The Role of Self-Esteem in Suicides Among Young Men.

This study explores self-esteem in suicide among young males with no earlier history of suicide attempt(s) or treatment in mental health services. The data come from an ongoing psychological autopsy study; 10 cases of young men aged 18 to 30, were selected to generate a phenomenologically based understanding of the psychological mechanisms and processes involved in the suicidal process. The analyses are based on in-depth interviews with 61 closely connected individuals, as well as suicide notes. We used Interpretative Phenomenological Analysis. For these young men, the transition to young adulthood, a period of major life challenges, seemed to be associated with personal defeats. According to their significant others, the deceased seemed to have experienced intolerable discrepancies between their actual performances and their ideal self standards. Four themes emerged from the analysis: (a) striving to find a viable path to life as an adult man; (b) experiencing a sense of failure according to own standards; (c) emotional self-restriction in relationships; and (d) strong feelings of loneliness and rejection of self. Improved understanding of suicides outside the mental illness paradigm may have important implications for preventive strategies.

A comparison of suicide notes written by men and women.

Previous research using small samples and subjective judgments has failed to identify reliable gender differences in suicide notes. Suicide notes written by 166 women and 513 men collected by Edwin Shneidman were analyzed by the Linguistic Inquiry and Word Count computer program. Six significant differences and four trends were identified. The suicide notes written by women had a higher percentage of words found in the dictionary, negations, words indicative of cognitive process, discrepancies and present tense verbs. The suicide notes of women seemed to have more content indicative of hopelessness, defeat-entrapment and falling short of internalized standards.

The Mask of Suicide.

Although it has been stated that the majority of suicidal people give definite warnings of their suicidal intention, a percentage of suicidal people may dissemble (or mask), possibly 20%. The aim of this psychological autopsy (PA) study was to explore the mask of suicide, examining age and sex of the decedent, and survivors' relationship to the deceased. A PA study in Norway, with 120 survivors/informants, was undertaken. Overall, 80% of informants reported manifest and/or latent content of deception (dissembling); well above the 20% suggested. Three main themes emerged from the interviews of the 95 survivors that were related to the mask. In the opinion of the bereaved, reasons for the mask were due to: 1) Inability to adjust/impairment; 2) Relational problems; and 3) Weakened resilience. Differences in masking or (self) deception were found in the age of the decedent, but not in sex, nor in the survivors' closeness of the relationship. Older deceased people were perceived to exhibit more dissembling, associated to the suicide. Limitations are noted in this beginning study into the mask of suicide, and it is concluded that much greater research is needed to unmask the dangerous dissembling, maybe in some, self-deception.

Identity of victims from fragmented and decomposed remnants by DNA profiling in a case of serial killings.

A 28-year-old man, Surinder Koli, from a Nithari village adjoining Delhi, India committed serial murder. This case was of paramount importance in medico-legal investigations, as it was a landmark case of a serial killer reported from India. The skeletal remains (627 pieces) including skull/skull portions (19) were recovered from the nearby sewer drain, sump and the backyard of the house in which this man was residing. In addition, soft tissues (51) were also recovered from the same sewer drain. The victims were killed over a two-year period. The establishment of identity of the victims was crucial to prove the case in the court of law as well as for the claimants. Nineteen sets were prepared by radiology/anatomical examination from the exhibits recovered. DNA profiling confirmed the correctness of these sets and also short tandem repeat typing of nuclear DNA successfully identified eight individuals. Both DNA profiling and radiography/anatomical examination played an important role in solving this complicated case.

Suicide notes from Mexico and the United States: a thematic analysis.

OBJECTIVE: This study sought to investigate suicide notes drawn from Mexico and the United States (US) as these countries share geographical proximity, but markedly different cultures and suicide rates. MATERIAL AND METHODS: A theoretical conceptual analysis of 102 suicide notes drawn from these countries, matched for age and sex, was undertaken based on a thematic model of suicide developed by Leenaars,1,2 across countries. RESULTS: The inter-judge reliability was adequate (.86 coefficient of concordance). CONCLUSIONS: The results suggested that there are more psychological commonalities than differences. Yet, as this study marks the first one using suicide notes, between Mexico and the USA, much greater study is warranted.

