinal Examination of Rural Status and Suicide Risk Based on the RAI-Home Care (RAI-HC)
Eva Louise Neufeld1, John P Hirdes2, Christopher M Perlman2, Terry Rabinowitz3
Laurentian University, Canada; 2University of Waterloo, Canada; 3University of Vermont Medical Center, USA;
eneufeld@laurentian.ca
There is limited research on suicide risk in Canadian home care. Older adults have the highest rates of death by suicide
worldwide. Home care providers are well situated to assess and respond to potential risk of suicide among frail elders.
This poster presents characteristics of rural and urban home care recipients with a hospital or emergency department visit
for suicide attempts in Ontario, Canada. Key factors that increase or decrease risk for emergent care are highlighted.
1
National Cohort Study of Absolute Risk and Age-Specific Incidence of Suicide, Attempted Suicide
and Related Outcomes in Younger Age Males and Females
Pearl L.H. Mok1, Sussie Antonsen2, Carsten Bøcker Pedersen2,3, Louis Appleby1, Jenny Shaw1, Roger T. Webb1
1
Centre for Mental Health and Risk, University of Manchester, United Kingdom; 2Centre for Integrated Register-based
Research, CIRRAU, Aarhus University, Denmark; 3National Centre for Register-Based Research, Aarhus University,
Denmark; pearl.mok@manchester.ac.uk
Background
Serious adverse outcomes, including suicidality, psychiatric illness, substance misuse, criminality, and premature death
affect some young people between adolescence and early middle age. These outcomes are strongly correlated, and yet
published studies of multiple adverse events in the same cohort of risk are uncommon in the literature.
Objectives
We estimated sex- and age-specific incidence rates and absolute risks of suicide, suicide attempt, and other correlated
adverse outcomes between mid-adolescence and mid-adulthood in a national cohort, under the following three main
outcome categories: 1. Premature mortality (suicide, accident, all causes); 2. Psychiatric morbidity (suicide attempt,
alcohol or drug misuse disorder, any mental illness); 3. Criminality (violent offending, receiving a custodial sentence,
convicted of driving under the influence of alcohol or drugs).
Method
Using interlinked registers, all persons born in Denmark between 1966 and 1996 who were living in the country on their
15th birthday were followed until their 40th birthday or 31 December 2011. Overall, 2,070,904 persons were followed for
28.9 million person years. We estimated sex- and age-specific incidence rates and cumulative incidences of the first
occurrence of each outcome of interest. Age-specific cumulative incidences were calculated for each sex and adverse
outcome separately using competing risk survival analyses.
Results
Amongst the study cohort, 3.83% of females (95% CI 3.79% - 3.88%) and 3.33% of males (3.29% - 3.38%) had a suicide
attempt by their 40th birthday, while 0.08% (0.07% - 0.09%) and 0.32% (0.30% - 0.33%) of females and males,
respectively, died by suicide. Deaths by suicide were more common than from accidents. For both sexes, incidence rates
for suicides and accidental deaths doubled between ages 15-19 and 20-24 years, with the rates of increase falling
thereafter. For all three mortality outcomes, males had higher incidence rates than females across all age groups. Women
aged under 25 were more likely than men to attempt suicide, but this pattern was reversed beyond age 25. Of the nine
outcomes examined, for both males and females, the highest absolute risks by 40th birthday were for secondary care
treated mental disorder, and that females were more likely than males to be treated at all ages. However, the risks of
substance misuse and having a criminality outcome were much higher for males, especially younger males, than for
females. Across all adverse outcomes examined, the greatest gender differentials in incidence rates were in relation to the
criminality outcomes.
Conclusions
For the nine adverse events examined, males and females showed significantly different incidence rates and, in some
cases, distinctive patterns of risk by age. These epidemiological profiles will inform future research into the causal
mechanisms of these correlated outcomes.
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Decrease in Suicide Rates in Quebec: A Brief Look at Four Strategies
Jérôme Gaudreault, Michael Sheehan
Association québécoise de prévention du suicide, Canada; lmsheehan@videotron.ca
The Province of Quebec has long been recognized for high suicide rates. In 1999, the worst year for suicides on record,
1620
people committed suicide with a rate of 26.5 deaths per 100,000 residents. Ten years later, in 2011, there were 1105
suicides, a
rate of 13.7 per 100,000. Progress was particularly noted in the first half of the 2000s, with the largest decline in rates
being in
among the youth. This encouraging decline suggests that suicide prevention efforts are in fact bearing fruit, although with
three deaths
a day by suicide, it would still be inappropriate to speak in terms of success. It is essential to understand the various
reasons of this
multifaceted issue in order to reinforce prevention and to develop effective measures. Indeed, the suicide prevention
stakeholders in
Quebec have put forward various hypotheses. They believe that the following measures have had an influence on the
drop in suicide
rates: telephone intervention, training in efficient intervention processes, networks of sentinels and social mobilization.
The
presentation will explain these four measures and will highlight the difficulties and the keys involved in their
implementation.
Effectiveness of the Manga Leaflet for Suicide Prevention in Undergraduates
Ami Yamamoto1, Emi Tsujimoto1, Reiko Taketani1, Mikoto Yano1, Yuka Ito1, Toru Miyoshi1, Haruna Waki2, Hisae
Ono1,2
1
Department of Psychological Science, Graduate School of Humanity, Kwansei Gakuin University, Hyogo, Japan;
2
Department of Psychological Science, School of Humanity, Kwansei Gakuin University, Hyogo, Japan;
a.ymmt346@kwansei.ac.jp
【Background and Objective】 Suicide in young people has been one of the most important public health problems in
Japan. The Manga leaflet, which contains of information about the Student Support and Counseling Office, may be
effective for undergraduates. We studied the effectiveness of the Manga leaflet for suicide prevention in undergraduates.
【Subjects and Methods】 This was a before-and-after study conducted from April to May in 2014. A self-report
questionnaire was used to evaluate the participants’ attitude toward stressful events. The outcome variable was the
pattern of difference in the distribution of the answers to the questionnaire before and after reading the Manga leaflet. A
chi-squared test was used for statistical analysis using the IBM SPSS Statistics 22. This study was approved by Kwansei
Gakuin University Regulations for Research with Human Participants.
【Results】 In total, 367 undergraduates participated in the study (male: 96, female: 271, mean age ± standard deviation:
19.0 ± 1.4 years). Out of these, 341 (91.9%) answered “No” for the question “Do you consult teachers or counselors in the
university when you have a serious problem?”, and 25 (6.7%) answered “Yes,” before reading the Manga leaflet. After
reading the Manga leaflet, the “No” responses reduced to 232 (62.5%), and “Yes” responses increased to 130 (35.0%).
Reading the Manga leaflet significantly decreased the frequency of “No” responses (Chi-square: 91.85, p < .001, r = 9.6).
Additionally, 320 (86.2%) answered “No” for the question “Do you consult teachers or counselors in the university when
your friends ask for your help with a serious problem?”, and 45 (12.1%) answered “Yes,” before reading the Manga leaflet.
After reading the Manga leaflet, the “No” responses reduced to 206 (55.5%), and “Yes” responses increased to 156
(42.1%). Reading the Manga leaflet significantly decreased the frequency of “No” responses (Chi-square: 86.00, p < .001,
r = 9.3). As for the acceptance of the Manga leaflet, 89.2% (33 out of the total 37 comments received) were favorable.
【Conclusion】 The Manga format leaflet might be effective for suicide prevention in young people. However, follow-up
studies are necessary.
【Acknowledgment】 This study was supported by the Hyogo Prefecture grant, “Wakamono no jisatsu yobo shien enjo
jigyo,” 2013.
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Delivering a Suicide Postvention Service in a Rural Area with High Levels of Social Exclusion
Anne Embury
Outlook South West LLP, United Kingdom; anneembury@outlooksw.co.uk
Suicide bereavement is a growing area of research and was highlighted as a priority in England's Suicide Prevetnion
Strategy, 2012. Cornwall & Isles of Scilly's Suicide Liaison Service was launched in 2010 and, to date is the only NHSfunded suicide postvention service delivered in England & Wales, and has been based on delivery of a similar NHS
service by the Western Health & Social Care NHS Trust in Northern Ireland.
Cornwall & Isles of Scilly has a permanent resident popularion of approximately 530,000 and has between 60 and 80
deaths by suicide a year which is higher than the overall average rate of suicide for England & Wales.
The Suicide Liaison Service is a relatively inexpensive service funded for one full time post which is divided between the
Service Lead; one other part-time counsellor, and utilises the services of another counsellor on a part-time occasional
basis to help co-facilitate 8-week psychoeducation groups for people bereaved by suicide.
The service is delivered by a NGO which delivers mental health services for the NHS, including IAPT (Improving Access
to Psychological Therapies), the national primary care mental health initiative. The contention of the author is that
Registered (and Accredited in the UK with BACP) counsellors with experience of working in a mental health setting are
ideally placed to deliver this type of service, as essential criteria are (a) a knowledge and understanding of suicide
bereavement; (b) good working knowledge of local mental health services; and (c) an ability to recognise and monitor for
symptoms of trauma (post-traumatic stress disorder) with a knowledge of referral pathways for treatment where
necessary; and (d) training and experience in carrying out risk assessments (preferably ASIST trained).
Referrals are received mainly from GPs in through the Police. All referrals are responded to within 72-hours by telephone,
and a home visit takes place within two to three weeks, or earlier if possible. An assessment of need is carried out at the
initial meeting, and practical and emotional support is offered up to and including the inquest. Public inquests are always
held in England & Wales when a death is unexpected and, depending on the circumstances, can take between six months
and thre years to be held. The Coronial process can be distressing for the bereaved and much of the focus of the Suicide
Liaison Service's work is to provide support with this process.
The Suicide Liaison Service has also developed "closed" 8-week psychoeducation courses for people bereaved by
suicide based on similar programmes in New Zealand and Australia. The Service Lead has recently completed a Winston
Churchill Memorial Trust Fellowship and travelled to both New Zealand and Australia to witness best practice in
postvention services and specifically gain further knowledge about the delivery of psychoeducation courses for people
bereaved by suicide.
Suicide Prevention Training for Social Work Undergraduate Students in Japan: Current
Implementation and Future Issues for Suicide Education
Manami Kodaka1, Michiko Takai1, Emi Hikitsuchi1, Sumie Okada2, Yasue Watanabe1, Kiyoko Fukushima3,
Masatoshi Inagaki4, Mitsuhiko Yamada1, Tadashi Takeshima1
1
National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan; 2Showa Women’s University,
Japan; 3Japan Lutheran College, Japan; 4Okayama University Hospital, Japan; mkodaka@ncnp.go.jp
Background and aim: Social workers are expected to play an important role in suicide prevention, in collaboration with
professionals and stakeholders in various fields. In order for social workers to contribute further to suicide prevention, it is
important for them to acquire at least basic knowledge and skills about working with suicidal clients at an early stage of
professional training, such as undergraduate social work education. Most training programmes, however, target in-service
workers but not students. This study explored current implementation and future issues for suicide/suicide prevention
education at schools of social work in Japan.
Methods: Study participants were full-time faculty members who taught at social work schools in the Greater Tokyo Area,
and, in fiscal year 2013, were in charge of at least one of the courses which a social work student must complete in order
to qualify for the national board examination for a social work licence. We distributed a self-administered questionnaire to
participants through their department chairs. Survey items included 1) implementation of lectures on suicide/suicide
prevention, 2) opinions about the necessity of suicide/suicide prevention education in social work classes, 3) participants’
readiness to teach classes on suicide/suicide prevention, and 4) any concerns about teaching students about suicide and
inquiries about teaching methods. We used descriptive statistics from the data to overview current implementation and
future issues for suicide education, and also performed the Student’s t-test and calculated correlation coefficients to
explore the relationship between the current situation, the need for suicide education and participants’ readiness to teach
suicide/suicide prevention. Descriptive data were qualitatively analysed to examine in more depth the issues to be
addressed in order to include suicide/suicide prevention in social work undergraduate education. The Ethics Committee of
the National Center of Neurology and Psychiatry approved the study protocol.
Results: One hundred and thirty two (estimated response rate: 21.2 %) completed and returned the questionnaire.
Approximately half had given a lecture of some kind on suicide/suicide prevention, and more than 80% agreed to the
inclusion of suicide as a topic in the mandatory undergraduate courses for a social work licence. However, the
percentages who answered that they did not have enough knowledge or skills, were unable to prepare educational
materials to give a lecture on suicide, or were concerned about the psychological consequences to students of
suicide/suicide prevention education were 53.8%, 42.8%, and 65.6% respectively. Those who had taught suicide/suicide
197
prevention in their classes during the year were more likely to have confidence in their knowledge/skills and in the
preparation of educational materials. There was no significant relationship observed between concerns about the
psychological consequences to students of suicide education and readiness to teach about suicide.
Conclusion: It is important to develop a suicide education programme and associated educational materials for social
work undergraduate students, as well as giving faculty members guidelines and resources for teaching suicide/suicide
prevention. We will develop the education programme, examine its feasibility and effectiveness, and provide teaching
guidelines in the future.
BDNF Promoter Methylation Associated with Suicidal Ideation in Patients with Breast Cancer
Jin-Sang Yoon1, Jae-Min Kim1, Hee-Ju Kang1, Seon-Young Kim1, Sung-Wan Kim1, Il-Seon Shin1, Min-Ho Park2,
Myung-Geun Shin3
1
Chonnam National University Medical School, Korea, Republic of (South Korea); 2Breast and Endocrine Tumor Clinic,
Chonnam National University Hwasun Hospital, Hwasun, Korea; 3Department of Laboratory Medicine, Chonnam National
University Medical School, Gwangju, Korea; jsyoon@chonnam.ac.kr
Objective: Brain-derived neurotrophic factor (BDNF) has been considered a risk factor for suicidality. BDNF secretion is
influenced by epigenetic (DNA methylation) and genetic (val66met polymorphism) profiles. We aimed to investigate the
independent effects of BDNF promoter methylation status on suicidal ideation as well as the effects of its interaction with
the val66met polymorphism in patients with breast cancer.
Methods: A total of 279 patients with breast cancer were evaluated 1 week after breast surgery, and 244 (87%) were
followed up 1 year later. Suicidal ideation was identified using the item addressing suicidal thoughts on the Beck
Depression Inventory. The independent effects of BDNF methylation status on suicidal ideation at two points was
investigated using multivariable logistic regression models. The two-way interactive effects of BDNF methylation status
and the val66met polymorphism on suicidal ideation were also estimated using the same models.
Results: Increased BDNF methylation was significantly associated with suicidal ideation and depression 1 year after
breast surgery, and this association was independent of potential covariates, including previous depression, current
depressive symptoms, and BDNF genotype. No significant methylation–genotype interactions were found.
Conclusions: The BDNF hypothesis and the epigenetic origin of suicidality in patients with breast cancer were supported.
BDNF gene methylation status may be a biological marker for suicidality in patients with breast cancer.
