Patients' Satisfaction With the Therapeutic Relationship and Therapeutic Outcome Is Related to Suicidal Ideation in the Attempted Suicide Short Intervention Program (ASSIP).

Background: The therapeutic alliance may be a moderating factor of outcome in the Attempted Suicide Short Intervention Program (ASSIP). Aims: This study investigates the two components of the therapeutic alliance, patients' satisfaction with the therapeutic relationship and therapeutic outcome and their associations with suicidal ideation over time. Method: A total of 120 patients (55% female; mean age = 36 years) with a history of attempted suicide were randomly allocated to either the intervention group (N = 60) or the control group (N = 60). Patients' satisfaction with the therapeutic relationship and outcome were measured with the two subscales of the Helping Alliance Questionnaire. The Beck Scale of Suicide Ideation was used to measure suicidal ideation in this 24-month follow-up study. Results: The ASSIP group showed that patients' satisfaction with therapeutic relationship and outcome increased significantly from the first to the third session. Higher satisfaction with therapeutic outcome correlated significantly with lower suicidal ideation at follow-up. Conversely, the control group showed no significant results. Limitations: The collaborative approach adopted in the initial clinical interview of the control group could possibly have influenced the results of both scales. Conclusion: In particular, the component satisfaction with therapeutic outcome seems crucial to the subjectively perceived satisfaction of treatment and is associated with lower suicidal ideation over time. Thus, an enhanced understanding of components of the therapeutic alliance plays an important role in the development of interventions for suicidal patients.

[Validity of the suicidality assessment instrument PRISM-S (Pictoral Representation of Illness Self Measure - Suicidality)]. / Validierung des Suizidalitätseinschätzungsinstrumentes PRISM-S (Pictoral Representation of Illness Self Measure - Suicidality).

In routine clinical practice the assessment of suicidality proves to be difficult and complex. The aim of the present study was to examine if PRISM can be used to measure validly the person's subjectively perceived suicidality. The nonverbal visualization technique PRISM (Pictoral Representation of Illness and Self Measure) has been developed by Büchi et al. (2002) to evaluate the perceived burden of suffering due to physical illness. The adapted version of PRISM used in our study is called PRISM-S (Pictoral Representation of Illness and Self Measure - Suicidality). 156 eligible inpatients, admitted voluntarily to the crisis intervention centre Winterthur, participated in the study. We used as gold standards the well established assessment tools the Beck Scale of Suicide Ideation (BSS) and the Depressive Symptome Inventory - Subscale (DSI-SS). The results showed high correlations between PRISM-S and the BSS (r = - 0,73) and the DSI-SS scores (r = - 0,76). Clinicians, general practitioners, psychiatrists and psychologists receive with PRISM-S a valid suicidality assessment tool that is very brief and easy to administer in clinical settings.

Suicidality assessment with PRISM-S - simple, fast, and visual: a brief nonverbal method to assess suicidality in adolescent and adult patients.

BACKGROUND: The PRISM-S task was developed at the Crisis Intervention Center (KIZ) Winterthur, Switzerland, to enable an assessment of the degree of suicidality in less than 5 minutes with a simple, visual instrument. AIMS: Comparison of validity and clinical use of the new PRISM-S task with other instruments known as "gold standards". METHOD: Quantitative pilot study enlisting 100 inpatients admitted to the KIZ, aged 15-42 years. Patients' suicidality was assessed by the PRISM-S task during the first clinical interview and compared to data obtained by standardized suicidality instruments. RESULTS: The patients completed the PRISM-S task in 2 to 5 minutes without difficulty. Data show significant positive correlations between the suicidality as assessed by PRISM-S and the gold standards, i.e., DSI-SS (r = 0.59, N = 65, p < .0001). LIMITATIONS: There is no strong evidence that PRISM-S is useful for outpatients or in other settings. The experiences gained with outpatients/patients with other disorders are promising but have not been systematically evaluated. The results do not rely on a randomized design. The sample consists of persons coming to the crisis intervention center. CONCLUSIONS: PRISM-S offers a brief, easy-to-administer, and valid method to assess patients' suicidality. The simple instruction facilitates its use in other languages and other cultures as well. The acceptance by patients and health professionals was good, with no one refusing to complete the task.

Seasonality in suicide--a review and search of new concepts for explaining the heterogeneous phenomena.

Seasonality is one of the oldest and most resistant-to-elucidation issues in suicide research. However, in recent years epidemiological research has yielded new results, which provide new perspectives on the matter. This qualitative review summarizes research published since the 1990 s. In particular, the focus is on studies dealing with the historical change of seasonality, cross-sectional comparisons including method-specific diversity, and the association with weather variables and other putative covariates. Recent research has shown that in Western countries the seasonality of suicide is tending to diminish and may, eventually, disappear. It can no longer be considered a universal and homogeneous phenomenon. In addition, different major seasonal cycles have now been determined which mainly depend on different suicide methods. Just as in the epidemiology of suicide methods, the (seasonal) availability and perceived adequacy of methods emerge as the major driving force beyond the seasonal phenomena in suicide.

Methods of suicide: international suicide patterns derived from the WHO mortality database.

OBJECTIVE: Accurate information about preferred suicide methods is important for devising strategies and programmes for suicide prevention. Our knowledge of the methods used and their variation across countries and world regions is still limited. The aim of this study was to provide the first comprehensive overview of international patterns of suicide methods. METHODS: Data encoded according to the International Classification of Diseases (10th revision) were derived from the WHO mortality database. The classification was used to differentiate suicide methods. Correspondence analysis was used to identify typical patterns of suicide methods in different countries by providing a summary of cross-tabulated data. FINDINGS: Poisoning by pesticide was common in many Asian countries and in Latin America; poisoning by drugs was common in both Nordic countries and the United Kingdom. Hanging was the preferred method of suicide in eastern Europe, as was firearm suicide in the United States and jumping from a high place in cities and urban societies such as Hong Kong Special Administrative Region, China. Correspondence analysis demonstrated a polarization between pesticide suicide and firearm suicide at the expense of traditional methods, such as hanging and jumping from a high place, which lay in between. CONCLUSION: This analysis showed that pesticide suicide and firearm suicide replaced traditional methods in many countries. The observed suicide pattern depended upon the availability of the methods used, in particular the availability of technical means. The present evidence indicates that restricting access to the means of suicide is more urgent and more technically feasible than ever.