The functions of the dreams of the deceased: A qualitative study of women bereaved by partner's suicide.

Suicide bereavement is a challenging experience that affects relationships, feelings, and physical and mental health. The research on dreams during suicide bereavement might deepen the understanding of how the loved one's suicide affects the person and what functions the dreams can have during the bereavement process. Therefore, the goal of the current study was to explore the functions of the dreams of the deceased during suicide bereavement in a sample of 9 women bereaved by their partner's suicide. The data was gathered by conducting semi-structured interviews and analyzed using reflexive thematic analysis. Three themes were generated: dreams function as helping during the process of suicide bereavement; dreams reflect the traumatic aspects of suicide bereavement; dreams function as a space to maintain or sever an ongoing relationship with the deceased. The findings reveal that dreams can function in different ways and can be a valid part of suicide bereavement.

The Role of Spirituality during Suicide Bereavement: A Qualitative Study.

BACKGROUND: A loved one's loss due to suicide can be a traumatic experience and trigger a complex grief process. Although spirituality, defined as a search for the Sacred in a broad sense, can be a resource and an obstacle in coping with the suicide bereavement process, there is a gap in scientific understanding of the role spirituality plays during the process. METHODS: To explore the role of spirituality in people bereaved by suicide, we recruited 11 women who lost a life partner due to suicide. We conducted semi-structured interviews and analyzed the data using reflexive thematic analysis. RESULTS: We identified the following three themes: spirituality is a supportive resource that can be reached for or achieved without conscious involvement; spirituality provides helpful ways to cope with grief; spirituality makes the grief process more difficult. CONCLUSIONS: Spirituality, if personally meaningful and supported by others, can function as a resource after a loved one's suicide and even add to post-traumatic growth after the loss. On the contrary, spirituality-related issues, such as stigmatization and a lack of personally meaningful traditions, can distress the bereaved. Difficult spiritual experiences and questions can become an intricate part of the grief process.

Gender Self-Confidence as a Protective Factor for Suicide Risk: Analysis of the Sample of Lithuanian Men.

Background: Along with other suicide risk factors, masculinity has been analyzed as an important subject for suicidal behavior in men. This study examines masculinity as a gender self-confidence which is the intensity of an individual's belief that he meets his standards for masculinity. We use Hoffman and her colleague's concept, which provides two theoretical constructs as elements of gender self-confidence: gender self-definition and gender self-acceptance. Gender self-definition relates to how salient masculinity is in one's identity; gender self-acceptance relates to how positively one views his masculinity. Methods: The quantitative research approach was applied in the study. The survey with a nonprobability quota sampling design was implemented to collect the data. The sample consisted of 562 Lithuanian men from various age groups and regions. The age of participants varied from 18 to 92 years (M = 42.99, SD = 17.18); 40.9% of men were from cities, 28.1% from towns, and 30.8% from rural locations. We used the Hoffman Gender Scale to measure gender self-definition and gender self-acceptance. Suicide risk was estimated with the Suicide Behavior Questionnaire-Revised. Patient Health Questionnaire-2 was used to measure depression symptoms as a controlled variable. Statistical analysis of regression and moderation was used to test the hypothesis. Results: Higher gender self-definition and higher gender self-acceptance were associated with lower suicide risk. The moderation analysis showed that in men with relatively low gender self-definition, the effect of gender self-acceptance on suicidality was larger than in men with high or moderate gender self-definition. Discussion: We conclude that a stronger gender self-confidence is an important protective factor in male suicide risk. Both, a smaller part of masculinity in one's identity and a negative view of one's masculinity have a cumulative effect on increased suicide risk. The findings have been discussed in accordance with the theories that explain suicidal behavior through the lenses of self-concept.

How relatives look back at suicide risk after their close one's death by suicide.

The aim of the current study is to analyze how relatives understand in retrospect the suicide risk of their next of kin who died by suicide. We interviewed 103 adult relatives who lost their significant others to suicide, using qualitative content analysis to explore the data. Participants expressed difficulties understanding suicide risk by identifying personal traits incompatible with suicide, reasons to doubt the risk, life oriented actions, the situation seemed better than it was, or that the loved one denied suicide risk; only a few recognized suicide risk. Prevalent myths about suicide and denial are possible explanations for these findings.

Effectiveness of Applied Suicide Intervention Skills Training (ASIST) in Lithuania.