Examining Effectiveness and Policy Implications of University Campus Suicide Prevention
Programs: A Multi-Dimensional Perspective
Latise Hairston
Buffalo State College Institute for Community Health Promotion, United States of America; hairstl@buffalostate.edu
Gatekeeper training programs have been implemented on university campuses in response to the need for suicide
prevention efforts due to the significant increases in the number and severity of students in psychological distress. In this
workshop participants will be engaged in a discussion of a study that examined both face-to-face and web-based
gatekeeper training. Quantitatively, using inferential statistical analyses and generalizability (G-) theory, the overall
purpose of this study was to evaluate the effectiveness of a Web-based and a face-to-face QPR gatekeeper training
program, which was implemented on a university campus and within the surrounding community aimed at increasing
gatekeepers’ knowledge of suicide and confidence to intervene with those at risk of suicide. Barak and Grohol (2011)
contend that online interventions appear to have enormous potential because they are convenient, offer direct access to
resources that a person otherwise might not have and provides some assurance of program fidelity. Qualitatively, using
open-ended responses from follow-up surveys, the researcher identified themes regarding barriers and enablers in
implementing the knowledge and skills learned in face-to-face QPR gatekeeper training. Data from the face-to-face and
web-based gatekeeper training programs were studied over a three year period (2012, 2013, and 2014) to determine if
there was consistency in the results. The results and implications for policy, leadership and practice in higher education
will be discussed.
It’s Difficult to Swallow so Much Powder; Grinding Prescription to Prevent Intentional Drug
Overdose
Keisuke Takanobu
Kushiro City General Hospital / Japan, Japan; tknbksk1016@gmail.com
Most studies have reported intentional drug overdose(IDO) seems to be the most common form of hospital-treated
suicidal behavior. The most common type of drug taken in IDOs is psychotropic medication prescribed by doctor, in
particular benzodiazepines(minor tranquilizers). Owing to these backgrounds, many guidelines for suicide prevention
emphasize preventing inappropriate prescription of these drugs by educating doctors or other medical staffs such as
pharmacists. However, in the real world, these “idealistic” approaches have limitation and, in the present situation, not
sufficient yet to prevent completely. Particularly in Japan, where many doctors tend to prescribe polypharmacy of minor
tranquilizers, this trend is remarkable.
Here, from pragmatic view point, we suggest “grinding prescription” as a new means to prevent IDO. By grinding tablets,
even though equivalent quantity, drugs get far more difficult to swallowing so much, because their form metamorphose
198
into powder. Powder-form drug is more likely to choke by entering the trachea and more bothersome to use oblate than
tablet-form. These “physical” factors inhibit IDO. For instance, our psychiatric patients with a history of IDO (borderline
personality disorder, mental retardation, schizophrenia), after their drugs were grinded, have seldom committed IDOs
again. Even if they did, its harm was mild, because swallowing so much powder is physically difficult, they took less
quantity drugs. Grinding tablets are available in many hospital, and take low cost. For most kinds of drugs, even though
oral dispersing tablets, their quality are not so much impaired by transforming to powder.
Grinding prescription is reasonable, easy, safe, low-cost and very effective means to prevent IDO. For preventing IDO,
changing the form of drugs is “physical” and “pragmatic” means, and perhaps can be a new strategy .
A Meta-Analytic Investigation of the Scale for Suicidal Ideation
Zoe Grunebaum
Teachers College Columbia University, United States of America; zgrunebaum@gmail.com
The Beck Scale for Suicidal Ideation (SSI) is considered the gold standard for the assessment of suicidal ideation, intent
and planning. However, the SSI was not designed with suicidal behavior as the primary outcome of interest. Researchers
have nonetheless investigated its relationship with suicidal behavior due to a lack of alternative measures. A detailed
review of existing studies from 1979 through 2014 yielded 7288 of which only 8 met criteria to be included in this metaanalysis. All included studies analyzed adult clinical populations via prospective design. This study reports a metaanalysis of the 8 studies meeting criteria, which investigated the SSI prospectively across samples of varying size and
demographics. The results indicate a significant overall average effect size with a Z of 40.67(Zcrit=1.96 p<.05) using a
random effects model. This indicates potential for prediction of behavior using the SSI, however there is significant
heterogeneity amongst the included studies and more data is essential to answering this question. The findings are
placed in context of the range of measures assessing suicidal behavior prospectively. The author suggests a lack of
clinically relevant measures in existence and the need for increased research and development of novel assessment tools
in the future.
Do Attitudes towards Suicide Relate to Suicide Rates? A Study from Regions in 9 European
Countries
Melanie Straiton1, Heidi Hjelmeland2, Sandor Fekete7, Danutė Gailiene3, Onja Grad4, Roman Koposov5, Emina
Music6, Bedryie Oncu8, Ellinor Salander6
1
Norwegian Institute of Public Health, Norway; 2Norwegian University of Science and Technology; 3Vilnius University,
Department of Clinical Psychology, Lithuania; 4University Psychiatric Hospital, Ljubljana, Slovenia; 5UiT The Arctic
University of Norway; 6Umeå University, Department of Clinical Sciences, Sweden; 7University of Pecs, Department of
Psychiatry, Hungary; 8Ankara University, Department of Psychiatry, Turkey; heidi.hjelmeland@svt.ntnu.no
Background and aim: Suicide rates vary widely around the world, placing suicide in a social and cultural context. The aim
of this study was to determine whether there is an association between regional suicide rates and attitudes towards
suicide using two attitudinal components.
Method: Data from a total of 5663 participants who had completed Attitudes Towards Suicide (ATTS), demographic
information and previous suicidal history were used. These participants represented nine different regions / countries.
Regional suicide rates for the data collection period (2000-2005) and average scores for two attitudinal factors,
Acceptance of Suicide and Condemnation, were calculated. Mixed linear modelling was carried out to assess the
relationship between attitudes and suicide rates while controlling for demographics and previous suicidal history.
Results: Regional suicide rates were associated with Condemnation but not Acceptance of Suicide.
Conclusion: People are less condemning of suicide in regions with higher suicide rates than in regions with lower suicide
rates. However, higher suicide rates are not associated with greater acceptance of suicide. The causal direction of the
association is not known.
Urban and Gender Disparity in Age-Specific Suicide Rates in Taiwanese Population
Bih-Ching Shu1, For-Wey Lung2,3,4, Ming-Been Lee2,5,6
National Cheng Kung University, Taiwan, Republic of China; 2Taipei City Hospital; 3Taiwanese Society of Suicidology
(TSOS); 4National Defense Medical University; 5National Taiwan University College of Medicine; 6Taiwan Suicide
Prevention Center; shubih@mail.ncku.edu.tw
Suicidality is one of major public health issue and cause of mortality worldwide. Lots of studies have interested in
geographic and cultural characteristics, rural/urban and gender differences in suicidality. However, the impact of
urbanization and gender are controversial in suicide rates. Suicidality is a very complex phenomenon, and any patterns
observed in the past or in the West might not be valid at present or applicable to other non-western countries. Hence, this
study adjusted on potential risk factors and secular changes for suicide rates in gender and rural/urban area. The data of
suicide rate were recruited in 23 urban and rural areas in Taiwan from 1991 to 2013. The suicide rate divided into 4
groups: 15-24 years old, 25-44 years old, 45-64 years old and age above 65 years old. Some potential risk factor, such as
unemployment rate, divorce, and emotional distress, were also analyzed. In addition, the suicidal methods were also
explored in this study. The results showed unemployment rate is mainly caused the suicide rate in male with 45-64 years
old, and in female with 25-44, 45-64 and age above 65 years old in Taiwan. Moreover, the factors of divorce and
unemployment rate are mainly caused the suicide rate in male with 25-44 years old in Taipei city. In particular, the mainly
1
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suicide method was jumping from high building in suicide rate of Taipei city. On the contrary, the factor of divorce is
mainly caused the suicide rate in female in rural area in Taiwan. Seven years ago, Taiwan Suicide Prevention Center was
established and began to match national policy for the intervention of suicide. After intervention program, the suicide
behavior begins to decrease the rate in all urban and rural area by piece-wise regression method in Taiwan. This study
showed the cumulative effect of intervention program in decreasing suicide rate in Taiwan. Moreover, the gender-specific
suicidal rate and disparity in suicidal methods in urban and rural could provide a reference in further preventive strategies
in Taiwan.
Pseudobulbar Affect, Social Isolation, Hopelessness and Suicidal Ideation in Multiple Sclerosis: A
Cross-Sectional Study
Filipe Augusto Cursino de Freitas, Antônio Pereira Gomes Neto, Renata Brant de Souza, Albert Louis da Rocha
Bicalho, Paulo Pereira Christo
Santa Casa de Misericórdia de Belo Horizonte, Brazil; freitasfac@yahoo.com.br
Background: Due to its complexity, suicidal behavior requires evaluation of multiple risk factors, which may provide
valuable information to assessment, prevention and treatment for individuals at risk of suicide. Knowledge about suicide
risk factors is essential because it is not possible to infer for sure, among many individuals, who are those at increased
risk. Among these risk factors, previous suicide attempts, having a chronic and disabling disease, social isolation,
disability and mood disorders could be considered important issues. Hopelessness is the most common feeling reported
by people who are at risk for suicide and/or commited suicide.
Pseudobulbar affect is a symptom on which a person is not able to control his laughter or crying and that in not
necessarily involved with congruent feelings. Involuntary laughing or crying could happen with minimal or no stimuli. This
symptom could occur in diseases such as Alzheimer's disease, stroke, multiple sclerosis, lateral amyotrophic, brain
tumors and others.
Multiple sclerosis is a disabling disease that attacks 1.000.000 around the world. Pseudobulbar affect appears in 6,5% to
46,2% of patients with multiple sclerosis, which is a disease usually associated to mood disorders. Despite patients with
pseudobulbar affect pursue inappropriate emotional patterns, it is not clear if the resulting social isolation and its
emotional consequences are involved with an increased risk for suicide. Additionally, depression is considered the most
important risk factor for suicide in patients with multiple sclerosis, is usually associated with social isolation and is the
most common mental disorder in people with multiple sclerosis.
Objective: To evaluate if there is a relationship among pseudobulbar affect, hopelessness feelings and suicidal ideation in
individuals with multiple sclerosis, with and without depression. To evaluate which tracts are involved with pseudobulbar
affect, suicidal ideation and hopelessness feelings in this group.
Methods: 107 clinically stable multiple sclerosis patients defined with McDonald 2010 criteria for diagnosis of multiple
sclerosis, attended in Neurology Ambulatory of Santa Casa de Misericórdia de Belo Horizonte, Brazil, spontaneouly went
through a clinical interview including Center for NeurologicStudy - Lability Scale, Beck Depression Inventory and Beck
Hopelessness Scale. Data was analysed using SPSS 20.0. The null hypothesis was rejected at p<0,05.
Results: In 107 patients with multiple sclerosis, 34 (31,8%) presented symptoms of pseudobulbar affect with a strong
correlation between pseudobulbar affect and depression (p=0,026) and between depression and hopelessness/ suicidal
ideation (p=0,000). Nevertheless, there is no association between pseudobulbar affect and suicidal ideation and
hopelessness feelings in this group of patients if depression is (p=0,554) or is not (p=0,082) isolated as a confounding
information in the analysis.
Interpretation: Pseudobulbar affect has a close relation with mood disorders and suicidal ideation. Notwithstanding, there
is no relationship between pseudobulbar affect and suicidal ideation in this papper. There are probably differences
between risk factors to suicide in people with multiple sclerosis and the general population.
Discursive Psychology and Positioning Theory Applied to Suicide Attempt Cases
Raúl Armando Santana Rivas1, Roque Quintanilla Montoya1, Luis Miguel Sánchez Loyo1, Ferran Padrós
Blázquez2
1
University of Guadalajara, Mexico; 2Michoacana University of San Nicolás de Hidalgo, México; dragonia77@hotmail.com
INTRODUCTION: Discursive psychology (DP) emphasizes situational and interactive conditions where psychological
experiences are built on accurate and personified way scenarios. Within DP, positioning is a key to the psychological
discursive formations that fill experiences of conflicting character as series of rights and obligations acquired in the form of
devalued or unsupported identities. From a critical and realist epistemology, real life conditions (where individuals are
positioned along their biographies) and social relations (construction of identities) help to see the crisis episodes more
complex. AIM: Analyze descriptions of the life episode, subject positions and forms of action associated with attempted
suicide in the discourses of inpatients and accompanying family members. METHOD: Inpatients of suicide attempt and
their mothers were included, ages between 15 -17 years old, 3 women, 2 men living in Jalisco, México. Were treated at
the public health service of psychiatry at the Civil Hospital in Guadalajara. In-depth-interviews were applied while they
stayed in the hospital in order to identify the episode, positioning and acting. The codes included referred expressions as
reported speech about the every day life, situations and closed relationships as well as negotiations of meaning after the
suicide attempt. MAXqda11 was used to code. RESULTS: Episodes are related to the attempt: gaps in the family,
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changes of address or belong to families are reconstructed. In two cases positioned in a devalued way compared to a
brother or sister, whose have more social success, statements particularly close to their desire to no longer live. Position
has been uncertain too. In one, the young girl was adopted and not integrated; in other case the father of the inpatient
built another family and the boy had to live with relatives. In one case, a forced separation of the couple was the visible
trigger, but adverse positioning conditions were found. Actings were derived from misunderstanding or previous fights
triggered the plan to die.Whose suicide attempt was more elaborate, ideation persisted during internment (longer
positioning difficulties and devalued past). Mothers give another explanations.The episodes identified as related to the
attempt do not match, the positions tend to be defensive or attached to psychiatric diagnosis, relationships are slightly
modified or recognized as triggers. CONCLUSIONS: To improve the best intervention according to each case, this results
can be used as a via of comprehension of the position wherein the patient acts, as well as the shared construction of the
crisis and response inside the family. Discursive psychology has been used little or nothing in suicidology, this approach is
considered to make clear the conditions under which suicide attempters considered the possibility of ending his/her own
life, how they meditated and organized the event, and the way it is understood by relatives.
Profiling Suicide Attempts at Emergency Medical Services in Nara, Japan
Kazuya Okamura1, Katsumi Ikeshita2, Shigero Shimoda2, Kazunobu Norimoto3, Keisuke Arita2, Toshifumi
Kishimoto2, Hideki Uemura1
1
Department of Psychiatry,Nara Prefecture General Medical Center, Japan; 2Department of Psychiatry, Psychiatric
Institute, Nara Medical University, Japan; 3Department of Emergency and Critical Care Medicine, Nara Medical
University, Japan; kaz19840521@gmail.com, ikeshita@naramed-u.ac.jp, midsheltiger@yahoo.co.jp,
norimoto@naramed-u.ac.jp, arita@naramed-u.ac.jp, toshi.k@naramed-u.ac.jp, hideki@naramed-u.ac.jp
Objectives:
The aim of the study was to investigate the characteristics of suicide attempt in patients who visited to advanced
emergency medical services in Nara prefecture.
Methods:
We evaluated 202 cases of attempted suicide (85males and 117females), who visited to advanced emergency medical
services in Nara, Japan between April 1, 2012 and March 31, 2014. Clinical data and socio-demographic characteristics,
including age, sex, psychiatric diagnosis (ICD-10) and method of suicide attempt were collected from medical records
retrospectively. This study was carried out at two advanced emergency medical services for medically severe patients
who require a high level emergency care.
Results:
The mean age of total subjects was 45.7±19.7 years (85 males, 13-81 years, mean age 46.3±18.1; 117 females, 13-90
years, mean age 45.2±20.8). 25.2% (n=51) of 202 subjects completed suicide (28 males and 23 females, 13-90 years,
mean age 51.0±21.2) and the rest (n=151, 74.8%) were attempters (57 males and 94 females, 15-83 years, mean age
43.8±18.8). The most common diagnosis were affective disorders (n=64, 31.7%), personality disorders (n=29,14.4%) and
schizophrenia spectrum disorders (n=21, 10.4%). The most used suicide methods were drug poisoning (n=61, 30.2%),
followed by hanging (n=48, 23.8%) and pesticide poisoning (n=28, 13.8%). Furthermore regarding pesticide poisoning,
the most frequent pesticide was Organophosphate. Among those completed suicide, hanging was the most frequent
method followed by jumping from height. 51 suicide completers were more likely to be male, older and to have used a
more lethal method.
