Rozprawy doktorskie na temat „Suicide at work”

Suicide and suicidal behavior affect individuals of all ages, genders, races and religious groups in all countries, representing an important social issue. The major risk factor associated with suicide is depression. However, in some instances, suicide is not preceded by warning signs of mental disorders. Variations in the sociopolitical structures in the communities in U.S. may hold the explanation of variations on suicide rates. The objective of this study is to understand how suicide relates with variations in the community structure. Some specific socio-structural elements of a community have the potential to protect against distress by protecting individuals socio-psychological health. Specifically, variations in structural pluralism affect a communitys welfare because of the potential presence of dense networks of associations that create problem-solving capacity for the community. The problem solving capacity of communities results from pluralistic political structures with dense networks of associations, advocating civic welfare. As one of the consequences of influence on communitys welfare, the structural pluralism theory is tested here as a direct protection again suicide. To address this objective, county-level data are needed. Several data sources will be used to provide information essential for the analysis in this study. The suicide rates will be calculated from the Centers for Disease Control, National Center for Health Statistics Compressed Mortality File for the years of 1998-2002. To provide information on structural pluralism, data from the 2000 County Business Patterns will be used. The 2000 Census data and the Religious Congregations and Membership Study 2000 will be used to provide information on demographic characteristics.

While the rate of suicides is increasing in the United States, these tragedies leave behind loved ones or suicide survivors who experience not only the grief of loss but also unresolved emotions accompanying this complex and often stigmatized form of death. The bereavement needs associated with suicide survivors are unique. The purpose of the thesis was to develop a curriculum addressing the conditions surrounding individuals completing suicide and the effects on suicide survivors. The Mindfully Healing Suicide Survivor Bereavement curriculum consists of ten-week sessions tailored to the specific needs of the bereavement processes for suicide survivors. The curriculum utilizes an integration of psychoeducational content and mindfulness-based practices activities emphasizing the bereavement processes of suicide survivors. The methods include didactic information, interactive discussion, creative expression, and the development of mindfulness-based practice skills.

During 2010, 1446 people committed suicide in Sweden. Research shows that groups that are less favored in society have an increased risk of suicide. Social services often encounter groups of people that have a high risk of suicide, for instance welfare recipients or substance abusers. The purpose of this study was to shed light on how social workers talk about suicide and how this might affect interactions with suicidal clients. The study is based on qualitative interviews with five social workers in Stockholm. The results were analyzed using the theory of professional discretion and the perspective of existentialism. The most important results were that social workers do not think that they can help suicidal clients on their own, instead they need psychiatric help. Meeting with suicidal clients raises a lot of feelings and one way to cope with this is by distancing oneself from the client. The study also showed that suicide is a complex issue and it can be hard to find a position between the human right of autonomy and the will to help people. Continuity was viewed as an important factor, but due to the work load it can be hard to follow up these clients.

Virtually every mental health problem carries stigma, but suicide appears to run so counter to our accumulative, achievement-oriented society, that it poses even greater threat of stigma. While suicide is inherently troubling in that it opposes the fundamental human instinct for self-preservation, the tendency to stigmatize and reject individuals affected by suicide appears to be counterproductive and excessive. Hence, the purpose of this three-manuscript dissertation is to gain a more nuanced understanding of suicide attitudes from an exploratory and terror management theory perspective. More specifically, this dissertation attempts to answer three general questions: (1) how do suicide attitudes differ from other stigmatized deaths – namely, unintentional opioid overdose, (2) does death anxiety and baseline self-esteem impact attitudes toward suicide, and (3) can the effects of death anxiety on suicide attitudes be reversed by temporarily boosting self-esteem? To address the first question, Study 1 compares suicide attitudes to attitudes toward opioid overdose death – another type of stigmatized death that has emerged as a major public health issue in the U.S. in recent years. Study 2 addresses the second question by examining the effect of mortality salience on attitudes toward suicide and by investigating whether participants’ baseline self-esteem will moderate this effect, in keeping with the theory’s claim that self-esteem buffers against death anxiety. Building on the theoretical assumptions of the second study, Study 3 tests whether the effects of death anxiety on suicide attitudes can be reversed by temporarily bolstering the participant’s self-esteem using experimental manipulation. In other words, can cultural worldview validation and self-esteem enhancement inhibit the awareness of personal death and promote prosocial attitudes and behavior? All three proposed studies used quantitative research strategies to examine the research questions detailed above. Study 1 used a traditional questionnaire method to explore and compare attitudes toward suicide and drug overdose death; whereas Study 2 and 3 employed an experimental design to test the MS hypothesis on suicide attitudes. Participants were recruited online using an inexpensive crowdsourcing service called Amazon MTurk. Findings from these studies could have important implications for how we understand the psychological underpinnings of suicide stigma and contribute to the growing body of evidence of the role of existential mortality concerns in hostile attitudes and discriminatory behavior. Not only are we confronted with death reminders in our everyday lives, the topic of suicide is inherently a reminder of death – making the problem of death anxiety even more relevant and unavoidable. These findings could expand our understanding of how cultural worldview and self-esteem are relevant to mitigating death anxiety, and the relationship between death anxiety and suicide.

