[Acute mental health-caregivers speaking about Meaning in Life when assessing suicidality: a qualitative study]. / Zingeving en suïcidaliteit volgens crisisdiensthulpverleners: een kwalitatief onderzoek.

BACKGROUND: The Multidisciplinary guideline for diagnostics and treatment of suicidal behaviour recommends paying attention to the patients’ perception of meaning in life (MiL) while examining their suicidality. It is unknown how caregivers do this in practice. AIM: To gain insight into the way and the extent in which clinicians explore MiL with patients being assessed for
suicidality and their experiences with it. METHOD: Qualitative research with in-depth interviews among eleven caregivers in acute mental health of Altrecht: data were thematically analysed both deductively and inductively. RESULTS: Five themes emerged: how aspects of MiL emerge in the conversation about suicidality; the intention to understand suicidality by exploring possible protective factors; the effect on patients; the helping and impeding factors for discussing MiL; the participant’s attitude of being present while speaking about the patient’s MiL. CONCLUSION: Participants experience the conversation about MiL with suicidal patients as relevant. It provides information about protective factors, which contributes to the understanding of suicidality. The concept of MiL requires further operationalisation. Follow-up research into the several aspects of MiL in relation to diagnostics of suicidality is recommended.

[Assessment of the suicidal state with the CASE approach: a closer look at the design]. / Beoordeling van de suïcidale toestand met de CASE-benadering.

BACKGROUND: Shawn Shea's Chronological Assessment of Suicide Events (CASE approach) is worldwide, including the Netherlands, a well-known and widely used method for clinical interviewing a patient's suicidal state. However, the original description of the author is not always followed. AIM: Comparing the Dutch CASE approach with the original description. METHOD: The Dutch CASE approach has been explored on the basis of the text of the Dutch multidisciplinary guideline and current handbooks. This approach is compared with the original description. RESULTS: Three differences emerge. The main difference is that in the original CASE approach, seven validity techniques represent the foundation for investigation the suicidal state, while these are missing from the Dutch texts. Second, the chronological interview system in the Netherlands is interpreted differently than in the original CASE approach. Third, in the Netherlands, in contrast to the original approach, risk factors and protective factors are included in the study of the suicidal state. CONCLUSION: In the Netherlands, the CASE approach has been adopted in a simplified form, which is useful as a basic skill in the study of suicidal behavior. The diagnosis of suicidality can gain in depth, especially for advanced mental health professionals, by paying attention in training and education to the interviewing techniques of the original CASE approach.

[The associations between God representations and suicidality among Christian patients with a major depressive disorder]. / De relatie tussen godsrepresentaties en suïcidaliteit bij christelijke patiënten met een depressieve stoornis.

BACKGROUND: Depression strongly increases the risk of suicide. Religion is described as a protective factor against suicide. Considering the emotional blunting associated with depression, it is important to investigate the affective dimension of religion. This dimension is conveyed in God representations.
AIM: To describe what types of God representation occur among Christian patients with major depressive disorder and to determine whether there is a relationship between types of God representation and suicide.
METHOD: Clinical and outpatients with a major depressive disorder (n=155) completed the Questionnaire God Representations and the Paykel Suicide Items. A k-means cluster analysis is applied to examine which types of God representations occur among depressed patients. Whether there is a relationship between the different God representations and suicide is examined by applying a linear regression analysis.
RESULTS: Depressed patients uphold two types of God representation: a positive type (n=82) with positive feelings towards God and where God was experienced as supportive, and a negative type (n=73) with anger and anxiety towards God and where God was experienced as passive. Patients with a negative type of God representation scored significantly higher on suicidality. The severity of depression was the main predictor of suicidality, but God representations were also related with a 4% increase in the explained variance.
CONCLUSION: In Christian patients with major depressive disorder a negative and a positive God representation emerged. Patients with a negative God representation mainly seem to feel abandoned by God. The suicidality is significantly increased in patients with a negative God representation, however, the increase in the proportion of the explained variance is small.