Conclusions:
Our results were similar to previous studies in most parts, but this study revealed the proportion of pesticide poisoning
was larger in comparison to other urban area reports in Japan. This result suggests that it is necessary to consider the
prevention for pesticide poisoning suicide attempts in Nara.
Associations of Reasons for Self-Injurious Behaviors with Suicidal Thoughts and Behaviors
Elise Kathleen Paul, Aliona Tsypes, Laura Eidlitz, Janis Whitlock
Cornell University, United States of America; ekp39@cornell.edu
Background: Prior research has found associations between non-suicidal self-injury and suicidal thoughts and behaviors.
However, most of this work has treated non-suicidal self-injury categorically and distinguished the two phenomena based
on the presence or absence of the intent to die. Evidence from clinical settings suggests that individuals engage in selfinjury for multiple reasons, may think about suicide while self-injuring, and have ambivalent feelings about living or dying.
In order to guide clinicians in assessing which individuals who self-injure may be at the greatest risk for suicide, we
examined reasons for self-injurious behaviors, including those related to suicide, in relation to suicidal ideation, plan, and
attempt.
Methods: Data were collected via a web-based survey of well-being using a random probability sample of students from 8
universities in the United States. Participants in the analytic sample (N = 13,396) were emerging adults (Mage = 20.90,
SD = 2.63, Range = 18-29 years) who had complete data on reasons for self-injury, sex (male/female), and suicidal
thoughts and behaviors. Individuals who endorsed ever engaging in at least one of 20 self-injurious behaviors with the
intention of hurting themselves were asked to check all that applied from a list of 26 reasons for self-injury. Reasons for
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self-injury with at least 10 participants per self-injury reason/suicide group cell were retained for analyses. Binary logistic
regressions that controlled for sex were used to examine individual reasons for self-injury in relation to suicide ideation,
plan/method, and attempt. To account for multiple testing, a p-value of 0.001 was used.
Results: Individual reasons for self-injury showed differential associations with suicidal thoughts and behaviors.
Specifically, suicidal ideation was associated with only one reason for self-injury (“to help me cry”), while three reasons for
self-injury (“to change emotional pain into something physical”, “to avoid committing suicide”, and “because of my selfhatred”) were related to having made a suicide plan. More than half (11/18) of the reasons for self-injury examined were
associated with suicide attempt. Engaging in self-injury to practice suicide, avoid committing suicide, to “feel something”,
and because of self-hatred demonstrated the strongest relationships with suicide attempt.
Conclusions: When examining risk for suicide, our findings suggest the importance of assessing client’s reasons for
engaging in self-injury beyond intent to die, especially those that relate to avoiding or practicing suicide.
Brazilian Myth: A Child Does Not Attempt Suicide
Michelle Alexandra Gomes Alves
Centro Universitário UNA-BH, Brazil; michellealexandra.ga@bol.com.br
Introduction: The attempt to self-extermination of children is a difficult topic to be worked in Brazil. There are few Brazilian
studies on this topic and the child often is seen as incapable of committing this act and most of the attempts are
underreported, being recorded as simple accidents. This subjugated view of the child is understandable, since in Brazilian
society the child and the adolescent become citizens, just after the promulgation of the Constitution of 1988, which they
had their guaranteed social rights. This was the beginning of a paradigmatic transformation process that culminated in the
Law nº8.069/90 (The Child and Adolescent Statute) which emphasized social rights, saving and fully protecting this public
and considering them as subjects. Objective: Discussing the demythologizing of the idea that children do not attempt
suicide, based on the presentation of the data collected in master's research conducted in the city of Matozinhos, Minas
Gerais, Brazil, questioning the results of underreporting. Methodology: Quanti-Qualitative research, which data collection
took place in the existing records in the city of Matozinhos from 2008 to 2012 and also through the sensitive and creative
method. The analysis of the material was performed using the Statistical Package for Social Sciences, version 19.0 and
based on Bardin content references. Results: It was found that 59 children between 3 and 11 years, 21 females and 38
males, possibly attempted suicide; but the cases were treated as mere accidents and, therefore, were classified as
suspected cases. They were distributed almost symmetrically within the territory and therefore a municipal phenomenon.
The profile of children who attempted suicide predominantly age up to five years, male gender and the choice of
autointoxication as a method. In the qualitative data, the children listened reported attempting self-extermination and put
on paper, through drawings, stories told. Making explicit as to the fragility of family ties interferes in the committed acts.
Conclusion: This study testifies the demythologizing that children do not attempt suicide, from the quantitative data and
productions and speeches of the children. Faced with this finding, there is an urgent need to build preventive proposals in
the qualitative health, based on dialogues and conversations and also in the elaboration and testing of quantitative
instruments for measuring suicidal ideation in infant-juvenile public, since those existing do not apply to Brazilian children
and adolescents according to age group classified by The Child and Adolescent Statute.
Investigation of the Psychometric Properties of the Interpersonal Needs Questionnaire and the
Acquired Capability for Suicide Scale in Adolescents
Jessica King1,2, Sarah Horton1,2, Jacquelyn Matney1,2, Jennifer Hughes1,2, Betsy Kennard1,2, Nicholas Westers1,2,
Taryn Mayes1,2, Graham Emslie1,2, Jane LeVieux1,2, Sinong Chen3, Sunita Stewart1,2
1
University of Texas Southwestern Medical Center at Dallas; 2Children's Medical Center at Dallas; 3Southern Methodist
University; sunita.stewart@utsouthwestern.edu
Scales to assess key constructs in the Interpersonal-Psychological Theory of Suicide (IPTS; Joiner, 2005): Perceived
Burdensomeness (PB) and Thwarted Belongingness (TB) assessed by the INQ, and Fearlessness About Death
measured by the ACSS-FAD, have been validated in adults but not adolescents. This study examined the psychometric
properties of the INQ and ACSS-FAD in an adolescent clinical sample.
Method
This study was approved by the UT Southwestern IRB. Participants were 133 youth (Mean, SD for age = 14.72, 1.42
years; 70% Caucasian; 75% girls) recruited from an inpatient psychiatric unit at a pediatric hospital. They completed three
self-reports, the 15-item INQ, 7-item ACSS-FAD, the Quick Inventory of Depressive Symptomology Self-Report, and one
clinician-rated measure, the Columbia Suicide Rating Scale. Abuse history was gathered from participants’ medical
records.
Results
An exploratory factor analysis (EFA) for the INQ yielded two factors with most negatively worded items loading on a
separate factor. A three-factor solution was interpretable in the IPTS context, with all PB items loading >.40 on one factor,
and most TB items on a second factor. The third factor contained two items which both described feeling disconnected
from others. However, these two items also loaded well on the second factor with other TB items. The subscales had
Cronbach’s alpha's (α) of .93 (item-total correlations [ITC] =.72 - .87) for the PB and .89 (ITC = .45 - .74) for the TB
scales.
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The EFA for the seven-item ACSS-FAD yielded two factors, with all items loading >.40 on one factor. Two items also
loaded on a second factor. A one-factor solution showed all 7 items clearly loading on one factor. The α for these items
was 0.84 (ITC = .40 - .79).
Initial evidence for validity was provided by correlations with the following constructs for PB and TB respectively (all p
values < .05): depressive symptoms (r =. 61 and .71); suicidal ideation (r =.56 and .58); and suicide attempts (r=.28
and .26). The ACSS-FAD was associated with lifetime total number of suicide attempts (r=.20, p < .05) and physical
abuse (r=.20, p < .05) as predicted by the IPTS. Divergent validity was evident in the weaker correlation of ACSS-FAD
with each of the INQ subscales (r=. 47, p<.01 for both TB and PB), and high correlations of PB and TB subscales (r
= .72).
Conclusion
The current study indicates acceptable psychometric properties and initial evidence for validity of the INQ and ACSS-FAD
in an adolescent clinical sample. However, the high correlation of PB and TB scales may be due to high rates of
depression in the sample that likely impact both constructs. Future research should evaluate the psychometric properties
of the INQ and ACSS-FAD in diverse samples of adolescents, using broader approaches to validity including
assessments of the value of these measures in prospectively predicting suicidality.
Attempted Suicide among Patients Attending Neuropsychiatry Department – A Study from Tertiary
Care Neuroscience Hospital in Bangladesh
M M Jalal Uddin1, Mohammad Tariqul Alam2, Helal Uddin Ahmed2, Mohamad Golam Rabbani2, Md. Badrul Alam1,
Quazi Deen Mohammad1
1
National Institute of Neurosciences and Hospital, Bangladesh, People's Republic of; 2National Institute of Mental Health,
Dhaka, Bangladesh; jalal29march@yahoo.com
Background
Attempted suicide is a growing problem with significant clinical and public health importance globally as well as
developing countries like Bangladesh. Psychiatric disorders are the most common reasons for suicide or suicidal behavior
among other causes of such behavior.
Objective
The objective of the study was to find out the suicide attempts among the patients with psychiatric disorders attending the
neuropsychiatry department of National Institute of Neurosciences and Hospital (NINS&H), Dhaka, Bangladesh.
Methodology
This descriptive cross sectional study was done in neuropsychiatry department of NINS&H, Dhaka, Bangladesh from July
2013 to August 2014. Psychiatric diagnoses of the patients were done by the psychiatrist following Diagnostic and
Statistical Manual of Mental Disorders –IV-Text Revision (DSM-IV-TR) diagnostic criteria. Semi structured questionnaire
was used to collect socio-demographic data and details about suicidal attempts. Ethical issues were maintained strictly.
Results
Total 63 patients were found with history of single or more than one suicidal attempt out of 954 patients who were
attended to neuropsychiatry department during the study period. Among the suicidal attempts 34(53.97%) were male and
29(46.03%) were female and majority 38(60.32%) belonged to 20 years to 40 years age group. In this study the most
common methods of suicidal attempt were found taking over dose of sedatives and multiple drugs 22(34.92%), ingestion
of pesticides and other corrosive agents 17(26.98%), hanging 14(22.22%), self cutting injury 3(4.76%), jumping from
height 2(3.17%. Psychiatric disorders wise distribution of suicidal attempts were found major depressive disorder
18(28.57%), borderline personality disorder 14(22.22%), schizophrenia and related disorders 10(15.87%) substance
related disorder 8(12.70%), bipolar mood disorder 5((7.94%), somatoform disorders 3(4.76%), adjustment disorder
3(4.76%), epilepsy 2(3.17%).
Conclusion
Results of the study indicate that all attempts of suicide should be taken seriously and crisis hot line and emergency
services should be ensured for this group. Policy makers and health care professionals should give attention in this
regards. Further broad based study is required to have more evidences in this regard.
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The Wnt Pathaway Genes and Suicidal Behavior in Bipolar Disorder
Humberto Correa, Simone Becho, Debora Miranda, Fernando Neves
Federal University of Minas Gerais, Brazil; correa@task.com.br
Bipolar Disorder (BD) is a severe and chronic psychiatric illness with progressive increase in the severity of episodes. The
prognosis for patients with BD is poor, with high rates of relapse in residual symptoms, cognitive impairment and
decreased quality of life and suicidal behavior. In fact BD is the psychiatric diagnosis where suicidal behavior is more
frequent.
A growing body of research supports the assumption that BD arises from abnormalities in neuronal plasticity. Several
lines of evidence suggests that the Wnt family is involved in this pathway since it is related to key developmental
processes such as cell growth, migration and cell differentiation. Therefore, the aim of our study was to evaluate whether
genes of the Wnt pathway are associated to BD and/or suicidal behavior.
Our sample consisted of 546 individuals: 306 patients with BD and 240 healthy controls. We used the genes WNT2B,
WNT3A, WNT5A, WNT7A, APC1 and FZD3. We found no correlation between the studied tagSNPs and BD. However,
we found a positive association between ACP1 tagSNP, rs7419262, and violent suicide attempt. We conclude that the
Wnt pathway may be associated with susceptibility to BD and suicide.
Existential Density as a Protective Factor to Suicide
Carlos Henrique de Aragão Neto
University of Brasília, Brazil; caragao.neto@gmail.com
The present work aims to make a relationship between meaning in life, the existential emptiness and suicide. The search
for meaning is part of the human condition throughout the existence, and its absence leads to the existential void,
considered the fundamental problem of modern man. In the speech of people who thought or tried to take their own life,
the lack of meaning in life and the existential void are very often mentioned as risk factors. In this qualitative study, five
people were asked to talk about the meaning of life, in a non-structured interview: two religious leaders, a physician and a
couple bereaved by suicide of a son. The theoretical framework of Logotherapy, a proposal for psychotherapy based on
the search of sense and meaning for the human existence, was the ballast of this study. The concept of Existential
Density emerges as a protective factor to the process that can lead an individual to suicide, a serious public healthy
problem considered by WHO. Find meaning in life building an existential density is directly proportional to suicide
prevention.
The Suicide Prevention Models and Characteristics of Taiwan Life Line International
Yu-Chia Chen1,2, Yu-shun Huang1, Cheng-Hsiung Lee1, Chun-Yu Chang1, Chen-Yu Ho1,3, Chiao-Yi Chung1,4
1
Taiwan Lifeline, Taiwan, Republic of China; 2National Tainan Junior College of Nursing; 3Tunghai University; 4National
Dong Hwa University; yuchia5755@gmail.com
This paper review the suicide prevention models of Taiwan Life Line International over the past three years. This paper
indicate that there are three major models of suicide prevention: 1. Suicide Prevention Helpline, 2. Suicide Prevention
Community Promotion Programs, 3. Post-Suicide Follow Up Counselling. One hundred and Seventy thousand
calls(almost 170,000) are serviced per year in 23 helpline centers over all Taiwan area. Through provided care and
support, helping callers find the courage to live on. On Suicide Prevention Community Promotion Programs, there are
vary by community-need: such as in-campus life education lectures, in-prison spiritual growth lectures, gate-keeper
training courses, suicide crisis recognition, EAP employee assistance programs, senior citizen care and suicide
prevention lectures, action drama, and juvenile mental health programs. Post Suicide Follow Up Counselling provides
case management and home visit for high risk suicide attempters. Several distinguishing characteristics have emerged
from services provided over the past three years. Life Line centes in various areas have responded to local needs, walked
out of their call centres, and united with their communities. Many service programs have resulted from their seeing local
requirements, and through various methods of service they have developed local suicide prevention networks to reach the
goal of preventing suicide.
L’évaluation des besoins en matière de prévention du suicide chez les aînés : étude exploratoire
Lynda Poirier, Sophie Ethier, Jean Vezina, Michèle Morin, Eddy Larouche, Catherine Grégoire
Centre de prévention du suicide de Québec, Canada; lpoirier@cpsquebec.ca
Nous proposons d’aborder la littérature traitant du suicide des aînés selon la structure de notre étude, soit en fonction des
objectifs de recherche, lesquels ont également guidés l’analyse des données. Ainsi, nous nous arrêterons sur quelques
connaissances actuelles par rapport au suicide des aînés afin de mieux saisir l’étendue de la problématique et, par la
même occasion, contribuer à déboulonner certains mythes. La perception du suicide et de la détresse des aînés forme la
deuxième partie. Puis, sont abordés les signes de détresse et les moments critiques, communément appelés facteurs de
risque, ainsi que les facteurs de protection spécifiques à la clientèle gérontologique. Enfin, différentes stratégies de
prévention du suicide s’adressant aux personnes âgées seront présentées afin d’illustrer concrètement des exemples
d’interventions possibles pour lutter contre le phénomène.