Impact of death by suicide of patients on Thai psychiatrists.

The objective of this study was to identify the impact of a patient's suicide on psychiatrists in Thailand. A confidential coded postal questionnaire survey was sent to 320 eligible psychiatrists; with a response rate of 52.18%). The results showed that 94 (56.28%) of responding psychiatrists had a patient die by suicide, consistent with high rates found in similar large-scale studies in the United States and United Kingdom. Less than half (41.5%) of patients had been diagnosed with schizophrenia, 33% had a depressive disorder, and the others had a wide array of diagnoses. More than 50% of psychiatrists reported personally experiencing sadness, depression, hopelessness, and guilt; 74.5% reported professional reactions, most frequently a review of their practice (93.4% reported being more aggressive in assessment of suicidality). Respondents were diverse in their postvention; 90% of Thai psychiatrists reported that working through with colleagues was most helpful. Family and friends helped. A majority (72.4%) of psychiatrists prayed or did "merit" for the dead patient; 86.8% found it helpful. This finding suggests that cultural sensitivity may be needed to understand the impact of suicide on psychiatrists but also to its response.

Psychache and suicide: a preliminary investigation.

Shneidman's Psychological Pain Assessment Scale (PPAS; 1999) was administered to 88 psychiatric patients. Both current and worst-ever psychache were significantly higher in those patients judged by a psychiatrist, on the basis of a structured clinical interview, to be at risk of suicide. However, current and worstever psychache were not associated with having attempted suicide in the past. Thus, for the present sample of psychiatric patients, the PPAS appears to be more sensitive to current suicidality than to past suicidality. Further, there are validity issues with the PPAS, with the need for multi-item measures and probably a multifactor measure.

Farewell to the world: suicide notes from Turkey.

There has been limited study of suicide in Islamic countries. This paper marks the first study of suicide notes in Turkey, an Islamic country. Using a classification scheme, 49 suicide notes (a rate of 34.5%) were studied. The results show that note writers do not differ greatly from other suicides. Further analysis of younger (<40) and older (>40) suicide note writers reveal few significant differences. Our results, together with the results of classification studies in different countries, suggest that caution is in order in transposing findings from one country to other countries. Future study of suicide notes should, in fact, focus on cross-cultural investigation.

A Multidimensional Theory of Suicide.

BACKGROUND: Theory is the foundation of science; this is true in suicidology. Over decades of studies of suicide notes, Leenaars developed a multidimensional model of suicide, with international (crosscultural) studies and independent verification. AIM: To corroborate Leenaars's theory with a psychological autopsy (PA) study, examining age and sex of the decedent, and survivor's relationship to deceased. METHOD: A PA study in Norway, with 120 survivors/informants was undertaken. Leenaars' theoretical-conceptual (protocol) analysis was undertaken of the survivors' narratives and in-depth interviews combined. RESULTS: Substantial interjudge reliability was noted (κ = .632). Overall, there was considerable confirmatory evidence of Leenaars's intrapsychic and interpersonal factors in suicide survivors' narratives. Differences were found in the age of the decedent, but not in sex, nor in the survivor's closeness of the relationship. Older deceased people were perceived to exhibit more heightened unbearable intrapsychic pain, associated with the suicide. CONCLUSION: Leenaars's theory has corroborative verification, through the decedents' suicide notes and the survivors' narratives. However, the multidimensional model needs further testing to develop a better evidence-based way of understanding suicide.

Gun-Control Legislation and the Impact on Suicide.