Thesis advisor: Thanh V. Tran
Suicide is an escalating public health crisis for Black people in the United States, yet the majority of the suicide research in the United States is based on the European American population. The psychological impact of the centuries of persistent stress and pain Black Americans have endured in the U.S., fueled by racism since the tragic period of slavery, is well-documented. However, despite the unrelenting historical and contemporary manifestations of racism and other systems of oppression in U.S. society, Black Americans have chosen death by suicide at rates lower than White Americans. Previous research has established the complexity of suicide and revealed that there are multiple personal and societal stress factors that contribute to creating risk factors for Black suicide. Research has also established that Black Americans historically have cultivated a resistance to the desire to take their own lives, seemingly linked to religious/spiritual and cultural coping resources that have served as a protective factor against suicidal behavior. Yet, there is a lack of scholarship that explores the impact of these resources on suicide in this population. Suicidologists are calling for suicide to be examined within a multidimensional contextual framework and for there to be a shift from a deficit approach to a strengths-based approach. There is a need for greater research focus on the factors that influence suicidal behavior in Black Americans, as well as the factors that are associated with creating a shield of protection against this self-destructive behavior. Through a convergent mixed-method approach, and guided by a robust cluster of theories, with Critical Race Theory and the Afrocentric Worldview as the overarching theoretical and philosophical approaches, this dissertation aims to address the gaps in the literature by examining several research questions. The following questions are examined through quantitative research: (1) Do racial discrimination and personal stress influence suicide attempts among Black people in the U.S., and does religion/spirituality serve as a protective factor and moderate the relationship between attempted suicide and racial discrimination and personal stress?; (2) Do post-incarceration status and personal stress influence suicide attempts among Black people in the U.S., and does religion/spirituality serve as a protective factor and moderate the relationship between attempted suicide and post-incarceration and personal stress?; (3) Do veteran status and personal stress influence suicide attempts among Black people in the U.S., and does religion/spirituality serve as a protective factor and moderate the relationship between attempted suicide and veteran status and personal stress? The data for this study were drawn from the cross-sectional National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) III which covers April 2012-June 2013. Logistic regression was employed to analyze the data. The quantitative research explores the impact of personal and societal stressors on the mental health of Black people and the role of religion/spirituality in cultivating a healthy emotional and mental environment that insulates them from suicide. The qualitative data include interviews with three adult Black men from the researcher’s family across three generations. Through three generations of Black men from one family, this dissertation further aims to examine whether religion/spirituality is a protective factor insulating Black people in the U.S. from developing suicidal behavior as they navigate societal stress factors including racial discrimination, post-incarceration status, and veteran status and whether religion/spirituality as a protective factor is passed down intergenerationally. If so, it aims to explore whether there are any intergenerational patterns and/or differences in the utilization of religion/spirituality as a source of protection against developing suicidal behavior. Assessed together, the findings from the quantitative and the qualitative research underscore the potential impact of stress and societal stress factors on suicidal behavior among Black people. Specifically, the quantitative research shows an association between personal stress and societal stress factors including racial discrimination, post-incarceration status, veteran status, and suicide attempts. The quantitative research also underscores the complexity of the role of religion/spirituality as a protective factor, as the findings from the quantitative research show that religion/spirituality was not a buffer against suicide attempts for the participants in that study. The findings from the qualitative research reveal that religion/spirituality can serve as a buffer and illustrates religion/spirituality functioning as an extension of Afrocentric culture and serving as a protective shield enabling some Black people to resist the full psychological impact of personal and societal stressors. This dissertation provides the foundation for the broader work highlighted through this study encapsulated in the Ubuntu Relational Framework for the Study of Black Suicide, an Afrocentric framework I developed that emerged as a guide for exploring the risks and protective factors of Black suicide. The constructs of death consciousness and Divine consciousness emerged during the analysis of the qualitative research as a way of conceptualizing the influence of societal stressors and protective factors on suicidal behavior, and they are an expression of Afrocentric culture. This framework highlights the need to equally prioritize the concern of what animates Black people’s desire to live, which was illuminated through the qualitative research, along with the question of what factors make them at risk for cultivating a desire to die. It further attends to the need for social workers to address the conditions of the racist U.S. environment these factors are assessed within. This dissertation also includes my autoethnography which serves as an analytic review and critical analysis of key concepts related to the study of Black suicide. It is a resource for further grounding in the historical and contemporary context of the Black experience and the Afrocentric worldview incorporated in this work. Autoethnography is an epistemological site for exploring Divine consciousness and the role of religion/spirituality and culture passed down intergenerationally as a protective factor against suicidal behavior. It further outlines a methodology for employing spiritual and cultural resources and operationalizing spiritual resistance. Finally, this dissertation goes beyond identifying risk and protective factors for suicidal behavior in Black people. It outlines a structure for training social work clinicians and researchers in this Afrocentric framework that would expand social workers’ knowledge of African-centered social work, and a method appropriate for responding to this multidimensional mental health problem that requires a creative, culturally rich approach. The training includes a methodology for employing religious/spiritual and cultural resources that operationalizes spiritual resistance that will equip social workers for supporting Black people in developing a healthy holistic mental and social environment within an oppressive racist environment
Thesis (PhD) — Boston College, 2021
Submitted to: Boston College. Graduate School of Social Work
Discipline: Social work

This study explores therapists' experience of working with suicidal clients. Using a Hermeneutic-phenomenological method informed by Heidegger [1889 – 1976] this study provides an understanding of the meaning of therapists' experiences from their perspective as mental health professionals in New Zealand. Study participants include thirteen therapists working as mental health professionals in District Health Boards from the disciplines of psychiatry, psychology and psychiatric nursing. Participants' narratives of their experiences of working with suicidal clients were captured via audio taped interviewing. These stories uncover the everyday realities facing therapists and provide an ontological understanding of their experiences working with suicidal clients in District Health Boards. The findings of this study identified three themes. All the participants experienced shock and surprise upon hearing their clients had committed suicide without presenting with signs and symptoms associated with suicidality in their assessment. All the participants experienced the responsibility of assessing suicidal clients and intervening to be a burden. Further, they suffered from guilt and fear of punishment in the aftermath of a client's suicide. They also found themselves in a professional and personal crisis as a result of their experiences and struggled to come to terms with events. This study has shown how these experiences could be understood by uncovering the perspectives therapists bring to working with suicidal clients. I have shown how mainstream prevention and intervention strategies follow on from the misrepresentation and misinterpretation of our traditional way of knowing what it means to be human. I show when therapists discover that phenomena are not necessarily what they appear to be they feel unsettled and confused about their responsibilities and what it means to live and die as a human being. The experience of being a therapist to a person who commits suicide has been revealed in this thesis to leave a profound legacy of guilt, doubt and fear. This thesis proposes that it may be time for the profession to care for its own that therapists in turn may not shy back from caring for and about the vulnerable other.

Currently in the United States, five states have enacted physician-assisted suicide as a legal end of life option for terminal patients. Research indicates that most patients who have died under this mean have been enrolled in hospice services. With the recent enactment of California’s End of Life Option Act, hospice social workers will find themselves educating and assisting patients and/or their families with this and other end of life decisions. Research has thoroughly examined physician and nurses’ involvement and attitude in the matter, but little has been researched regarding social workers. This study aimed to identify the factors that affect hospice social workers’ attitude towards physician-assisted suicide and how California’s End of Life Option Act affects their practice. In-depth face-to- face interviews with 8 hospice social workers were conducted. The study found that all 8 participants held positive attitudes towards physician-assisted suicide, support the End of Life Option Act, and feel prepared to assist patients and handle requests for the End of Life Option. Factors such as social work values and professional experience have a positive effect and validate their attitude, and factors such as religion does not affect their attitude. Due to low participation, the overall results were limited; therefore, additionally research should be extensively conducted to gain a better understanding. Regardless, a structured physician-assisted suicide protocol for social workers would benefit micro practice and macro developments.

The purpose of this project was to design a comprehensive suicide prevention and early intervention program for local youth, identify potential funding sources, and submit a program proposal for implementation to Precious Life Children and Educational Counseling Center, located in in the City of San Bernardino, California. Precious Life was selected due to its location and its history with the Latino community—an important consideration, given the focus of this project and the risk factors currently present in this community.