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The Benefit Analysis of Hot Lines and Suicide in Taiwan
Min-Wei Huang1,2,3
Bali Psychiatric Center, Ministry of Health and Welfare, Executive Yuan, Taiwan, Taiwan, Republic of China; 2Taiwan
Life Line International; 3Taiwanese Society of Suicidology; hminwei@gmail.com
Objective:
1
Suicide mortality rates have been steadily rising in Taiwan, and suicide has been among the top-ten causes of death
for the last consecutive eight years. In response to this situation, suicide prevention plans and related care delivery
system networks nationwide were necessary. The Taiwan life line international was one of the largest NGO, who will offer
a helping hand for individuals who have attempted suicide,
maintaining a spirit of showing positive values and achieving mutual benefits.
Methods:
The study included annual statistics of life lines in 2013, the descriptive statistical analysis methods was used to
understand the relationship between the calls for help and suicide.
Results:
According to annual statistics of life lines in 2013, they were about 2,800 volunteers providing telephone services and over
166,582 calls recorded in the whole year. It reached a historic high in Taiwan. It was about 57.5% of calls from the
women. It was about 60%, most of the age group belongs to 30 to 59 years old. It was about 45%, the high school level of
education tried to use the lifeline services. The main problems in the lifeline services were about personal feelings,
interpersonal relationship, couples, and family issues accounted for 33.32% ; followed by psychological problems,
accounting for 24.86%; other issues, including sexual problems, economic , legal, academic, vocational, health care, life /
religion, politics, alcoholism and other drug problems again, the total accounted for 14.77%.
Conclusion:
In the past five years, the declined suicide rate correlated with the gradually increased lifeline hotline services. The lifeline
of the hotline services is indeed one important role to promote the core values of "Saving Life, Restoring Hope". It is
worthy for the Taiwan Lifeline to analyze the cost benefit for each of its programs and to form a strong foundation for
future work. The Lifeline will provide continuous training and certification to strengthen the abilities of all individuals
involved in
dealing with depression and intervention to prevent suicide attempts.
Blueprint of an E-Conceptual Model for Technology Based Suicide Prevention (Euregenas, Work
Package 5)
Eva De Jaegere1, Marjolijn van den Berg2, Matic Megic3, Jolien Quisquater1, Kees van Heeringen1, Gwendolyn
Portzky1
1
Unit for Suicide Research, Ghent University, Belgium; 2Flemish Agency for Care and Health; 3Matic Meglic s.p.;
eva.dejaegere@ugent.be
• Study objectives
Euregenas (European Regions Enforcing Actions Against Suicide) is a three year project, which aims to contribute to the
prevention of suicide in Europe. The aim of work package (WP) 5 is to provide all information necessary for developing an
integrated support and intervention system for stepped care in E-mental Health, directed at the prevention of suicide.
• Methods and material
To meet the objective WP 5 aims at developing quality criteria and ethical guidelines for ICT applications in suicide
prevention. This work package also aims at creating the inventory and evaluating e-mental health applications on suicide
prevention in selected partner regions. The development of the model will require two analyses. An analysis of
accessibility and usability of existing programs or tools identified as relevant for the model, and an analysis on the
feasibility to adapt an integrated program for suicide prevention to regional needs, languages and culture. Making use of
the information of others WPs, WP 5 aims to consolidate e-mental health needs from partner regions with current best
practices in the field of e-mental health care.
• Results
The aim of WP 5 is to provide all necessary information to be able to create an integrated support and intervention system
for e-mental health, directed at the prevention of suicide, called a blueprint of an e-conceptual model that can be adapted
to local needs in all European regions and regional health care organisations. The blueprint will be based on quality
criteria and ethical guidelines, the expressed regional needs in e-mental health, the evaluated support and care programs,
an analysis of the feasibility and costs for the regions and the technical requirements for such a program.
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• Conclusion
The final deliverable is a blueprint of an integrated e-conceptual model for suicide prevention, which can be adapted to
local needs in regional health care organizations in all European regions.
Critical Approach to the Experience of the Voluntary Termination of Unwanted Pregnancy: Mental
Distress and Suicidal Behavior among Youth in Mexico
Angela Martinez
Colegio de Mexico, Mexico; angelabeatrizma@gmail.com
The teenage pregnancy is a health problem by mortality, morbidity and incidence produced. In addition, the socio-cultural
dimension that accompanies it, as a matter of human rights of women. Unwanted pregnancy and most serious
consequence, induced abortion, are priorities for public health in Latin America and the Caribbean. Moreover, suicide is
among the main causes of death in adolescents, after assaults and deaths from transport accidents, all classified as
violent deaths.
One of the most problematic aspects of reproduction in adolescence is its frequent involuntary undoubtedly, this scenario
is not unique to adolescents: motherhood is not the result of a decision itself, is a problem at any age is presented.
Suicide as certain subjects living phenomenon emerges in social spaces in expressing their practice subjectivities
associated with this social space; subject and context seems more related emphasizes this sense of individual and
collective dimension of suicide.
The main objective of this paper is to present some conceptual theoretical approaches about an ongoing investigation and
therefore the panorama offered is still incomplete. It seeks to present an argument that problematic the unwanted youths
attended at Health Center T-III "Beatriz Velasco German and Hospital Mexico Spain and in a private clinic in Mexico City
pre- and post-abortion emotional reactions. The joint is made by a circumscribed health of adolescent mental illness, the
meaning they attach to motherhood and voluntary abortion reading. The subjectivity of women can be transformed or
changed with it, especially when going through an unplanned pregnancy.
Few attempts have been made to know and identify suicide risk that a young teenager may result in an unwanted
pregnancy. From this perspective it can preset a gap in the literature, although some researches finding are oriented only
to consider depression as a dominant disease in women.
In order to open up new fronts of analysis, the main concern has been raised and the urgent need to build a body of
knowledge that has taken account the dimension that teenage girls living in Mexico City, which it has been practiced in
them a voluntary termination of an unwanted pregnancy, compared to the mental suffering and the spectrum of behavior.
In this paper, an approach to understanding the phenomenon of suicide and voluntary abortion is attempted, build a look
by including notions of motherhood, meaning of abortion and pregnancy and gender bias. Problematize the subjective
dimensions and the social context in which this emerge and lead to suicide. As part of an investigation still ongoing,
successive lines are emerging as a theoretical reflection that addresses a criticism of the hegemonic model of emotional
pathologies of the female gender, which remains centrally biological and predominantly male.
How Do People with Self-Harm Behaviors and Suicide Survivors Engaged in the Social Services in
the North District?
Frances Yik-wa LAW2, Paul Siu-fai YIP1,2, Carmen, Chui-shan LAI1
Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong S.A.R. (China); 2Department of
Social Work and Social Administration, The University of Hong Kong; carmenlai@hku.hk
Background: Suicide has been one of the ten leading causes of death in Hong Kong. The suicide rate hits the historical
high of 18.6 per 100,000 in 2003 (Yip, 2008) and dropped to 12.3 per 100,000 in 2013. Yet, self-harm behaviors becomes
one of the concerns. Empirical research also shows that there is a trend toward an increasing prevalence of self-harm
behaviors. The prevalence of self-harm behavior has been found to co-occur with suicidal ideation and suicide attempts.
The lethality of self-harm behavior is also suggested to be a strong indicator for suicide. However, the possibility for
people with self-harm behavior to use the social service is quite a little. According to the study conducted by CSRP, HKU,
more than 30% of respondents with DSH behavior expressed that they did not know what kind of services to be provided
by NGOs. Little is known about the pattern of people with deliberate self-harm behavior and suicide survivors to seek help
from social work professionals.
1
Method: The new initiative, the referral mechanism of the individuals with self-harm behavior and suicide survivors among
Police and social welfare sectors, was proposed and being implemented in 2013. Objectives, components of the referral
systems, its outcomes and its challenging will be reviewed.
Result: A total of 157 attempted suicide and suicide cases identified by Police in North District from 2013 to 2014. 59
(37.6%) cases had given the consent to be approached by social workers while 69.5% (41 out of 59 cases) received
social services or being attended by other social service units.
Negative Affect and Suicidal Behaviour: The Mediating Role of Emotion Regulation Difficulties
among Community Adolescents
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Valentin Mbekou1, Sasha MacNeil1, Réal Labelle2, Alain Janelle2, Johanne Renaud1
Institut universitaire en santé mentale Douglas, Canada; 2Université du Québec à Montréal;
sasha.macneil@douglas.mcgill.ca
Suicide constitutes the second leading cause of mortality among in adolescents aged 15 to 19 years, representing up to
16.5% of the deaths in this age group (Institut de la statistique du Québec, 2009). A majority of adolescents with past
suicide attempts do not report wanting to die as the motivating reasons for such actions (Jacobson et al., 2013). As such,
research investigating conditions surrounding suicide risk are important for appropriate prevention and treatment. Some
studies have demonstrated that emotion regulation difficulties are one such risk factor for suicide attempts in community
adolescents (Dour et al., 2011; Jacobson et al., 2010). Another important risk factor for suicide attempts in adolescence is
low positive affectivity and high negative affectivity (Rojas et al., 2014). This study aims to examine the association of
negative affectivity and emotion regulation problems with suicidality in community adolescents. It is hypothesized that
negative affectivity will predict higher suicidality, and that this association will also be mediated by emotion regulation
problems.
1
Method: 217 participants aged 14 to 17 years were recruited in high schools. They completed the Suicidal Behaviours
Questionnaire-Revised (SBQ-R; Osman et al., 2001), the negative affect subscale of the Positive and Negative Affect
Schedule-Child Form (PANAS-C; Laurent et al., 1999) and the Difficulties in Emotion Regulation Scale (DERS; Gratz &
Roemer, 2004).
Results: Negative affect and emotion regulation were both significant predictors of suicidality (p < .000). Mediation
analyses showed a significant direct effect of negative affect on suicide risk and a significant indirect effect of negative
affect on suicide risk mediated by emotion regulation difficulties.
Conclusion: It is possible that adolescents may have higher suicidality as a result of maladaptive coping strategies. As
such, these results suggest that negative affect and emotion regulation difficulties are important targets to consider in the
prevention of adolescent suicide.
Qui sont les personnes suicidaires utilisatrices d’Internet au Québec? Résultats d’une étude de
besoins
Marie-Josée Girard, Liesette Brunson
Université du Québec à Montréal, Canada; girard.marie-josee.2@courrier.uqam.ca
La priorité d’action des organismes de prévention du suicide du Québec est de joindre les personnes suicidaires les plus
à risque. Des études suggèrent que les personnes isolées socialement ou avec un problème de santé mentale
entretiennent des relations virtuelles qui sont plus nombreuses et plus influentes que leurs relations avec les gens qui les
entourent quotidiennement. Ces mêmes personnes ont également tendance à ne pas demander de l’aide auprès des
ressources d’aide dans la communauté ou auprès des professionnels de la santé. Ainsi, la recherche d’aide et
d’information sur Internet par des personnes vulnérables au suicide devient un enjeu prioritaire pour les organismes de
prévention du suicide. Quelles sont les préférences des personnes vulnérables au suicide qui se tournent vers l’aide
virtuelle? Quel est le profil psychologique de ces personnes méconnues des services de santé? Une recherche-action a
été déployée en partenariat avec Suicide Action Montréal afin de répondre à ces questions. À partir de liens affichés sur
plusieurs sites web et pages Facebook d’organismes en prévention de suicide et en intervention psychosociale du
Québec, des personnes à risque ou non de suicide ont été invitées à participer à un sondage en français sur l’Internet et
le suicide. La participation a été restreinte aux personnes âgées de 18 ans et plus. 336 réponses ont été recueillies, dont
la moitié (N=174) présente un risque suicidaire selon le Beck Scale for Suicide Ideation, adaptée pour l’étude. Une
analyse comparative entre la population à risque de suicide qui utilise Internet et celle qui ne présente pas de risque de
suicide permet de décrire le profil d’utilisation et de préférences Internet spécifiques aux personnes à risque de suicide.
Entre autres, on note que les personnes à risque de suicide passent plus d’heures par semaine sur Internet et lise plus
fréquemment les discussions et les échanges entre internautes que les personnes non à risque. De plus, les personnes
suicidaires qui utilisent Internet pour leurs idées suicidaires ont moins parlé à des intervenants de leurs idées suicidaires
durant la dernière année que les personnes suicidaires qui n’utilisent pas Internet pour des raisons liées au suicide. Les
résultats de cette étude permettront aux ressources québécoises de mieux se rapprocher des besoins spécifiques des
personnes à risque de suicide qui consultent Internet.
Collaboration of Emergency and Psychiatry Units in Brussels’ Hospitals Regarding Intake and
Referral of Persons Who Attempted Suicide
Marc Roelands, Johan Bilsen
Vrije Universiteit Brussel (VUB), Belgium; Marc.Roelands@vub.ac.be
Introduction: Suicide rate in Belgium is among the highest in Europe. Persons who attempted suicide are often referred to
the emergency unit of a hospital. Research has shown that the risk of recidivism is lower in patients who received a
psychiatric consultation during hospitalization and those who were referred to specialised mental health care services
after hospitalization.
Objectives: To describe the collaboration of emergency and psychiatry units in hospitals regarding the intake and referral
of persons who attempted suicide.
Aims: The study results will be used to improve the quality of care for persons who attempted suicide.
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Methods: The perspective of four groups will be investigated, being the heads of both medical and nursing staff in these
units. All hospitals in Brussels-Capital Region (total sample) will be contacted for participation in the study. Data will be
obtained by means of semi-structured interviews, using a topic list developed on the basis of literature and discussion with
an emergency physician and a psychiatrist. The qualitative data will be analysed with the software NVivo. Results:
Currently, data collection is being prepared. We will present intake and referral procedures, bottlenecks in care provision
and barriers to quality care as perceived by the four groups included in the study. Conclusion: Findings will be discussed,
suggesting ways to improve the collaboration of emergency and psychiatry units in hospitals regarding the care of
persons who attempted suicide.
The study was commissioned and financed by Innoviris, the Brussels Institute for Research and Innovation.
Effect of Social Network Indicator on Bullied Experience and Mental Health among Junior High
School Students in Taiwan
Yu-Jung Lin1, Yi-Chen Chiang1,2, Wen-chi Wu3, Hao-Jan Yang1,2, Dai-Chan Lin1
School of Public Health, Chung Shan Medical University, Taiwan; 2Department of Family and Community Medicine,
Chung Shan Medical University Hospital, Tai-Chung, Taiwan; 3Department of Healing Science and Health Marketing,
School of Healthcare and Management, Kainan University, Taoyuan, Taiwan; jyjlove@gmail.com, jyjlove@gmail.com,
jyjlove@gmail.com, jyjlove@gmail.com, jyjlove@gmail.com
Bullying is a major public health problem that demands the concerted and coordinated time and attention of health-care
providers, policy-makers and families. Importantly, bullying has linked to many negative outcomes including impacts on
mental health, substance use, and suicide. Longitudinal study findings indicate that there is an increased risk of suicidal
ideation and (or) suicide attempts associated with bullying behaviors. Particularly, past studies have found that social
network indicator appears to be one of the strongest predictors of bullying. Thus, the purpose of this study was to realize
the rate of bullied behaviors among junior high school students in Taiwan and to determine which factors can improve
social network indicator; to investigate the effect of social network indicators between bullied experiences and mental
health.
