ABSTRACT
We modified an accident analysis model for the study of acute suicidal episodes (ASEs). Our aim was to use this model (SCREAM, Suicidal Cognitions' Reliability and Error Analysis Method) as a lens to understand the worst-ever ASEs of nine patients who took part in repeated in-depth interviews. Guided by the theory of SCREAM including four predetermined categories, nine themes were identified. ASEs were triggered by interactions with the interpersonal and physical environment and spiraled into a state of lost control. Timing and the availability of promoters and barriers in the environment were salient features. Findings may aid person-centered safety planning.
ABSTRACT
There are three main points (guidelines, patient safety and taboo of suicide) in the article. Guidelines for meeting suicidal patients presented by the Aeschi group are now available. These are based on the psychology of suicidality and are in line with the issue of client-centeredness in health care. To view suicidality as a patient safety issue also means that suicidal acts can be understood as a form of accident. The taboo of suicide has decreased, which has opened new doors for research.
Subject(s)
Suicide Prevention , Suicide , Evidence-Based Medicine , Humans , Patient Safety , Patient-Centered Care , Practice Guidelines as Topic , Professional-Patient Relations , Suicidal Ideation , Suicide/psychology , TabooSubject(s)
Suicide/psychology , Cognition , Cognitive Behavioral Therapy , Humans , Risk Factors , Suicide PreventionSubject(s)
Suicide Prevention , Health Policy , Humans , Public Health , Suicide/psychology , Suicide, Assisted/psychology , SwedenABSTRACT
OBJECTIVE: The authors' goal was to study the importance of different psychiatric disorders in relation to suicide in individuals 65 years old or older. METHOD: The psychological autopsy approach was used to study 85 cases of suicide among subjects who were 65 years old or older; 153 living comparison subjects from the same age group who were randomly selected from the tax register were interviewed face-to-face. Retrospective axis I diagnoses were made according to DSM-IV on the basis of interview data and medical records. RESULTS: Ninety-seven percent of the suicide victims fulfilled criteria for at least one DSM-IV axis I diagnosis, compared with 18% of the living comparison subjects. Recurrent major depressive disorder was a very strong risk factor for suicide, as was substance use disorder. An elevated risk was also associated with minor depressive disorder, dysthymic disorder, psychotic disorder, single-episode major depressive disorder, and anxiety disorder. Comorbid axis I disorders were observed in 15 (38%) of the 39 elderly subjects with major depressive disorder who had committed suicide. CONCLUSIONS: Although recurrent major depressive disorder was the mental disorder most strongly associated with suicide, the findings of this study suggest that elderly individuals who commit suicide represent a heterogeneous group with regard to mental disorders, implying a need for differentiated prevention strategies.