A review of the literature was conducted to define the factors contributing to the widespread problem of teenage suicide, to assess the particular risks associated with living as a cultural and/or ethnic minority in San Bernardino, to examine how this often-marginalized status intersects with other risk factors, and to evaluate existing suicide prevention programs currently implemented within this county. The proposed program seeks to increase community awareness of suicide among teenagers, as well as to raise the funding for Precious Life staff to participate in necessary training, with a focus on crisis intervention and addressing suicide risk factors, attempts, and completions. Thus Precious Life will be equipped to provide counseling, mental health screenings, referrals, and a crisis hotline.

EMS providers work in a high-stress environment and are routinely exposed to critical incidents. Many providers are left to deal with the chronic stress on their own, either because of lack of effective employer-based programs or a culture that discourages its use. The extent to which these factors -- as well as personal characteristics such as resilience, PTG, and coping skills -- influence PTSD and suicide ideation among EMS providers has not been well studied among EMS providers. An online survey was administered to a convenience sample of EMS providers. Of the 2,683 respondents, more than one quarter (27.7%) met the PTSD criteria of 50 or higher on the PCL-M. Close to half of the respondents (42.0%) reported having contemplated suicide in the last six months. Of those who had contemplated suicide in the last 30 days, nearly one third (27.1%) thought about suicide 10 or more days in the last 30 days. EMS culture and resilience were negatively associated with PTSD, while positive associations were found with some coping styles. PTSD scores and suicide ideation frequency were highest when post-incident services were not available in the workplace. No significant relationships were found between personal factors and suicide ideation.

Syftet med uppsatsen är att få en bild av lärarnas erfarenheter och upplevelser av självmordsproblematik på skola. För att besvara syftet finns fyra frågeställningar vilka berör lärarnas reaktioner vid ett självmord av en elev och hanteringen av dessa reaktioner, lärarens upplevelse i mötet med de kvarvarande eleverna, lärarens roll i självmordsproblematiken och lärarens samarbete med andra aktörer på skolan gällande självmordsproblematiken. I avsnittet tidigare forskning redogörs för lärarens yrkesroll, begreppet självmord och självmord ur ett historiskt perspektiv, ur ett internetionellt perspektiv och krismetod på skolan. Studiens tolkningsram består av lärarens roll i mötet med de sörjande eleverna, kristeori, begreppet empati och systemteori. Metoden som används i studien är kvalitativ och består av sex kvalitativa intervjuer med lärare som är verksamma på gymnasieskola och har erfarenhet av att en elev begått suicid. Studiens resultat visar att erfarenhet och personlighet har en betydelse för lärarnas agerande och syn på hur de bör agera då en elev begår självmord. Ett självmord hos en elev följs, beroende av hur lärarna definierar relationen till eleven, av en personlig sorg hos lärarna. Vid en elevs suicid skapas hos de kvarvarande eleverna en hysteri kring och till viss del glorifiering av den döda eleven. Eleverna reagerar även med sorgereaktioner, spekulationer, och i viss mån ryktesspridning. Lärarna påtalar vikten av att ha kollegor omkring sig vid en elevs självmord och skolkuratorns betydelse i självmordsproblematiken.

The purpose of this essay is to describe teachers´experiences and feelings about suicidal behaviour among their students at school. Our study is based on four questions, touching upon the teachers´reactions to comitted suicides among their students and how they dealt with these reactions, the teachers´experiences of meeting the schoolmates of deceased, the teachers´ role in suicidal problem area and the cooperation of the teachers with other professional actors at school concerning suicidal behaviour among their students. The chapter about previous research gives an overview of the following subjects: the profession of teaching, the concept of suicide, suicide viewd from a historical perspective, from an international perspective, and methods of dealing with crisis-like events in school. A method based om qualitative interviews has been used in this study. Six teachers, working at the level of upper secondary school, and with experiences of suicides comitted among their students, have been interviewed. In analyzing the interviews we have used concepts from a crisis theory, system theory, theory of empathy, and thoughts about the teachers´ role when meeting students in griefe, as our analytical tools. The result indicate that personality and experience affect the teachers´acting and teir opinions about how a teacher should act in case of suicideal events among their students. A suicide among the students leads to individual grief for the teacher. The strength of the experiences and feelings of grief held by the teachers depend on how they define the relationship between teacher and student. When a student commits suicide, his/her schoolmates have a tendancy ta act and react with some hysteria. At the same time they tend to glorify, in some way or another, the dead student and the suicide. The schoolmates also react with grief and with speculations about the suicide. The importance of colleagues and of school counsellours when a suicide has occurred among the students at school, is emphasized by the teachers.

Syftet med denna studie var att genom en enkät kartlägga socialsekreterares upplevelse av beredskap och förekomst av möten med självmordsnära klienter inom socialtjänsten. I Sverige dör cirka 1100 människor årligen genom suicid och det klassas idag som ett folkhälsoproblem. Enligt forskning, kommer socialsekreterare inom socialtjänsten ofta i kontakt med suicidala klienter men hur dessa möten hanteras har inte studerats i någon större utsträckning. Studiens urval har avgränsats till Stockholm samt tre andra län och enheterna försörjningsstöd och vuxen/beroende valdes ut för närmare granskning. Forskning pekar på olika riskfaktorer för självmord, som exempelvis psykisk ohälsa, socioekonomisk utsatthet eller missbruk, därav valet av dessa enheter. Empirin bearbetades med hjälp av programmet SPSS, genom vilket bi- och univariata analyser utfördes. Resultatet analyserades sedan med hjälp av tidigare forskning, samt med teori om suicidprevention. Ett av studiens huvudresultat var att många socialsekreterare stöter på självmordsnära klienter. En majoritet av dessa socialsekreterare har träffat en eller flera självmordsnära klienter det senaste året. Vidare visade resultatet att de medverkande i viss utsträckning upplever sig beredda i möten med dessa klienter. En femtedel av de medverkande uppgav att de genomgått utbildning i suicidprevention och resultatet visade att sådan utbildning har positiv påverkan på deras upplevelse av beredskap.
The purpose of this study was to map out social workers’ preparedness and the occurrence of encounters with suicidal clients within the social services, through a survey. Nearly 1100 people in Sweden dies because of suicide every year and suicide is classified as a public health problem. According to research social workers often encounter suicidal clients, but how these encounters are handled have not been studied in any greater degree. The study’s selection was defined to Stockholm and three other counties. The units within the social services that were chosen for further examination were income support and adult/addiction. Research revolving suicide indicate that socioeconomic vulnerability, addiction and mental illness are risk factors connected to suicide, hence the choice of these units. The collected data material was processed by means of SPSS, through which univariate and bivariate analyses have been executed. The results were interpreted by means of earlier scientific findings, as well as theories concerning suicide prevention. One of the main findings that could be extracted from this study was that many social workers encounter suicidal clients. Most of the social workers have met one or several suicidal clients during the past year. The results also implies that the participants believe that they have preparedness to some extent in encounters with these clients. One fifth of the participants state that they have passed training in suicide prevention and the results show that training of such has a positive impact on their experience of preparedness.

