Recognising and responding to suicidal crisis within family and social networks: qualitative study (original) (raw)
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Objective To shed light on the difficulties faced by relatives, friends, and colleagues in interpreting signs of suicidality and deciding whether and how to intervene. Design Qualitative study of completed suicides, based on in-depth interviews with multiple informants. Setting London, southwest England, and south Wales. Participants 31 lay informants (one to five for each case), including parents, partners, siblings, friends, and colleagues of 14 cases of suicide in which the deceased was aged 18-34 and was not in contact with secondary mental health services. Results Informants described both intellectual and emotional barriers to awareness and intervention within the family and social network. They reported that signs and communications of distress were often oblique and difficult to interpret, that they may have disregarded warning signals and focused instead on positive signs, and that, even when they were aware that something was seriously wrong, taking any action at all involved considerable personal risks. Conclusions As the suicidal process unfolds, significant others are faced with a highly complex task. Their proximity to the suicidal person and their emotional investment in the relationship make it difficult for them to see what is happening, to say anything to the person or to other members of the network, or to seek help outside the network. Efforts to strengthen the capacity of lay people to play a role in preventing suicide are urgently needed and should be informed by a thorough understanding of these difficulties. They should highlight the ambiguous nature of warning signs and should focus on helping people to acknowledge and overcome their fears about intervening.
Caring for the Suicidal Person
2021
A sweeping glance at the World Health Organization (WHO) suicide epidemiologic data shows a global health problem, with an estimated 804,000 suicide deaths worldwide, representing a global age-standardized suicide rate of 11.4 per 100,000 population [1-3]. However, differential analysis of these suicide rates and methods demonstrates variations when looking at economic level, sex, age, religion, and geography (see Table 1). Consequently, care of the suicidal person varies within diverse biological, social, and cultural contexts. Average suicide rates are slightly higher in high-income countries (12.7) compared to low-and-middle-income countries (LAMICs) (11.2). The suicide rate among men is three times higher than that of women in high-income countries but this ratio decreases to 1.5 to 1 in LAMICs [2]. Conversely, suicide rates are higher in women in Afghanistan,
Public Involvement In Suicide Prevention: Understanding and Strengthening Lay Responses to Distress
BMC Public Health
Abstract Background: The slogan "Suicide prevention is everyone's business" has been used in a number of campaigns worldwide in recent years, but most research into suicide prevention has focused on the role of medical professionals in identifying and managing risk. Little consideration has been given to the role that lay people can play in suicide prevention, or to the resources they need in order to do so. The majority of people who take their own lives are not under the care of specialist mental health services, and around half have not had recent contact with their general practitioner. These individuals are not known to be 'at risk' and there is little or no opportunity for clinical intervention. Family members and friends may be the only ones to know that a person is troubled or distressed, and their capacity to recognise, assess and respond to that distress is therefore vitally important. This study aims to discover what the suicidal process looks like from the point of view of relatives and friends and to gain insight into the complex and difficult judgements that people have to make when trying to support a distressed individual. Methods/Design: The study uses qualitative methods to build up a detailed picture of 15–20 completed suicides, aged 18–34. Data are gathered by means of in-depth interviews with relatives, friends and others who knew the deceased well. In each case, as many informants as possible are sought using a purposive snowballing technique. Interviews focus on the family and social network of the deceased, the ways in which relatives and friends interpreted and responded to his/her distress, the potential for intervention that may have existed within the lay network and the knowledge, skills and other resources that would have helped members to support the distressed individual more effectively. Discussion: The study will inform interventions to promote public mental health awareness and will provide a basis on which to develop community-focussed suicide prevention strategies.
