Rozprawy doktorskie na temat „Suicidal thought”

The primary aim of this thesis is to analyze the consideration of suicide by modernity which imposes life as the most essential and unconditional affirmation and death as the absolute opposite of life. Herein, the mutual exclusiveness of life and death is considered under the guidance of Foucault&rsquo<br>s critique on modernity. Thus, the potential of suicide as a resistance to the primacy of life in modern times is discussed in a Foucauldian framework. From this point forth, with inspiration from existentialist thought, a hypothetical category of philosophical suicide is defined to emphasize a peculiar form which has a more radical potential to resist the pre-given and unconditional affirmation of life than any other form of suicide. Within this framework, the peculiarity of this hypothetical category of philosophical suicide is discussed by focusing on its radical potential to resist the mode of existence dictated by modernity.

Background: The effects of physical illness and psychiatric disorders have been extensively investigated in fatal and non-fatal suicidal behaviour. Although different study designs have focused on the independent roles of physical and mental illness in suicidality, few studies have examined the relationship between co-occurring physical and mental health conditions (multimorbidity) and suicide risk. Considering the paucity of research, the present doctoral programme of research aimed to investigate if populations with physical/mental multimorbidity have an increased risk of suicidal thoughts and behaviours, compared to those with neither physical nor mental health conditions, and further investigate if this effect is stronger than either of the health conditions alone. Methods: Based on the well-established terms of comorbidity and multimorbidity, the effect of co-occurring health conditions in the risk of suicidality was investigated by undertaking an overview of reviews and a systematic review. Four empirical studies of existing datasets were conducted in order to explore if suicidality (suicidal thoughts and suicide attempts) varies as a function of physical/mental multimorbidity. Two national mental health surveys from the United Kingdom (National Psychiatric Morbidity Survey 2000, n = 8575; Adult Psychiatric Morbidity Survey 2007, n = 7389) and one cohort study carried out in Scotland (West of Scotland Twenty-07 study, n = 4510) were used and both cross-sectional and prospective study designs were employed. Results: Findings indicated that those with physical/mental multimorbidity are more likely to have suicidal thoughts and attempt suicide, compared to those with neither physical nor mental health conditions. The results were consistent: having both physical and mental health conditions did not increase risk of suicidal thoughts or attempts, beyond the risk conferred by mental illness alone. Having only physical health conditions was not associated with either suicidal thoughts or suicide attempts. Conclusions: Overall, the findings suggest a potential risk of suicidality for populations with physical/mental multimorbidity. Although multimorbidity was a predictor of suicidality, it did not increase the risk of any suicide-related outcome more than mental health conditions alone. The current findings highlight that health care professionals should focus on populations who have reached services for non-mental health issues, but subsequently develop mental illness, as this pattern of multimorbidity could potentially be a risk factor for suicidal thoughts and behaviours. Further research is needed to better understand the risk of suicide in individuals with physical/mental multimorbidity.

This research project demonstrates the importance of the use of Cognitive Behavioral Therapy for Post-Traumatic Stress Disorder and its relationship to the frequency of suicidal thoughts in veterans through the use of the positivist paradigm. The correlation that was found showing that Cognitive Behavioral Therapy does reduce the frequency of suicide ideation through the collection of quantitative data, and the understanding of Cognitive Learning Theory it is this study offers clinicians another tool to combat suicide in veterans.

Objective: The relationship between alcohol use and suicidal behaviors is well-accepted, but less is known about the contribution of its early initiation. This study was designed to test the association of early alcohol initiation versus later initiation with suicidal ideation and attempt in an ethnically diverse sample. Methods: The Collaborative Psychiatric Epidemiology Surveys (CPES), 2001-2003 (n = 20,013), database was used. A total of 13,867 participants were selected included 56.9% females and 43.1% males. Race and ethnicity were reported as 28.8% non-Hispanic White, 39.1% Black, 20.3% Latino, and 11.9% Asian. Logistic regression analyses tested the associations between early (< =14 years) and later (> =15) age alcohol initiation with suicide ideation and attempts. Alcohol initiation was indexed by self-report of the first time that any alcohol product was consumed. Potential confounders were controlled. Results: Early alcohol initiation was associated with higher odds (AOR = 3.64, 95% CI [2.51, 5.28]) of suicide ideation as compared with adults who had initiated > = age 15 (AOR = 2.11, 95% CI [1.46, 3.04]). Early age initiation was also associated with higher odds (AOR = 3.81, 95% CI [2.02, 7.18]) of lifetime suicide attempt versus later age initiators (AOR = 2.03, 95% CI [1.08, 3.79]). Significant differences were found between early and later age of initiation. Conclusion: Early age of alcohol initiation has profoundly increased odds of suicide ideation or attempt. It is critical that effective prevention programs for children and their caregivers be implemented to prevent or delay alcohol initiation and lessen the risk for future suicidal behaviors.

