Gwendolyn Portzky

The prevention and treatment of complicated grief: a meta-analysis.

BACKGROUND Bereaved individuals are at increased risk of mental and physical disorders, and prevention and treatment of complicated grief is indicated. Earlier quantitative reviews have not focused on the effect of bereavement interventions on (complicated) grief. Therefore the main objective of this meta-analysis was to determine the short-term and long-term effect of both preventive and treatment interventions on complicated grief. METHODS Randomized controlled trials for prevention or treatment of complicated grief were identified through a systematic literature search. Electronic databases and reference lists of earlier review articles served as data sources. Data were analyzed with REVMAN 5.0.14. RESULTS Fourteen randomized controlled trials met the inclusion criteria. Study quality differed among the trials. Contrary to preventive interventions, treatment interventions yielded significant pooled standardized mean differences in favor of the (specific) grief intervention at post-test and follow-up. During the follow-up period, the positive effect of treatment interventions for complicated grief even increased. CONCLUSIONS Treatment interventions can effectively diminish complicated grief symptoms. Preventive interventions, on the other hand, do not appear to be effective. Limitations of the meta-analysis and future research options are discussed.

Reasons for adolescent deliberate self-harm: a cry of pain and/or a cry for help? Findings from the child and adolescent self-harm in Europe (CASE) study.

The present study examines reasons for adolescent deliberate self-harm. A cross-sectional survey using an anonymous self-report questionnaire was carried out in seven countries (Australia, Belgium, England, Hungary, Ireland, the Netherlands and Norway). Data on 30,477 school pupils between the ages of 14–17 were analysed. Past year and lifetime deliberate self-harm were assessed, along with the self-reported reasons for deliberate self-harm. The results showed that ‘wanted to get relief from a terrible state of mind’ and ‘wanted to die’ were most commonly reported. Principal component analysis indicated two underlying dimensions in the reasons for deliberate self-harm, i.e. a cry of pain motive and/or a cry for help motive. The majority of self-harmers reported at least one cry of pain motive (‘to die’, ‘to punish myself’, and ‘to get relief from a terrible state of mind’) and an additional cry for help motive (‘to show how desperate I was feeling’, to frighten someone’, ‘to get my own back on someone’, ‘to find out whether someone really loved me’, and ‘to get some attention’). Females reported more reasons than males. Only females showed an age difference, with girls aged 16–17 more frequently reporting a cry for help motive. There was considerable consistency in choice of motives across countries and genders. Systematic assessment of the reasons for deliberate self-harm can help clinicians to better understand the meaning of self harming behaviour, select appropriate treatment, suggest alternative coping strategies, and hopefully prevent future suicidal behaviour.

Suicide among adolescents : A psychological autopsy study of psychiatric, psychosocial and personality-related risk factors

BackgroundThe suicide rate among young males in Belgium has doubled over the last decade. As more knowledge about risk factors is required to develop national prevention strategies, we investigated adolescent suicides using the psychological autopsy method.MethodsA total of 32 informants were interviewed regarding 19 suicide cases (aged 15–19). A semi-structured interview schedule, constructed by Houston et al. (J Affect Disord 63:159–170, 2001), was used.ResultsAll adolescents were suffering from one or more mental disorder(s) at the time of their death, and almost half of them were diagnosed with personality disorders. Adjustment disorders were diagnosed in one fifth of the sample, which appears to be relevant in view of the multiple life events and other psychosocial problems which adolescents were facing shortly before death. This suggests that difficulties in coping with stressful psychosocial problems are important in the course of the suicidal process. Only a small minority was receiving treatment for their disorders.Conclusions Mental disorders, commonly untreated and combined with personality disorders and psychosocial problems, are frequently found in young suicide victims. This study suggests that education in the diagnosis and treatment of depression, adjustment disorders and suicide is important in the prevention of suicide.

Sociodemographic and Psychopathological Risk Factors for Repetition of Attempted Suicide: A 5-Year Follow-Up Study

The present study examines the association between repetition of suicide attempts and sociodemographic and psychopathological characteristics of patients during a 5-year follow-up period. Participants were 874 suicide attempters referred to the University Hospital of Ghent, among whom 361 (41.3%) patients were available for follow-up analysis. Within 5 years, 29.2% of those admitted for an index suicide attempt repeated non-fatal suicidal behavior. Repetition of suicidal behavior was associated with high scores on measures of psychopathology. In addition, the risk of repetition was increased if the patient was female, aged between 20 and 49, and had a lower education. Multivariate analysis showed significant results for age, the Buglass & Horton Risk of Repetition Scale and for anxiety. Repetition of suicidal behavior is associated with high anxiety, severe depression, more psychiatric symptoms and is increased in young patients.

Psychosocial and psychiatric factors associated with adolescent suicide: A case–control psychological autopsy study

This study aimed at the investigation of psychosocial and psychiatric risk factors of adolescent suicide by means of a case-control psychological autopsy study. Relatives and other informants of 19 suicide victims and 19 matched psychiatric controls were interviewed by means of a semi-structured interview schedule. Psychiatric controls included adolescents, individually matched according to gender, age and time between interview and suicide/admission, who had been admitted to a Psychiatric Department with suicidal ideation or attempted suicide at admission. Results showed that suicide victims had been exposed more frequently to suicidal behaviour by friends and through media and experienced more relational problems in the past year. Suicidal communication was less frequently reported in suicide victims than in controls and when communication did occur, it was less often directed towards parents. Treatment of psychiatric disorders was significantly less found in suicide victims. Psychiatric control patients were more likely to have comorbidity of psychiatric disorder, conduct disorder, delinquency or academic difficulties. This study showed significant differences between young suicide victims and psychiatric controls for life events, exposure, communication and treatment. These results also suggest that more symptoms and more externalizing behaviour can be observed in psychiatric control patients which could indicate more warning signals of possible psychiatric problems for the environment, which could result in more help-seeking behaviour and treatment.

