Are Nonfatal Suicide Attempts Instrumental in Achieving Personal and Interpersonal Goals?

This study focused on the well-being of the survivors of suicide attempts and the well-being of their interpersonal relationships after the attempt. The data came from a sample of 392 college students from 10 Muslim majority countries who reported having attempted suicide in the last 4 years. Suicide was conceptualized as a goal-directed behavior embedded in a sociocultural context and motivated by personal or interpersonal goals. We tested a process that linked culturally shaped self-construal to the postsuicidal personal and interpersonal well-being. We posited that this process would operate through the attitudes towards suicide, motives for suicide, the strength of the intention to die. Our model indicated that the acceptability of suicide was positively associated with escape motives, and this association was even stronger for the individuals with interdependent self-construals. Escape motives were negatively associated with postsuicidal personal and interpersonal well-being, but communication motives were not associated with these outcomes. We also found evidence that having an interdependent self-construal might be beneficial for postsuicidal personal and interpersonal well-being. Our results further suggested that the postsuicidal personal and interpersonal well-being of highly interdependent individuals may depend on the interpretation of their act of suicide by their close others.

Cultural and interpersonal risk factors for suicide ideation and suicide attempts among Muslim college students from 11 nations.

BACKGROUND: Research on suicidality in low to middle-income countries is scarce. We addressed this issue by investigating suicidality in a cross-national college student samples from 11 predominantly low to middle-income majority Muslim countries. METHODS: The sample consisted of 7427 college students (56% female) who reported to be affiliated with Islam. Data on self-construal, social support, negative life-events, acceptability of suicide, suicidal ideation, and suicide attempts were collected with self-administered questionnaires. RESULTS: Acceptability of suicide and the experience of negative life-events were positively, and perceived social support was negatively associated with suicidal ideation. Interdependent self-construal was negatively related to the acceptability of suicide and positively associated with perceived social support, implying a negative indirect effect on suicidal ideation although its direct effect was positive. The number of negative life-events was the strongest positive predictor of ever attempting suicide. The interdependent self-construal moderated the association of negative life-events with suicide attempts. LIMITATIONS: Cross-sectional and self-report nature of the study were its major limitations. Participants may have suppressed their responses about suicide because of religious and legal reasons. CONCLUSION: Remarkable similarities across 11 country samples emerged in the linkages between cultural and interpersonal factors with suicidality. Our findings highlight the value of a nuanced approach to suicidality, that can recognize the differences in the processes associated with suicidal ideation and suicide attempts, as well as the need to consider the interplay of a broad range of personal, interpersonal, and cultural influences.

Associations of religiosity, attitudes towards suicide and religious coping with suicidal ideation and suicide attempts in 11 muslim countries.

OBJECTIVE: The study investigated the associations of religiosity, religious coping and suicide acceptance to suicide ideation and attempts in 7427 young adults affiliating with Islam from 11 Muslim countries. METHOD: A self-administered questionnaire was used to collect the data. We used F and χ2 tests and correlation analyses to report descriptive statistics. Multi-group path models with (i) a zero-inflated Poisson distribution and, (ii) a Binomial distribution were used to model the number of occurrences of suicidal ideation, and occurrence of a suicide attempt, respectively. RESULTS: Religiosity was negatively associated with acceptability of suicide, but it was positively related to punishment after death across the 11 countries. Religiosity was negatively associated with ever experiencing suicidal ideation, both directly and indirectly through its association with attitudes towards suicide, especially the belief in acceptability of suicide. Neither positive nor negative religious coping were related to suicidal ideation. However, religiosity was negatively related to suicide attempts among those who experienced suicidal ideation at least once. This association was mediated through the belief in acceptability of suicide and religious coping. Negative religious coping was positively associated with suicide attempts probably because it weakened the protective effects of religiosity. CONCLUSIONS: Findings from this study suggest that the effects of religiosity in the suicidal process operate through attitudes towards suicide. We therefore conclude that clinical assessment as well as research in suicidology may benefit from paying due attention to attitudes towards suicide.

Is Individualism Suicidogenic? Findings From a Multinational Study of Young Adults From 12 Countries.

