François Chagnon

Suicide attempts: prevention of repetition

Objective: To present an overview of promising strategies to prevent repetition of suicidal behaviours. Method: This literature review on tertiary preventive interventions of suicide attempts was produced using the computerized databases PubMed and PsycINFO from January 1966 to September 2010, using French- and English-language limits and the key words: suicid* or deliberate self-harm and treatment* or therapy or intervention* or management. Results: Thirteen of the 35 included studies showed statistically significant effects of fewer repeated attempts or suicides in the experimental condition. Overall, 22 studies focused on more traditional approaches, that is, pharmacological or psychological approaches. Only 2 of the 6 pharmacological treatments proved significantly superior to a placebo—a study of lithium with depression and flupenthixol with personality disorders. Eight out of 16 psychological treatments proved superior to treatment as usual or another approach: cognitive-behavioural therapy (CBT) (n = 4), (including dialectical behaviour therapy [n = 2]); psychodynamic therapy (n = 2); mixed (CBT plus psychodynamic therapy [n = 1]); and motivational approach and change in therapist (n = 1). Among the 8 studies using visit, postal, or telephone contact or green-token emergency card provision, 2 were significant: one involving telephone follow-up and the other telephone follow-up or visits. Hospitalization was not related to fewer attempts, and 1 of the 4 outreach approaches had significant results: a program involving individualized biweekly treatment. The rationale behind these single or multiple approaches still needs to be clarified. There were methodological flaws in many studies and some had very specific limited samples. Conclusions: There is a need for more research addressing the problem in definitions of outcomes and measurement of the dependent variables, gender-specific effects, and inclusion of high-risk groups. There is a need for the development and evaluation of new approaches that support collaboration with community resources and more careful assessment and comparisons of existing treatments with different populations.

Completed Suicides in a Youth Centres Population

Objective: From 1995 to 2000, 422 youths, aged 18 years and under, died as a result of suicide in Quebec. More than one-third had received services from youth centres (YCs) at some point. This study sought to characterize a sample of those youths to improve services for this at-risk population. Method: From a retrospective study of YCs and coroners office files, we investigated the clinical features of youths who had received YC services and died by suicide. We compared them with YC patients matched for age, sex, and geographic area who had reported suicidal behaviour or who had no such symptoms. Results: Among those who committed suicide, we found a ratio of 3.8 boys for 1 girl, with a mean age of 16.8 years. Hanging, used by 73.6%, was the most frequent means; 53.6% had a previous suicide attempt. The group that committed suicide had more indicators of major depression, substance abuse, and disruptive behaviours, as well as more adverse events. Conclusions: Interventions should focus on screening for mental disorders and suicidal behaviours on the initial contact with YC services. This screening should be implemented through a medical multidisciplinary team that includes psychoeducational services.

Identification of sexually abused female adolescents at risk for suicidal ideations: a classification and regression tree analysis.

This study explored the clinical profiles of 77 female teenager survivors of sexual abuse and examined the association of abuse-related and personal variables with suicidal ideations. Analyses revealed that 64% of participants experienced suicidal ideations. Findings from classification and regression tree analysis indicated that depression, posttraumatic stress symptoms, and hopelessness discriminated profiles of suicidal and nonsuicidal survivors. The elevated prevalence of suicidal ideations among adolescent survivors of sexual abuse underscores the importance of investigating the presence of suicidal ideations in sexual abuse survivors. However, suicidal ideation is not the sole variable that needs to be investigated; depression, hopelessness and posttraumatic stress symptoms are also related to suicidal ideations in survivors and could therefore guide interventions.

Predicting suicidal ideations in sexually abused female adolescents: a 12-month prospective study

This study investigates the contribution of posttraumatic stress symptoms to the prediction of suicidality among female adolescent survivors of sexual abuse. A one-year prospective study of 52 female survivors aged 12 to 18 years was conducted. A negative binomial regression analysis revealed that depressive symptoms as well as posttraumatic stress symptoms associated with the sexual trauma were significant predictors of suicidal ideations a year later. Posttraumatic stress symptoms remained a significant predictor of suicidal ideations even when controlling for depressive symptomatology and the presence of a past suicide attempt, thus emphasizing the relevance of posttraumatic stress symptoms in regard to suicidality in sexually abused youths. Results are discussed within the context of therapeutic modalities for survivors of a sexual trauma.

Comparison of the Effects of Telephone Suicide Prevention Help by Volunteers and Professional Paid Staff: Results from Studies in the USA and Quebec, Canada

Research since the 1960s has consistently found that lay volunteers are better at helping suicidal callers than professionals. Yet, professional degrees are increasingly becoming requirements for helpline workers. In our first study, we conducted post hoc comparisons of U.S. helplines with all professional paid staff, all lay volunteers, and a mix of both, using silent monitoring and standardized assessments of 1,431 calls. The volunteer centers more often conducted risk assessments, had more empathy, were more respectful of callers, and had significantly better call outcome ratings. A second study of five Quebec suicide prevention centers used silent monitoring to compare telephone help in 1,206 calls answered by 90 volunteers and 39 paid staff. Results indicate no significant differences between the volunteers and paid employees on outcome variables. However, volunteers and paid staff with over 140 hours of call experience had significantly better outcomes. Unlike the United States, Quebec paid employees were not required to have advanced professional degrees. We conclude from these results and previous research that there is no justification for requiring that suicide prevention helpline workers be mental health professionals. In fact, the evidence to date indicates that professionals may be less effective in providing telephone help to suicidal individuals when compared to trained lay volunteers.