Perception of rearing circumstances relates to course of illness in patients with therapy-refractory affective disorders.

BACKGROUND: Qualitative aspects of childhood experiences are believed to have an impact on course in affective disorder. Does perception of parental rearing correlate to persistence of affective illness? METHODS: In retrospective life charts were recorded every previous illness episode for 38 consecutive patients with treatment-refractory affective disorder. A semi-structured interview was used for collecting information about perception of parental rearing. RESULTS: Ten patients perceived themselves as "unwanted" during childhood, and 28 as "wanted". These former were found to have a more malignant illness course, as measured by total days in illness, percent of life in illness, and illness days per episode. LIMITATIONS: The patient sample was small and the findings require replication. CONCLUSIONS: Perception of not having been wanted by parents during upbringing might be an important vulnerability factor in the persistence of depressive symptomatology into adult life.

Violence and its prediction at a psychiatric hospital.

Aggressive behaviour in psychiatric inpatients was assessed before and after a training course for staff members. The Social Dysfunction Aggression Scale (SDAS) was used to report and assess aggressive behaviour over time, and the Staff Observation Aggression Scale (SOAS) to report and assess single aggressive incidents. In addition, the numbers of nursing staff members who were on sick leave because of injuries in the periods before and after the course were recorded and compared. No statistically significant reduction was found in the number of aggressive patients or in the number of staff members on sick leave. One interesting finding was a lower reporting on the SOAS of perceived aggressive incidents after the training course in comparison with the SDAS reports. Directed verbal aggressiveness and violence towards things were found to be predictors of violence.

Suicidal feelings in the last year of life in elderly people who commit suicide.

We examined suicidal feelings noted by doctors and by relatives of 85 elderly (> or = 65 years) people who died by suicide. When depression is suspected in an elderly patient, suicidal feelings should be assessed even during follow-up treatment.

[Non-profit networks for suicide prevention]. / Ideella nätverk utvecklar självmordspreventionen.

Survival groups and suicide clusters constitute new challenges for suicide prevention. Emergency ward and intensive care personnel and psychologists working in close co-operation with general practitioners are strategically important in such preventive endeavours. Scientists and health care personnel need to develop joint strategies for the purpose. Politicians and administrators are important target groups for information on suicide prevention. The foregoing are important findings in the first year's experience of the West Swedish Network for Suicide Prevention.

Suicidal feelings in a population sample of nondemented 85-year-olds.

OBJECTIVE: The authors studied the 1-month frequency of suicidal feelings among very old people. METHOD: A population sample (N = 345) of nondemented 85-year-olds in Gothenburg, Sweden, were examined by a psychiatrist. Suicidal feelings were rated by the system of Paykel et al. Mental disorders were diagnosed according to DSM-III-R. RESULTS: Of the mentally healthy subjects (N = 225), 4.0% had thought during the last month that life was not worth living, 4.0% had had death wishes, and 0.9% had thought of taking their own lives. None had seriously considered suicide. The figures were higher among subjects with mental disorders (N = 120); 29.2% had thought that life was not worth living, 27.5% had had death wishes, 9.2% had thought about taking their lives, and 1.7% had seriously considered suicide. Among the subjects with mental disorders, including depression, suicidal feelings were associated with greater use of anxiolytics but not of antidepressants. Women who felt that life was not worth living had a higher 3-year mortality rate than did women without these feelings (43.2% versus 14.2%). This finding was independent of concomitant physical and mental disorders. CONCLUSIONS: Mild suicidal feelings are common in elderly subjects with metal disorders but infrequent in the mentally healthy. The substantially higher mortality rate in women who felt that life was not worth living, compared to women who did not, suggests these feelings must be taken seriously. Because of the high suicide rate in the elderly, there is a need for better diagnosis and treatment of mental disorders in this age group.

The suicidal process in suicides among young people.

Fifty-eight consecutive suicides among 15- to 29-year-olds (42 men and 16 women) were investigated by modified psychological autopsies and examined from the perspective of the suicidal process. Previous suicide attempts were evident in 66% and more than two suicide attempts found in 17% of men and in 56% of women. The median interval from first suicidal communication to the suicide was shorter in men than in women (12 vs 42 months). The median interval was 47 months in schizophrenia, 30 months in borderline personality disorder, 3 months in major depression and < 1 month in adjustment disorder. There were also differences in the prevalence of next-of kin models for suicidal behavior, previous suicidal communication and in the characteristics of the suicide. We conclude that focusing on the process heightens understanding of serious suicidal behavior in young people.

National suicide prevention programme and railway suicide.