The associations of individualistic versus collectivistic value orientations with suicidal ideation and attempts, attitudes towards suicide and towards suicidal individuals, and psychological distress were investigated across 12 nations (N = 5572 university students). We expected differential associations of value orientations with suicidal behavior and moderating effects of the prevailing value orientations in the various countries. Findings showed that intermediate levels of individualism appeared protective against suicide attempts across all investigated nations, but that, otherwise, there seemingly are no universal associations of individualism and collectivism with suicidal behaviors. High collectivism was associated with less suicidal ideation only in individualistic countries. Low individualism appeared to be a risk factor for suicidal ideation specifically in Muslim collectivistic cultures, whereas high individualism in Asian collectivistic cultures. Collectivistic values are uniformly associated with less permissive attitudes to suicide, whereas individualistic values with a more stigmatized view of suicidal behavior. Both individualistic and collectivistic values were associated with socially accepting attitudes to a suicidal peer, helping a suicidal friend, and emotional involvement. The associations of individualistic and collectivistic values with disapproving attitudes to suicidal disclosure were complex. Beliefs in punishment after death for suicide, seeing suicide as mental illness, and emotional involvement with a suicidal friend were lower in high-suicide-rate countries. These evidence patterns are discussed in the light of related research evidence, along with directions for future research in this area.

The Role of Religion in Suicidal Behavior, Attitudes and Psychological Distress Among University Students: A Multinational Study.

The purpose of this study was to determine the associations between religion, suicidal behavior, attitudes and psychological distress in 5572 students from 12 countries by means of a self-report questionnaire. Our results showed that an affiliation with Islam was associated with reduced risk for suicide ideation, however affiliating with Orthodox Christianity and no religion was related to increased risk for suicide ideation. While affiliating with Buddhism, Catholic religion and no religion was associated with lowered risk for attempting suicide, affiliation with Islam was related to heightened risk for attempting suicide. Affiliation with Hinduism, Orthodox Christianity, Catholicism, other religions and with no religion was associated with decreased risk for psychological distress but those reported affiliating with Islam evinced greater risk for psychological distress. The associations of the strength of religious belief to suicidal ideation and attempts were in the expected direction for most but had a positive relation in respondents affiliating with Catholicism and other religions. Students reporting affiliation with Islam, the Christian Orthodox religion and Buddhism were the least accepting of suicide but they displayed a more confronting interpersonal style to an imagined peer with a suicidal decision. It was concluded that the protective function of religion in educated segments of populations (university students) and in university students residing in Muslim countries where freedom from religion is restricted or religion is normative and/or compulsory is likely to be limited. Our findings suggest that public policies supporting religious freedom may augment the protective function of religion against suicide and psychological distress.

Validity and reliability of the Turkish version of the European Health Literacy Survey Questionnaire.

Health literacy is a public health priority which refers to individual's knowledge, motivation and competence to access, understand, appraise and apply health information to prevent disease and promote health in daily life. This study aimed to adapt European Health Literacy Survey Questionnaire (HLS-EU-Q47) into Turkish and to investigate its psychometric properties. The questionnaire was translated into Turkish by using both group translation and expert opinion methods. Forward translation-back translation method was used for language validity and the final Turkish version (HLS-TR) was formed. HLS-EU-Q47 and Health Awareness Scale (HAS) were administered to 505 respondents. The scale reliability was examined using Crohnbach's alpha coefficient and the construct validity was assessed by principal axis factoring procedure. The convergent validity was obtained by Pearson correlation coefficients between HLS-TR and HAS scores and discriminant validity was examined comparing the scores of participants who were stratified according to ages, educational status, gender, general health status and social status. Cronbach's alpha coefficient for the whole scale was 0.95. Principal axis factoring extracted nine factors which eigenvalues were >1 and explained 50.01% of total variance. Factor matrix displayed that all items gave greater load in factor 1, showing that health literacy measured with one factor. Positive and significant correlation was found between HLS-TR and HAS. Significant relations were found between HLS-TR scores and selected determinants of health. This study revealed that the HLS-TR was a valid and reliable measuring instrument with appropriate psychometric characteristics.

Suicidal Thoughts, Attempts and Motives Among University Students in 12 Muslim-Majority Countries.