1
Method
Data were obtained partly from the research plan: “The relationship of health and characters of Taiwan junior high school
students in School violence”. The sample involved 2, 474 seventh to ninth graders in northern, middle, southern and
eastern Taiwan via stratified, multistage, random cluster sampling. UCINET software was utilized to obtain the social
network indicators. Social network indicators were used in peer nomination (nominate up to three classmates) to classify
the numbers of indegree and outdegree. Bullied behaviors can be classified into three types as physical, verbal and
relation. Logistic regression models and Linear regression models were analyzed by SAS software and Structural
Equation Modeling was analyzed by LISREL software.
Results
The highest proportion of students with verbal bullied experience were observed during junior high school years. We
further found that lower indegree and higher outdegree were more likely to be bullied (physical/verbal/ relational). In
particular, indegree had a significant direct effect on depression, whereas outdegree had an indirect effect on depressive
symptoms which through the bullied experiences. Moreover, witty-response humor had indirect effect on depressed
through social network indicator and bullied experiences. Furthermore, peer-valued characteristics was a protective factor
against social network indicator.
Conclusion
Social network indicator were significantly associated with bullied experience and mental health. In particular, positive
humor style and peer-valued characteristics will improve social network indicator. Teachers and parents should recognize
the importance of school bullying prevention and consider teaching positive ways of humor performance and improving
personal peer-valued characteristics in every school period.
Predictive Value of eC-SSRS Assessments for Identifying Risk of Prospective Reports of Suicidal
Behavior During Clinical Research Participation
Michael Federico
ERT, inc.; mfederico@ert.com
Objective: Examine the ability of baseline electronic Columbia–Suicide Severity Rating Scale lifetime suicidal ideation and
behavior categories to predict prospective reports of suicidal behavior in psychiatric and non-psychiatric research
participants.
Design: Meta-analysis of 74,406 eC-SSRS assessments completed between September 2009 and December 2012.
Setting: Thirty-three clinical research studies that used the electronic Columbia–Suicide Severity Rating Scale to assess
suicidal ideation and behavior at baseline and prospectively during follow-up visits.
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Participants: Records from 6,760 patients with psychiatric disorders (opioid dependence, generalized anxiety, major
depressive, and posttraumatic stress disorders) and 2,077 nonpsychiatric disorder patients (chronic obstructive
pulmonary disease, epilepsy, fibromyalgia, human immunodeficiency virus, insomnia, multiple sclerosis, osteoarthritis,
pain/back pain, Parkinson’s disease,
restless leg syndrome) were analyzed.
Measurements: Electronic Columbia–Suicide Severity Rating Scale assessment of lifetime suicidal ideation (5 severity
levels) and suicidal behavior (4 types) at
baseline and prospectively reported suicidal behavior during study participation.
Results: Increasingly more severe lifetime suicidal ideation at baseline was associated with a progressively greater
likelihood of prospectively reported suicidal behavior during study participation. Intent to act on suicidal ideation was most
predictive of reports of suicidal behavior.
Reports of lifetime suicidal behaviors at baseline also predicted subsequent suicidal behavior, and multiple lifetime
behaviors monotonically increased prospective risk of suicidal behavior. Baseline suicidal ideation and behavior predicted
future suicidal behavior in both psychiatric and non-psychiatric trials.
Conclusions: Lifetime reports of suicidal ideation and/or behavior at baseline significantly increased risk of prospectively
reporting suicidal behavior during research trial participation in both psychiatric and nonpsychiatric patients. Lifetime
prevalence of suicidal ideation and behavior is higher among psychiatric
patients, but also presents a safety concern among nonpsychiatric patients when reported.
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PP19-1: Parallel Plenary: Bridging the Gap between Emergency
Department and Community by Psychosocial Assessments and
Interventions in the Care of Suicide Attempters [Plénière parallèle: Faire le
pont entre les services d'urgence et la communauté]
Bridging the Gap between Emergency Department and Community by Psychosocial Assessments
and Interventions in the Care of Suicide Attempters / [Faire le pont entre les services d'urgence et la
communauté]
Chair(s): Mitsuhiko Yamada (National Center of Neurology and Psychiatry, Japan)
A prior suicide attempt is the single most important risk factor for suicide in the general population (WHO World Suicide
Report, 2014). In addition, risk of suicide is greatly increased in the period after discharge from emergency department.
Although most suicidal patients are suffering from mental health problems, these patients often do not receive adequate
mental health-care management in their communities after discharge from emergency departments. Therefore,
emergency department visits for attempted suicide are increasingly recognized as opportunities for intervention to prevent
later suicides. The aim of this symposium is to discuss and understand appropriate psychosocial assessments and
effective interventions for suicide attempters in emergency departments with five distinguished investigators. 1) First, we
will share the importance of emergency departments. In this session, we will recognize the gap between emergency
department and community health services in the care of suicide attempters. 2) The next speaker will summarize the
psychosocial risks and protective factors for suicide attempters in emergency departments and community. 3) The third
speaker will discuss about the assertive outreach services after their discharge from emergency department to engage
the suicide attempters in after-treatment, based on the experiences of the AID study. 4) Then, the fourth speaker will
discuss about assertive case management based on psychiatric diagnoses, social risks, and needs of suicide attempters
who were admitted to emergency departments, based on the experiences of the ACTION-J study. 5) Then, the last
speaker will discuss about effective interventions for suicide attempters after discharge from emergency unit, based on
the results from a systematic review and meta-analysis of randomized controlled trials including the AID study and the
ACTION-J study. Finally, we will propose a model of possible collaboration between general hospitals and community
health services in the care of suicide attempters after discharge from emergency departments. The evidence-based
practice for suicide prevention is a crucial task. We hope that this symposium will help the audience to understand the
initial steps needed to bridge the gap between emergency department and community health services in the care of
suicide attempters.
Presentations of the Symposium
Psychosocial Risks and Protective Factors for Suicide Attempters in Emergency Department and
Community / [Facteurs psychosociaux de risque et de protection des personnes suicidaires au sein
des services d’urgence et dans la communauté]
Vita Poštuvan
Slovene Centre for Suicide Research, University of Primorska
Suicidal behaviors develop through complex processes in which psychological, social, neurobiological, and demographic
factors combine to place individuals at risk (Nock et al., 2013). Previous systematic reviews of psychological autopsy
studies revealed that more than 90% of the people who die by suicide have a diagnosable mental disorder at the time of
their death (Arsenault-Lapierre et al., 2004; Bertolote et al., 2004). On the other hand, recently it is reported that most of
the suicidal patients in emergency departments are also suffering from mental health problems. Mood disorders were the
most frequent psychiatric disorders among suicide attempters in the emergency department (Kawashima et al., 2014).
Therefore, a routine psychiatric evaluation would be recommended to determine whether the patient should be referred
for further treatment—for example, general practitioner, psychological therapy, or treatment for alcohol abuse. On the
other hand, a number of psychosocial risk factors have also been reported to be significantly associated with the risk of
suicide. They include family/romantic conflicts, bereavement, marital disruption, legal/disciplinary problems,
unemployment, lower socio-economic status, living alone, a recent migration, early parental deprivation, family history of
suicidal behavior and psychopathology, poor physical health including chronic pain and other stressful life events. Suicidal
behaviors most often are preceded by these stressful life events. It is important to know that psychiatric diagnosis and the
other psychosocial risk factors could have independent effects on suicide (Cheng et al., 2000). Whereas risk factors
increase the likelihood of suicidal behaviors, protective factors decrease their probability. Protective factors for suicide
including social or familial support have been less frequently examined than risk factors. Psychiatric evaluation and
appropriate psychosocial assessments of risk and protective factors are initial steps to bridge the gap between emergency
department and community health services in the care of suicide attempters.
Assertive Outreach Services after their Discharge from Emergency Department to Engage the
Suicide Attempters in After-Treatment / [Suivis proactifs après traitement à l’urgence pour tentative
de suicide]
Britt Reuter Morthorst, Jesper Krogh, Annette Erlangsen, Merete Nordentoft
Mental Health Centre Copenhagen, University of Copenhagen
Patients with suicidal behavior have been characterized as difficult to engage in after-treatment. Various trials of
interventions offering help after contact with emergency rooms have focused on treatment accessibility and adherence to
after-treatment, to optimize the treatment chain for suicide attempters. Recently, we have conducted a randomized
controlled trial, AID study, to assess whether an assertive outreach intervention after suicide attempt could reduce the
210
frequency of subsequent suicidal acts, compared with standard treatment. (Morthorst et al., 2012). The AID intervention
was provided as case management with crisis intervention and flexible, problem solving, assertive outreach through
motivational support and actively assisting patients to and from scheduled appointments, to improve compliance with
after-treatment. The intervention represented eight to 20 flexible outreach consultations performed by specialized nurses
(AID managers) over 6 months in addition to standard treatment. The first consultation was offered a few days after
discharge and focused on acute prevention strategies, such as developing a crisis intervention plan in case of relapse.
Subsequent consultations established a professional relationship, addressed problem-solving strategies, and undertook
specific actions. To ensure continuity, the same AID manager contacted the patient throughout the 6 months of the
intervention. Motivation towards after-treatment was stressed as a core feature and referral was organized. Consultations
were provided equally as home visits or meetings in cafes, as preferred, as well as meetings with healthcare, official, and
social services to accommodate individual needs. The AID manager was responsible for maintaining contact, but the
patient was asked to make contact between consultations if necessary. Telephone calls and text messages were
frequently used to strengthen the alliance. The manager offered mediating family consultations to adolescents and their
relatives, and suggested the involvement of social or professional networks irrespective of age. During relapse or stressful
life events, frequency of contact was intensified, including availability of contact out usual hours to prevent subsequent
suicidal behavior. If the patient had severe suicidal impulses, the manager asked him or her to take a prepaid taxi to the
psychiatric emergency room if all other items on the crisis intervention plan had failed in changing the impulses or
providing relief of psychic pain.
Assertive Case Management Based on Psychiatric Diagnoses, Social Risks, and Needs of Suicide
Attempters Who Were Admitted to Emergency Departments / [Gestion des cas proactive basé sur le
diagnostic psychiatrique, les facteurs de risque psychosociaux et les besoins des personnes
admises à l’urgences suite à une tentative de suicide]
Chiaki Kawanishi1, Yoshio Hirayasu2, Toru Aruga3, Mitsuhiko Yamada4
Health Management and Promotion Centre, Yokohama City University, 2Dpt. Psychiatry, Yokohama City University,
3
Dpt. Emergency Medicine, Showa University, 4National Center of Neurology and Psychiatry, Japan
Recently, we have conducted a multicenter, randomized controlled trial, ACTION-J, to investigate whether assertive and
continuous case management could reduce the incidence of repetition of suicide attempts in adults with mental health
problems who had attempted suicide, compared with enhanced usual care (Kawanishi et al., 2014). Although it was not
effective at reducing the incidence of repetition of suicide attempts in the long term, the results of our ad-hoc analyses
suggested that it was effective for up to 6 months. In this study, assertive case managements were provided based on the
psychiatric diagnoses, social risks, and needs of suicide attempters. Briefly, after suicide attempters were physically
stabilized and alert consciousness was confirmed, the patients received thorough psychosocial assessment, including
assessment of the social, psychological, and motivational factors specific to the self-harm event and an assessment of
mental health, social risks, and needs, as recommended by UK national clinical practice guidelines (British Psychological
Society and Royal College of Psychiatrists, 2004). Next, psychiatrists or other trained medical personnel gave the patients
semi-structured psychoeducation, as suggested by WHO (World Health Organization, 2002). In addition, these patients
were given an information pamphlet listing available social resources (health care-based and local government services)
every time they visited for periodic assessments. Then, assertive and continuous case management were provided by
dedicated case managers who were trained experts in mental health (psychiatrists, nurses, social workers, or clinical
psychologists). Encouragement to participate in psychiatric treatment was a core feature and appointments with
psychiatrists and primary care physicians were organized. To facilitate the case management, the psychoeducation was
also provided to participants’ family members during the participants’ initial stay in the hospital. The case managers
periodically contacted participants assigned to the intervention group for 18 months after randomisation (at week 1 and at
months 1, 2, 3, 6, 12, and 18) during their stay at the emergency department and after discharge. When applicable, the
case managers contacted the participants every 6 months until the end of the trial. In principle, case management was
accomplished through direct dialogue (face-to-face interviews by the case managers at the hospital), or by telephone
conversation as the next best option. Our results suggested that assertive case management is effective and feasible in
real-world clinical settings. Now, we are developing educational programs to implement and promote ACTION-J case
management.
1
Effective Interventions for Suicide Attempters after Discharge from Emergency Unit: A MetaAnalysis of Randomized Controlled Trials / [Interventions efficaces avec les personnes ayant fait
une tentative de suicide après leur sortie de l’urgence : une méta-analyse des essais cliniques
randomisés]
Mitsuhiko Yamada1, Masatoshi Inagaki2, Chiaki Kawanishi3, Yoshitaka Kawashima1, Katsumi Ikeshita4, Hirokazu
Tachikawa5, Naohiro Yonemoto1
1
National Center of Neurology and Psychiatry, Japan, 2Dpt. Neuropsychiatry, Okayama University Hospital, 3Health
Management and Promotion Centre, Yokohama City University, 4Dpt. Psychiatry, Nara Medical University, 5Dpt.
Psychiatry, University of Tsukuba
A huge number of patients with self-harm and suicide attempt visit to emergency departments (EDs). EDs are increasingly
recognized as an important setting for introducing suicide prevention measures, and studies have focused on developing
effective interventions for initiation during an ED stay for patients with attempted suicide. However, recently, inconsistent
results were reported between two randomized controlled trials examining the effectiveness of interventions in suicidal
patients admitted to the ED. Therefore, we systematically reviewed and performed meta-analyses of randomized
controlled trials and examined the effects of interventions initiated when suicidal patients were admitted to the ED. We
searched the databases of MEDLINE, PsychoINFO, CINAHL, and EMBASE through August 2013. Eligible studies were
randomized controlled trials assessing the effects on repeat suicidal behavior of interventions initiated in suicidal patients
211
admitted to EDs. Out of 5390 retrieved articles, 24 trials were included. Independent reviewers extracted data.
Interventions in each trial were classified into groups by consensus. Twenty-four trials were classified into four groups (11
active contact and follow-up including AID study, nine psychotherapy, one pharmacotherapy, and three miscellaneous).
Although caution is needed regarding the heterogeneity of the effects, the active contact and follow-up group at 12
months (nine trials, n=5319), but not at 24 months (two trials, n=925), was shown to be effective. Effectiveness of the
psychotherapy trials (two trials, n=559) at 12 months was not clear. In conclusion, interventions of active contact and
follow-up are recommended to reduce the risk of a repeat suicide attempt at 12 months in patients admitted to EDs with a
suicide attempt. However, the long-term effect was not confirmed. This finding obtained from the meta-analysis is
consistent with the result of a large sized well-organized multicenter trial, ACTION-J, demonstrating that assertive case
management is effective at reducing the incidence of repetition of suicide attempts for up to 6 months, but not in the long
term. These results suggest that the active contact and follow-up intervention needs to be taken over by community health
services or community mental health caregivers within 6–12 months, dependent on the availability of medical and social
resources in the community.
