Review of suicide-prevention programs in Queensland: state- and community-level activities.

OBJECTIVE: Information regarding the availability of suicide-prevention programs in Australia is sparse and rather difficult to obtain. This study aimed to report and describe suicide and/or self-harm-prevention programs in Queensland. METHODS: Programs were classified by type of intervention, predominant type of program, setting of delivery and targeted population-at-risk. RESULTS: Sixty-six organisations were identified, providing a total of 101 suicide-prevention programs. The majority of programs operated at the prevention or treatment level, with less than half providing continuing (long-term) care. The programs targeted 12 different risk groups and were most frequently delivered within community settings. CONCLUSIONS: The findings show a diverse distribution of activities across the levels of prevention and different risk populations. This survey demonstrates the existence of remarkable gaps in coverage and provision of programs for specific high-risk groups.

Fluctuations of suicidality in the aftermath of a marital separation: 6-month follow-up observations.

BACKGROUND: There is a lack of understanding of how the changing nature of the separation process impacts on suicidality. AIMS: This paper aims to identify factors contributing to fluctuations in suicidality during the process of marital/de facto separation along a 6-month follow-up. METHOD: Separated persons who had contacted relationship-counselling services, help-line services, and variety of support and self-help groups were asked to participate in the first assessment. A 'Follow-Up Questionnaire' was sent 6 months later. Participants were required to be 18 years or older and separated from their married/de facto partner within the previous 18 months but not yet divorced. RESULTS: Overall, in the first assessment, separated females presented lower levels of suicidality than males. During the follow-up suicidality decreased. There were some gender differences in terms of predictors of changes in suicidality. Separated males who showed an increase or stability in suicidality were more affected by stressful experiences such as legal negotiations on obtaining a divorce, feelings of loss and loneliness, loss of social networks and financial difficulties than males who were not suicidal in either assessment. Separated males and females who remained suicidal were more likely to report different mental and physical illnesses. LIMITATIONS: Relatively low response rates of the follow-up (60%) limited our statistical analyses as some of the groups were too small and did not enable modelling. CONCLUSIONS: Suicidality decreased, which seems to indicate that individuals adjusted to their new life circumstances. However, persons whose suicidality remained or increased reported more frequently stressful life events, physical and mental illnesses.

Suicide of first-generation immigrants in Australia, 1974-2006.

PURPOSE: This study analysed suicide rates among first-generation immigrants in Australia from 1974 to 2006, and compared their suicide risks against the Australian-born population. It also examined the associations between the suicide rates of immigrants from 23 selected countries of birth during 2001-2006, and in their home countries. METHOD: Age-standardised suicide rates (15+ years) and rate ratios, with a 95 % confidence interval, during 1974-2006 were calculated for country of birth (COB) groups. Spearman's rank correlation coefficient was calculated between COB-specific immigrant suicide rates during 2001-2006 in Australia and in their homelands. RESULTS: Suicide rates showed a decreasing time-trend among all COB groups for both genders in Australia. The lowest suicide rates were found during 2004-2006, compared to other year groups. Throughout the study period, males born in Eastern, Northern and Western Europe and New Zealand had the highest suicide rates in Australia. For females, the highest rates were among those born in Western Europe and the UK (including Ireland). Male and female migrants born in North Africa and the Middle East, Southern and Central Asia and South East Asia showed the lowest suicide rates. There was a significant correlation between male immigrant suicide rates by COB and the rates of their home countries. CONCLUSION: The patterns of suicide rates in immigrants were influenced by the social and cultural norms of their COB. The overall decrease in suicide risk among immigrants was particularly evident in males.

Marital breakdown, shame, and suicidality in men: a direct link?

The influence of feelings of shame originating from marital breakdown on suicidality is examined. The role of mental health problems as probable mediating factors is also considered. Internalized shame, state (related to separation) shame, and mental health problems were significantly correlated with the score for suicidality during separation in both genders. Tested structural equation model indicated that internalized shame was not directly linked to suicidality, but was mediated either by state shame or mental health problems in males in the context of separation. Our findings seem to indicate that separated males are more vulnerable to the experience of state shame in the context of separation, which might lead to the development of suicidality.

Suicidal ideation and behaviour in the aftermath of marital separation: gender differences.

BACKGROUND: The limited studies on the consequences of the separation process on suicidal behaviour seem to indicate that separated people are at increased risk of suicide. AIMS: The current study aims to compare suicidality immediately after the separation among males and females, and to analyse possible differences in predictors of serious suicidal ideation. METHOD: Separated males and females who had contacted relationship counselling services, help-line services, and a variety of support and self-help groups were asked to participate in the study. Participants were required to be 18 years old or older, and have separated from their married/de facto partner within the previous 18 months but not yet divorced. For categorial variables odds ratios with 95% CI and for continuing variables t-tests were calculated. Multinomial logistic regression was applied to estimate the independent contribution of significant predictors. RESULTS: Separated males (n=228) were at an increased risk of developing suicidality during the separation process compared to separated females (n=142), even after adjusting for age, education, employment and children with the separated partner. The psycho-social risk factors identified in the development of serious suicidal ideation were mental health problems (during the previous year), history of suicide attempts and internalised shame. For separated males, significant predictors also included lower education, separation-related shame and stress from legal negotiations, especially about property/financial issues. CONCLUSIONS: The findings provide a better understanding of suicidal behaviours in the aftermath of marital or de facto separation. This knowledge could be used in the implementation of future suicide prevention strategies in people who are going through the process of a marital/de facto separation.