There is a scarcity of research on suicidal phenomena in the Muslim world. Therefore, this study aimed at investigating the self-reported prevalence of suicidal thoughts, attempts and motives in 12 Muslim countries. A total of 8417 (54.4% women) university students were surveyed by means of a self-report questionnaire. Overall, 22% of the participants reported suicidal ideation and 8.6% reported attempting suicide. The odds of suicidal thoughts were elevated in Azerbaijan, Indonesia and Saudi Arabia, while reduced ORs were recorded in Egypt, Jordan, Lebanon and Malaysia. While odds of suicide attempts were high in Azerbaijan, Palestine and Saudi Arabia reduced odds ratios (OR) were detected in Indonesia, Iran, Jordan, Lebanon, Malaysia and Tunisia. Taking drugs and using a sharp instrument were the two most frequently used methods to attempt suicide. Only 32.7% of attempts required medical attention. Escape motives were endorsed more than social motives by participants who attempted suicide. Suicidal behaviors were more frequent in women than in men. Compered to men, fewer attempts by women required medical attention. Moreover, our results show that making suicide illegal does not reduce the frequency of suicidal behavior. Results from this comparative study show that suicidal thoughts and attempts are frequent events in young adults in countries where religious scripture explicitly prohibit suicide and the frequencies of nonfatal suicidal behavior show large variation in nations adhering to the same religion.

Cross-national comparisons of attitudes towards suicide and suicidal persons in university students from 12 countries.

This paper reports the results of a comparative investigation of attitudes to suicide and suicidal persons in 5,572 university students from 12 countries. Participants filled out two scales measuring attitudes towards suicide and suicidal persons, a measure of psychological distress together with the questions about suicidal behavior. Results showed that the highest suicide acceptance scores were observed in Austrian, UK, Japanese and Saudi Arabian samples and the lowest scores were noted in Tunisian, Turkish, Iranian and Palestinian samples. While the highest social acceptance scores for a suicidal friend were noted in Turkish, US, Italian and Tunisian samples, the lowest scores were seen in Japanese, Saudi Arabian, Palestinian and Jordanian samples. Compared to participants with a suicidal past, those who were never suicidal displayed more internal barriers against suicidal behavior. Men were more accepting of suicide than women but women were more willing to help an imagined suicidal peer. Participants with accepting attitudes towards suicide but rejecting attitudes towards suicidal persons reported more suicidal behavior and psychological distress, and were more often from high suicide rate countries and samples than their counterparts. They are considered to be caught in a fatal trap in which most predominant feelings of suicidality such as hopelessness or helplessness are likely to occur. We conclude that in some societies such as Japan and Saudi Arabia it might be difficult for suicidal individuals to activate and make use of social support systems.

Suicidal Behavior and Psychological Distress in University Students: A 12-nation Study.

This study investigated the prevalence of suicidal behavior and psychological distress in university students across 12 nations. A total of 5,572 university students from 12 countries were surveyed about suicide ideation, suicide attempts, and psychological distress by means of a self-administered questionnaire. Almost 29% of the samples reported having contemplated suicide and 7% reported attempting suicide. Of the total sample, 51.1% scored above the General Health Questionnaire-12 ≥ 3 cut-off points, 41.6% above the GHQ-12 ≥ 4 cut-off points, and 33.8% scored above the GHQ-12 ≥ 5 cut-off points. While odds of suicide ideation were elevated in Austria and the UK, reduced ORs were detected for China, Italy, Saudi Arabia, Tunisia, and Turkey. Similarly, while odds of suicide attempt were high in Jordan, Palestine, Saudi Arabia, and to some extent in Turkey, reduced ORs were observed for Austria, China, Italy, Japan and the United States. Elevated ORs for psychological distress were seen in Japan, Jordan, Palestine, Saudi Arabia, Tunisia, and Turkey but reduced ORs were noted in Austria, China, Iran, Italy, and the United States. Psychological distress was strongly associated with reports of suicide ideation and attempts. Suicide ideation, suicide attempt, and psychological distress are common in university students but their rates vary depending on the sociocultural context. Due attention should be devoted to the mental health needs of young adults enrolled in higher educational institutions and more cross-cultural research is warranted to better understand the etiology of the observed intersocietal variations in suicidal behavior and psychological distress.

Factors related to regular use of complementary/alternative medicine in Turkey.

OBJECTIVES: The purpose of this study is to determine the frequency of regular complementary/alternative medicine (CAM) use and to investigate the relations between some of the psychosocial and health related factors and the regular use of any CAM method. METHOD: Nine hundred and eighty-eight adults whose ages ranged from 18 to 80 were surveyed in Izmir, Turkey. Participants were grouped as "regular CAM users" (n = 404), "irregular CAM users" (n = 445) and "non-users" (n = 139). RESULTS: Praying was the most frequently used CAM method (76%) among regular CAM users. Results of logistic regression analysis revealed that the variables significantly related with the regular CAM use were perceived effectiveness of the CAM method used in the past, attitudes towards CAM, having information about CAM methods, health awareness and educational status. CONCLUSIONS: Participants who positively perceived the effects of the CAM method they had practised, have positive attitudes towards CAM, have higher health awareness, have more information about the CAM methods and have primary school degree were more likely to be a regular user of CAM.