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PP19-2: Parallel Plenary: Methodological Developments for the Study of
Social Media, Self-Harm and Suicide [Plénière parallèle: Développements
méthodologiques pour l'étude des médias sociaux, de l'automutilation et
du suicide]
Methodological Developments for the Study of Social Media, Self-Harm and Suicide /
[Développements méthodologiques pour l'étude des médias sociaux, de l'automutilation et du
suicide]
Chair(s): Nina Jacob (Cardiff University, UK)
Social media is now a major site for research on suicide and self-harm. Methodology is rapidly advancing and the aim of
this symposium is to take stock of the research methods in this field, showcasing some cutting-edge studies and
considering where the emphasis of future studies should lie. It will be an inter-disciplinary symposium, featuring
psychology, sociology and computer science. Presenters are from the US, Canada and the UK. The emphasis of the
symposium will be on basic research to better understand the phenomenon of social media rather than intervention
research, although the latter will also feature to an extent. The methods used include qualitative and quantitative analysis
of both text and images, with some studies using linguistic and other software to allow for the analysis of large amounts of
data.
The examples of cutting-edge studies are as follows: real-time monitoring of Facebook, Twitter and Google+ content, with
user permission; the development of a classifier to automatically sort suicide-related Twitter and Tumblr postings into six
different categories of suicidal communication; comparison of social media and conventional news reporting of youth
suicides and further comparison with road traffic accidents in adolescents; analysis of suicidal Twitter users’ social
networks, via re-tweets and followers; use of Tumblr’s application programming interface to identify self-injury images,
combined with qualitative interviews with young people recruited via Facebook; examination of the role and potential
impact of YouTube self-injury videos.
Presentations of the Symposium
A Social and Computer Science Collaboration to Study Social Media and Youth Suicide / [Une
collaboration sciences sociales/informatique pour l’étude des médias sociaux et du suicide des
jeunes]
Jonathan Bryn Scourfield, Gualtiero Colombo, Pete Burnap, Adam Edwards, Rhiannon Evans, Andrei Hodorog,
William Housley, Nina Jacob, Matthew Williams
Cardiff University, UK
In recent years there has been considerable concern about the possible impact of social media communication on suicidal
behaviour. For example, the use of the social networking site Bebo was noted at the time of the 2008 suicide cluster in
Bridgend, UK, with particular concern being raised about the possible glorifying effect of RIP pages set up for the
deceased. There is relatively little research evidence to support or challenge this concern about the role of social media.
There may be an element of moral panic about the supposed dangers of communication technology or it may be that a
concentration of social media communication about a young death does indeed contribute to a process of making youth
suicide seem a less extreme option for troubled young people. Arguably, widely used social networking sites such as
Facebook and Twitter are more important media to study for the understanding of suicide ‘contagion’ than suicide-specific
websites. What research has been done on social media in relation to suicidality has tended to use relatively small
samples, rather than taking advantage of the very large data sets that are publicly available.
A collaboration between social and computer scientists at Cardiff University, UK, has set out to explore the potential of
computer programming and linguistic software to study the use of social media in connection with suicide. The study’s
research questions include: What kind of language is used in social media in relation to suicide? What social networks
can be identified via social media and which voices are influential? Is there any evidence of ‘contagion’ of suicidal intent?
Where teenage deaths – both suicides and road traffic accidents - have been reported, what is the frequency of social
media communication about these deaths? The study includes the following strands:
- Development of a classifier to identify six different categories of suicide-related communication in Twitter and Tumblr;
- Integration of this classifier into the Collaborative Online Social Media Observatory (COSMOS), an open-source platform
which harvests, archives, analyses and visualises data from a number of different Internet sources;
- Comparison of Facebook memorial sites for teenagers who have died through suicide and road traffic accidents;
- Comparison of the frequency of conventional news and Twitter reporting of teenage suicides and road traffic accidents;
- A study of the social networks of suicidal Twitter users, based on retweets and follower relationships;
- A study of the frequency and content of Twitter communication in relation to a high profile television soap opera suicide.
After an overview of the whole project, the presentation will focus in particular on the stages involved in developing a
classifier for suicide-relate communication.
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Realising the Potential of Social Media for Self-Harm Research / [Réaliser le plein potentiel des
médias sociaux pour la recherche sur les comportements d’automutilation et des tentatives de
suicide]
Nina Jacob
Cardiff University, UK
The opportunities that social media offer to research have unquestionably afforded new methodological directions to be
taken as well as opening up potential solutions to some old dilemmas of research. In the first instance, this discussion will
consider the role that social media can play in terms of recruitment to research studies. At the most straightforward level,
social media potentially enables the targeting of some hard to reach groups, in our case young people who self-harm who
are not in contact with professional services. In particular the global social media platform Facebook was used to target
and recruit participants geographically dispersed across the study region to take part in semi-structured interviews about
their online activities for self-harm purposes. A targeted advertisement was developed which was aimed at young people
aged between 16 and 25 living in Wales in the U.K. Specific activities were screened for, such as interest in a number of
Welsh-based services for young people, as well as local pages dedicated to improving emotional well-being and mental
health. The success of the campaign was striking with over 100 young people wanting to take part.
Young people’s use of the social media site Tumblr for self-harm purposes is widely reported in British press, and is
something that was confirmed through the qualitative interviews. Accordingly a content analysis of self-harm related
visual data uploaded to Tumblr was developed. Specifically the Tumblr application programming interface (API) was used
by a computer programmer to collect all uploads to Tumblr with the tag #self-harm over three 24 hour periods. The
method as well as the analyses of these data will be discussed.
Self-Injury on YouTube: Impact, Implications, and Opportunities / [Automutilation et tentatives de
suicide sur YouTube : Impact, implications et opportunités]
Stephen P. Lewis1, Nancy L. Heath2
University of Guelph, Canada, 2McGill University, Canada
Non-suicidal self-injury (NSSI) refers to purposeful destruction of one’s body tissue (e.g., cutting, burning) in the absence
of suicidal intent. Rates of NSSI among youth and emerging adults often range range from 14 to 28% and NSSI confers
risk for repeated NSSI, physical injuries, scarring, and mental health difficulties (e.g., anxiety, depression). Moreover,
NSSI may represent a unique risk factor for suicide. Unfortunately, many individuals who self-injure express reticence to
disclose their behavior to others or to seek help. A growing body of research suggests that the Internet may be a preferred
communication platform for many youth and emerging adults who engage in NSSI. Notwithstanding the salience of ecommunication for these individuals, online NSSI activities appear to represent a double-edged sword. Indeed, there may
be both benefits and risks associated with NSSI e-communication. This presentation will provide an overview of key
findings from a program of research examining the scope of NSSI e-communication. Focus will be attenuated to NSSI ecommunication on YouTube to illustrate key issues in the field, including: what is communicated about NSSI and how,
what motivates NSSI e-communication, and how individuals may be impacted by repeated NSSI e-communication. To this
end, results from a comprehensive content analysis of 100 popular NSSI videos on YouTube will be presented. This will
be followed by findings from a follow-up study in which the nature of over 800 viewer comments to these videos was
content analyzed. From here, the presentation will address how YouTube, and the Internet more broadly, can be used as
a means to: a) examine NSSI more generally, b) investigate the impact of NSSI e-communication, and c) provide needed
outreach and resources to those who struggle with NSSI and those can support them. The presentation will conclude with
a summary of implications for mental health professionals and other major stakeholders.
1
The Durkheim Project / [Le projet Durkheim]
Chris Poulin
Durkheim Project
The Durkheim Project was a successful DARPA (Defense Advanced Research Projects Agency) sponsored program that
recently established both validated risk metrics for suicidality, and a capability to scale to larger opt-in data networks (both
social and mobile). The various data and revised indicators are then fed into a predictive analytics environment, which will
eventually enable both accurate and timely interventions by clinicians.
The Durkheim Project consists of three distinct phases:
During phase 1, linguistics-driven prediction models were developed to estimate the risk of suicide. These models were
generated from unstructured clinical notes taken from a national sample of United States VA medical records. The
protocol for this study was approved by the Institutional Review Board (IRB) of the VA Medical Center, where the study
was conducted. We created three matched cohorts: veterans who completed suicide, veterans who used mental health
services and did not complete suicide, and veterans who did not use mental health services and did not complete suicide
during the observation period (eventual n = 70 in each group). From the clinical notes, we generated datasets of single
keywords, and multi-word phrases, and constructed prediction models using a supervised machine-learning algorithm
(Looks, 2006, 2007; Goertzel et al., 2013). The resulting inference accuracy was at first 65%, and then consistently 67%
or more. This data suggests that computerized text analytics can be applied to unstructured sections of medical records to
estimate the risk of suicide (Poulin et al. 2014).
While Opt-in data collection and analysis for our phase 2 is now underway. The phase 2 protocol for collecting and
analyzing opt-in social media postings and presenting predictions to clinicians via the Durkheim Project’s Clinicians’
dashboard was also approved by our IRB. When the system is fully operational (see Phase 3 below), a clinician will see
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predictive models of suicide risk for a patient constructed from the patient’s medical records and the patient’s opt-in social
media postings. Subjects are being recruited via targeted efforts. Subjects will be recruited through our collaboration with
Facebook (see PR Newswire 2013). A Facebook App window is being used to recruit people that Facebook has identified
as being military personnel or veterans. This system can collect data and provide risk scores for thousands of users, at
Internet scale.
Finally, for our phase 3, a new protocol has been completed and will soon be deployed. This protocol includes an unblinded, 3-cohort design, for a pilot program, which proposes to isolate serious suicide risks for individuals in real-time and
to develop a prediction triage model for improved suicide intervention.
The complete system described above potentially allowing clinicians to screen seemingly healthy patients at the primary
care level, and to continuously evaluate suicide risk among psychiatric patients.
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PP19-3: Parallel Plenary: Mapping an Agenda for Suicide Bereavement and
Postvention Research - Outcomes from the IASP SIG Taskforce on Suicide
Bereavement Research
Mapping an Agenda for Suicide Bereavement and Postvention Research - Outcomes from the IASP
SIG Taskforce on Suicide Bereavement Research
Chair(s): Myfanwy Maple (University of New England)
Suicide bereavement and postvention research has contributed to the understanding of suicide and suicidal behaviours
for over four decades, with the American suicidologist Edwin Shneidman coining the term ‘postvention’ in the late 1960’s
through detailing the importance of care for the bereaved in prevention in future generations. During the past decades
there has been growing activity in the bereavement and postvention field. Recent research publications continue to
demonstrate the need to better understand the needs of those bereaved, as well as those more distantly connected, how
best to support them, as well as the important interplay between being exposed to a suicide death and the increased risk
for suicidal behaviours in those affected.
Recent increase in interest in the field of postvention and suicide bereavement has resulted in increased research
outputs. It is therefore timely to: (1) analyze the research that has been published to date reporting on suicide
bereavement and postvention; (2) Examine the research questions currently being addressed in active research across
the globe; and, (3) propose a research agenda to encourage researchers to work toward answering the ‘big questions’ in
this field, to encourage collaboration (especially internationally) and to support research outputs.
This symposium will present the outcomes of the IASP SIG taskforce on mapping the suicide bereavement and
postvention research to date and suggest an agenda for research priorities into the future.
Presentations of the Symposium
A Tribute to Norman Farberow, a Founding Father of Suicidology and Postvention
Jean-Pierre Soubrier
Centre de Ressources en Suicidologie - CRES, Paris, France
‘A Tribute to Norman Farberow’ was shown in Los Angeles at the American Association of Suicidology AAS Conference in
April 2014 in his presence. This video is an exceptional, extraordinary document about the history of Suicidology and
Postvention. “It’s a remarkable collection of memories that I have about the development of our movement for the
acknowledgement, the recognition, and the reaction and response to Suicide in California, perhaps the United States, and
even worldwide…” (Dr Norman Farberow, Ph. D.)
As well, it evokes the origin and development of modern Suicide Prevention with the work of the Los Angeles Suicide
Prevention Center. The audience can understand why and how definitions of Suicidology and Postvention changed over
the time. It illustrates how Psychological Autopsy led to Postvention program through modern Suicide Prevention.
It contains the first days of the remarkable collaboration between Norman Farberow and Edwin Shneidman strengthened
later by Robert Litman. “The work of postvention, the work of really understanding began with this team, this incredible
team….” (Michael Pines, Ph. D.)
Norman Farberow has contributed deeply to the global expansion of IASP including the writing with the founding
President Erwin Ringel the first full constitution of the Association.
The first Norman Fareberow award for postvention was presented in 1997 in Adelaide (Australia) at the XIXth IASP
Congress to recognize advances in the field of postvention and continues to be awarded bi-annually at the international
IASP congress.
The video contains a selection of interviews, documents and pictures celebrating the magnificent career of Norman
Farberow, with narrative provided by Jean-Pierre Soubrier, IASP President 1995-1997
Taking Stock of Postvention Knowledge: A Systematic Review of the Literature on Suicide
Bereavement and Postvention
Karl Andriessen1, Julie Cerel2, Myfanwy Maple3, Angela Castelli4, Rebecca Sanford5, Tania Pearce6
university of New South Wales, 2university of Kentucky, 3university of New England, 4university of Applied Sciences and
Art Western Switzerland, 5University of Kentucky, USA, 6University of New England, Australia
During the past decades international research interest in the field of suicide bereavement and postvention (i.e., the
support offered to the survivors / people bereaved by suicide) has increased. In order to take stock of current knowledge
the Research Taskforce of the IASP SIG on Suicide Bereavement and Postvention is conducting a systematic review and
analysis of the published literature. The presentation will provide a critical overview of research findings regarding
characteristics of suicide bereavement, and support offered to people bereaved through suicide. The review will also
identify gaps in the knowledge, and provide clues for future research.
1
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Contributions and Limitations of Current Research in Suicide Bereavement and Postvention
Julie Cerel1, Myfanwy Maple2, Karl Andriessen3, Angela Castelli4
university of Kentucky, university of New England, 3university of New South Wales, 4university of Applied Sciences and
Art Western Switzerland
This presentation examines the limitations of the suicide bereavement knowledge base using a critical review of the
literature. Areas of strength, and limitations, will be examined. This is followed by a discussion of the need to define the
suicide bereaved population, as well as understand the effect of suicide bereavement.
1
2
Research Currently Underway across the Globe in Suicide Bereavement and Postvention
Angela Castelli1, Karl Andriessen2, Myfanwy Maple3, Julie Cerel4
university of Applied Sciences and Art Western Switzerland, 2university of New South Wales, 3university of New
England, 4university of Kentucky
This presentation will report results from a survey sent out through IASP and national suicide prevention associations to
members to understand what research is currently underway in the field of suicide bereavement and postvention.
Researchers were asked to broadly disclose what research questions they are currently working on answering, how they
are doing this, with which populations and when they hope to report on the outcomes. This survey was undertaken to
ensure that the research agenda prepared by the taskforce was able to take into consideration current research.
1
Research Agenda for Suicide Bereavement and Postvention for the Next Decade
Myfanwy Maple1, Karl Andriessen2, Julie Cerel3, Angela Castelli4
university of New England, 2university of New South Wales, 3university of Kentucky, 4university of Applied Sciences and
Art Western Switzerland
The IASP special interest group on suicide bereavement and postvention’s taskforce on research conducted a systematic
review of the literature, an assessment of qualities and limitations of current research, and a survey of IASP members and
beyond to map research currently underway. Based on the findings of these activities, the TF formulated a research
agenda for suicide bereavement and postvention for the next decade. This agenda takes into consideration what has
been done to date, the strengths and limitations of this work, the research currently underway, and the big questions that
require attention. This proposal of a research agenda will be further discussed with the members of the IASP SIG on
Suicide Bereavement and Postvention, and disseminated to the suicidology community at large.