Native American Adolescents between 15 and 24 years of age have the highest rate of suicide compared to their other race peers in the same age group. Recent statistics provided by the Center for Disease Control (CDC) indicate that in 2011, Native American males between ages 15 and 24 had a suicide rate of 22.8 per 100,000, as compared to white males, 14.3 per 100,000, and black males, 6.3 per 100,000 of the same age (CDC, 2014). Native American females had a rate of 8.0 per 100,000 deaths compared to 3.8 per 100,000 for white females and 2.0 per 100,000 for black females respectively (CDC, 2014).

A collection of factors such as prolonged generational trauma, substance abuse, untreated mental illness and depression leads to high suicide rates in Native Americans. Using Durkheim’s work on suicide as a framework, this study utilizes the National Youth Risk Surveillance Survey (YRBSS) to examine the way in which trauma, depression, substance use, and mental health issues impact the high Native American adolescents’ suicide rate. An in depth analysis of each factor is provided as well as a discussion of the findings. The dissertation also offers conclusions and social work implications of the study.

This thesis examines the suicide preventive work done in the Swedish municipalities with a focus on the municipal officials responsible for suicide preventive work within the municipality and the state’s governance. The study uses a qualitative research design and the empirical material consists of interviews done with the municipal officials in nine different municipalities around Sweden. The intention of the thesis is to study the governing mechanisms and how the suicide preventive work is implemented in the Swedish municipalities. Furthermore, this study examines the municipal officials’ perceptions of the suicide preventive work. The officials’ perception of the suicide preventive work is essential and is a ground pilar in the work. The thesis also applies the implementation perspective along with the governance perspective to understand the suicide prevention’s challenges and the process of the work. Moreover, the thesis briefly summarizes two reports from Public Health Agency of Sweden (Folkhälsomyndigheten) regarding Sweden’s suicide preventive work in all the municipalities, regions and county administrative boards to give a summary of the work being done in Sweden as well as comparison to the interviews.    The thesis establishes that the suicide preventive work differs between the municipalities and that municipal officials have a much bigger effect on the result than anticipated. The size of the municipalities does not play a huge role, but the politics and resources are essential if the municipalities want to succeed. However, the goal of the government is their vision zero and the interviews have shown that Sweden is nowhere near its goal. The government’s use of soft power seems to have a contributing effect in this and the lack of demands in the suicide preventive work shows that municipalities have handled the issue differently: some have come a long way and have very developed work, and some have a lot left to work with.

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
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

The aim of this essay is to try to gain understanding and to get a more profound knowledge of suicide. The questions at issue were 1) What empirical factors are mentioned in the research as possible to explain suicide. 2) Which theoretical perspectives are discussed in research concerning suicide. To answer our questions at issue we carried out a selective research overview with a qualitative perspective. The primary documents that has been the foundation of this essay is constituted by nine of the leading researchers publications in the area of suicidology. The questions of issue were analyzed and answered on the basis of social constructionist theory. The research findings showed that suicide is a complex area with no single answers. There are several empirical variables that the researches describe as factors that might influence suicidal behavior and the research has shown patterns in certain risk groups. These variables interact in dynamic processes and shall not be regarded on a one to one basis. The theoretical perspectives that are discussed in research are divided up in three main areas; Sociological, Psychological and Neurobiological & Genetic theories. Although all theories have their own approach and explanation to the phenomena of suicide the research findings are moving towards a more multidisciplinary approach. The social constructionist perspective of this essay gives the reader a new dimension to the phenomena. Empirical and theoretical findings can be seen as constructions aroused from the interaction among people in our society which we all are a part of maintaining.

This study adds to the existing research concerning ecological relationships between suicide rates, social integration, and urbanicity in the U.S. Age-sex-race adjusted five-year averaged suicide rates for 1993-1997 and various measures of urbanicity are used. Some proposed relationships held true, while others indicate that social integration and urbanicity are so intertwined in their effects on suicide that no clear, unidirectional pattern emerges. The religious affiliation measure captured unique variations in the role religion plays in this relationship; depending on how urbanicity was measured. Findings suggest closer attention needs to be paid to how both urbanicity and religious affiliation are measured. Overall, vast regional variation exists in suicide rates and the role of urbanization can be misunderstood if not properly specified.

The purpose of this study was to examine people with professional experiences involving young men’s tendency to seek professional help, and also to analyse male standards and masculinities influence, due to the high statistics of mental illness and suicide among young men in Sweden. We used a qualitative method and obtained the material by semistructured interviews. Four participants, from three different organisations, participated in this study and shared their perception about the current situation. The material was examined through a thematic analysis. The result showed that male standards and masculinities are a contributing factor to why young men are reluctant to seek professional help, but also why it is more complicated for young men then young women to show their emotional needs. The informants were however clear on emphasising that this is far from the only reason and that committing suicide is an issue which goes beyond gender.

2019-01-15

The purpose of this project was to explore perceptions of effective components in adolescent suicide prevention programs among San Bernardino school counselors. The stress model and the mental health model are the two models implemented in suicide prevention programs.