[Prevalence of and factors related to depression in high school students]. / Lise ögrencisi ergenlerde depresyonun yayginligi ve iliskili oldugu etmenler.

OBJECTIVE: The study aimed at investigating the prevalence of and factors related to depression in high school students. METHOD: A total of 805 (n = 367 girls; n = 438 boys) first year students from three high schools in the city of Aydin filled in a self-report questionnaire that contained questions about socio-demographics, academic achievement and religious belief. It included also a depression rating scale, social support scale, problem solving inventory and an assertiveness scale. T-tests, chi-square tests, Pearson moment products correlation coefficients, and logistic regression analysis were used to analyze the data. RESULTS: 141 students (17.5%) scored on and above the cut-off point on the Children Depression Inventory (CDI). In the first regression analyses low self-esteem, low grade point average (GPA) and low perceived social support from friends in boys, and low self-esteem, low paternal educational level and low social support from friends were the predictors of girls' depression. When self-esteem scores were excluded, low GPA, low perceived social support from friends and family, and inefficient problem solving skills were predictors of depression in boys; low perceived social support from friends and family, low paternal educational level, and inefficient problem solving skills were the independent predictors of depression in girls. CONCLUSION: Depression is prevalent in high school students. Low self-esteem, low perceived social support from peers and family, and inefficient problem solving skills appears to be risk factors for adolescent depression. Low GPA for boys and low paternal education for girls were gender specific risk factors. Psychosocial interventions geared for increasing self-esteem, social support and problem solving skills may be effective in the prevention and treatment of adolescent depression.

Validation of a Turkish translation of the Communication Skills Attitude Scale with Turkish medical students.

OBJECTIVE: In recent years, many medical schools have added communication skills training to their curricula, and some studies have measured medical students' attitudes toward learning communication skills. The Communication Skills Attitude Scale (CSAS) was developed in England; however, there is no scale to measure these attitudes in Turkey. This study aims to adapt and examine the psychometric properties of a Turkish translation of the Communication Skills Attitude Scale in a group of Turkish medical students. METHODS: One hundred and seventy nine students from years 1 to 5 in Adnan Menderes University Medical School in Turkey voluntarily participated in the study. Mean age was 19.7 years (+/-3.8). Factor analysis was conducted to assess construct validity, and Cronbach alphas were calculated to evaluate internal consistency. RESULTS: Exploratory factor analysis confirmed the original structure of the scale as positive and negative subscales, with some modifications. After putting items 8 and 13 into the positive subscale and item 22 into the negative subscale, alphas were calculated as 0.92 and 0.71, respectively. For divergent validity, comparisons showed that groups from training years 1 to 5 differed (p<0 .001) in their positive and negative subscale scores. CONCLUSIONS: This study substantiates the validity and internal consistency of the Turkish version of the CSAS and demonstrates that it can be used in future studies and educational evaluations to measure medical students' attitudes towards learning communication skills.

[Teaching empathy in medical education]. / Tip Egitiminde Esduyumu Ogretmek.

OBJECTIVES: To determine whether there is any difference in empathic tendencies and attitudes towards communication in medical practice among the first-year students of Adnan Menderes University Medical School, and to determine the effect of education and the relation between these two features. METHOD: The Empathic Tendency Scale and Attitudes Towards Communication in Medical Practice Questionnaire were used to collect data from 36 (55.3 % of the total) students (65.7 % female; mean age: 18.3). RESULTS: Students are clustered into two groups for both scales using K-means analysis, which was used to see whether the students were homogeneous regarding empathy and communication attitudes at the beginning of the teaching period. According to the Empathic Tendency Scale results 25% of students have a high empathic tendency (HET) and 75% have a low empathic tendency (LET) and the results of the Attitudes Towards Communication in Medical Practice Questionnaire indicated that 56% have positive and 44% have negative attitudes towards communication. However, the difference between the pre-and post-teaching results of either group seems to show a tendency towards change (p< 0.10). The change has a negative and a positive tendency in the HET and LET groups, respectively. CONCLUSION: Our results seem to verify the predicted differences among the students in their empathic tendencies and attitudes towards communication in medical practice. It seems that empathic tendency is more likely to be changed by an appropriate teaching technique when change within the groups is concerned.