The purpose of this investigation was to examine the role of distress tolerance in suicidality among Black college students. It was hypothesized that (1) individuals with low levels of distress tolerance would report higher levels of suicide ideation; (2) individuals with high levels of distress tolerance would report greater suicide attempts; (3) social support would moderate the relationship between distress tolerance and suicide ideation; (4) social support would moderate the relationship between distress tolerance and suicide attempts; and that (5) family and peer support would act as distinct buffers against suicidality. These hypotheses were tested by surveying 47 undergraduate university students (female = 49%; mean age = 22.45). Participants completed packets with self-report measures that included: the Self-Harm Behavior Questionnaire, the Distress Tolerance Scale, the Child and Adolescent Social Support, and demographics. Results suggested that individuals with low levels of distress tolerance showed greater history of self-harm behavior when compared to individuals with high levels of distress tolerance. Results indicated that social support moderated the relationship between distress tolerance level and history of self-harm behaviors. Results also indicated that family support acted as significant protective factor against suicidality.

El objetivo general de esta tesis es estudiar la frecuencia (prevalencia, incidencia y persistencia) de los pensamientos y conductas suicidas entre los universitarios españoles, así como aportar evidencia sobre su asociación con una amplia gama de factores de riesgo y protección. Presentamos los resultados de las encuestas en línea basal (T1) y de seguimiento 12 meses (T2) del proyecto de investigación UNIVERSAL “Universidad y Salud Mental”, del que se han analizado 2.118 estudiantes de primer año de 5 universidades españolas. La prevalencia a los 12 meses es del 9,9% para idea suicida, 5,6% plan y 0,6% intento. La incidencia a los 12 meses de idea suicida por primera vez en la vida es del 3,2%; y la persistencia del 21,2% de los casos con ideas suicidas previas. El principal factor asociado con la idea suicida es la presencia de un posible trastorno del estado de ánimo los últimos 12 meses, junto con: psicopatología de los padres, haber sufrido maltrato emocional o negligencia en la infancia o sufrir una agresión sexual o violación. Las relaciones positivas en la infancia y el sentido de pertenencia a la universidad se asociaron con una menor presencia de idea suicida. Los resultados de esta tesis señalan una elevada prevalencia e incidencia de pensamientos y conductas suicidas en universitarios de primer año en España. Estos resultados sugieren la necesidad de llevar a cabo estrategias de motorización y prevención dirigidas a tanto a los estudiantes con posibles trastornos del estado de ánimo como al conjunto de la población de universitarios de primer año.<br>The main objective of this thesis is to assess the frequency (prevalence, incidence and persistence) of suicidal thoughts and behaviors among Spanish university students, as well as to provide evidence about their association with a wide range of risk and protective factors. Baseline (T1) and 12-month follow-up (T2) online surveys data from the UNIVERSAL research project "University and Mental Health" were used for this thesis. A total of 2,118 first-year students from 5 Spanish universities were analyzed. Prevalence at 12 months is 9.9% for suicidal ideation, 5.6% for plan and 0.6% for attempt. 12-month first-onset incidence is 3.2%; and persistence of suicidal ideation among those with previous suicidal ideation is 21.2%. The main factor associated with suicidal ideation is presence of a possible mood disorder in the previous 12 months, along with: parents’ psychopathology, having suffered emotional abuse or neglect in childhood, or suffering a sexual assault or rape. Positive childhood relationships and a higher sense of university membership are associated with a lower likelihood of suicidal ideation. Results from this thesis show that there is a high prevalence and incidence of suicidal thoughts and behaviors among first-year Spanish university students. These results suggest to the need to carry out motorization and prevention strategies focused on students with mood disorders as well as on the entire population of first-year university students

