Marianne Wyder

Separation as an Important Risk Factor for Suicide: A Systematic Review

Examining how different phases of relationship separation effects the development of suicidal behaviors has been largely ignored in suicide studies. The few studies conducted suggest that individuals experiencing the acute phase of marital/de facto separation may be at greater risk of suicide compared with those experiencing long-term separation (divorce). To clarify the effects of these factors on detection and prevention of suicidal behaviors, a critical review of the English-language literature on this topic from 1966 to 2008 was undertaken. No studies reliably indicate the impacts of acute separation versus long-term divorce on suicidality. Moreover, research has not specifically addressed the interaction between the psychosocial factors influencing suicidal behaviors in the context of a marital/de facto separation. Considering the large proportion of suicides that occur in the context of marital/de facto separation, our limited understanding of the factors involved in the development of these suicidal behaviors is of concern.

A pilot study of the suicide victim's last contact with a health professional.

Suicide victims frequently have contact with health care professionals in the months before death. The primary aims of this pilot psychological autopsy study were to determine the feasibility of undertaking a full study and to describe the characteristics of the last health care professional contacts with suicide victims aged > 34 years. We interviewed the informants of 52 suicides. Interviews were obtained from 37 health care professionals who had contact with 28 of the suicides during the 3 months before death. The primary reasons for the last contact with the health care professional were mental health (62%), physical health (22%), and social (14%). 87% of health care professional contacts occurred within 1 month of death. Symptoms of depression were noted in 49% of health care professional contacts. Consensus psychological autopsy diagnoses of depression were made in 64% of suicide victims. Overall suicide risk was assessed by 38% of health care professionals during their last contact. This was more likely to occur when the deceased presented as depressed, was aged < 60 years or seen by a psychiatrist. None was assessed to be suicidal. The family informants regarded nine of the suicide victims to have been suicidal before death but informed a health care professional in only one third of the cases. Critical information that might have altered the management is not often accessed from family members.

The Recovery Framework as a Way of Understanding Families' Responses to Mental Illness: Balancing Different Needs and Recovery Journeys

Abstract Personal recovery is a guiding principle in mental health and suggests that consumers own and are responsible for their own recovery. An exclusive focus on the recovery of those living with mental illness challenges the relevance of recovery concepts to families’ experiences. This paper extends these recovery principles to consider if the recovery framework is helpful in understanding families’ experiences. We distinguished the familys recovery task by recovery-oriented support and the familys own recovery journey. By applying recovery frameworks developed by Davidson et al. and Leamy et al. to these two tasks, we were able to highlight similarities and points of tension between consumer and family recovery tasks. The tasks for families include: (1) maintaining hope; (2) reconnecting; (3) overcoming secondary trauma; and (4) journeying from carer to family. Family response to mental illness is a dynamic, multilayered process rather than a static and enduring role of caregiving. The recovery framework offers an alternative way to understand a familys response to mental illness and suggests possibilities for social work practice with families.

Age Variation in the Prevalence of DSM-IV Disorders in Cases of Suicide of Middle-Aged and Older Persons in Sydney

Data concerning 127 persons aged 35 years or above who died by suicide (as determined in consecutive cases by a Sydney coroner) were analyzed. Psychological autopsy (PA) interviews were conducted in 52 cases, and details were compared with the 75 cases where data were available only from coroners files (CF). Most characteristics of the two groups were similar, although more CF suicide victims were of Asian background and unable to speak English fluently. Consensus diagnoses were reached following detailed discussion about PA and CF cases. Logistic regression showed no significant difference between age-groups in the proportion diagnosed with major depression, which contrasts with the results of an earlier U.S. study.

Compulsory community treatment and ethnicity: Findings from a culturally and linguistically diverse area of Queensland

OBJECTIVE To compare the use of community treatment orders (CTOs) and forensic orders (FOs) in a culturally and linguistically diverse (CALD) population to that in a non-CALD population. METHODS We analysed the relationship between coming from a CALD background and the use of CTOs and FOs on discharge from hospital using merged data from the Metro South Addiction and Mental Health Services Transitions of Care (ToC) and Consumer Integrated Mental Health Application (CIMHA) databases. RESULTS Nine hundred and seventy-six individual records were included in the data set, of whom eighty-six were from a CALD background (8.8%). Three hundred and eleven patients were on compulsory community treatment. Use of compulsory community treatment (CTOs and FOs) was similar for those born in Australasia, British Isles, North America and Europe but significantly higher for those born elsewhere even after adjusting for socio-demographic and clinical variables (Adj OR 2.19, 95% CI 1.36-3.52). The use of an interpreter significantly increased the likelihood of compulsory community treatment (Adj OR 2.76, 95% CI 1.20-6.35). Restricting the analyses to CTOs only did not alter these results. CONCLUSIONS Metro South residents from a CALD background outside of Europe were over-represented on compulsory community treatment orders. This could reflect the difficulties in accessing voluntary services, communication barriers, stigma associated with mental illness, discrimination, or issues related to accurately diagnosing mental illness cross-culturally. Clinicians need to be aware of the complexity of working with people from diverse cultures and apply these orders judiciously.