Characteristics of police officer suicides in the Federal Austrian Police Corps.

BACKGROUND: Suicide rates among police officers may be high because of strong occupational stressors. AIMS: This study examined the suicide rate and suicide characteristics among police officers in the Federal Austrian Police Force. METHODS: All suicides among policemen during the period 1996-2006 were analyzed retrospectively on the basis of personalized police record files from all Austrian police departments. Information on sex, age, marital status, children, region, method and place of suicide, suicide notes, position, and length of service was extracted from these files. The general Austrian population, adjusted for sex and age composition, served as the comparison group. RESULTS: The suicide rate among male police officers was 30.2/100,000 (SD 11.0), which was comparable to the suicide rate in the adjusted general population (30.5/100,000; SD 2.9). The female police officer suicide rate was 1.8/100,000, while the corresponding suicide rate of the adjusted female general population was 12.5/100,000 (SD 1.7). Firearms were the most frequent suicide method (77.8%), and the incidence of suicide notes was 30.8%. CONCLUSIONS: Suicide rates among police officers seem comparable to those of the age-adjusted general population. Given the healthy-worker effect, these results still suggest an increased risk of suicide among police officers. These findings should stimulate further research on stressors and risk factors for suicide among officers and should also encourage departments to increase awareness regarding suicidal signs among officers.

Influence of psychotherapist density and antidepressant sales on suicide rates.

OBJECTIVE: Antidepressant sales and suicide rates have been shown to be correlated in industrialized countries. The aim was to study the possible effects of psychotherapy utilization on suicide rates. METHOD: We assessed the impact of antidepressant sales and psychotherapist density on suicide rates between 1991 and 2005. To adjust for serial correlation in time series, three first-order autoregressive models adjusted for per capita alcohol consumption and unemployment rates were employed. RESULTS: Antidepressant sales and the density of psychotherapists in the population were negatively associated with suicide rates. CONCLUSION: This study provides evidence that decreasing suicide rates were associated with both increasing antidepressant sales and an increasing density of psychotherapists. The decrease of suicide rates could reflect a general improvement in mental health care rather than being caused by antidepressant sales or psychotherapist density alone.

[Crisis intervention with elderly people]. / Krisenintervention bei alten Menschen.

This paper gives an overview about the most important aspects of crisis intervention, with special emphasis on crisis intervention with elderly people. First a review of the development of crisis intervention is given, including of some of the major concepts, with particular emphasis on psychoanalytic aspects of crisis intervention. Then a clinical case example of a crisis intervention with an elderly woman following a suicide attempt is given and discussed. The focus lies on the description of the transference-countertransference relationship, with attempts of pressing the therapist to comply with superficial, denying and minimizing fantasies. Peculiarities of crisis intervention with elderly people are highlighted: it is necessary to emphasize that elderly people are underrepresented in most crisis services, whereby they represent the group with the highest suicide risk. Peculiarities of elderly people still are not sufficiently met and they are created by a particularly wide range of aspects.

[Application of a context-oriented model for the planning of psychotherapy]. / Kontextorientierte Modellentwicklung in der Psychotherapieplanung.

Since clinical experience has shown that creating a therapeutic setting with borderline or psychotic patients is extremely difficult the Department of Psychoanalysis and Psychotherapy at Vienna University Hospital has developed a method of treatment designed to increase the possibilities to work with this group of patients. This procedure is conceptualised as "context oriented model exploration in psychotherapy planning" COMEPP. Initially the context is explored in which the psychotherapeutic model should be implemented which has so far failed for different reasons. Following this a setting is created in which the therapeutic team and the patient(s) can constructively and creatively reflect on alternative therapeutic models. A clinical case illustrates the problems and the basic structure of COMEPP in a schematic and condensed form.

Mass media, cultural attitudes, and suicide. Results of an international comparative study.