Introduction. Recent studies have suggested a secular increase in the prevalence of self-harm, suicidal ideation and depression in young people. This study aims to report the changes in prevalence of psychological disturbance over time in a clinic population. Method: Data on the prevalence of psychological symptoms was measured by the Youth Self-Report (YSR) and Child Behaviour Checklist (CBCL), in a 21-year clinic cohort of adolescents aged from 12 to 17. This data was analysed to investigate secular changes and predictors of disorder. Results: Significant secular increases were demonstrated in parent reports of self-harm and suicidal ideation, of 5percent and 4percent per cohort year respectively, but there was no significant change in the anxious/depressed sub-scale. There were no changes demonstrated in self-reports of self-harm, suicidal ideation or anxiety/depression. Self-harm and suicidal ideation, both parent reported and self-reported, significantly increased with increasing age, female gender, drug use, anxiety/depression and other clinically significant scores on the YSR and CBCL sub-scales. The YSR was a more accurate predictor of both self-harm and suicidal ideation than the CBCL. Conclusions: The results of this study suggest that there has not been a significant increase in psychological disorder in this population. There was, however, an apparent increase due to increasing parental awareness of some symptoms, particularly self-harm and suicidal ideation. While parents have a higher rate of reporting disorder, young people's self-reports remain a more accurate predictor of specific symptoms, including self-harm and suicidal ideation.

The primary interest of this investigation concerned the self-injurious thoughts and behaviors (SITBs) of inpatient adolescents. Previous researchers have provided descriptive information regarding either automatic (or intrinsic) and social components using the Self-Injurious Thoughts and Behaviors Interview (SITBI). However, the presence and trends of these components have not firmly been established, suggesting the need to explore this area further. Eighty-two adolescent inpatients were selected and interviewed using the SITBI to evaluate the predictive ability of self-reported self-injurious behavior with regard to social and automatic, negative and positive functions. Results showed that depending on the type of thought or behavior displayed one could discern the motivation behind their actions. Automatic-Negative was seen to have the strongest relationship across all SITB behaviors while Automatic-Negative was not found to be relatively low compared to other SITB behaviors. Both Social-Positive and Social-Negative were found to be present in moderate relationships compared to Automatic in general.

This thesis explores the origin and expression of dialectical thought in the life and writings of the American modernist Laura Riding. Within a biographical framework, I trace the steps by which it became the defining characteristic of her poetic, literary and critical works. A few have noted Riding's dialectical manner; none have appreciated its centrality. This is the first detailed study. An introductory outline of the origin and definition of dialectic provides a working theoretical context for the study that follows. Riding was born Laura Reichenthal in New York City, 1901. Her father, a Jewish émigré, was a committed activist for the left and included Riding in his campaigning at a very young age, immersing and educating her in the political and philosophical radicalism thriving in New York's Jewish communities of the era. There she internalised the revolutionary dialectics that would inform her aesthetic practice. Breaking with her father in her teens, she abandoned politics for literature. As Laura Riding - the name she adopted in 1927 and with which her literary writings continue to be associated - she moved to London and began collaborating with Robert Graves, relocating with him to Majorca in 1929. Producing poetry, fiction, criticism and experimental philosophico-literary works, she became a formidable presence within European literary modernism. Many aspects of her work are dialectical. Paradox, inversion and negation are perennial textual features. Key events in her life were also experienced as dialectical. Her insistence upon 'death' as an inverted sigil of unmediated vitality points toward a negatively dialectical mode of thought. In this regard, the theories of Theodor W. Adorno prove invaluable. Adorno provides a unique lexicon of terms - 'constitutive subjectivity', 'administered world', 'true object' - with which to draw out Riding's dialectical subtleties. Reading them alongside Adorno's negatively dialectical theory of modernist art and aesthetic praxis, certain aspects of Riding's writings are illuminated and, in some respects, they correspond. After a suicide attempt in 1929, Riding's perspective changed. Before it, her point of view was positioned within institutionally determined 'reality', and 'truth' beyond it was adumbrated by dialectical means. Afterwards, she believed herself transfigured: the embodiment of immediate, consciously apprehended noumenal objectivity. But the written word remained recalcitrant toward her attempts to inscribe this newfound positive 'truth'. This frustration contributed to her abandonment of poetry at the end of the 1930s. Re-emerging in the 1960s as Laura (Riding) Jackson, her disavowal of poetry and exploration of 'truth-potential' in language utilised dialectical approaches derived from her earlier experiences and writings.

