Jacinta Hawgood

Anxiety disorders and suicidal behaviour: an update

Purpose of review The primary aim of this review is to present the main findings from the literature published between January 2006 and May 2007 on anxiety and suicidal behaviour. The secondary aim is to present critical comments on methodological issues, highlighting areas for future research. Recent findings Traditionally, anxiety disorders have not been viewed as independent risk factors for suicidal behaviour, and therefore assessment of anxiety disorders has not been particularly emphasized in clinical enquiries and suicide screening tools. This review identifies evidence suggesting that specific anxiety disorders (e.g. generalized anxiety disorder, panic disorder and obsessive–compulsive disorder) may be independently associated with suicidality, to which they particularly contribute when they are co-morbid with bipolar disorder, depression, schizophrenia, or post-traumatic stress disorder, in both child/adolescent and adult populations. Summary Despite methodological issues preventing firm conclusions from being drawn in most cases, these findings should prompt clinicians to evaluate more specifically the impact of anxiety disorders on suicidal behaviour, particularly when they are co-morbid. Further research into treatment of anxiety disorders in relation to preventing suicide is required.

Suicide in selected occupations in Queensland: Evidence from the State suicide register

Objective: Prior research has suggested an association between suicide and certain occupations. The aim of the present study was to report on suicide rates in selected occupations in Queensland (QLD). Method: Suicide mortality data from the QLD Suicide Register and population data from the Australian Bureau of Statistics were obtained for the period 1990–2006. Suicide rates were calculated for each occupational group and compared to rates within the general population (15–64 year age group) and the employed population of QLD. Results: There was significantly higher risk of suicide for male subjects in the agricultural, transport and construction sectors of QLD. High suicide rates were also found in female nurses, artists, agricultural workers and cleaners, while education professionals (of both genders) appeared at lower risk. Conclusions: The significantly higher suicide rates for employees of the agriculture, construction, and transport industries indicate a need for further research into the occupation-specific conditions and individual or other social–environmental factors that may accentuate suicide risk within these professions. Use of higher quality occupational data is also warranted in future studies.

Is suicide prevention properly taught in medical schools

Objective: To determine the need and feasibility of developing a national suicide prevention (SP) curriculum for undergraduate medical students. Design: Exploratory study using semi-structured phone interviews and surveys. Data was obtained from ten (out of 15) Australian Medical Schools (AMS), 373 medical students from one Queensland medical school, and 24 Australian General Practitioners, between April and June, 2006. Results: Convergent views of AMS, medical students, and GPs revealed a high need and support for SP curricula, especially on skills-based education. Students who previously received SP education rated themselves significantly higher on skills-based SP abilities than those who had not. Over one-third of GPs had not received SP training from their universities (37.5%), yet 66% had experienced a case of suicide among their patients, and a third recorded on average a case of suicide every two years. The majority of students and GPs rated themselves as least competent on skills-based SP capabilities, yet rated these capabilities very high in importance for the medical profession. Whilst 80% of AMS provides some form of SP education, the quantity and quality of this is divergent. All AMS indicated support for a more uniformed SP curriculum, identified priority SP topics and delivery mechanisms, and 80% agreed to participate in a future piloting of a SP curriculum. Conclusions: SP curriculum may positively impact on students perceived competency. Skills-based SP curricula were highly recommended to improve ‘hands-on’ assessment, intervention and management capabilities. Further consultation is required with all AMS to specify structure and resource needs for a national SP curriculum.

Development of ACROSSnet: an online support system for rural and remote community suicide prevention workers in Queensland, Australia

Communication and information technologies can reduce the barriers of distance and space that disadvantage communities in Australias underserved rural areas, where the health status of residents is often worse than that of their urban counterparts. ACROSSnet (Australians Creating Rural Online Support Systems) is a 3 year collaborative action research project that aims to design and develop an online support system that will assist rural communities in accessing information, education and support regarding suicide and its prevention, whilst considering the challenges of Internet speed, cost and availability that can impede the delivery of online services. The site provides three distinct levels of access: one level for community members, and two further levels for appropriately credentialled mental health workers. In creating this environment, the ACROSSnet team hopes that online communities of practice will develop, engaging participants of different ages, income and education levels, location, and socioeconomic backgrounds.

Correlates of suicide in building industry workers.

Suicide within the construction industry in Queensland, Australia was reportedly high in a recent Royal Commission report. The current study examined the incidence and causes of suicide in this industry using psychological autopsy and focus group investigations. A total of 64 male suicides occurred over the seven-year period, representing a crude suicide rate of 40.3 per 100,000, significantly greater than the working age Australian male rate. Young employees were at excessive risk with separation/divorce, relationship problems, and untreated psychiatric conditions the major contributors. Focus groups emphasized the importance of work/home interface factors and industry-specific factors preceding suicide.

Personal Stigma in Suicide Attempters

The aim of this study was to explore suicide attempters’ experiences of personal stigma. This qualitative study included a focus group of 7 experienced clinicians and semi-structured interviews with 8 suicide attempters. Thematic analysis of the data yielded four main themes: seriousness, care, “badness,” and avoidance. Experiences of stigma pervaded all contexts, but were most emotionally upsetting to the participants in interpersonal relationships. The findings show the importance of evaluating stigma for suicide attempters during suicide risk assessment and the need for specifically tailored interventions to combat suicide stigma at the individual level.