This study evaluated the effectiveness of the Lithuanian translation of the Applied Suicide Interventions Skills Training (ASIST). In total 248 participants (45.7%) completed pre- and post-assessment and 146 (26.9%) had data at 3-month follow-up. Suicide Intervention Response Inventory (SIRI-2) was used to evaluate suicide intervention skills. The results indicated no change in the overall SIRI-2 score following training or at a 3-month follow-up. A more detailed analysis of the response pattern indicated that both following training and at 3-months follow up participants were better at identifying helpful responses but tended to overestimate their helpfulness.

Changes in prospective helpline volunteers' suicide intervention skills throughout the initial training.

The objective of this study was to evaluate the changes in prospective helpline volunteers' suicide intervention skills throughout the training in Lithuania. In total, 90 participants of the Youth Line volunteer initial training course completed the Suicide Intervention Response Inventory (SIRI-2) before any training, before and after the suicide intervention module, and after all training. There was a steady and significant increase in the trainees' suicide intervention competencies during the training. Younger and less skilled trainees benefited more from the training. These results indicate that helpline volunteers can be trained in suicide intervention skills in a relatively short time.

Factors of Seeking Professional Psychological Help by the Bereaved by Suicide.

BACKGROUND: Studies show that people bereaved by suicide often feel a strong need for professional help. It is hypothesized that aspects related to suicide bereavement, such as stigmatization, shame or guilt, hinder help-seeking process of the bereaved. However, little is known about help-seeking behaviors of people who has lost someone due to suicide. AIMS: This study was conducted to attain a better understanding of the contributing factors, including the specific features of grief following suicide, to help-seeking behaviors of the bereaved by suicide. METHODS: The sample consisted of 82 adults bereaved by suicide (64 female; average age 37.79, SD = 14.33). Instruments assessing stigmatization, shame, guilt levels, well-being, tendency to disclose emotional distress and attitudes toward seeking professional psychological help were used. The participants were also asked an open-ended question what professional help-seeking barriers they had encountered. Comparisons between the groups, logistic regression analysis and thematic analysis of the qualitative data were performed. RESULTS: The findings revealed that bereaved participants who sought professional psychological help reported experiencing stigmatization and feeling guilty after the loss significantly more often. Also the results showed that attitudes toward mental health specialists had the highest prognostic value in predicting help-seeking behaviors of the bereaved. The participants themselves identified the gaps in the health care system as main barriers to seeking help. CONCLUSION: The results challenge previously spread notion that stigmatization, guilt and shame after suicide can act only as help-seeking barriers.

The role of therapist support on effectiveness of an internet-based modular self-help intervention for adjustment disorder: a randomized controlled trial.

BACKGROUND: Adjustment disorder is among the most often diagnosed mental health disorders. Still, there is a lack of specific interventions available for adjustment disorder. OBJECTIVES: The aim of this study was to test if an internet-based self-help intervention for adjustment disorder could be effective without therapist involvement. DESIGN: A parallel group randomized controlled trial design was used to test the effectiveness of the Brief Adjustment Disorder Intervention (BADI) - an internet-based intervention for adjustment disorder. METHODS: In total 1077 participants were randomized into two conditions: BADI intervention and BADI intervention with therapist support. The main outcome measures were symptoms of adjustment disorder and well-being. RESULTS: Pre-intervention to post-intervention adjustment disorder effect size for the BADI intervention group was d = 0.64, and for the BADI with therapist support group the effect size was d = 0.53. CONCLUSIONS: The present study supported the effectiveness of the BADI intervention. Our findings also indicated that adding therapist support to the standard BADI intervention did not significantly improve the outcomes.

'It will get even better': preliminary findings from a trauma-focused psychotherapy effectiveness study reveal false positive patients' long-term outcome expectations after the treatment.