De quelle manière le travail influence-t-il la suicidalité des individus ? La littérature cherche à répondre à cette question en explorant les traits de personnalité, en mesurant l’impact des stresseurs professionnels, ou encore en investiguant l’effet déclencheur des événements de leur vie personnelle. La part relative de ces facteurs n’est que rarement identifiée. La plupart de ces études sont athéoriques et de nature transversale, ce qui ne permet pas d’établir des liens de causalité, ou de saisir la dynamique temporelle des processus. La présente thèse vise à identifier la part des différents facteurs de risque : stresseurs professionnels, burnout, événements de vie négatifs hors-travail et facteurs de personnalité, séparément et conjointement, pour mesurer leur effet respectif sur les idéations suicidaires d’un groupe professionnel, celui des vétérinaires français. Une méthodologie exploratoire a été utilisée. Nous avons tout d’abord mené une pré-enquête qualitative par entretiens auprès de 39 vétérinaires français dans le but d’identifier les stresseurs et les ressources de leur pratique, de questionner leur état de santé perçu, ainsi que leur suicidalité. Puis nous avons réalisé une étude quantitative longitudinale de 33 mois en trois temps de collecte par auto-questionnaire. Celle-ci avait pour premier objectif de mesurer les stresseurs perçus par les vétérinaires (Vet-SQ), le burnout (MBI-GS), les facteurs de personnalité (addiction au travail et évaluations fondamentales de soi) et les événements de vie rencontrés en dehors du travail. Le second objectif consistait à mesurer l’impact respectif et conjoint de ces différentes variables sur les idéations suicidaires transversales et longitudinales des vétérinaires. Deux théories psychosociales du suicide, la théorie Défaite-Piège, et la Théorie Interpersonnelle du Suicide ont également été mobilisées pour tester leur pouvoir prédicteur sur les idéations suicidaires au travail. Les résultats montrent que les vétérinaires sont particulièrement vulnérables aux idéations suicidaires. Les analyses factorielles révèlent 8 stresseurs professionnels : la surcharge de travail, l’exposition à la négligence des propriétaires, les exigences émotionnelles de la profession, les inquiétudes financières, les conflits entre collègues, la peur des erreurs professionnelles, la peur d’être blessé au travail, et le fait d’avoir un travail morcelé. Ces stresseurs prédisent 14 % de la variance des idéations suicidaires concomitantes des vétérinaires (n = 3324), et 10 % de leurs idéations suicidaires à 33 mois (n = 289). Le burnout médiatise partiellement l’effet des stresseurs professionnels sur les idéations suicidaires. Les théories du suicide expliquent conjointement 31 % de la variance des idéations suicidaires ultérieures. L’effet de la crainte de commettre des erreurs médicales engendre chez les vétérinaires des sentiments de défaite, de piège, de fardeau et d'appartenance contrariée, expliquant l’apparition d’idéations suicidaires ultérieures. Les événements de vie négatifs hors du travail ont également un effet significatif sur les idéations suicidaires concomitantes et à distance dans le temps. L’analyse du rapport au travail des vétérinaires a permis d’identifier des profils d’addiction associés aux idéations suicidaires, les travailleurs workaholiques étant les plus affectés. Les évaluations fondamentales de soi prédisent également les idéations suicidaires à T1 et à T3. L’étude de l’effet conjoint des variables sur les idéations suicidaires à distance montre un effet prépondérant des évaluations fondamentales. Ces résultats conduisent à redéfinir la place des évaluations fondamentales de soi, qui témoignent d’une image de soi impactée par l’effet des stresseurs du travail, à l’origine d’idéations suicidaires ultérieures. L’ensemble de ces processus permet donc de mieux appréhender l’effet des variables liées au travail sur les idéations suicidaires des vétérinaires<br>Abstract : How does work influence individuals' suicidality? Literature typically seeks to answer this question by exploring personality traits, by measuring the impact of occupational stressors, or investigating the triggering effects of personal life events. However, the relative contribution of these factors is rarely identified. Most of the studies are atheoretical and cross-sectional, which limits the comprehension of causal links and fails to capture the temporal dynamics of these processes.Considering this context, we designed the present thesis to identify the contribution of various risk factors: occupational stressors, burnout, negative life events, and personality traits, both separately and jointly, to measure their respective effects on the suicidal ideations of a professional group - namely, French veterinarians.An exploratory methodology was employed. First, we conducted a preliminary qualitative study through interviews with 39 French veterinarians, to identify the stressors and resources of their practice, assess their perceived health, and inquire about their suicidality. Subsequently, we carried out a longitudinal quantitative study over 33 months, comprising three data collection stages by online self-questionnaires. The first objective was to measure the stressors perceived by veterinarians (Vet-SQ), burnout (MBI-GS), personality factors (work addiction and core self-evaluations), and negative life events. The second objective was to measure the respective and joint impacts of these variables on the veterinarians' cross-sectional and longitudinal suicidal ideations. Two psychosocial theories of suicide, the Defeat-Entrapment Theory and the Interpersonal Theory of Suicide, were also chosen to test their predictive power on suicidal ideations at work.Consistent with the literature, the results indicate that veterinarians are particularly affected by suicidal ideations. Factorial analyses revealed eight occupational stressors: workload and its effect on work-life imbalance, exposure to neglect and abuse from animal owners, emotional demands of the profession, financial worries, colleague conflicts, fear of making professional mistakes, fear of being harmed at work, and experiencing fragmented work.These stressors, particularly perceived workload overload and fear of professional mistakes, account for 14% of the variance in concurrent suicidal ideations among veterinarians (n = 3,324) and 10% of their suicidal ideations at 33 months (n = 289). Burnout (emotional exhaustion and cynicism) partially mediates the effect of occupational stressors on suicidal ideations, highlighting one of the processes by which work stress contributes to their suicidality.The suicide theories jointly explain 31% of the variance in subsequent suicidal ideations. The fear of making medical errors leads veterinarians to experience feelings of defeat, entrapment, burdensomeness, and thwarted belongingness, which chronologically explains the emergence of subsequent suicidal ideations.Negative life events (changes in mental health status, conflicts and relationship breakups, and threatened physical integrity) also have a significant effect on both concurrent and distant suicidal ideations (33 months).Veterinarians' relationship to work revealed profiles of work addiction, which are linked to their suicidal ideations, with workaholics’ veterinarians being the most affected. Core self-evaluations also predict suicidal ideations at T1 and T3.The study of the joint effect of all variables on distant suicidal ideations reveals a predominant effect of fundamental self-evaluations. These results necessitate a redefinition of the role of these self-evaluations, which reflect a self-image impacted by the effects of workplace stressors, leading to subsequent suicidal ideations.Overall, these processes contribute to a better understanding of the impact of work-related stressors on veterinarians' suicidal ideations