1
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OP19-5B: Symposium: Post-Treatment Technology-Based Caring Contacts
for Suicide Prevention [Suivi post-tentative et prévention des récidives par
l'utilisation des nouvelles technologies d'intervention]
Post-Treatment Technology-Based Caring Contacts for Suicide Prevention / [Suivi post-tentative et
prévention des récidives par l'utilisation des nouvelles technologies d'intervention]
Chair(s): David D. Luxton (Naval Health research center & U. of Wash. school of medicine)
The time period following discharge from inpatient psychiatry and emergency department treatment is one of heightened
risk for repeat suicide attempts for patients. The majority of post-hospitalization re-attempts and suicides occur during the
first month after discharge with most occurring within a week after discharge (Luxton, June & Comtois, 2013). The caring
contact concept is a suicide prevention intervention that involves the sending of brief messages of care and concern to
patients at high risk for suicide following discharge from treatment.
This international symposium brings together researchers to present the underlying theory of caring contacts and data
regarding the effectiveness of brief contact interventions for reducing self-harm, suicide attempt and suicide. Findings
from a study (Chalker, Kerbrat & Comtois, in press) that examined the association between technology use, perceived
social connectedness, and severity of suicidal ideation and behavior are presented. Findings from a meta-analytic study
(Milner, Carter, Pirkis, Robinson, Spittal, in press) that included 12 randomized controlled trials of brief contact
interventions (telephone contacts; emergency or crisis cards; and postcard or letter contacts) are also discussed. The
methodology and preliminary findings from two multi-site randomized controlled trials of technology-based (email and
SMS texting) caring contact interventions that are being conducted at U.S. military and Veterans medical treatment
facilities are also presented. One of the studies (Luxton et al) is based on the original Motto (1976) caring letters study but
updates the intervention with emails. Primary outcomes of the trial are suicide mortality rates and re-hospitalization rates
for suicide attempts (to be determined 24 months post-discharge from index hospital stay). Time to self-directed violent
behavior is also measured, and additional data are being collected regarding psychosocial and other suicide risk
variables. The second study (Comtois et al) consists of two United States Marine Corps and one United States Army
installations. Usual care is compared to usual care plus caring text messages from a study clinician. The schedule of the
text messages closely replicates trials from Australia and Iran with additional text messages sent 1 day and 1 week after
baseline interview. Primary outcomes are at 12 months and include suicide attempts or interventions such as
hospitalization or medical evaluation to prevent suicide as well as suicidal ideation. Additional data is being collected
regarding thwarted belongingness, outpatient behavioral health service utilization, mental health symptoms, and
resilience.
The panel will also present recommendations for implementing caring contact interventions in diverse treatment settings.
These include clinical, safety, privacy, and legal issues associated with caring contacts interventions.
Presentations of the Symposium
Technology Use and Perceived Social Connectedness: Are We Really Connected, and Is There a
Connection? / [Utilisation de la technologie et perception des liens sociaux : sommes-nous
réellement branchés, et y a-t-il un une connexion?]
Samantha Chalker
Dept. Psychiatry, U. of Wash. School of medicine
In a growing age of technology, with suicide numbers remaining high, it’s possible that there may be a relation between
the two. With each younger generation growing up with more ready access to technology, it seems imperative to
understand their technology use and its impact. There is a dearth of research on personal technology use, and even less
on suicidal behavior in association with that usage. Current research regarding technology and suicide, which is often with
active duty military personnel and Veterans, is primarily limited to how to treat suicidal individuals with new technologies.
With many moving full speed ahead with technological interventions to treat suicidality, we decided in the current study to
take a step back and examine personal technology use and determine associations between technology use and
perceived social connectedness.
Using a cohort of active duty Soldiers and Marines (N=253) with a personal cell phone who were enrolled in a study due
to recent thoughts of suicide, we will also examine the relationships between technology usage, perceived social
connectedness, and severity of suicidal ideation and behavior.
In our predominately male sample (82.6%), with almost three-quarters (74.7%) being 28 years old or younger, we sought
to define the usage of various technology devices, particularly mobile phone use. Almost all (94.5%) of this suicidal
sample reported having a smart phone as their personal mobile phone, and two-thirds (63.9%) have had their personal
mobile numbers for over a year. Over 80% have their personal mobile phones on or near them (close enough to know if
they were receiving a call/text message) for 76% or more of an average day and 92.5% have an unlimited text message
plan for their personal mobile phones. Using their personal mobile phones, 80.5% reported making a call at least once a
day, and 71.5% sending and receiving email, though 60.7% did not use chat apps, e.g., Skype. 15.6% reported never
using a social networking site on their personal mobile phones, but 78.1% used a social networking site on some device.
For those that had been deployed to a war zone, almost three-quarters (73.8%) left their personal mobile phone at home
and instead used the web or email to stay connected when deployed. Per day, on average, 19.5% service members
received more texts than they sent, while 9.7% sent more texts than they received. For this presentation, we will present
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data on relationships between indices of social connectedness (e.g., Joiner’s Interpersonal Needs Questionnaire), social
usage of technology, and variations in suicidal ideation and behavior. Personal use of technology could be telling of a how
socially connected one is, and this social connectedness may be associated with suicidal behavior and we hope it could
promote future advances in the technology based interventions for suicidal individuals.
A Systematic and Meta-Analytic Review of Brief Contact Interventions for Reducing Self-Harm,
Suicide Attempts, and Suicide / [Méta-analyse et revue systématique des interventions brèves par
contact pour réduire l’automutilation, les tentatives de suicide et le suicide]
Gregory Carter
U. of Newcastle
There is growing interest in brief contact interventions for self-harm and suicide attempt. Thus far, the evidence has been
inconclusive about their effectiveness. The aim of this presentation is to present data regarding the evidence regarding
the effectiveness of brief contact interventions for reducing self-harm, suicide attempt and suicide. A systematic review
and meta-analyses were conducted of randomised controlled trials using brief contact interventions (telephone contacts;
emergency or crisis cards; and postcard or letter contacts). Random effects meta-analyses were conducted on eligible
studies providing information on: (1) the number of individuals with and without any subsequent episodes of self-harm or
suicide attempt; (2) the total number of repeated episodes of self-harm or suicide attempt; and (3) the number of
individuals who subsequently died by suicide. Several sensitivity analyses were conducted to examine study quality and
subgroup effects. The literature search yielded 14 eligible studies overall, of which 12 were used in meta-analyses. For
any subsequent episode of self-harm or suicide attempt, there was a non-significant reduction in the overall pooled odds
ratio of 0.87 (95% CI 0.74-1.04, p=0.119) for intervention compared to control. The number of repetitions per person was
significantly reduced in intervention versus control (IRR 0.66, 95% CI 0.54-0.80, p<0.001). There was no significant
reduction in the odds of suicide in intervention compared to control (OR 0.58, 95% CI 0.24-1.38). A non-significant
positive effect on repeated self-harm or suicide attempt and a significant effect on the number of episodes of repeated
self-harm or suicide per person (based on only three studies) means that brief contact interventions cannot yet be
recommended for widespread clinical implementation. We recommend further assessment of possible benefits in welldesigned trials in clinical populations.
Feasibility and Acceptability of Caring Contacts via Text: Increasing Connection with Marines and
Soldiers to Prevent Suicide Attempts and Ideation / [Faisabilité et acceptabilité des contacts aidants
par texto : Augmenter les liens avec les Marines et les soldats pour prévenir les tentatives de
suicide et les idéations suicidaires]
Katherine Anne Comtois
University of Washington School of Medicine
Increased suicidal behaviors and death by suicide among active duty Service Members have gained considerable
attention as active duty males now carry—for the first time in history—a risk of death by suicide that is greater than
comparable men in the general population. Furthermore, Service Members are at increased risk for suicide due to their
access to lethal means. In 2009, the majority (59%) of military suicides were by firearm. While there is access to
behavioral health services in the military, many Service Members choose not to use them or don’t find them helpful,
suggesting the need for innovative interventions to prevent suicide.
This study reports evidence for the feasibility and acceptability of an intervention to prevent suicidal ideation and attempts
in active duty Soldiers and Marines using caring contacts via text message (CCVT). “Caring contacts” (connecting via
non-demanding expressions of caring and concern) by letters, postcards, phone, and (in person) visits have been shown
to reduce suicide deaths, attempts, and/or ideation in previous clinical trials. This study extends this research to use the
technology of text messaging to connect with a young and transitory active duty population. CCVT are sent over the
course of one year to participants’ personal cell phones—following them to most deployments, transfers to other bases,
as well as to civilian life if retired, separated, or otherwise discharged from the military.
At the time of this submission, 269 Soldiers and Marines have enrolled in this clinical trial with half randomized to receive
CCVT for one year. As of March 2014, we had a total of 307 “texting months” (given the total number of months over
which 74 CCVT participants received texts). During that time, we received 75 replies to our texts. Two-thirds (61%) have
been positive (e.g., “feeling much better”), a quarter (23%) have been neutral (e.g., “Roger. Got it.”), and the remaining
16% have expressed distress of some sort (e.g., “not so great”). Only 2 texts indicated high risk, resulting in our team
responding immediately to the participant to assure he or she was connected to care. Installation leadership and clinicians
have been very positive about the study (with few exceptions, who are disinterested rather than negative) and feel that
texting adds to what they are doing. Operations leadership has been particularly supportive in the face of an ongoing
service-wide drawdown of military personnel, since the intervention stays connected with the Service Member after the
end of a military career (and for many, the end of access to military health services). In this presentation, we will also
update with new cases and add the results of our 12-month post-CCVT interviews with participants in which their
satisfaction with and opinions about CCVT are assessed, demonstrating that caring contacts via text are an acceptable
and feasible intervention and our study procedures are also feasible and acceptable.
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Caring Emails for Military Suicide Prevention: Preliminary Results and Recommendations /
[Courriels aidants pour la prévention du suicide chez les militaires : Résultats préliminaires et
recommandations]
David D. Luxton
Naval Health Research Center & U. of Wash. School of medicine
The caring letters concept is a suicide prevention intervention whereby brief messages of caring concern are sent to
patients following treatment discharge (Motto, 1976; Luxton, June & Comtois, 2013). Caring letters, or “caring contacts”, is
the only intervention shown to reduce suicide mortality rates in a randomized controlled trial (Luxton, June & Comtois,
2013). In the original Motto trial (1976), psychiatric inpatients were mailed brief caring letters following treatment discharge
for five years. Compared to a control group with no further contact, the “caring letters” group had a significantly lower
suicide rate for the first two years of the trial (Motto & Bostrom, 2001).
Given the elevated risk for suicide among post hospitalized psychiatric patients, including military Service members and
Veterans (Luxton, Trofimovich, Clark, 2013; Valenstein et al., 2009), it is vital to test interventions that can help prevent
suicide among these high risk groups. We are therefore conducting a five year randomized controlled trial (RCT) that aims
to test the benefits of caring contacts to help prevent suicide and self-directed violence among post-hospitalized U.S.
military personnel and veterans. The trial includes six psychiatric inpatient units at four US Military hospitals and two
Veteran’s hospitals. The trial is registered on the United States National Institutes of Health Clinical Trials Registry,
(ClinicalTrials.gov Identifier # NCT01473771) available online at: http://clinicaltrials.gov/show/NCT01473771.
The methodology of the trial is similar to the original Motto caring letter study; however, it updates the intervention by
using emailed letters. Participants randomized to the caring letters group are sent a total of 13 emails based on a predetermined schedule that begins when the participant is discharged from the inpatient psychiatry unit. The schedule of
email contacts replicates the first two years of the original Motto trial (monthly for four months, then every two months for
eight months, and then every three months). One additional email contact was added during the first week after hospital
discharge when suicide risk is expected to be the highest. Primary outcomes of the trial are suicide mortality rates and rehospitalization rates for suicide attempts (to be determined 24 months post-discharge from index hospital stay). Time to
self-directed violent behavior is also measured, and additional data are being collected regarding psychosocial and other
suicide risk variables.
The aims of this presentation are to report preliminary results from the in-progress trial that demonstrate how a caring
emails intervention is providing the benefit of reconnecting patients in potential crisis to care services. These findings,
along with the methodology, safety protocol, and recommendations for implementing caring contact interventions will be
presented.
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OP19-5C: Symposium: Living with a Suicidal Person: Support for Families
in Crisis [Vivre avec une personne suicidaire: soutien pour les familles en
crise]
Living with a Suicidal Person: Support for Families in Crisis / [Vivre avec une personne suicidaire:
soutien pour les familles en crise]
Chair(s): Xénia Halmov (CRISE, Université du Québec à Montréal)
There is little published literature addressing the impact of suicidal behavior and suicide attempts on families, nor on their
needs, and there are limited findings about how to best support family members living with a suicidal person. Policies and
training programs recommend that support should be provided to the family and next of kin, but very little is said about
how to help them deal with these situations. This symposium summarizes the present state of knowledge on the needs of
the families of suicidal persons and how to best help them, including several new empirical studies. Information will be
provided on coping strategies, protective factors and specific courses of action that can be taken to bring about more
effective support to families.These four presentations concur in recommending that health care workers should establish
communications with and within families as part of the safety net for the suicidal person, but also to provide them the
support they need, including the children and adolescents. The first presentation, “Support After a Suicide Attempt: What
Families Want,” presents research on the impact of a suicide attempt on family members and the different issues that
need to be considered. The needs of family members in these very stressful situations are addressed, especially in terms
of communication at different stages and various forms of support that can be provided.The second presentation,
``Families’ reaction to a family member’s mental distress and subsequent suicide``, discusses a lived experience
concerning mental illness and its impact on the family, especially when symptoms worsen and a hospitalisation occurs,
and the relationship between family members and health services. The family members’ perceptions of the mental health
services, the emotions they experience, from the first symptoms of mental illness they see in their loved one, to suicidal
behaviour, completed suicide and the aftermath, may provide healthcare workers an interesting and different insight on
family’s needs.
The third presentation, by Xenia Halmov, ``Coping strategies and psychosocial needs in adolescents and young adults
after a parent’s suicide attempt``, focuses on children in the family, adolescents and young adults, and what they
experience after their parent has attempted suicide: impact on them, various strategies used to cope with the situation,
and needs in terms of psychosocial support.
The last presentation, by Philippe Angers and Josianne Beaumont, ``Prendre soin de soi comme proche: des outils
concrets``, presents a practical tool, developed by Suicide-Action-Montreal to help family members and significant others
take care of their own needs, as sometimes it becomes very difficult for them to continue being helpful without becoming
exhausted and discouraged. They are reasons for living for the suicidal person, and are important links that keep the
person connected with life and health care services
Presentations of the Symposium
Support after a Suicide Attempt: What Families Want / [Besoins des familles en matière de soutien
après une tentative de suicide]
Annette Beautrais
University of Canterbury, New Zealand
There is little published literature addressing the impact of suicide attempts on families, or exploring needs that families
have for support after suicide attempts. There are limited findings about types of services to best support such families.
The following issues are relevant to consideration of families’ needs and will be discussed in this presentation:
- Most people who make serious suicide attempts have a mental illness. Professional treatment of this illness is the first
line of support for families.
