Alexandre Reynders

Suicide Intervention Skills and Related Factors in Community and Health Professionals

Health and community professionals have considerable exposure to suicidal people and need to be well skilled to deal with them. We assessed suicide intervention skills with a Dutch version of the SIRI in 980 health and community professionals and psychology students. Suicide intervention skills clearly differed among professional groups and were strongly related to experience, especially suicide-specific experience. Some community professionals scored below acceptable levels on their ability to respond appropriately to suicidal people they encounter, and tended to overestimate their skills level. Training is therefore indicated for these groups, and may be useful to more highly experienced groups too.

The reliability of suicide rates: an analysis of railway suicides from two sources in fifteen European countries.

BACKGROUND National suicide data are an underestimation of the actual number of suicides but are often assumed to be reliable and useful for scientific research. The aim of this study is to contribute to the discussion of the reliability of suicide mortality data by comparing railway suicides from two data sources. METHODS Data for the railway suicides and the concurrent causes of death of fifteen European countries were collected from the European Detailed Mortality Database and the European Railway Agency (ERA). Suicide rates, odds ratios and confidence intervals were calculated. RESULTS The suicide data from the ERA were significantly higher than the national data for six out of fifteen countries. In three countries, the ERA registered significantly more railway suicides compared to the sum of the national suicides and undetermined deaths. In Italy and France, the ERA statistics recorded significantly more railway related fatalities than the national statistical offices. In total the ERA statistics registered 34% more suicides and 9% more railway fatalities compared with the national statistics. LIMITATIONS The findings of this study concern railway suicides and they cannot be extrapolated to all types of suicides. Further, the national suicide statistics and the ERA data are not perfectly comparable, due to the different categorisations of the causes of death. CONCLUSIONS Based on the data for railway suicides, it seems that the underestimation of suicide rates is significant for some countries, and that the degree of underestimation differs substantially among countries. Caution is needed when comparing national suicide rates. There is a need for standardisation of national death registration procedures at the European level.

Help-seeking, stigma and attitudes of people with and without a suicidal past. A comparison between a low and a high suicide rate country

BACKGROUND A significant proportion of suicidal persons do not seek help for their psychological problems. Psychological help-seeking is assumed to be a protective factor for suicide. However, different studies showed that negative attitudes and stigma related to help-seeking are major barriers to psychological help-seeking. These attitudes and stigma are not merely individual characteristics but they are also developed by and within society. The aim of this study is twofold. First, we investigate if persons with a suicidal past differ from people without a suicidal past with respect to help-seeking intentions, attitudes toward help-seeking, stigma and attitudes toward suicide. The second aim is to investigate if these attitudinal factors differ between people living in two regions with similar socio-economic characteristics but deviating suicide rates. METHOD We defined high (Flemish Community of Belgium) and low (The Netherlands) suicide regions and drew a representative sample of the general Flemish and Dutch population between 18 and 65 years. Data were gathered by means of a postal questionnaire. Descriptive statistics are presented to compare people with and without suicidal past. Multiple logistic regressions were used to compare Flemish and Dutch participants with a suicidal past. RESULTS Compared to people without a suicidal past, people with a suicidal past are less likely to seek professional and informal help, perceive more stigma, experience more self-stigma (only men) and shame (only women) when seeking help and have more accepting attitudes toward suicide. In comparison to their Dutch counterparts, Flemish people with a suicidal past have less often positive attitudes toward help-seeking, less intentions to seek professional and informal (only women) help and have less often received help for psychological problems (only men). LIMITATIONS The main limitations are: the relatively low response rate; suicidal ideation was measured by retrospective self-report; and the research sample includes only participants between 18 and 65 years old. CONCLUSIONS Having a suicidal past is associated with attitudinal and stigmatizing barriers toward help seeking and accepting attitudes toward suicide. Prevention strategies should therefore target people with a suicidal history with special attention for attitudes, self-stigma and feelings of shame related to help-seeking.

Stigma, attitudes and help-seeking intentions for psychological problems in relation to regional suicide rates.

In this ecological study, we investigated whether help-seeking related to stigma, intentions, and attitudes toward suicide are associated with the suicide rates of 20 regions within the Netherlands and Belgium. Significant associations were found between regional suicide rates and the intention to seek informal help (β = -1.47, p = .001), self-stigma (β = 1.33, p = .038), and shame (β = .71, p = .030). The association between self-stigma and suicide rate was mediated by intentions to seek informal help. These results suggest that to promote suicide prevention at the level of the regional population, stigma, shame, and intentions to seek help should be targeted in the public domain.

Suicide registration procedures and practices in Europe

Suicide is an important primary outcome measure for evaluating the effectiveness of intervention programmes. The aim of the current study was to describe and compare suicide-registration procedures in eight European countries, pinpoint potential deficiencies and provide recommendations on how best to improve the quality of suicide registration in the EU. Qualitative data on suicide registration were collected within the OSPI-Europe project from country experts using a structured questionnaire. Suicide registration was based on the medico-legal system in six countries and the coronial system in two. Differences not only between, but also within these two systems emerged. In every country, the process starts after the fact of death has been ascertained by a physician and any suspicion of injury death has arisen. It ends with registration of the death in the national mortality statistics. Between these stages, several elements that are crucial to the consistency of suicide registration were identified: the professional background and co-operation among the authorities involved, performance of the legal inquiry and forensic autopsy, certification and final decision-making, and the coding and registry system. A model for recording suicides with maximum accuracy should include: (1) a comprehensive, accurate and time-limited legal inquiry; (2) obligatory forensic autopsy in all cases of injury death; (3) reciprocal and accurate communication among the authorities involved; (4) electronic data transmission; (5) final decision-makers access to comprehensive information and (6) specially trained coders entitled to obtain additional information from the legal authorities and the certifiers.