Suicidality: prevention, detection and intervention
Australian prescriber, 2017
Australian suicide rates are increasing. GPs have a key role in the early detection and management of suicidality and the treatment of commonly associated mood disorders and substance misuse. Drugs are indicated for moderate to severe depression. They can also be considered for patients who have been unable to access, do not want or have not responded to psychological treatments. Selective serotonin reuptake inhibitors are less toxic than serotonin noradrenaline reuptake inhibitors. Tricyclic antidepressants are the most dangerous in overdose. Mood stabilising drugs can be prescribed, but in large quantities they are dangerous in overdose. In depressed adolescents psychological therapies are first-line treatments. When drugs are indicated, in older people selective serotonin reuptake inhibitors are generally well tolerated, but paroxetine and fluoxetine are best avoided. Suicide prevention is most likely to be effective if a combination of evidenced-based strategies are used both at the individual and population levels. 1,4 One of the strongest evidence-based strategies for suicide prevention is the education of primary care clinicians. 10 In Australia, GPs are the most frequent providers of mental health care and many patients who attempt suicide visit their GP in the preceding months. 11 This makes GPs well placed to help reduce the rate of suicide. Doctors should remember that a therapeutic relationship can be protective. 12-14 The approach to the suicidal patient Most suicidal patients will be distressed and many will feel stigmatised and ashamed. Clinicians should offer comfort, reassurance and hope, and avoid judgement. 15 When a patient admits to suicidal thoughts or behaviour, understanding their predicament begins with an exploration of these phenomena (Box 1). This includes the nature of the thoughts or behaviours, any plans, previous suicide attempts and access to means of harm, for example firearms, poisons, and medicines that are dangerous in overdose such as quetiapine, opioids and tricyclic antidepressants. The clinician should then review the circumstances that might be contributing to the patient's suicidality (Box 2). Management plans should be negotiated with the patient. In most cases family, friends or other psychosocial supports should be involved. 15 A key element of any management plan will be to consider the least restrictive environment for safely starting treatment. Most patients can be managed
Suicides A Tragic Silent Issue and Potential Solutions
Science Insights, 2016
Suicide is the second leading cause of death for youth between the ages of 15 and 24. Of them, depression is a notorious contributor, and a suicidal thought is one of the most frightening things a person can face in their lifetime. However, acting on the suicidal thoughts is a far too common scenario for a large popula--tion across the world. Of the major contributing reasons, lacking of confidentiali--ty is the one underlying the emerging incidences of student suicide. It is of ex--tremely importance for the student to be protected and the school personnel to be enabled to provide assistance on this issue. It is known about the necessity for providing pertinent assistance, yet it is often difficult to obtain actual information upon the student's real condition. Theoretically, we can figure out a list of the measures solving this problem, like securing a signed release from parents/ guardians to communicate with the student's therapist/counselor. Nonetheless, it is hard to put them into practice. Attempting to solve this issue is needed to have a straightforward communication between school and parents or guardians, through which vital decisions concerning needed supports and the student's schedule can be made. All related issues are likely to surface and need to be con--sidered seriously on a case--by--case individual basis. In this review, we will dis--cuss at length about the student suicide and will provide potential solutions to help conquer it.■
A qualitative study of help seeking and primary care consultation prior to suicide
The British journal of general practice : the journal of the Royal College of General Practitioners, 2005
Many suicides may be preventable through medical intervention, but many people do not seek help from a medical practitioner prior to suicide. Little is known about how consulting decisions are made at this time. To explore how distressed individuals and members of their lay networks had made decisions to seek or not to seek help from a medical practitioner in the period leading up to suicide. Qualitative analysis of psychological autopsy data. One large English county. Semi-structured interviews with close relatives or friends of suicide victims were conducted as part of a psychological autopsy study. Sixty-six interviews were transcribed verbatim and analysed using a thematic approach. Relatives and friends often played a key role in determining whether or not suicidal individuals sought medical help. Half the sample had consulted in their final month and many were persuaded to do so by a relative or friend. Of those who did not consult, some were characterised as help-resisters bu...
Suicide and Self-Harm: It’s Everyone’s Business
Handbook of Rural, Remote, and very Remote Mental Health, 2021
Globally suicide is often reported as being one of the top ten causes of death across many countries, and so suicide and self-harm are global issues that warrant closer inquiry. The global suicide rate is estimated to be over 10 per 100,000, and those who self-harm have higher suicide risks. Many countries have found that the rate of suicide increases with greater distances from major centres. There are a number of specific external and internal factors that have been found to contribute to suicide in rural and remote communities.