Is suicide prevention properly taught in medical schools?

OBJECTIVE: To determine the need and feasibility of developing a national suicide prevention (SP) curriculum for undergraduate medical students. DESIGN: Exploratory study using semi-structured phone interviews and surveys. Data was obtained from ten (out of 15) Australian Medical Schools (AMS), 373 medical students from one Queensland medical school, and 24 Australian General Practitioners, between April and June, 2006. RESULTS: Convergent views of AMS, medical students, and GPs revealed a high need and support for SP curricula, especially on skills-based education. Students who previously received SP education rated themselves significantly higher on skills-based SP abilities than those who had not. Over one-third of GPs had not received SP training from their universities (37.5%), yet 66% had experienced a case of suicide among their patients, and a third recorded on average a case of suicide every two years. The majority of students and GPs rated themselves as least competent on skills-based SP capabilities, yet rated these capabilities very high in importance for the medical profession. Whilst 80% of AMS provides some form of SP education, the quantity and quality of this is divergent. All AMS indicated support for a more uniformed SP curriculum, identified priority SP topics and delivery mechanisms, and 80% agreed to participate in a future piloting of a SP curriculum. CONCLUSIONS: SP curriculum may positively impact on student's perceived competency. Skills-based SP curricula were highly recommended to improve 'hands-on' assessment, intervention and management capabilities. Further consultation is required with all AMS to specify structure and resource needs for a national SP curriculum.

An assessment of relative transcriptional availability from nonviral vectors.

To design better delivery systems that enhance transfection efficiency of nonviral vectors, we need to improve our understanding of the mechanisms governing both the amounts of plasmid delivered to the nucleus and gene expression. What is needed is a measure of transcriptional availability (TA): the average level of gene expression per plasmid delivered to the nucleus over the course of an experiment. We describe a method to measure TA and demonstrate its application. The chloramphenicol acetyltransferase reporter gene was transfected into NIH/3T3 cells using either cationic liposomes (TFL-3; O,O'-ditetradecanoyl-N-(alpha-trimethylammonioacetyl) diethanolamine chloride (DC-6-14), dioleoylphosphatidylethanolamine (DOPE) and cholesterol, molar ratio 1/0.75/0.75) or cationic polymer (PEI; polyethylenimine). The time courses of both nuclear delivery of plasmids and reporter gene expression were measured for 4 h thereafter. For the conditions used, time courses of gene expression and plasmid nuclear delivery for the two vectors were different. To understand the origins of those differences, we applied a simple pharmacokinetic model, used the data to estimate the values of the model parameters, and interpret differences in estimated parameter values. The rate constant of delivery of plasmids into the nucleus for the TFL-3 vector was twice that of the PEI vector, whereas rate constant of elimination of plasmids in the nucleus for the PEI vector was four times that for the TFL-3 vector. The gene expression rate constant for the TFL-3 vector was estimated to be seven times larger than that of the PEI vector for the conditions used. The pharmacokinetically determined average exposure of a nucleus to plasmid was about 17 times larger for the TFL-3 vector, relative to the PEI vector. That greater exposure resulted in increased relative gene expression. Overall, the TA from the TFL-3 vector was about 13 times greater than from the PEI vector. The experimental design combined with the adoption of pharmacokinetic concepts and principles provide a method to measure TA along with detailed insights into the mechanisms governing gene delivery and expression.

Quantitative analysis of correlation between number of nuclear plasmids and gene expression activity after transfection with cationic liposomes.

PURPOSE: A quantitative understanding of the intracellular trafficking of plasmids delivered by nonviral vectors is essential for optimizing vector functions to increase their transfection efficiency. In this study, quantitative methods were developed to measure plasmids delivered to the nucleus, and the relationship between transfection activity and the number of plasmids in the nucleus were analyzed. METHODS: AH130 cells were transfected with plasmids in cationic liposomes at various doses. The nuclear fraction was isolated after NP-40 lysis. and the unincorporated plasmids were enzvmatically degraded and washed away. Intranuclear plasmids were amplified by quantitative PCR. and the number of plasmids was determined. Plasmid amounts in the nucleus were also measured by Southern analysis to confirm the quantification. RESULTS: Both methods led to similar results in measuring the nuclear plasmids within the same order of magnitude. A remarkable saturation was found for transfection activity vs. number of plasmids in the nucleus, whereas no saturation was observed in nuclear-delivered plasmids vs. dose. CONCLUSIONS: These results clearly demonstrate the importance of the quantitative measurement of intracellular trafficking of plasmids after transfection. The findings herein described suggest that efficient transgene expression as well as enhanced nuclear delivery is required in order to achieve the maximal transfection activity of nonviral vectors.