Gun control is the prototypical example of controlling the environment for the means of suicide, an effective public health approach to suicide prevention. Canada's Criminal Law Amendment Act of 1977 (Bill C-51) provides an excellent opportunity to illustrate the effects of legislative gun-control laws and the impact on suicide. The research in Canada supports the significant effect of C-51 in reducing suicides and firearm suicides, even if one controls for socioeconomic factors, although not equally for all ages. The young, a high-risk group, show the most significant decrease, without significant substitution of other methods (displacement). Studies on gun-control laws from New Zealand, the United States, and Australia support the Canadian findings. It is concluded that, although not equally applicable in all countries, gun control may well have significant applications in reducing suicide worldwide.

Menstruation and suicide: an exploratory study.

Previous research has reported mixed findings on the effect of the menstrual cycle on suicidal behavior. The contribution of menstruation to completed suicide is also controversial, though the studies are very limited and have not been carefully designed. To explore the relationship, 217 autopsies on completed suicides were performed, matched to a control group at the All India Institute of Medical Sciences in New Delhi. The results show that 54.46% of people who died by suicide were menstruating (results excluded pregnancies), compared to 6.75% of the control group. Menstruation in those who completed suicide, compared to a control group, appeared to have an association with suicide. More research is warranted.

Life time suicidal thoughts in an urban community in Hanoi, Vietnam.

BACKGROUND: Suicidal thought is a risk factor and a stage in the suicidal process from planning to attempting and dying by suicide. To date, studies on suicidal thought in the general population, especially in Asian communities, have been limited. METHOD: The WHO SUPRE-MISS (the multisite intervention study on suicidal behaviours) community survey questionnaire was filled in for 2,280 randomly selected residents of the DongDa district of Hanoi, Vietnam by means of face-to-face interviews. This multi-factor questionnaire includes such variables as sociodemographic information, suicidal thought and history of suicide attempts, physical health, alcohol consumption and medication. RESULTS: Prevalence rates for life time suicidal thoughts, suicide plans and suicide attempts were 8.9%, 1.1% and 0.4% respectively. Suicidal thoughts are associated with multiple characteristics, such as female gender, single/widowed/separated/divorced marital status, low income, lifestyle (use of alcohol, sedatives and pain relief medication), but not with low education or employment status. Having no religion and being a Buddhist appear to be protective factors for suicidal thought. The ratio of suicidal thoughts, suicide plans and suicide attempts on a lifetime basis is 22.3:2.8:1. CONCLUSION: In Vietnam, as in Western and other Asian countries, suicidal thoughts are associated with similar negative psychosocial risk factors, lifestyle and emotional problems, which implies that suicide preventive measure developed elsewhere can be adjusted to Vietnamese condition. Understanding the unique and common risks in a culture may assist in prediction and control.

Suicide notes in Mexico: what do they tell us?

According to international and Mexican official statistics, there is a dramatic rise in suicide in Mexico; however, research in this area is severely limited. This is the first study of suicide notes from Mexico in the international literature. From a population of 747 registered suicides, a sample of 106 note-writers and 106 non-note writers was examined. Using the demographic (descriptive) scheme of Ho, Yip, Chiu, and Halliday (1998), the results indicate that note writers do not differ greatly from other suicides. The less educated understandably wrote fewer notes. The most intriguing finding was that suicide in Mexico was associated with an array of factors, notably interpersonal problems.

Psychotherapy with suicidal people: the commonalities.

This review article outlines the research basis for an effective approach to psychotherapy with suicidal people. It answers the question, "Is psychotherapy effective with suicidal people?" Based on the notable historical publications and the most recent (Lambert, 2004), it is shown that psychotherapy works, largely because there are commonalities (i.e., common factors) that may be the overriding important factor in all forms of psychotherapy. The therapeutic relationship is primary; this and other common factors are illustrated with suicidal people. Patient qualities, therapist qualities, and a multi-modal or multi-component approach are reviewed. On an empirical basis, it is concluded that one has to be person-centered (or patient centered): You have to know whom you are treating.

Suicide among indigenous peoples: introduction and call to action.

