Ad J. F. M. Kerkhof

Parasuicide in Europe: the WHO/EURO multicentre study on parasuicide. I. Introduction and preliminary analysis for 1989

The WHO/EURO multicentre study on parasuicide is a new, coordinated, multinational, European study that covers two broad areas of research: monitoring trends in the epidemiology of parasuicide (epidemiological monitoring study); and follow‐up investigations of parasuicide populations, with a view to identifying the social and personal characteristics predictive of future suicidal behaviour (repetition prediction project). This article provides background information on the development and organization of the multicentre study, and presents selected findings from the epidemiological monitoring project, based on a preliminary examination of data collected in 15 centres on parasuicides aged 15 years and over treated in health facilities in defined catchment areas during the year 1989. The overall parasuicide incidence varied considerably across the centres, from a high (event) rate of 414 per 100,000 males in Helsinki to a low of 61 among males in Leiden. The highest female event rate was 595 in Pontoise, and the lowest 95 in Guipuzcoa. The mean event rate across all centres was 167 among males and 222 among females. Parasuicide incidence tended to be elevated among 15‐ to 34‐year‐olds, with lowest rates among those aged 55 years and over. With one exception (Helsinki), the female parasuicide rate was higher than the male rate, the F:M ratio ranging from 0.71:1 to 2.15:1, with a median of 1.5:1 (events). Short‐term repetition rates (as measured by the event:person ratio) differed between centres, from 1.03 to 1.30 (median = 1.12) among males, and from 1.07 to 1.26 (median = 1.13) among females. Although we warn against generalizing from our findings to make statements about differences in parasuicide between countries, we argue that the differences between centres are valid and should be addressed in further research.

Definitions of Suicidal Behaviour:Lessons learned from the WHO/EURO Multicentre Study.

Based on the experience matured during the 15 years of the WHO/EURO Multicentre Study on Suicidal Behavior, this paper provides an excursus on main elements that characterize components for definitional needs. It describes the rationale for choosing the initial set of definitions within the study and the subsequent problems and developments. As a result, unifying terminologies are proposed.

Why people engage in parasuicide: a-cross-cultural study of Intentions.

Information obtained at interview from 1,646 parasuicide patients in 14 regions in 13 European countries participating in the WHO/EURO Multicentre Study on Suicidal Behaviour was used to study self-reported intentions involved in parasuicide. Comparisons were made across cultures, genders, and age groups. Although some statistically significant differences were found, the effect sizes were very small. The main finding from this study is thus that parasuicide patients in different countries tend to indicate that similar types of intentions are involved in their acts of parasuicide, and that the intentions do not vary greatly with gender or age. The hypothesis that rates of suicide and parasuicide vary between regions with the frequency with which suicidal intention is indicated by the patients was also tested, but was supported only for women and in relation to national suicide rates. The findings from this study are likely to be generalizable to other settings and have implications for clinical practice.

Relation between attempted suicide and suicide rates among young people in Europe.

STUDY OBJECTIVE: To determine if there are associations between rates of suicide and attempted suicide in 15-24 year olds in different countries in Europe. DESIGN: Attempted suicide rates were based on data collected in centres in Europe between 1989 and 1992 as part of the WHO/EURO Multicentre Study of Parasuicide. Comparison was made with both national suicide rates and local suicide rates for the areas in which the attempted suicide monitoring centres are based. SETTING: 15 centres in 13 European countries. PATIENTS: Young people aged 15-24 years who had taken overdoses or deliberately injured themselves and been identified in health care facilities. MAIN RESULTS: There were positive correlations (Spearman rank order) between rates of attempted suicide and suicide rates in both sexes. The correlations only reached statistical significance for male subjects: regional suicide rates, r = 0.65, p < 0.02; national suicide rates, r = 0.55, p < 0.02. CONCLUSIONS: Rates of attempted suicide and suicide in the young covary. The recent increase in attempted suicide rates in young male subjects in several European countries could herald a further increase in suicide rates.

Mental disorders in European Prison Systems

American and European prison systems are faced with large numbers of mentally ill prisoners. It is estimated that correctional facilities in the United States house twice as many persons with serious mental illnesses as do mental hospitals (Torrey, 1995). North American studies (e.g., Roesch & Golding, 1985; Teplin, 1990) and European studies have found high prevalence rates of mental disorders in penal institutions. European studies have yielded fairly consistent findings about the prevalence rates of mental disorders in samples of unsentenced prisoners. Lifetime prevalence rates of mental disorders, including substance-related disorders and personality disorders, were found to be 71% in Denmark (Andersen, Sestoft, Lillebaek, Gabrielsen, & Kramp, 1996) and 71% in England (Birmingham, Mason, & Grubin, 1996). Current prevalence rates were found to be 64% in Denmark (Andersen et al., 1996), 62% in England (Birmingham et al., 1996), 63% in England and Wales (Brooke, Taylor, Gunn, & Maden, 1996) and 62% in Ireland (Smith, O’Neill, Tobin, Walshe, & Dooley, 1996). Thus,

Methods used for parasuicide: results of the WHO/EURO Multicentre Study on Parasuicide