Cette thèse a pour objectif de rendre compte des ressorts contemporains de la suicidalité en France. Ce travail a été pensé dans une double perspective. D'une part, il s'est agi d'analyser la dynamique propre aux conduites suicidaires, en questionnant autant les motifs que les causes qui suscitent ces conduites. D'autre part, il a été question d'étudier l'organisation de leur prise en charge médicale, en s'intéressant au fonctionnement des services d'urgences qui accueillent la majorité des tentatives de suicide connues. Ces deux axes d'investigation ont été pensés de façon complémentaire, si bien que l'approche théorique et méthodologique qui organise cette démarche lie intimement la compréhension des conduites suicidaires avec celle de son traitement médical. La lecture que nous proposons ici consiste à penser la suicidalité, ainsi que sa prise en charge, à travers les transformations normatives des sociétés contemporaines. Ces transformations sont caractérisées par l'affirmation et la valorisation inédite d'un certain type de relation sociale, faisant de la capacité d'autodétermination individuelle et de l'accomplissement personnel une référence centrale pour orienter l'action. L'autonomie, l'indépendance, l'authenticité et la responsabilité seraient ainsi inscrites dans nos pratiques les plus communes, de sorte qu'elles sont devenues un principe du fonctionnement des rapports sociaux et de la mesure de la valeur de chacun. Cette individualisation recompose les zones de tensions que les acteurs sont tenus de résoudre en contexte, selon leurs ressources propres, et au risque pour eux, parfois, d'y perdre toute possibilité d'agir. C'est donc l'esquisse d'une nouvelle économie du suicide et des tentatives de suicide que nous avons souhaité mettre en lumière. Pour ce faire, nous avons mis en place une ethnographie des services d'urgences générales et psychiatriques, visant à analyser le déroulé de la prise en charge des tentatives de suicide au décours du geste suicidaire. Cette démarche vise à saisir la manière par laquelle les conduites suicidaires s'inscrivent dans la logique qui préside à l'univers médical, hypothèse étant faite ici que les tensions suscitées par l'autonomie se rejouent précisément dans cette rencontre singulière et incertaine entre suicidalité et soin
The aim of this Ph.D thesis is to understand the contemporary issues about French suicidality. Two different dimensions have been investigated. First, we interrogated the dynamic of suicidal process, considering both individual motives and social causes of suicidal behaviors. Second, we studied emergency departments of the French public hospitals, that take care of the majority of suicide attempts known in France. The methodological and theoretical principles adopted in this work articulate our understanding of suicidal process with our analysis of its medical treatment. In this work, we will suggest that suicidality and its medical treatment are shaped by normative transformations of contemporary societies, which place autonomy, independence, authenticity and responsibility as preeminent values. Yet, such values enhance a new type of social bound. This individualization changes the type of problems that actors have to solve with their own economic, cultural and social resources, which are sometimes not sufficient. Thus, this new normativity tends to affect suicidal issues. In summary, we propose to enlighten a new economy of suicides and attempted suicides. To do so, we conducted an ethnographic investigation of general and psychiatric emergency services. The main hypothesis of this approach precisely supports that this new type of problems shaped through individualization arises in a specific manner in the medical treatment of suicidal behaviors

Grief research generally demonstrates that children and teenagers who have lost a parent in suiciderisk developing severe psychological and physical morbidity, as well as social disabilities, in adultlife as a result of traumatic aspects of the death and complicated grief reactions. The youngbereaved also run a highly increased risk of developing suicidal behaviour or to commit suicidethemselves. Despite these alarming reports, the research field is poorly explored and studies thattake an interest in the long-term consequences and the subjective experiences of the bereavedyoungsters are lacking. A qualitative study using narrative methods has been carried out toexamine the experiences of four young women, who during adolescence lost a father in suicide.The study specifically focuses on the grief process, the short- and long-term consequences, and theneed for social support in relation to family, extended network and society. The study reveals thatthe women’s traumatic loss has shattered their basic assumptions about the world as a safe andmeaningful place. A fear of losing another significant person, i.e. the remaining parent, siblings ora life partner is also a common denominator. The women have experienced complicated griefreactions such as guilt, shame, anger, feelings of abandonment and “why-questions” regardingtheir fathers’ suicide motives. They have found it difficult to receive social support due to moralaspects of suicide as a death cause – sometimes even within their own family – and due to a fear ofbeing condemned or regarded abnormal if they told others about their trauma. The time aspect isnot found to have affected the grief process. This process has been facilitated, however, throughsocial support from family, relatives, friends and professionals. Moreover, “sense-making”, or thecapacity to construct an understanding of the loss experience, as well as the active process of“re-membering”, has been found valuable in the grief process as it contributes to the constructionof an inner representation of the father. A continued relationship to the father after his death has inmost cases been regarded as helpful in the grief process. The women describe that the father’ssuicide has affected their self-conception and their life contents. Coping with the loss the womenseem to have developed stronger self-esteem, but at the same time some of them have come toregard themselves as “odd” and more mature in comparison with their peers. All women talk abouttheir fathers’ deaths with high actuality, indicating that the grief is most present. The womendescribe a re-priority of what they find important in life; close relationships are portrayed as moreimportant, as well as being helpful to others.

Support groups for suicide loss survivors are a relatively common resource used by those who are left to cope in the aftermath of a suicide death. Though descriptive studies have been used to provide an overview of support groups in the past, there have been no efforts to understand nuances of these groups and the impact of these groups and differing facilitation styles on the bereavement experience for attendees. This study explores primary data collected between March 2015 and December 2015 with a sample of 138 survivor of suicide loss support group facilitators in the United States and several other countries. Meaning making and meaning reconstruction is presented as the primary theory used to examine the attitudes of support group facilitators. Basic analytic procedures were used to explore sample descriptives, and an Exploratory Factor Analysis (EFA) with an oblique rotation was used to identify the factors within the Survivor of Suicide Loss Support Group Facilitator Scale. Three factors were revealed with a simple structure, representing the latent themes of (1) Facilitator Perspective on the Role of the Story (α=.73), (2) Facilitator Perspective on the Role of the Facilitator (α=.63), and (3) Facilitator Perspective on Role of the Loss Survivor (α.59). Bivariate analyses revealed that factors 1 and 2 both had a significant relationship with length of time the facilitator had been leading the group, facilitator’s level of compassion satisfaction, and facilitator’s level of burnout. The findings of the EFA support the use of the scale as a tool to discern differences in attitudes about the role of meaning making and sharing of stories in the group as well as the role of the facilitator in aiding this process. The findings provide important information for understanding variation in support group facilitation styles and have implications for future exploration of outcomes for group attendees based on facilitator attitude and style. Implications for practice and future research are discussed.

Les suicides sur les lieux de travail, perçus comme l’acmé d’un phénomène de souffrance au travail, proposent une confirmation au malaise dans la culture bien qu’ils renvoient l’énigme au champ social. Ils formulent avec insistance des interrogations à destination de la société du travail comme des questions singulières sur le passage à l’acte. La thèse s’attache d’abord à établir les fondements épistémologiques tant sociologiques que psychanalytiques qui permettent d’expliciter la question et les effets que les suicides établissent. Puis, c’est en définissant les conditions du cas que le propos entre ensuite dans les distinctions spécifiques au sein de la causalité inconsciente du passage à l’acte d’une part et de la cohérence de la structure sérielle du phénomène d’autre part. L’issue conclusive ouvrira sur les enjeux de jouissance au champ économique et social
Suicides at workplaces, received as the peak of a suffering-at-work phenomenon, confirm the unease in the culture as well as it sends back its mystery to the social sphere. These suicides ask insistent questions to the working society and peculiar ones about the acting out. First this thesis endeavours to establish the epistemological basis, that is to say the sociologicals and psychoanalyticals ones, that enable to explain both the question and the effects suicides establish. Then, thanks to a clinical case, we will suggest a particular distinction between the unconscious causality of the acting out on the one hand, and the consistency of the phenomenon’s serial organization on the other hand. The conclusion will lead to what is at stake of enjoyment from an economic and social point of view

Suicide is the ultimate outcome of mental illness and is a big and serious problem in society. About 1500 persons commit every year suicide in Sweden and many more engage in suicidal behaviour. This review aims at, from research studies from the 21th century, find out the knowledge of riskfactors regarding the risk for committing suicide among adolescents. The research questions are: What does research say, from a psychobiological perspective, about riskfactors among adolescents regarding the risk for suicidal behaviour? How much does genetic factors have an effect on the risk for suicidal behaviour among adolescents? and : What is the importance of environmental factors such as family connections, friends and school environment concerning suicidal thoughts among adolescents?