Syftet med denna uppsats var att ta reda på vilka arbetssätt och bemötande professionella använder gentemot klienter med självmordstankar. Uppsatsen bygger på en kvalitativ intervjustudie där fem professionella som i sitt arbete möter klienter med självmordstankar varit delaktiga. Resultat visade att professionella använder sig av kartläggande samtal, bedömningsformulär, samtal och uppföljning i arbetet med dessa klienter. De professionella uppgav att det viktigaste i bemötandet är att lyssna, våga fråga, låta klienten berätta och visa att man finns där för klienten. Resultatet förväntades bidra till ökad kunskap om arbetssätt och bemötande gentemot klienter med självmordstankar för oss socialarbetare. Detta för att vi upplevde att vi saknade specifik utbildning i ämnet inom socionomutbildningen.<br>The aim of this study was to investigate the existing types of working methods and approaches used by professionals on clients with suicidal thoughts. Through interviews with five professionals who meet clients with suicidal thoughts, data were collected for a qualitative study. The result suggested that the working methods used by these professionals are mapping based on therapy talk, evaluation forms, talks and follow-ups. The professionals treat their clients by listening, having the courage to ask questions about suicide, to allow the client to narrate their story and to be there for the client. The results are expected to contribute to increasing our knowledge as social workers on working methods and approaches towards clients with suicidal thoughts. Our choice was based on the lack of specific training on that field within the study program in social work.

The paper explores historical positions on suicide and philosophical, theological, and moral positions on physician-assisted suicide and euthanasia. In 1900, most people died from infectious diseases, which have relatively short periods of morbid decline. With advances in the biomedical sciences, people are living longer, and most people die from chronic diseases, which are usually accompanied by prolonged periods of morbid decline. In addition to living longer, people today are generally more individualist and seek methods to control many aspects of life. While assisted death is rarely used, it represents a means to control end-of-life suffering. The paper demonstrates that there is substantial opposition to assisted death among philosophers, theologians and bioethicists. The paper also argues that improved education about end-of-life palliative alternatives would alleviate fears about end-of-life suffering. The thesis is that the use of palliative alternatives is morally and ethically superior to physician-assisted suicide or euthanasia.