Indigenous people around the world have the highest suicide risk of any identifiable cultural (or ethnic) group. It is a youth epidemic. The World Health Organization (WHO) has called for action; this special issue of Archives of Suicide Research (ASR) is an attempt to heed this call. Scholars, indigenous and non-indigenous, present data from the Arctic, Canada, Australia, New Zealand, Brazil, and other regions. It is concluded that not only data, but also explanations are needed. Suicide is multi determined. Colonialism and its associated genocide are, however, cited as a common factor. Yet, much greater cooperative international efforts are needed to not only understand, but also predict and control the epidemic.

The Balkan Piedmont: male suicide rates pre-war, wartime, and post-war in Serbia and Montenegro.

The epidemiology of suicide in Serbia and Montenegro from 1989 to 2003, a period of civil war, is presented. Following the break-up of former Yugoslavia, Serbia and Montenegro underwent a period of war from 1991-1994 and another in 1999. During the war years, the number of suicides increased, reaching its peak in 1993. Male suicides outnumbered female suicides by a ratio of 2:1. Male suicides decreased slightly after the war of 1991-1994 only to rise in 1997 and continue at this higher level throughout the nineties. In Serbia alone, male suicide reached its peak in 2002 (nearly 29/100,000). The methods of suicide changed significantly, with the use of firearms doubling during and after the war years. Speculations are offered about the findings, many consistent with Durkheim's classical hypothesis concerning suicide and unpopular wars.

Suicidality, bipolar disorders, and pharmacotherapy.

Although the existence of mood disorders was identified centuries ago, the present state of knowledge is unsatisfactory. This special issue of Archives of Suicide Research (ASR), the official journal of the International Academy for Suicide Research, presents the state of the science and collects new empirical data. Different aspects of suicidality in bipolar and bipolar spectrum disorders are outlined and the prophylactic aspects of pharmacotherapy are noted, especially the anti-suicide effect of lithium. A call for further study is, however, necessary.

Human immunodeficiency virus (HIV) and suicide in a region of Eastern Province ("Transkei"), South Africa.

HIV/AIDS is an alarming illness worldwide. It is known to have a significant association to suicide, despite a lack of in depth study. Early studies suggested suicide risk 20 to 36 times higher than the general population, but more recent trends in America show a decline. This is not true in Africa, including the region of Eastern Province, South Africa. There is abundant political and health discussion, but little study. This article presents descriptive statistics and case histories. These beginning studies must be augmented by comprehensive study of not only the epidemiology, but also the psychological and social correlates. Regrettably, there are numerous obstacles to such study in South Africa.

Suicide in Thailand, 1977 to 2002.

The epidemiology of suicide in Thailand from 1977-2002 was presented. In the years 1977 and 2002, the suicide rates were 5.9 and 7.8 per 100,000 population. This is low compared to nearby Asian countries. The highest suicide rate was 8.6 per 100,000 in the year 1999, a time of economic crisis. The ratio of male to female suicide rate was 1.14:1 in the year 1977 and increased to 3.16:1 in the year 2002. The highest suicide rate was in young males, ages 25-29 and the trend shows an increase. Despite the increasing incidence, there has been little study to date; however, HIV/AIDS has been identified as a major risk factor.

Can a theory of suicide predict all "suicides" in the elderly?

Older adults consistently have the highest rates of suicide in most societies. Despite the paucity of studies until recently, research has shown that suicides in later life are best understood as a multidimensional event. An especially neglected area of research is the psychological/psychiatric study of personality factors in the event. This paper outlines one comprehensive model of suicide and then raises the question: Is such a psychiatric/psychological theory applicable to all suicides in the elderly? To address the question, I discuss the case of Sigmund Freud; raise the topic of suicide and/or dignified death in the terminally ill; and examine suicide notes of the both terminally ill and nonterminally ill elderly. I conclude that, indeed, greater study and theory building are needed into the "suicides" of the elderly, including those who are terminally ill.