The Role of Mobile Phone Technology in Understanding and Preventing Suicidal Behavior

In this editorial, we discuss how mobile phone technology has the potential to move the field forward in terms of understanding suicide risk as well as laying foundations for the development of effective treatments/interventions. We have focused on mobile health technology given the rapid growth of mobile health approaches in suicide prevention (De Jaegere & Portzky, 2014; Mishara & Kerkhof, 2013) and psychological research more generally (Myin-Germeys et al., 2009; Nock, Prinstein, & Sterba, 2009; Palmier-Claus et al., 2011) and because mobile phone use is ubiquitous, with 75% of the world having access to a mobile phone (Kay, 2011). (aut. ref.)

A CBT-Based Psychoeducational Intervention for Suicide Survivors

BACKGROUND Bereavement following suicide is associated with an increased vulnerability for depression, complicated grief, suicidal ideation, and suicide. There is, however, a paucity of studies of the effects of interventions in suicide survivors. AIMS This study therefore examined the effects of a cognitive behavioral therapy (CBT)-based psychoeducational intervention on depression, complicated grief, and suicide risk factors in suicide survivors. METHOD In total, 83 suicide survivors were randomized to the intervention or the control condition in a cluster randomized controlled trial. Primary outcome measures included maladaptive grief reactions, depression, suicidal ideation, and hopelessness. Secondary outcome measures included grief-related cognitions and coping styles. RESULTS There was no significant effect of the intervention on the outcome measures. However, the intensity of symptoms of grief, depressive symptoms, and passive coping styles decreased significantly in the intervention group but not in the control group. CONCLUSION The CBT-based psychoeducational intervention has no significant effect on the development of complicated grief reactions, depression, and suicide risk factors among suicide survivors. The intervention may, however, serve as supportive counseling for suicide survivors.

A comparative follow-up study of aftercare and compliance of suicide attempters following standardized psychosocial assessment

This comparative longitudinal study investigated aftercare and compliance of attempted suicide patients after standardized psychosocial assessment. Structured interviews were conducted 1 month (FU1) and 6 months (FU2) after an index suicide attempt. Assessment was associated with more frequent discussion of treatment options with the patient at the hospital and a shorter interval between discharge and contacting the general practitioner (GP). A near significant effect was found for discussing the suicide attempt with the GP more frequently and with start or change of the medication scheme after the index attempt. The current findings support the use of a standardized tool for the assessment of suicide attempters and are in line with the chain of care model for suicide attempters.

Epidemiological Trends in Attempted Suicide in Adolescents and Young Adults Between 1996 and 2004

BACKGROUND Notwithstanding the epidemiological studies indicating an increased risk of attempted suicide among adolescents and young adults, there is a scarcity of international studies that examine long-term epidemiological trends in rates and characteristics of this vulnerable group. AIMS This article describes the results of a 9-year monitoring study of suicide attempts in adolescents and young adults referred to the Accident and Emergency Department of the Gent University Hospital (Belgium). METHODS Between January 1996 and December 2004, trends, sociodemographic, and methodrelated characteristics of suicide attempts were assessed by a psychiatrist on data sheets. RESULTS Attempted suicide rates declined from 1996 to 2001 and then rose until 2004, but did not exceed previous rates. During the 9 years of monitoring, there was a preponderance of female suicide attempters, except for 1997. Rates of attempts and of fatal suicide were negatively correlated. Significantly more males than females deliberately injured themselves. Younger attempters, especially females, significantly more often poisoned themselves with analgesics. In nearly one in five attempts, alcohol was used in combination with other methods, and alcohol intake was more commonly observed in older suicide attempters. Nearly half of the adolescents were identified as repeaters. CONCLUSIONS The results of this study warrant further monitoring of trends and characteristics of young suicide attempters.

Attempted suicide in patients with eating disorders

BACKGROUND Suicide is a major cause of mortality for patients with eating disorders (ED), especially for patients with anorexia nervosa. Attempted suicide is also relatively common in patients with anorexia or bulimia nervosa. AIMS This study aimed at examining associations between attempted suicide and trait- and state-dependent characteristics in a large clinical population of ED patients. METHOD The sample consisted of 1,436 in- and outpatients of the Centre for Eating Disorders of the Ghent University Hospital. Measures of ED symptoms, psychopathology, and personality traits were compared between ED patients with and ED patients without a history of attempted suicide. RESULTS A history of attempted suicide was found in 11.8% of the ED patients and lifetime suicidal ideation was reported by 43.3%. Multivariate analyses showed that a history of attempted suicide was associated with higher scores on depression, purging symptomatology, early-developed cognitive schemes (impaired autonomy and increased inhibition), and social insecurity. CONCLUSION These findings support the increased risk of suicidal behavior in ED. The presence of particular personality traits, of cognitive schemes, and of purging and depressive symptoms should increase vigilance for suicidal behavior.