- Recent changes in delivery of mental health care has seen care moved from being institutionally-based to having a
community and primary care focus. This trend has placed an increasing demand upon families for care and support of
people who make suicide attempts.
- Guidelines for assessment, treatment and management of those who make suicide attempts and present to Emergency
Departments recommend that all who present in this way should receive a suicide risk assessment and a psychiatric
assessment, and that a treatment and care plan, and a crisis plan, should be developed for each person before discharge.
These guidelines recommend that family and significant others be consulted for information in assessment of the patient,
and in developing treatment, care and crisis plans.
- Both suicide attempts and mental illness in a family member engender stress and distress in significant others. Having a
family member with mental illness also causes stress. Many of those who make serious suicide attempts will have a
mental illness and/or stressful life circumstances.
- Those who make suicide attempts may have estranged or difficult relationships with family members. They may also
have difficult behaviours. While most family members feel sympathetic towards the person who has attempted suicide,
some may feel angry and guilty; it may be helpful for professionals to acknowledge that such feelings are understandable.
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- Families of those who make suicide attempts need information, access to clinical guidance and advice, access to help in
crises, access to respite care, and emotional support. For some, counselling, and learning problem-solving or stress
management techniques may also be useful.
- Many families report difficulties in communicating with health care professionals. A particular issue relates to
information-sharing, privacy and confidentiality, with many families believing that they do not have access to information
they need to provide care and safety for a family member.
- Families of those who attempt suicide may derive some support from sharing their experiences in support groups with
others with similar experiences. There is a need to explore other sources of acceptable support for such families,
including various forms of support groups, educational programmes, telephone support, online internet support, and
emergency access cards for use in crises.
Families’ Reaction to a Family Member’s Mental Distress and Subsequent Suicide / [La réaction des
familles à la détresse psychologique et au suicide d’un membre de la famille]
Corinda Taylor
Life Matters Suicide Prevention Trust
The reaction of families when one of their members is affected by mental illness and suicidal behaviour is not a well
discussed topic. Shame and guilt are common and predominant responses following a suicide after a protracted period of
mental illness. Families often feel stigmatised and the silence that prevails is deafening.
Case presentation: A young man aged 18 presents with prodromal symptoms of aches, pains and unusual behaviour.
Gradually the situation deteriorates. The patient is taken to see a general practitioner who states that it is depression. The
situation worsens and the young man becomes paranoid, angry, and unmanageable with increased risk taking behaviour
all indicative of first episode psychosis. The patient is sectioned and involuntarily hospitalised with suicidal intention. The
family is not given any support or education relating to the young man’s condition and not informed of suicidal ideation.
The young man completes suicide within 1 year of contact with mental health services who specialises in early
intervention.
When mental illness strikes families often experience heartache and devastation likened to grief. Families are in shock,
confused, upset and distraught when a family member takes ill. Progression of mental illness is puzzling and unsettling.
Mental illness wreaks havoc on the entire family and many devoted families are left floundering on their own without
adequate support and education. Lack of sensitivity and compassion from health services are often cited by families and
add to their bewilderment.
Families often perceive, for right or wrong, that mental health clinicians have a cavalier attitude to the family’s
involvement. This does not help the relationship between families and the treating team. When a suicide then occurs
families often project their anger towards the team and/or psychiatrist, especially if the relationship with the family was
strained. This projected anger is a method of protecting them against grief after a completed suicide. These families who
then feel unsupported by clinicians are at risk of taking their own lives. Compassion, empathy and understanding from the
treating team can be a protective factor for the affected family. When a suicide happens, the immediate impact can be
anxiety-provoking and often life-changing for families. They often blame themselves and may experience acute stress.
Symptoms associated with post-traumatic stress are experienced after a traumatic event such as suicide and are
emotionally painful. Better support and education systems for families and inclusion in the treatment plan can aid families’
understanding and support recovery of the patient.
Les stratégies d’adaptation et besoins psychosociaux des adolescents et jeunes adultes vivant
avec un parent qui a fait une tentative de suicide / [Coping Strategies and Psychosocial Needs of
Adolescents and Young Adults Living with a Parent Who Has Attempted Suicide]
Xenia Halmov
Université du Québec à Montréal
Bien qu’il existe de nombreuses études sur l’association entre les tentatives de suicide des parents et le développement
de comportements suicidaires chez leurs enfants, il y en a peu sur la façon dont ces enfants font face à cette réalité et sur
comment les aider après qu’un parent ait tenté de s’enlever la vie. Nous présentons les résultats d’une étude exploratoire
qui visait à savoir comment les jeunes vivant avec un parent qui a fait une tentative de suicide percevaient la situation
prévalant dans leur famille, les impacts qu’a eus sur eux la tentative de suicide ainsi que la façon dont ils ont géré ces
impacts. Nous avons voulu également vérifier quel type de soutien psychosocial pouvait possiblement les aider. Nous
avons effectué des entrevues semi-structurées auprès de dix jeunes âgés entre 14 et 20 ans qui vivaient à temps plein ou
à temps partiel avec un parent ayant fait une tentative de suicide dans les deux années précédentes. La grande majorité
de ces jeunes était au courant de la tentative de suicide de leur parent. Lorsqu’ils ont appris cette nouvelle, ces jeunes ont
eu d’abord une réaction de choc et un grand sentiment d’insécurité, surtout quant au danger que leur parent récidive. Ils
avaient tendance à le surveiller pour le protéger et ils ont vécu beaucoup d’incompréhension face au fait qu’il ait tenté de
s’enlever la vie même s’il avait un enfant qui les aimait.
Comme stratégie d’adaptation positive, les jeunes ont largement utilisé le soutien social au plan émotif mais encore plus
au plan de l’accompagnement social en termes de distraction. Bien que tous les parents aient été hospitalisés à la suite
de leur tentative de suicide, la majorité des jeunes n’ont eu aucune offre de soutien professionnel et n’ont reçu aucun
soutien de ce type. Cependant, ils ont trouvé des moyens de combler plusieurs de leurs besoins. Parmi les besoins que
nous avons identifiés était le besoin de soutien informationnel. En effet, ces jeunes ne comprenaient pas que la détresse
puisse affecter une personne au point où elle pose un tel geste même si elle a des raisons de vivre aussi importantes que
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des enfants. Ils auraient voulu avoir de l’information sur l’état de leur parent dans les heures et les jours suivant la
tentative. Ils se demandaient ce qu’ils auraient pu faire pour aider leur parent, avant et après la tentative de suicide. De
plus, ils voulaient savoir comment aider leurs frères et sœurs, surtout les ainés de famille. Nous concluons qu’une aide
proactive devrait être offerte aux familles touchées par une tentative de suicide afin de favoriser la communication et le
retour du sentiment de sécurité parmi ses membres. Cette présentation vise à sensibiliser les intervenants qui œuvrent
auprès d’individus suicidaires à l’importance de prioriser une approche écosystémique et de considérer les besoins de
l’ensemble des membres de la famille d’une personne suicidaire. Elle vise aussi à apporter de l’information concrète sur
le point de vue et l’expérience des jeunes de ces quelques familles touchées par la tentative de suicide d’un parent.
Prendre soin de soi comme proche: des outils concrets / [Taking Care of Yourself as Kin: Some
Concrete Tools]
Philippe Angers, Josianne Beaumont
Suicide-Action-Montréal, intervenants, services aux proches
Le suicide constitue souvent l’aboutissement d’un processus de désintégration sociale qui coupe progressivement la
personne des liens qui la rattachent à la vie. Les études qui ont analysé les derniers mois de la vie de personnes qui se
sont suicidées montrent que le décès survient souvent dans une période où il y a perte de contact entre la personne et
son entourage.
Souvent, c’est la personne suicidaire elle-même qui s’isole, qui érige un mur entre elle et le monde. Elle souffre, se sent
incomprise, n’a pas envie de parler de sa détresse, de déranger les autres avec ça. La famille et les proches ne savent
pas trop comment agir, comment aller la rejoindre dans sa bulle de souffrance et lorsqu’ils tentent une approche, ils ne
sont pas toujours bien reçus. Après quelques temps, les plus optimistes se sentiront bien impuissants, la plupart seront
tout simplement découragés, excédés. Pour se protéger, l’entourage peut commencer à éviter la personne suicidaire ou
rompre les liens. C’est à ce moment que les passages à l’acte risquent davantage de survenir, la personne ayant épuisé
son réseau.
La famille et les proches sont pourtant de puissants facteurs de protection du suicide. Ils sont une source de soutien
important, mais aussi des intermédiaires souvent essentiels entre la personne suicidaire et les ressources du réseau de la
santé et des services sociaux. Par leur présence, ils procurent à la personne suicidaire des raisons de vivre donnant un
sens à leur existence et pouvant leur redonner goût à la vie. Bien que la détresse de la personne suicidaire soit au cœur
des préoccupations, les besoins des familles et des proches sont tout à fait légitimes et tout aussi importants.
Cette présentation sera l’occasion de présenter des moyens et outils concrets permettant aux proches de prendre aussi
d’eux dans la situation, en validant leurs limites et en les aidant à se réapproprier des choix afin de continuer à aider, sans
s’épuiser.
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OP19-5D: Symposium: Use of Health Services and Cost-Effectiveness of
Treatment for Patients with Suicidal Behaviour
Use of Health Services and Cost-Effectiveness of Treatment for Patients with Suicidal Behaviour
Chair(s): Egil Haga (University of Oslo), Lars Mehlum (University of Oslo)
Background: Patients with suicidal behaviour are potentially resource-demanding, receiving treatment and help from a
broad range of health services. The aim of cost-effectiveness studies is to evaluate whether the costs of a new treatment
are reasonable in relation to treatment effects. Given limited resources such studies are important for decision-makers
when making priorities with respect to implementation of new treatments.
Objectives: The main objective of this symposium is to present recent research concerning the use of health services by
patients with repeated self-harm, as well as existing and planned studies of cost-effectiveness of treatment for this patient
group.
Format: Four presentations with time for discussions, within a time-frame of 90 minutes.
Content/papers
•Tørmoen et al. Contact with child and adolescent psychiatric services among self-harming and suicidal adolescents in the
general population.
•Haga et al. The cost-effectiveness of Dialectical Behaviour Therapy vs Enhanced Usual Care in the treatment of
adolescents with deliberate self-harm
•Guimond et al. Cost Effectiveness Methodologies: Application to a Study of Dialectical Behaviour Therapy (DBT) versus
General Psychiatric Management (GPM)
•van Spijker et al. Reducing Suicidal Ideation: Cost-Effectiveness Analysis of a Randomized Controlled Trial of Unguided
Web-Based Self-help
Presentations of the Symposium
Contact with Child and Adolescent Psychiatric Services among Self-Harming and Suicidal
Adolescents in the General Population: A Cross Sectional Study
Anita J. Tørmoen, Ingeborg Rossow, Erlend Mork, Lars Mehlum
University of Oslo
Background: Studies have shown that adolescents with a history of both suicide attempts and non-suicidal self-harm
report more mental health problems and other psychosocial problems than adolescents who report only one or none of
these types of self-harm. The current study aimed to examine the use of child and adolescent psychiatric services by
adolescents with both suicide attempts and non-suicidal self-harm, compared to other adolescents, and to assess the
psychosocial variables that characterize adolescents with both suicide attempts and non-suicidal self-harm who report
contact.
Methods: Data on lifetime self-harm, contact with child and adolescent psychiatric services, and various psychosocial risk
factors were collected in a cross-sectional sample (response rate=92.7%) of 11,440 adolescents aged 14–17 years who
participated in a school survey in Oslo, Norway.
Results: Adolescents who reported any self-harm were more likely than other adolescents to have used child and
adolescent psychiatric services, with a particularly elevated likelihood among those with both suicide attempts and nonsuicidal self-harm (OR=9.3). This finding remained significant even when controlling for psychosocial variables. In
adolescents with both suicide attempts and non–suicidal self-harm, symptoms of depression, eating problems, and the
use of illicit drugs were associated with a higher likelihood of contact with child and adolescent psychiatric services,
whereas a non-Western immigrant background was associated with a lower likelihood.
Conclusions: In this study, adolescents who reported self-harm were significantly more likely than other adolescents to
have used child and adolescent psychiatric services, and adolescents who reported a history of both suicide attempts and
non-suicidal self-harm were more likely to have used such services, even after controlling for other psychosocial risk
factors. In this high-risk subsample, various psychosocial problems increased the probability of contact with child and
adolescent psychiatric services. Other studies have pointed out that adolescents contact with mental health services
increase with the severity of their suicidal behaviour (i.e. from less severe suicidal ideation to actually having a plan to
commit suicide) and found that most adolescent with severe suicidal behaviour actually are in contact with mental health
services before the onset of the behaviour. The present and other studies indicate that adolescents with self-harm
behaviour is a group of patients with extensive use of mental health services.
The Cost-Effectiveness of Dialectical Behaviour Therapy vs Enhanced Usual Care in the Treatment
of Adolescents with Deliberate Self-Harm
Egil Haga, Eline Aas, Berit Grøholt, Lars Mehlum
University of Oslo
Objective: The aim of the paper is to evaluate the cost-effectiveness of Dialectical Behaviour Therapy (DBT) for
adolescents compared to enhanced usual care (EUC).
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Method: In a randomized controlled study 77 patients were allocated to DBT (n = 39) and EUC (n = 38). The main
inclusion criteria were age (12-18 yrs), repeated deliberate self-harm (DSH) and at least three criteria of borderline
personality disorder (BPD). The patients received outpatient treatment, and they were assessed for a period of 19 weeks
from treatment start (intervention period) and at 71 weeks (follow-up). The primary outcome measures were deliberate
self-harm, suicidal ideation, depressive symptoms and use of emergency services. Data on use of resources (such as
outpatient treatment, inpatient treatment/hospitalizations, emergency department visits, general practitioners contacts)
were collected over the same periods. To evaluate cost-effectiveness incremental cost-effectiveness ratios (ICERs) will be
calculated and bootstrapping will be used to generate a distribution of means and standard deviations of the ICERs.
Results: During the intervention period DBT was superior to EUC in reducing self-harm, suicidal ideation and depressive
symptoms. At follow-up assessment, 71 weeks after treatment start, DBT had still a significantly larger reduction in selfharm, however, there were no between-group differences with respect to suicidal ideation and depressive symptoms. At
19 weeks DBT had significantly higher outpatient treatment costs, whereas EUC had significantly higher outpatient
treatment costs in the follow-up period, so that there was no significant difference with respect to outpatient treatment
costs for the entire period of 71 weeks. EUC had on average higher emergency treatment costs both at 19 weeks and 71
weeks, mainly due to two relatively long inpatient admissions. DBT had significantly higher total treatment costs at 19
weeks, however for the entire period of 71 weeks the difference in total treatment costs was not significant.
Conclusions: Our findings show that DBT and EUC incurred similar total treatment costs from treatment start to follow-up
(71 weeks). Cost-effectiveness will be discussed on the basis of the probability that the intervention is being cost-effective
given a certain threshold of willingness to pay for incremental effect.
Cost Effectiveness Methodologies: Application to a Study of Dialectical Behaviour Therapy (DBT)
versus General Psychiatric Management (GPM)
Tim Guimond, Shelley McMain, Paul Links, Michael Escobar
University of Toronto
Cost-effectiveness studies complement outcome studies by providing evidence about the relative costs of treatments
relative to their effects (or outcomes). This information is important for policy makers to guide funding of treatments, their
relative availability and potentially the order of access to treatments. Early cost-eff