Timelines for difficult times: use of visual timelines in interviewing suicide attempters

ABSTRACT The stories of people who attempt suicide are insufficiently reflected in suicide research in psychology. This article outlines a method using a visual timeline during the interviews to explore the narratives of suicide attempts. The method was successfully employed in two studies to collect data on the suicidal process from people with prior experience of suicide attempts. The advantages of the method in collecting comprehensive data, building rapport, and fostering participants’ insight are outlined. Strategies that were used to ensure safety of participants are described in addition to the requirements for interviewers seeking to apply this method.

Assessment of acquired capability for suicide in clinical practice

Abstract The Interpersonal Psychological Theory of suicide proposes that the interaction between Thwarted Belongingness, Perceived Burdensomeness, and Acquired Capability for Suicide (ACS) predicts proximal risk of death by suicide. Instruments to assess all three constructs are available. However, research on the validity of one of them, the acquired capability for suicide scale (ACSS), has been limited, especially in terms of its clinical relevance. This study aimed to explore the utility of the different versions of the ACSS in clinical assessment. Three versions of the scale were investigated, the full 20-item version, a 7-item version and a single item version representing self-perceived capability for suicide. In a sample of patients recruited from a clinic specialising in the treatment of suicidality and in a community sample, all versions of the ACSS were found to show reasonable levels of reliability and to correlate as expected with reports of suicidal ideation, self-harm, and attempted suicide. The item assessing self-perceived acquired capacity for suicide showed highest correlations with all levels of suicidal behaviour. However, no version of the ACSS on its own showed a capacity to indicate suicide attempts in the combined sample. It is concluded that the versions of the scale have construct validity, but their clinical utility is limited. An assessment using a single item on self-perceived ACS outperforms the full and shortened versions of ACSS in clinical settings and can be recommended with caution for clinicians interested in assessing this characteristic.

Do we need education on right‐to‐die issues? Medical perspectives from Australia

An increasing demand for physicians’ involvement in life‐ending decisions has led to extensive debate on euthanasia and right‐to‐die issues by social, political and medical groups. The Commonwealth Department of Health and Aged Care commissioned an evaluation of the need to educate undergraduate medical students on suicide prevention, euthanasia and life‐ending issues.Introduction An increasing demand for physicians’ involvement in life-ending decisions has led to extensive debate on euthanasia and right-to-die issues by social, political and medical groups. The Commonwealth Department of Health and Aged Care commissioned an evaluation of the need to educate undergraduate medical students on suicide prevention, euthanasia and life-ending issues. Methods Semi-structured interviews were conducted on samples of medical school coordinators, medical students and general practitioners (GPs). Key academics in Curriculum and/or Accreditation Committees from 10 of 15 Australian Medical Schools (AMS) participated in a survey on the possible implementation of suicide prevention, euthanasia and life-ending issues in undergraduate courses. Medical students (n = 373) were asked to rate their attitude toward the same issues. Twenty-four GPs from six different states (rural/urban environments) were asked to rate the level of importance of a specific curriculum on suicide prevention, euthanasia and life-ending issues. Results Medical students showed high interest in learning about euthanasia and life-ending issues (76.8%), quality of life and quality of death (85.1%), and different types of euthanasia and physician-assisted suicide (70%). They reported that physicians should be involved in ending-life decisions (89%). Forty per cent of AMS thought education on euthanasia and life-ending issues was essential. Fifty-four per cent of GPs considered education in euthanasia and related issues a high priority. Discussion The increasing aging population and the high prevalence of chronic illness call for a growing involvement of physicians in this difficult area of medical practice. Globally, the need for undergraduate education on these matters is perceived as important and urgent.

Suicide and other sudden death bereavement of immediate family members: An analysis of grief reactions six-months after death

INTRODUCTION While suicide bereavement has been assumed to be different from bereavement following death by other modes, a number of studies have reported that there are several similarities, particularly for violent deaths. The aims of the current study are to test, using confirmatory factor analysis, the factor structure of Grief Experience Questionnaire (GEQ) that has been proposed in other studies; and to compare short term grief reactions, mental health, and suicidality six-months after bereavement in close family members bereaved by suicide versus sudden death. METHODS Participants were 142 adults who were bereaved following a suicide and 63 who were bereaved following the sudden death of a family member. Data were collected six-months after the death. RESULTS Analyses did not show good fits for the factor structures proposed for the GEQ in earlier studies. However, a relatively good fit was found for an 8-factor version of the originally proposed GEQ. Bereavement type (suicide vs. sudden death) significantly predicted rejection, somatic reactions, stigmatisation, responsibility and shame on the GEQ, after adjusting for kinship type, gender, age, pre-bereavement diagnosis of mental illness and self-harm behaviours of both the deceased and the bereaved, and current mental health and suicidal ideation of the bereaved. LIMITATIONS Different recruitment methods were used and response rates were relatively low. CONCLUSIONS The new knowledge of bereaved experiences specific to suicide loss at six-months post death, should be channelled into determining the most practical and satisfactory ways to alleviate the impacts of these potentially changeable states of experience.