The method that is used in order to answer these questions is a researchreview including ten research-studies. The theory that is used for the analyse of the results is the psychobiologial perspective, which includes genetic and psychological theories. The conclusion of the review is, not surprisingly, that the genetic factors are of great importance for the development of suicidal behaviour. These factors interact with environmental factors in a complex way and is an explanation for suicidal thoughts among adolescents. The most prominent riskfactors mentioned in the result are: Psychiatric disorders and suicidal behaviour among parents, psychiatric disorders among the adolescents, neclect, psycial abuse, sexual abuse and also longtime unemployment among mothers. Furthermore are lack of friends and being victim of bullying serious riskfactors for developing suicidal behaviour.

A organização do trabalho passou por diversas modificações ao longo da história e as mudanças de paradigma nos processos laborais geraram mudanças significativas na construção da subjetividade do indivíduo e na dialética do sujeito com o mundo. Podese observar que as transformações no campo produtivo, ocasionadas por múltiplos fatores, como os processos de gestão, a organização do sistema econômico vigente e as reestruturações ocorridas com a globalização transmutaram o trabalho em mercadoria, impactando diretamente no processo de saúde-doença dos trabalhadores. A padronização e sistematização do processo de trabalho, proposto por diversos autores, a priori, adotado nos processos de produção industrial, passam a ser adotados pelas organizações de assistência à saúde, ocasionando arredamentos diversos no modo de produção deste setor, expondo os profissionais que ali executam suas atividades laborais a situações de fragilização e adoecimento. O debate em torno do processo de trabalho nas organizações dos serviços de saúde tem se mostrado extremamente importante, particularmente quando nos debruçamos sobre a micropolítica de organização do trabalho nessas instituições. Diante desta problematização, este estudo teve como objetivo estimar a prevalência de ideação suicida e de transtorno mental comum em trabalhadores de um hospital geral, buscando associação com categoria profissional, sexo, idade, escolaridade, estado civil, tempo de trabalho na instituição, tempo de trabalho na profissão. Trata-se de um estudo epidemiológico de delineamento transversal descritivo, de amostragem não probabilística, com amostra por quotas da população investigada. A presença das variáveis TMC e ideação suicida foram avaliadas a partir do Self Reporting Questionnaire (SRQ). Para a avaliação das possíveis variáveis associadas, os participantes responderam a um questionário sociodemográfico. Os resultados obtidos neste estudo evidenciaram a presença de TMC superior aos estudos correlacionados na literatura e aos índices apresentados na população geral; as queixas sobre o processo de trabalho, que se apresenta como propiciador de sofrimento atinge quase ¼ desta população. O agrupamento dos itens da escala SRQ-20, que apresentou menor representatividade estatística, foi a ideação suicida, sendo considerado com relevância neste estudo por ser indicador de risco direto de vida. Apesar de haver limitações do estudo em estabelecer um nexo causal entre TMC e ideação suicida com os processos de trabalho, o alto índice de adoecimento evidenciado ressalta a necessidade da realização de medidas interventivas, pois independente se ocasionados pelo processo de trabalho, estes indivíduos expressam essa realidade no setor de atuação profissional. Diante disso, estabelecer alternativas que possibilitem a criação de novos meios de intervenção, estratégias que proporcionem melhorias dos ambientes de trabalho para promoção e proteção da saúde desses profissionais, podem contribuir para A organização do trabalho passou por diversas modificações ao longo da história e as mudanças de paradigma nos processos laborais geraram mudanças significativas na construção da subjetividade do indivíduo e na dialética do sujeito com o mundo. Podese observar que as transformações no campo produtivo, ocasionadas por múltiplos fatores, como os processos de gestão, a organização do sistema econômico vigente e as reestruturações ocorridas com a globalização transmutaram o trabalho em mercadoria, impactando diretamente no processo de saúde-doença dos trabalhadores. A padronização e sistematização do processo de trabalho, proposto por diversos autores, a priori, adotado nos processos de produção industrial, passam a ser adotados pelas organizações de assistência à saúde, ocasionando arredamentos diversos no modo de produção deste setor, expondo os profissionais que ali executam suas atividades laborais a situações de fragilização e adoecimento. O debate em torno do processo de trabalho nas organizações dos serviços de saúde tem se mostrado extremamente importante, particularmente quando nos debruçamos sobre a micropolítica de organização do trabalho nessas instituições. Diante desta problematização, este estudo teve como objetivo estimar a prevalência de ideação suicida e de transtorno mental comum em trabalhadores de um hospital geral, buscando associação com categoria profissional, sexo, idade, escolaridade, estado civil, tempo de trabalho na instituição, tempo de trabalho na profissão. Trata-se de um estudo epidemiológico de delineamento transversal descritivo, de amostragem não probabilística, com amostra por quotas da população investigada. A presença das variáveis TMC e ideação suicida foram avaliadas a partir do Self Reporting Questionnaire (SRQ). Para a avaliação das possíveis variáveis associadas, os participantes responderam a um questionário sociodemográfico. Os resultados obtidos neste estudo evidenciaram a presença de TMC superior aos estudos correlacionados na literatura e aos índices apresentados na população geral; as queixas sobre o processo de trabalho, que se apresenta como propiciador de sofrimento atinge quase ¼ desta população. O agrupamento dos itens da escala SRQ-20, que apresentou menor representatividade estatística, foi a ideação suicida, sendo considerado com relevância neste estudo por ser indicador de risco direto de vida. Apesar de haver limitações do estudo em estabelecer um nexo causal entre TMC e ideação suicida com os processos de trabalho, o alto índice de adoecimento evidenciado ressalta a necessidade da realização de medidas interventivas, pois independente se ocasionados pelo processo de trabalho, estes indivíduos expressam essa realidade no setor de atuação profissional. Diante disso, estabelecer alternativas que possibilitem a criação de novos meios de intervenção, estratégias que proporcionem melhorias dos ambientes de trabalho para promoção e proteção da saúde desses profissionais, podem contribuir para A organização do trabalho passou por diversas modificações ao longo da história e as mudanças de paradigma nos processos laborais geraram mudanças significativas na construção da subjetividade do indivíduo e na dialética do sujeito com o mundo. Podese observar que as transformações no campo produtivo, ocasionadas por múltiplos fatores, como os processos de gestão, a organização do sistema econômico vigente e as reestruturações ocorridas com a globalização transmutaram o trabalho em mercadoria, impactando diretamente no processo de saúde-doença dos trabalhadores. A padronização e sistematização do processo de trabalho, proposto por diversos autores, a priori, adotado nos processos de produção industrial, passam a ser adotados pelas organizações de assistência à saúde, ocasionando arredamentos diversos no modo de produção deste setor, expondo os profissionais que ali executam suas atividades laborais a situações de fragilização e adoecimento. O debate em torno do processo de trabalho nas organizações dos serviços de saúde tem se mostrado extremamente importante, particularmente quando nos debruçamos sobre a micropolítica de organização do trabalho nessas instituições. Diante desta problematização, este estudo teve como objetivo estimar a prevalência de ideação suicida e de transtorno mental comum em trabalhadores de um hospital geral, buscando associação com categoria profissional, sexo, idade, escolaridade, estado civil, tempo de trabalho na instituição, tempo de trabalho na profissão. Trata-se de um estudo epidemiológico de delineamento transversal descritivo, de amostragem não probabilística, com amostra por quotas da população investigada. A presença das variáveis TMC e ideação suicida foram avaliadas a partir do Self Reporting Questionnaire (SRQ). Para a avaliação das possíveis variáveis associadas, os participantes responderam a um questionário sociodemográfico. Os resultados obtidos neste estudo evidenciaram a presença de TMC superior aos estudos correlacionados na literatura e aos índices apresentados na população geral; as queixas sobre o processo de trabalho, que se apresenta como propiciador de sofrimento atinge quase ¼ desta população. O agrupamento dos itens da escala SRQ-20, que apresentou menor representatividade estatística, foi a ideação suicida, sendo considerado com relevância neste estudo por ser indicador de risco direto de vida. Apesar de haver limitações do estudo em estabelecer um nexo causal entre TMC e ideação suicida com os processos de trabalho, o alto índice de adoecimento evidenciado ressalta a necessidade da realização de medidas interventivas, pois independente se ocasionados pelo processo de trabalho, estes indivíduos expressam essa realidade no setor de atuação profissional. Diante disso, estabelecer alternativas que possibilitem a criação de novos meios de intervenção, estratégias que proporcionem melhorias dos ambientes de trabalho para promoção e proteção da saúde desses profissionais, podem contribuir para o processo de saúde destes trabalhadores e a qualidade do ambiente de atuação profissional desses indivíduos.
The organization of work has undergone several modifications throughout history, these paradigm changes in labor processes have generated significant changes in the construction of the subjectivity of the individual and in the dialectic of the subject with the world. It can be observed that the transformations in the productive field, caused by multiple factors, such as the management processes, the organization of the current economic system, the restructurings with globalization, transmute the work into merchandise, directly impacting the health-disease process of the workers. The standardization and systematization of the work process, proposed by several authors, a priori, adopted in the processes of industrial production, are now adopted by health care organizations, causing various drawbacks in the way of production of this sector, exposing the professionals that there they carry out their work activities to situations of embrittlement and illness. The debate about the work process in health service organizations has been extremely important, particularly when we look at the micropolitics of work organization in these institutions. In view of this problem, this study aimed to estimate the prevalence of suicidal ideation and common mental disorder in workers of a general hospital, seeking association with professional category, gender, age, schooling, marital status, working time in the institution, work in the profession. This is an epidemiological study with descriptive cross-sectional, non-probabilistic sampling, with a sample of the population investigated. The presence of TMC variables and suicidal ideation were assessed from the Self Reporting Questionnaire (SRQ). For the evaluation of possible associated variables, participants answered a sociodemographic questionnaire. The results obtained in this study evidenced the presence of MCT superior to the correlated studies in the literature and the indices presented in the general population; the complaints about the work process, where it presents itself as a propitiator of suffering reaches almost ¼ of this population. The grouping of SRQ-20 items that presented less statistical representativeness was suicidal ideation, but was considered relevant in this study, since it is an indicator of direct risk of life. Although there are limitations of the study in establishing a causal nexus between CMD and suicidal ideation with work processes, the high rate of illness evidenced highlights the need for interventional measures, because if they are caused by the work process, these individuals express this reality in the professional sector. Therefore, establishing alternatives that allow the creation of new means of intervention, strategies that provide improvements in work environments for the promotion and protection of the health of these professionals, can contribute to the health process of these workers and the quality of the professional environment of these workers. individuals.

