Conceptualising global water challenges: A transdisciplinary approach for understanding different discourses in sustainable development.

Global challenges impact upon substantial numbers of people in different locations and inform policy at multiple levels under the United Nation's Sustainable Development Goals (SDGs). An aspect of the SDGs framework is the stated inter-relationship between SDGs and local, regional and global partnerships for research and development. In response to dissatisfaction with existing approaches to addressing such complex problems the purpose of this paper is to propose a problem-language-context (PLC) model as a way of framing sustainable development challenges; and in so doing create a heuristic that allows challenges such as water security to be understood using a logically consistent framework. Such an approach builds on a growing transdisciplinary innovation literature that strives to generate knowledge that is problem-focused and inclusive of both scientific and societal stakeholders. The utility of the PLC model is then examined using a case study review carried out on a body of evidence - the United Nations World Water Development Reports (WWDRs) 2003-2019. The result of this review suggests that such problem framing can be of value in revealing the implicit (and sometimes contradictory) assumptions held by policy makers, practitioners and researchers. The main conclusion is that a transdisciplinary approach is one way of better understanding some of the conflicting viewpoints evident in discipline-based approaches to sustainable development, global water challenges and water security.

The failure of suicide prevention in primary care: family and GP perspectives - a qualitative study.

BACKGROUND: Although Primary care is crucial for suicide prevention, clinicians tend to report completed suicides in their care as non-preventable. We aimed to examine systemic inadequacies in suicide prevention from the perspectives of bereaved family members and GPs. METHODS: Qualitative study of 72 relatives or close friends bereaved by suicide and 19 General Practitioners who have experienced the suicide of patients. RESULTS: Relatives highlight failures in detecting symptoms and behavioral changes and the inability of GPs to understand the needs of patients and their social contexts. A perceived overreliance on anti-depressant treatment is a major source of criticism by family members. GPs tend to lack confidence in the recognition and management of suicidal patients, and report structural inadequacies in service provision. CONCLUSIONS: Mental health and primary care services must find innovative and ethical ways to involve families in the decision-making process for patients at risk of suicide.

Substance misuse in life and death in a 2-year cohort of suicides.

BACKGROUND: Although substance misuse is a key risk factor in suicide, relatively little is known about the relationship between lifetime misuse and misuse at the time of suicide. AIMS: To examine the relationship between substance misuse and subsequent suicide. METHOD: Linkage of coroners' reports to primary care records for 403 suicides occurring over 2 years. RESULTS: With alcohol misuse, 67% of the cohort had previously sought help for alcohol problems and 39% were intoxicated at the time of suicide. Regarding misuse of other substances, 54% of the cohort was tested. Almost one in four (38%) tested positive, defined as an excess of drugs over the prescribed therapeutic dosage and/or detection of illicit substances. Those tested were more likely to be young and have a history of drug misuse. CONCLUSIONS: A deeper understanding of the relationship between substance misuse and suicide could contribute to prevention initiatives. Furthermore, standardised toxicology screening processes would avoid diminishing the importance of psychosocial factors involved in suicide as a 'cause of death'.

An exploration of integrated data on the social dynamics of suicide among women.

The gender-based nature of suicide-related behaviour is largely accepted. However, studies that report exclusively on female suicides are rare. Here we demonstrate how female suicide has effectively been 'othered' and appears incidental in studies which compare female and male behaviour. We highlight how recent studies of suicide have tended to be dominated by male-only approaches, which increasingly link issues of masculinity with male death by suicide. Drawing on data collected from the general practitioner and coroner's office, we then apply the sociological autopsy approach to a cohort of 78 deaths recorded as suicides in the UK between 2007 and 2009. By focusing on females in isolation from males, we demonstrate that, as in male-only suicide studies, it is similarly possible to draw out issues associated with the feminine identity, which can be linked to death by suicide. We find that bereavement, sexual violence and motherhood could all be linked to the lives and help-seeking of the females who died. In closing, we suggest that a reorientation towards sociological analytic approaches of female suicide may help to produce further reductions in the rate of female death by suicide. A Virtual Abstract of this paper can be found at: https://www.youtube.com/watch?v=a0w9KKMFdIQ.

When health services are powerless to prevent suicide: results from a linkage study of suicide among men with no service contact in the year prior to death.

AIMS: To investigate cases of suicide in which there was no healthcare contact, by looking at history of help-seeking and evidence of previous mental health vulnerability. To identify any life events associated with suicide for which individuals did not seek help. BACKGROUND: Previous research has suggested that non-consultation is the main barrier to suicide prevention among men. Estimates suggest approximately 22% of men who die by suicide have not consulted their GP in the year before their death. Little is known about the lifetime pattern of engagement with services among these individuals and whether or not this may influence their help-seeking behaviour before death. METHODS: Coroner records of suicide deaths in Northern Ireland over 2 years were linked to general practice (GP) records. This identified 63 individuals who had not attended health services in the 12 months before death. Coroner's data were used to categorise life events associated with the male deaths. Lifetime mental health help-seeking at the GP was assessed. FINDINGS: The vast majority of individuals who did not seek help were males (n=60, 15% of all suicide deaths). Lack of consultation in the year before suicide was consistent with behaviour over the lifespan; over two-thirds had no previous consultations for mental health. In Coroner's records, suicides with no prior consultation were primarily linked to relationship breakdown and job loss. These findings highlight the limitations of primary care in suicide prevention as most had never attended GP for mental health issues and there was a high rate of supported consultation among those who had previously sought help. Public health campaigns that promote service use among vulnerable groups at times of crisis might usefully be targeted at those likely to be experiencing financial and relationship issues.

Patterns of presentation for attempted suicide: analysis of a cohort of individuals who subsequently died by suicide.

All suicides and related prior attempts occurring in Northern Ireland over two years were analyzed, focusing on number and timing of attempts, method, and mental health diagnoses. Cases were derived from coroner's records, with 90% subsequently linked to associated general practice records. Of those included, 45% recorded at least one prior attempt (with 59% switching from less to more lethal methods between attempt and suicide). Compared with those recording one attempt, those with 2+ attempts were more likely to have used less lethal methods at the suicide (OR = 2.77: 95% CI = 1.06, 7.23); and those using less lethal methods at the attempts were more likely to persist with these into the suicide (OR = 3.21: 0.79, 13.07). Finally, those with preexisting mental problems were more likely to use less lethal methods in the suicide: severe mental illness (OR = 7.88: 1.58, 39.43); common mental problems (OR = 3.68: 0.83, 16.30); and alcohol/drugs related (OR = 2.02: 0.41, 9.95). This analysis uses readily available data to highlight the persisting use of less lethal methods by visible and vulnerable attempters who eventually complete their suicide. Further analysis of such conditions could allow more effective prevention strategies to be developed.