Suicidal behaviour is a public health problem closely related to other problems such as mental illness, abuse, violence and accidents. This approach is illustrated by the prevention of railway suicides. A theoretical framework is sketched, which allows for the use of principles from injury prevention in the prevention of suicide. ICD-9 encoded death certificates from 1974, 1980, 1986 and 1987 which concerned suicides and undetermined deaths on roads and railways were analysed (N = 294). Additional data were collected from autopsy, police and hospital protocols and from interviews with engine-drivers. Railroad victims dominated the sample (78% of cases). The mean age was 42 yr. Alcohol was detected in 27% of cases, drugs in 36% and severe illness (mostly psychiatric) in 57%. The relationship between types of collision and nature of injury is discussed. Environmental changes, such as changing the locomotive front design, are suggested as strategies for reducing accidents and suicides on railways.

Ethical aspects of psychological autopsy.

Survivors of suicide victims are usually vulnerable to new traumatic experiences. Researchers who have used the method of psychological autopsy, including interviews with survivors, have paid little attention to ethical questions. The purpose of this article is to discuss such issues based on empirical data. Data and experiences from 3 studies of suicide among men (n = 271), women (n = 104) and youth (n = 58) are presented; the last 2 also include telephone follow-up by an independent researcher who measured the reactions of the interviewees to the main interviews. The ethical problems for 3 groups of agents (informants and other relatives, including the deceased; the researcher; and the research) are discussed according to 3 basic ethical principles (nonmaleficence, beneficence and respect for autonomy). Many of the interviewees still had signs of crisis reactions and thus constituted a vulnerable group. Nevertheless, drop-out was infrequent. Nor did we find any interviewee who was hurt by the interview, even if the possibility cannot be excluded in a few cases (less than 4%). Many of the interviewees seem to benefit from the interview. The interviews ought to be done by researchers prepared to meet people in crisis situations. The informants had different opinions on whether letter or telephone was the best method for first contact. Tape-recording was generally accepted. It seems to be possible and advisable to further change the design to better meet the needs of the interviewees, without violating the requirements of the researcher and the research.

Borderline personality disorder in young Swedish suicides.

Fifty-eight consecutive suicides committed between 1984 and 1987 by adolescents and young adults (ages 15 to 29 years) in an urban community were the subject of retrospective investigation through interviews with survivors and analyses of medical records. Classification in accordance with DSM-III-R showed a large proportion of axis II disorders. Borderline personality disorder (BPD) was found in 19 subjects (33%). When compared with subjects with other disorders, BPD subjects showed more antisocial traits and substance use disorders. Early parental absence, substance abuse in the homes, employment and financial problems, lack of a permanent residence, and sentence by court were also more frequent in BPD subjects.

Reactions of survivors of suicide victims to interviews.

Fifty-eight consecutive suicides committed between 1984 and 1987 by adolescents and young adults (age 15-29 years) in an urban community were the subject of retrospective investigations by means of interviews with survivors. The outcome of the survivors' crisis reactions and the interviewees' capacity to participate in the interviews were evaluated. Two weeks after a main interview, a follow-up interview dealing with the interviewee's reactions to the investigation was performed. The cautious interview procedure seemed very acceptable to the survivors. An initial contact about 2 months after the suicide is recommended. Tape-recording was generally tolerated. There was a relationship between a satisfactory outcome of the crisis and good quality of the information given by the interviewee, but survivors in severe crisis may also cooperate well and give information with good trustworthiness and precision. An unsatisfactory crisis outcome was significantly more common in interview subjects with post-traumatic stress disorder according to DSM-III-R. Many interviewees benefit from the single interview.

Depression and suicide.

This article is a short review of associations between depression and suicide, and formed part of a symposium held in Munich in August 1988 to discuss toxicity in antidepressive therapy. The association between depressive disorders and suicide is well documented. The detailed characteristics of this association, however, are still under discussion. Phenomenological aspects of depression seem to be more important than nosological ones, especially associations between personality traits, aggression and depression. Differentiation of depressions into primary and secondary depressive disorders (the latter as consequences of somatic or especially other mental disorders, such as schizophrenia, personality disorder, or alcoholism) can be a fruitful approach to elucidating differences in the suicide pattern of these different disorders. Recurrent depressive episodes, although they may be short, may have as severe mental symptoms as more longstanding episodes and thus partly explain suicide in nonpsychiatric as well as psychiatric populations. Ways of preventing suicide are discussed from biological and clinical perspectives.

Psychological autopsies: methods and ethics.

Essential knowledge on suicide is derived from studies that include interviews with survivors. In this paper, we discuss methodological and ethical issues pertaining to the interview method known as "psychological autopsy"; the discussion is based on our application of the method to three studies of suicides in Sweden and on a review of other investigations. Interviewing a survivor is a delicate matter, and the integrity of the deceased, the integrity and health of the informant, and the psychological strain on the interviewer must all be taken into consideration. The interviewer should have clinical experience in order to be prepared to deal with interviewees in grief. Contact by telephone, followed by an introductory letter, provides an opportunity to meet survivors in an empathic manner and has a low rejection rate. A 2- to 6-month interval between suicide and interview is recommended. The survivor's reactions to the interview should be evaluated in order to expand the empirical base for ethical considerations. Studies on the validity and reliability of the method are necessary.