Objective: College students may be at heightened risk for suicide and suicidal behavior due to maladaptive cognitive-emotional factors and failure to practice basic health behaviors. However, self-compassion and wellness behaviors may protect against risk. The relation between self-compassion and suicidal behavior and the contributing roles of depressive symptoms and wellness behaviors was examined. Participants: Participants were 365 undergraduate students. Data were collected in April 2015. Methods: A cross-sectional, survey design was employed. Participants completed measures assessing self-compassion, depressive symptoms, wellness behaviors, and suicidal behavior. Serial mediation analyses were conducted covarying age, sex, and ethnicity. Results: Self-compassion was inversely related to suicidal behavior, and this relationship was serially mediated by depressive symptoms and wellness behaviors. Conclusions: Self-compassion may protect against suicidal behavior, in part, due to reduced depressive symptoms and heightened engagement in wellness behaviors. Individual and campus-wide strategies promoting self-compassion and wellness behaviors may reduce suicide risk on college campuses.

Forgiveness, a cognitive-emotional and behavioral reduction of negative responses to offenses, is directly related to less suicide risk, but may be indirectly related via its relation with future orientation, the ability to envision a positive future. In 100 rural primary care patients, we examined the association between self-forgiveness, other-forgiveness, and forgiveness by God and suicidal behavior, with future orientation as a mediator. Forgiveness was related to greater future orientation and, in turn, to, less suicidal behavior. Addressing the past may promote adaptive views of the future and reduce suicide risk, results suggesting potential temporal and forgiveness-based points for suicide prevention.