"Genuine Cherry Red" is a fiction novel. It is the story of three people who live in a house beside a hill in the flattest place on earth - an almost fable-like setting. In different ways, each is locked inside the order and control they have constructed through the years. Surrounded by nature and its reliable cycle, they are resisting change and denying the unpredictable randomness of life. Marta is a young woman who is both intelligent and naïve, caught inside a private maze of thinking and rethinking. She lives with her mother's cousin Ena who gave up nursing to take Marta in when her mother succumbed to depression, and Ena' s husband Len, a successful and prolific writer of cowboy fiction. Since a cancer diagnosis, Len - who had been living with multiple sclerosis - has been virtually catatonic ... until Grey Bob suddenly arrives. The central character of Len's fictional stories permeates their lives and things begin to change. The natural environment, the people of the nearby town, the order of the house all transform and Marta, Ena and Len struggle to cope. But they have no choice. When the inevitable shifts occur, spontaneous events have impact and disease progresses, each member of the family eventually finds a way to deal with the fact that reality can be haphazard and out of their control. So, through the presence of a fictional character, three people are forced to confront the erratic nature of human life.

Research Doctorate - Doctor of Philosophy (PhD)<br>This thesis explores determinants and moderators of suicidal ideation in Australia in three higher-risk populations: rural and remote residents, older adults, and people with co-occurring depression and substance misuse. It consists of an Introduction, nine papers and a final chapter providing a synthesis of the results and conclusion. At the time of submission, seven of the nine papers have been accepted for publication in peer reviewed journals, with two currently submitted for peer review. The Introduction provides an overview of suicidal thoughts and behaviours in Australia, summarising the current body of literature and drawing particular attention to higher-risk groups, established risk factors, and current treatments. Limitations in existing research are summarised in Paper 1 (“Urban-rural influences on suicidality: Gaps in the existing literature and recommendations for future research”). This section leads into a justification for the aims of this thesis and an outline of how they will be addressed. Chapter 2, Paper 2 (“Contributors to suicidality in rural communities: Beyond the effects of depression”) explores the extent of the relationship between depression and suicidal thoughts and behaviours in rural areas, determining that although these concepts are highly related, they remain independent. The discussion of this Chapter emphasises the variance in suicidal ideation not accounted for by depression, indicating the potential for other factors to contribute. This information is used to direct the analyses in Chapter 3. Chapter 3 explores the long-term risk factors for suicidal ideation within each of the key groups of rural residents, older adults, and people with a mental illness. Informed by Chapter 2, the papers presented in Chapter 3 incorporate a focus on social as well as psychiatric factors, while aiming to address the identified lack of longitudinal research investigating suicidal ideation. Longitudinal associations with suicidal ideation are explored in rural residents in Paper 3 (“You’ve got to have friends: The predictive value of social integration and support in suicidal ideation among rural communities”) and Paper 4 (“Longitudinal course and predictors of suicidal ideation in a rural community sample”); in older adults in Paper 5 ("Predictors of suicidal ideation in older people. A decision-tree analysis"); and in people with comorbid mental illness and substance use problems in Paper 6 (“Longitudinal risk profiles for suicidal ideation in comorbid depression and substance misuse”). Finally, Chapter 4 evaluates potential treatment options for suicidal thoughts and behaviours in terms of their accessibility, appeal, and efficiency. Rural residents are the focus of Paper 7 (“Facilitators and barriers to treatment-seeking for people with mental health problems in rural areas”) and Paper 8 (“Feasibility of internet-delivered mental health treatments for rural populations”), older adults are explored in Chapter 4.3, while people with a comorbid mental illness provide the data presented in Paper 9 (“Incidental treatment effects of CBT on suicidal ideation and hopelessness”). While this Chapter identifies flexible treatment options that may increase the accessibility of services for people experiencing suicidal ideation, the importance of overcoming attitudinal barriers to help-seeking is emphasised; limitations in current clinical treatment approaches are also discussed. The Discussion section synthesises the findings of the nine papers presented in this thesis, with a focus on the implications and future directions indicated by this research. It outlines a proposed multi-tiered approach to suicide prevention, incorporating strategies ranging from epidemiological through to clinical treatment strategies. Future research directions are also suggested.