Many studies indicate that the suicidal behavior in a society is affected by the suicide stories publicized. Cultural valuations appear in the way media present self-destruction. The reflection of sociocultural attitudes toward suicide can be observed and analyzed in these texts. In this research, reports about suicide (n = 2203) in the years from 1981 and 1991 taken from daily newspapers were gathered--three central and regional papers in each country. A content analysis was performed of the suicide reports in Hungary (n = 244), Japan (n = 684), the United States (n = 265), Germany (former West n = 458, former East n = 60), Austria (n = 405), and Finland (n = 81), on the basis of the following variables: mentioning of the name, personal data, prominence of the suicidal person, qualification of the suicide, methods, motives, positive or negative consequences, alternatives, and the expression(s) used to refer to the act. After a coding process, an analysis was conducted as to whether any significant differences existed in the rate of the several characteristics in the countries from the point of view of the possible imitation-identification and of the cultural differences are the most important findings interpreted.

[Patient suitability for discharge from psychiatric hospitals]. / Uber die Entlassbarkeit von Patienten in psychiatrischen Krankenhäusern.

OBJECTIVE: To assess the possibility of discharging psychiatric inpatients of two large Mental Hospitals in Lower Austria. METHODS: A point prevalence study was performed in 1992. Treating psychiatrists were asked to evaluate the possibility to discharge patients under the hypothetical assumption that a broad range of residential facilities were available. RESULTS: The inpatient proportion had decreased from 2179 in 1974 to 1032 in 1992. Of the 1992 population 75.7% might be discharged. Most patients (41.5%) were regarded as needing a permanently staffed home. CONCLUSIONS: Although the inpopulation of the two large Mental Hospitals studied had decreased over a period of 18 years already by over 50 percent, the results of this study show that there is a large potential for further reform. Since the evaluation was carried out by the treating psychiatrists in the hospital, who might have been in a conflict of interests or might have preferred the treatment they are providing themselves, this finding is particularly remarkable.

Attitudes towards suicide among medical students: comparison between Madras (India) and Vienna (Austria).

Attitudes towards suicide among medical students in Madras (India) and Vienna (Austria) were compared using the SUIATT questionnaire by Diekstra and Kerkhof (1989). Results show a very restrictive attitude in Madras, rejecting the right to commit suicide, nearly always judging suicide as a cowardly act, and rejecting the idea of assisted suicide. On the other hand, in Vienna a more permissive attitude was found. It is interpreted that the Indian pattern comes close to a "medical" or "disease model", with stronger emphasis on mental illness, impulsiveness and emotional aspects, whereas the Viennese pattern reflects a "theoretical", "rational model", concentrating on cognitive factors and minimizing the influence of mental illness, emotional difficulties and restrictions related to suicidal behaviour. This pattern may be influenced by the public discussion on assisted suicide and the right to die in Europe in the last decade. Possible relations to the risk for actual suicidal behaviour are discussed using respective answers concerning previous suicidal ideation and suicide attempts. The answers concerning suicidal ideation seem to be strongly influenced by the different attitude patterns: only 16.8% reported previous suicidal ideation in Madras, compared to 51.5% in Vienna, whereas the percentage of reported suicide attempts is equal in both centres (5.9%:4.9%).

Sex differential for suicide among Austrian age cohorts.

The suicide mortality data in Austria were studied over a period of four decades of continuous reporting. The data were studied for age, period and cohort effects. For the period 1951 to 1990 suicides among eight birth cohorts, born between 1932 and 1975, show a marked sex differential in time trends. Up to 1985, the rates increase in a constant manner for males in all age groups, in contrast to females. Results obtained using the Poisson regression models demonstrate a 35% (incidence rate ratio (IRR), 1.35%; 95% CI, 1.27-1.45) increased risk for male cohorts born later compared with those born earlier. The risk for later-born females was not increased (IRR, 1.03; 95% CI, 0.91-1.17). Explanations such as improved living conditions for Austrian women remain tentative, however, as age, period and cohort effects cannot be separated as independent variables in the suicide mortality data available in Austria.

Intravenous teicoplanin does not prevent Clostridium difficile associated diarrhea.