Background: National suicide statistics show remarkable differences in the frequencies of various methods used for completed suicide. The WHO/EURO Multicentre Study on Parasuicide makes possible for the first time an international comparison of the frequencies of methods used in attempted suicide, because the data are based on geographical catchment areas of medical institutions. Method: Ongoing standardized monitoring of attempted suicide in all medical institutions serving the catchment areas was performed in 14 centres in 12 European countries. The data analysis is based on 20,649 events involving 15,530 persons, recorded between 1989 and 1993. Results: The comparison of rates per 100,000 shows striking differences between the centres. The highest rates for drug overdoses were found for female attempters in Oxford (347/100,000), Helsinki (238/100,000) and Stockholm (221/100,000). Guipuzcoa had the lowest rates (61/100,000). The differences were most prominent in the age group 15–24, with outstanding rates for women in Oxford (653/100,000), which was mainly due to the frequent use of analgesics. Szeged had outstandingly high rates for pesticides and solvents. In some centres the use of multiple methods was frequent. Conclusions: There is a need, especially for areas with high frequencies for certain methods, to understand the factors involved and to develop new and specific prevention projects and to monitor their effects. The WHO/EURO Multicentre Study on Parasuicide has proved to be a useful and reliable instrument for continuous monitoring of trends in parasuicide.

Preventing suicide in prisons, part I. Recommendations from the International Association for Suicide Prevention Task Force on Suicide in Prisons.

In 2000 the Department of Mental Health of the World Health Organization (WHO) published a guide named Preventing Suicide. A Resource for Prison Officers as part of the WHO worldwide initiative for the prevention of suicide. In 2007 there are new epidemiological data on prison suicide, a more detailed discussion of risk factors accounting for the generally higher rate of suicide in correctional settings in comparison to the general population, and several strategies for developing screening instruments. As a first step, this paper presents an update of the WHO guide by the Task Force on Suicide in Prisons, created by the International Association for Suicide Prevention. A second paper, by the same Task Force, will present some international comparisons of suicide prevention services in correctional facilities.

A systematic review of the effectiveness of naltrexone in the maintenance treatment of opioid and alcohol dependence

This systematic review summarises evidence of the effectiveness of naltrexone (NTX) and the added value of psychosocial treatment in the maintenance treatment of opioid and alcohol dependence. Studies were selected through a literature search conducted in March 2004. Seven opioid and seventeen alcohol studies were identified. When possible, meta-(regression) analyses were performed. There is lack of evidence about the effectiveness of NTX in the maintenance treatment of opioid dependence. There is evidence for the effectiveness and applicability of NTX in the management of alcohol dependence. The opioid studies combined NTX with a variety of psychosocial interventions, which plagued the evaluation of their value. Concomitant psychosocial interventions used in the alcohol studies were mainly cognitive behavioural, which seems to be more effective than NTX combined with supportive therapy. Available data do not allow firm conclusions regarding the added effect of psychosocial interventions. However, the data suggest that a combination of naltrexone with cognitive behavioural relapse prevention therapy is beneficial in alcohol dependent patients.

Cognitive behaviour therapy to prevent complicated grief among relatives and spouses bereaved by suicide: cluster randomised controlled trial

Objective To examine the effectiveness of a family based grief counselling programme to prevent complicated grief among first degree relatives and spouses of someone who had committed suicide. Design Cluster randomised controlled trial with follow-up at 13 months after the suicide. Setting General practices in the Netherlands. Participants 122 first degree relatives and spouses of 70 people who committed suicide; 39 families (68 participants) were allocated to intervention, 31 families (54 participants) to control. Intervention A family based, cognitive behaviour counselling programme of four sessions with a trained psychiatric nurse counsellor between three to six months after the suicide. Control participants received usual care. Main outcome measures Self report complicated grief. Secondary outcomes were the presence of maladaptive grief reactions, depression, suicidal ideation, and perceptions of being to blame for the suicide. Results The intervention was not associated with a reduction in complicated grief (mean difference −0.61, 95% confidence interval −6.05 to 4.83; P=0.82). Secondary outcomes were not affected either. When adjusted for baseline inequalities, the intervention reduced the risk of perceptions of being to blame (odds ratio 0.18, 0.05 to 0.67; P=0.01) and maladaptive grief reactions (0.39, 0.15 to 1.01; P=0.06). Conclusions A cognitive behaviour grief counselling programme for families bereaved by suicide did not reduce the risk of complicated grief or suicidal ideation or the level of depression. The programme may help to prevent maladaptive grief reactions and perceptions of blame among first degree relatives and spouses. Trial registration Current Controlled Trials ISRCTN66473618.

Time perspective, personality and psychopathology: Zimbardo’s time perspective inventory in psychiatry

Time perspective theory assumes that behaviour is influenced by how individuals link their behaviour to their past, present, and future. This paper explores the concept of time perspective (Zimbardo and Boyd, 1999) within a psychiatric context. We compared 76 individuals, in treatment (n = 32) or not in treatment (n = 44). The participants completed the time perspective questionnaire ZTPI, the NEO-PI-R (personality traits), an instrument to measure personality problems SIPP-118, and the BDI-II (depression). We found correlations between measures of psychopathology and Past Positive, Past Negative and Present Fatalistic time perspectives. Particularly Past Negative appeared to be indicative for psychiatric problems.