Suicide represents a major problem for all members of society. Findings from studies have shown that suicide risk is among the highest in young adult populations. Although a variety of factors have been identified in trying to predict suicide risk in young adults, one variable that has received considerable attention has been social disconnectedness. For example, according to Joiner’s (2005) theory of suicide, being socially disconnected from others represents a critical factor that heightens a person’s risk for suicide. Consistent with this view, findings from numerous studies have shown a reliable association between loneliness and suicide risk (Hatcher & Stubbersfield, 2013). For example, Chang and his colleagues (Chang et al., 2015; Chang, Muyan, & Hirsch, 2015; Muyan & Chang, 2015) have found a reliable association between loneliness and greater suicide risk (e.g., hopelessness, suicidal behaviors) in diverse cultural groups. Indeed, in one study, Chang, Hirsch, Sanna, Jeglic, and Fabian (2011) found that loneliness was an important predictor of suicide risk in Latina college students. Although these findings are important and point to the potential value of loneliness as a predictor of suicide risk in diverse adult groups, they do not take into account more culture- specific variables. Accordingly, we conducted the present study to examine the extent to which culture- specific (emic) variables might play an important role in predicting suicide risk, and to also determine if the inclusion of a general (etic) explanatory variable would add to the prediction of suicide risk, namely, hopelessness and suicidal behaviors, in a sample of 155 Latino college students. We conducted a pair of regression analyses including demographic variables (viz., age & sex) in the First Step, ethnic identity variables (ethnic affirmation, ethnic identity achievement, ethnic behaviors, & other group orientation; Phinney, 1992) in the Second Step, and loneliness (Russell, Peplau, & Curtrona, 1980) in the final Third Step, in predicting hopelessness and suicidal behaviors. Results of these analyses for both outcomes indicated that demographic variables did not account for significant variance in suicide risk. However, ethnic identity variables, as a set, were found to account for a significant 11% of the variance in hopelessness, and a significant 10% of the variance in suicide behaviors. Noteworthy, the inclusion of loneliness was found to account for an additional 19% of unique variance in hopelessness, and an additional 13% of unique variance in suicidal behaviors. Taken together, our findings underscore the importance of considering both emic and etic factors in trying to identify variables that may place Latinos at heightened risk for suicide. Additionally, our findings also point to the potential value of targeting specific ethnic identity variables (e.g., ethnic identity achievement) as well as loneliness when working with Latinos at risk for suicide.

Suicide risk is increased for previous suicide attempters, who may be vulnerable to exacerbating factors such as daily hassles; yet, individual-level, adaptive characteristics may ameliorate risk. We examined the influence of daily hassles on suicidal ideation and the moderating role of spiritual well-being and its subscales of religious and existential well-being. In our cross-sectional study, 148 African-American female suicide attempters were recruited from a large, urban hospital and completed the Survey of Recent Life Events, Spiritual Well-Being Scale, and Beck Scale for Suicide Ideation. Religious and existential well-being moderated the association between hassles and suicidal thoughts; this relationship was weaker for individuals with greater levels of spiritual well-being. Historically, spiritual beliefs have been important to the African-American community and their promotion may effectively prevent additional thoughts of suicide by attempters experiencing hassles of daily life.

The present study sought to examine optimism and hope as predictors of suicidal behaviors (viz., suicide ideation and suicide attempt) in a sample of 179 adult primary care patients. Furthermore, we aimed to determine if the combination of hope and optimism would account for additional variance in the prediction model for suicidal behaviors among this population. In this cross-sectional study, participants completed measures of hope (viz., agency and pathways), optimism, and suicidal behaviors, as well as a series of demographics questions. Hierarchical regression analyses were conducted to test the aforementioned hypotheses. Results indicated that hope and optimism were both significant and unique predictors of suicidal behaviors among adult primary care patients. However, the hope-by-optimism interaction terms were not found to be significant. Some implications of the present findings are discussed.

Creation and defence of a suicidal death is a study of the aftermath of self inflicted death in young adults, from the perspective of their friends. Suicide is a leading cause of death among young adults. Those who die in youth are likely to be engaged in an extended social network and thus the impact of their death may be particularly widespread. Research on the aftermath of suicide has largely focused on the experiences of family members. Research with friends of those who die has tended to be quantitative in nature and has been principally concerned with the relationship between exposure to a peer's suicide and risk of suicidal ideation in those left behind. By contrast, this study aimed to illuminate how friends of young adults who ended their life while they were a student at university understood their experience. The analysis had a particular focus on how suicidal deaths are conceptualised and reacted to. Qualitative methodology informed the study design and the principles of phenomenology were employed to gain rich insight into this under explored group. Semi-structured interviews based loosely on a series of topics were undertaken, and in total twelve young adults were interviewed. The results of the analysis focused on the experiences described in relation to the suicidal death. The findings show that the experiences of this group were complex and contradictory; however, four core areas were identified as shaping the experiences of participants. These were participants' descriptions of labelling their friends' death as a suicide; their experiences in trying to identify an explanation for the suicide; the explanations they rejected and those they eventually offered for the death; and their own personal reaction to the suicide. Links between these categories and wider representations of suicide are discussed and a series of suggestions made for how these both enable and constrain the experience of bereavement by suicide. The study concludes by discussing the implications of these findings for practice and a series of suggestions are made about how this study may inform further research.

Oregon voters legalized physician-assisted death in 1997 by passing the Oregon Death with Dignity Act. This law allowed terminally ill, mentally competent adult residents of the state to legally obtain a physician's prescription to hasten death under narrow sets of circumstances. The purpose of this study was twofold: to examine contemporary patterns of support for the law in Oregon and to explore how opinions have changed over time on the issue. This study examined patterns of public support among a random sample of registered Oregon voters for the state's death with dignity law, using a mixed mode (mail, online, and phone) cross-sectional survey (n = 442). The findings indicate a pattern of growing support with potential Oregon voters split 80%-20% on the issue, a substantial increase from the 60%-40% approval margin at the ballot box in 1997. Various demographic variables, as well as attitudinal factors, were explored in building a binary logistic regression model predicting probability of support. Frequency of church attendance, views about physician participation in the process, and opinions about Death with Dignity as an individual right were significant predictors of support. Frequent churchgoers, regardless of denomination or religious tradition, were nearly five times more likely to oppose Death with Dignity than support it, holding all other variables constant. While the findings indicate a pattern of growth in support over the past 15 years, they indicate also a stability of opinion, with few individuals indicating they had changed their opinions about the issue since the first time they encountered it.

Norepinephrine (NE) is one of three catecholamine neurotransmitters in the brain and has been studied extensively in relation to the biology of suicide as well as psychiatric disorders that significantly increase the risk of suicide. NE became a candidate for the pathology of depression in the 1950s, but not because of a discovery of altered concentrations of NE in depressed patients or suicide victims. Instead, NE was one of the neurotransmitters along with dopamine and serotonin that was directly affected by newly discovered antidepressant drugs. Since that time, NE has been one of the most studied neurotransmitters with regard to depression biology and suicide, second only to serotonin. However, interest in the role of NE in suicide and depression has dwindled considerably over the past 10 years. In fact, interest in monoamines appears to be waning overall, possibly driven by a push by the National Institutes of Health for paradigm shifts in understanding psychiatric disease biology. The move away from interest in the monoamines is also being driven by high-throughput technologies such as microarrays, which divert investigators from traditional disease candidates to novel proteins and pathways. Despite the current trends, evidence that points to dysfunction in the central noradrenergic system in depression and suicide is very strong and it remains quite possible that deficits in NE signaling may lie at the very root of psychiatric disorders that contribute to suicide. This chapter reviews the neurobiology and functional output of the brain noradrenergic system in relation to the potential involvement of NE in depression and suicide.