This paper aims to provide insight into the risk factors contributing to suicidal ideation and behavior among adolescents. First, the author overviews the extant academic literature on the subject. She highlights the persistently high incidence of suicide among young people in the Czech Republic and briefly defines the stages of adolescence as well as the particular forms and methods of suicidal behavior. Subsequently, the author discusses in detail individual aspects of demographics, clinical data, familial environments and interpersonal relationships that the academic literature associates with an increased risk of suicidality among adolescents. Concluding the overview, the author sets the topic of suicide into the context of a children's crisis helpline. The author goes on to present an empirical analysis of reports documenting suicidal calls made to a children's crisis helpline. She uses both qualitative and quantitative methods to identify particular life circumstances that may contribute to the development of suicidal ideation and/or behavior, paying attention to distinct aspects of suicidality and to gender differences. As part of her analysis, the author critically evaluates the benefits and pitfalls associated with the use of data obtained from an anonymous crisis helpline.

BACKGROUND: Both mood and anxiety disorders are more prevalent in women than men with the onset typically occurring during adolescence or early childbearing years. These disorders are particularly prevalent during pregnancy and the postpartum period. While depression during the perinatal period has received significant attention recently, anxiety has not received the same amount of attention. METHODS: The current study was a secondary analysis of a prospective cohort study that followed 91 women with mood disorders through pregnancy and the postpartum period. Our objective was to determine if a correlation existed between anxiety and suicidality. We hypothesized that pregnant women with a history of a mood disorder and comorbid anxiety are more likely to be suicidal than those without comorbid anxiety. The presence of anxiety was determined using the anxiety subscale of the Edinburgh Postnatal Depression Scale, EPDS; a cut off score of six or greater was used to indicate significant anxiety. Suicidality was determined using three separate measures: question ten on the EPDS, question eighteen on the Inventory of Depressive Symptomatology, and question ten on the Montgomery-Asberg Depression Rating Scale. ANALYSIS: Chi square tests were used to compare the demographics of the anxious and non-anxious women based on both diagnosis of anxiety disorders and symptoms of anxiety. Z proportion tests were then used to compare the proportion women with anxiety versus those without anxiety who were suicidal. Lastly, binary logistic regression was used to determine if patients with anxiety were more likely to be suicidal. RESULTS: Among the women in this study, 62 (68.1%) had a diagnosis of major depressive disorder and 29 (31.9%) had a diagnosis of bipolar disorder based on DSM-IV-TR diagnostic criteria. In addition, 45 (49.5%) had a lifetime history of an anxiety disorder. The prevalence of significant anxiety symptoms, as determined by the anxiety subscale on the EPDS, ranged from 9.1-37.5% depending on the time point. Suicidality prevalence also varied depending on both the time point and the scale used: 0-17.5% using the MADRS, 6.7-24.7% using the EPDS, and 2.4-14.7% using the IDS. Using a binary logistic regression, we determined that anxiety was a risk factor for suicidality at time T3 (OR 2.106; 95% CI 1.274-3.481) and M1 (OR 2.057; 95% CI 1.179-3.586) on the MADRS and at T3 (OR1.758; 95% CI 1.219-2.535) on the EPDS.

碩士<br>南華大學<br>生死學研究所<br>96<br>In suicide events, it always shows the death and survivor of suicide. However, the facts couldn’t be change. The most important point is how to prevent from suicidal attempt .Proposes in this research are 1.To know the experiences and thoughts from an suicidal attempt who suicide many times from self-narrative method.2.To know cognitive in suicide behavior from this suicidal attempt’s relatives and friends.3.To know the differences ,in interaction, care and interrelationship , between this suicidal attempt before suicide and after suicide survive.This research use the method in self-narrative of narrative analysis, and semistructured interview. Participators are five, includes the one’s mother, a sister, two friends who take care of this survivor of suicide in the hospital. 　　 　　This research discover the reasons of taking suicide behavior are complicate, risk factors and protective factors are coexist .In the recover process ,good interaction and communication between relatives and friends can prevent next suicide .Within appropriate cognitive in suicide behavior can prevent next suicide behavior. Besides, brakes on communication between Suicidal attempt and his relatives are stigma, angry, grief, and guilty. Self-Healing and Self-Disclosure of Suicidal attempt can help their relatives and friends in interactions and communications.