BACKGROUND: There is considerable evidence that outcome expectations may predict psychotherapy outcomes. However, little is known about the long-term outcome expectations following the end of the treatment. AIMS: The aim of this study was to evaluate patients' long-term outcome expectations after trauma-focused post-traumatic stress disorder (PTSD) psychotherapy in a single group effectiveness study. METHODS: Twenty participants with various traumatic experiences who completed the Brief Eclectic Psychotherapy for Post-Traumatic Stress Disorder (BEPP) and all the assessments were included into the study. Self-report measures were used to evaluate the therapeutic outcomes: Impact of Event Scale-Revised (IES-R), Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at pre-treatment, post-treatment, and 6-month follow-up. Subjective Units of Distress Scale was used to measure long-term outcome expectations at post-treatment, asking participants to measure the expected distress in 6 months following the treatment. Assessments at 6-month follow-up were used to estimate the accuracy of patients' expectations of their distress at previous post-treatment assessment. RESULTS: Significant decline of PTSD symptoms at post-treatment with large effect sizes was observed. At post-treatment assessment participants expected significant improvement of their condition in 6 months after the treatment. However, therapeutic effects remained stable at the 6-month follow-up. CONCLUSION: It is concluded that the PTSD patients, even after successful trauma-focused treatment, tend to expect further significant positive changes. However, therapeutic effects were stable half a year after the psychotherapy, and patients tend to have false expectations about further improvement of their condition.

Internet-based modular program BADI for adjustment disorder: protocol of a randomized controlled trial.

BACKGROUND: Adjustment disorder is one of the most common mental health diagnoses. Still it receives relatively little attention from researchers trying to establish best interventions to treat it. With high prevalence of stressful life events, which might be leading to adjustment disorder, and limited resources of mental health service providers, online interventions could be a very practical way of helping people who have these disorders or are in the risk to develop them. The proposed study protocol is aimed to describe a randomized controlled trial of an internet-based modular intervention for adjustment disorder as it is defined in a proposal for the ICD-11. METHODS/DESIGN: This study is a two-armed Randomized Controlled Trial (RCT) to examine the effectiveness of a web-based intervention BADI (Brief Adjustment Disorder Intervention) for adjustment disorder symptoms. BADI has four modules: Relaxation, Time management, Mindfulness and Strengthening relationships. It is based on stress and coping research and integrates evidence-based treatment approaches such as Cognitive Behavioural therapy (CBT), mindfulness and body-mind practices, as well as exercises for enhancing social support. Primary outcome of the study are symptoms of adjustment disorder and well-being. Engagement into the program and motivation for change is a secondary outcome. All participants after completing the baseline assessment are randomly assigned to one of the two groups: either to the one in which participant will instantly gain access to the BADI intervention or a group in which participants will be given access to the BADI program after waiting one month. Participants of BADI can choose exercises of the program flexibly. There is no particular order in which the exercises should be completed. DISCUSSION: Study will provide new insights of modular internet-based interventions efficacy for adjustment disorders. The study will also provide information about the role of motivation and expectancies on engagement in modular internet-based interventions. In case this RCT supports effectiveness of fully automated version of BADI, it could be used very broadly. It could become a cost-effective and accessible intervention for adjustment disorder. TRIAL REGISTRATION: The study was retrospectively registered with the Australian and New Zealand Clinical Trials Registry with the registration number ACTRN12616000883415 . Registered 5 July, 2016.

Too strong? Barriers from getting support before a suicide attempt in Lithuania.

The study aimed to understand the tendencies of help seeking before a suicide attempt in Lithuania. An analysis of interviews with 21 Lithuanian adults demonstrated strong avoidance of seeking help. The main reasons for avoidance included a lack of trust in other people, thinking that one must solve problems independently without sharing them, avoiding troubling others, and a belief that showing genuine emotions is a sign of weakness. These findings may contribute to suicide prevention by more deeply understanding the barriers to help seeking among high suicide risk groups, particularly in countries with a traumatic historical experience.

County council politicians' attitudes toward suicide and suicide prevention: a qualitative cross-cultural study.

The purpose of the present study was to compare county council politicians' attitudes toward suicide and suicide prevention in five European countries. A questionnaire was distributed and here the responses to the open-ended questions are analyzed qualitatively. Considerable differences were found in what the politicians in the five countries believed to be the most important causes of suicide and how suicide can be prevented. There were also differences in to what degree the politicians revealed a judgmental attitude toward suicide, which seemed to be related to the magnitude of the problem in the respective countries. A certain implicit inconsistency in the logic directing the politicians' responses was found when their views on causes to suicide and suicide prevention strategies were compared. The responses indicate a need for increased consciousness and knowledge about suicide and suicide prevention among politicians in all the five countries. This is important since they are responsible for initiating and funding suicide preventive efforts.