A 59-year-old man with the diagnosis of endocarditis of the mitral valve due to Streptococcus mitis was treated with penicillin G, gentamicin, and later with clindamycin as inpatient for 3 weeks. Thereafter outpatient therapy with parenteral teicoplanin 3 x per week was initiated. After 17 days of teicoplanin treatment he developed severe diarrhea, and stool samples were positive for Clostridium difficile toxin. In addition to the ongoing parenteral therapy with teicoplanin, oral teicoplanin was administered. On the third day of this regimen the diarrhea and other disabling symptoms subsided, and test results for C. difficile toxin became negative. Oral teicoplanin was continued for 10 days and cleared C. difficile effectively after treatment as assessed by consecutive stool cultures (until 60 days thereafter). The parenteral administration of teicoplanin could not prevent the onset of C. difficile associated diarrhea in this patient, who previously had been treated with clindamycin. Thus, the administration of parenteral teicoplanin does not seem to be a treatment option for C. difficile associated diarrhea in patients in which oral therapy is not possible.

Imitative suicide on the Viennese subway.

The number of subway suicides in Vienna increased dramatically between 1984 and mid-1987. In the second-half of 1987 there was a decrease of 75% which has been sustained for 5 yr. This reduction in subway suicides began when a working group of the Austrian Association for Suicide Prevention developed media guidelines and initiated discussions with the media which culminated with an agreement to abstain from reporting on cases of suicide. The characteristics of suicide and attempted suicide on the Viennese subway are discussed and appropriate guidelines for media coverage of suicidal acts are presented.

[How reliable are official data on attempted suicides? (based on Vienna 1989 statistics)]. / Was können offizielle Daten über Suizidversuche aussagen? (anhand von Zahlen für Wien 1989).

The numbers for suicide attempts in Vienna 1989 from the following sources are compared: Statistical Department of the City of Vienna, hospital system of the City of Vienna, Vienna ambulance service, and Vienna Crisis Intervention Center. There are striking differences in the numbers reported by these institutions. In the data of the Statistical Department for the time period 1983 to 1989 there is a drastic decline of 56.5%, men exceeding women for the first time in decades. These results are not in agreement with the clinical experience of the authors. It is therefore possible that the official statistics underestimate the number of suicide attempts in Vienna. It appears the official data are markedly influenced by changes in the methods of data collection. Therefore, official numbers do not seem to be reliable and cannot be used to compare changes in suicide attempt frequency in the long run either. Possible reasons for the uncertainty of official numbers on suicide attempts are discussed.

[Austrian anomalous data in sex-specific trends in suicide rates of central Europe]. / Die österreichische Anomalie in den geschlechts-spezifischen Trends der Suizidraten Mitteleuropas.

To report on suicides among a nation's population over time 4 types of figures, hierarchically related, are used. The total yearly number (1), the crude rate (2), the set of age adjusted rates (3) and the standardized rate (4). Only the latter 2 figures can be used for comparisons among different nations as they adjusted for confounding by age. For the period 1970 to 1990 Austria's 24.4/100,000 person-years (women 13.2, men 38.0), is higher than all of its neighbors except Hungary. We observed, in contrast to reports from other countries, a sex differential in time trends for the same period: male rates increased, whereas those for females decreased over time. Trends in neighboring nations indicated for both sexes always in the same direction. A recent (1986 to 1991) drop in both male and female suicide rates could indicate an end to the observed exception. Thus the sex differential in Austrian rates should be monitored closely in the future.

Suicide following attempted suicide: a study of an unsuccessful intervention.

Unsuccessful interventions are often the best way to improve methods and techniques. This article presents a case study of a 55-year-old housewife who committed suicide after psychiatric inpatient treatment following a previous severe suicide attempt. The social and psychological situation of the patient is described, with special emphasis on her relationships with her husband, the therapist, and the other staff members on the ward. The steps in her "suicidal career" are described. The article then discusses the significance of this case, and the conclusions that were drawn by the therapy team about how inpatient treatment after suicide attempts could be better managed.