Suicide by patients: questionnaire study of its effect on consultant psychiatrists.
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ABSTRACT:
SUBMITTER: Alexander DA
PROVIDER: S-EPMC27400 | biostudies-literature | 2000 Jun
REPOSITORIES: biostudies-literature
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Suicide by patients: questionnaire study of its effect on consultant psychiatrists.
Alexander D A DA Klein S S Gray N M NM Dewar I G IG Eagles J M JM
BMJ (Clinical research ed.) 20000601 7249
<h4>Objective</h4>To identify the effect of patients' suicide on consultant psychiatrists in Scotland.<h4>Design</h4>Confidential coded postal questionnaire survey.<h4>Participants</h4>Of 315 eligible consultant psychiatrists, 247 (78%) contributed.<h4>Setting</h4>Scotland.<h4>Main outcome measures</h4>Experience of patient suicide; the features and impact of "most distressing" suicide and what helped them to deal with it.<h4>Results</h4>167 (68%) consultants had had a patient commit suicide und ...[more]
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Project description:BackgroundThe functional split model of consultant psychiatrist care for inpatients has been one of the major service redesign that has occurred in the NHS in the last decade. It is unclear if this new split model offers any advantages over the previous sectorised model of working. More recent evidence has suggested that patients, carers and professionals have varied views regarding the benefits of this model. This survey of patient's views on models of consultant working is the first in Scotland and we have attempted to include a large sample size. The results suggest that after providing sufficient information on both models, the majority of patients from various Scottish health boards have opted for the traditional sectorised model of working.MethodDuring a four week period consecutive patients across 4 health boards attending the General Adult consultant outpatient clinics and those who were admitted to their inpatient ward were offered a structured questionnaire regarding their views on the functional split versus traditional sectorised model. Space was provided for additional comments. The study used descriptive statistical measures for analysis of its results. Ethical approval was confirmed as not being required for this survey of local services.ResultsWe had a response rate of 67%. A significant majority (76%) of service users across the four different health boards indicated a preference for the same consultant to manage their care irrespective of whether they were an inpatient or in the community (Chi-squared = 65, df = 1, p < 0.0001). In their unstructured comments patients often mentioned the value of the therapeutic relationship and trust in a single consultant psychiatrist.ConclusionsOur survey suggests that most patients prefer the traditional model where they see a single consultant throughout their journey of care. The views of patients should be sought as much as possible and should be taken into account when considering the best way to organize psychiatric services.
| S-EPMC3849881 | biostudies-literature
Project description:BackgroundAttitudes and knowledge about suicide may influence psychiatrists' management of suicidal patients but there has been little research about this issue in China.MethodsWe used the Scale of Public Attitudes about Suicide (SPAS)--a 47-item scale developed and validated in China--to assess knowledge about suicide and seven specific attitudes about suicide in a sample of 187 psychiatrists from six psychiatric hospitals in Shanghai. The results were compared to those of 548 urban community members (assessed in a previous study).ResultsCompared to urban community members, psychiatrists were more likely to believe that suicide can be prevented and that suicide is an important social problem but they had more stigmatizing beliefs about suicidal individuals and felt less empathy for them. The belief that suicide can be prevented was more common among female psychiatrists than male psychiatrists but male psychiatrists felt more empathy for suicidal individuals. Only 37% of the psychiatrists correctly agreed that talking about suicide-related issues with an individual would not precipitate suicidal behavior and only 41% correctly agreed that those who state that they intend to kill themselves may actually do so.ConclusionsMany psychiatrists in Shanghai harbor negative attitudes about suicidal individuals and are concerned that directly addressing the issue with patients will increase the risk of suicide. Demographic factors, educational status and work experience are associated with psychiatrists' attitudes about suicide and, thus, need to be considered when training psychiatrists about suicide prevention.
| S-EPMC3987172 | biostudies-literature
Project description:ObjectivesThe novel coronavirus 2019 (COVID-19) has spread worldwide threatening human health. To reduce transmission, a 'lockdown' was introduced in Ireland between March and May 2020. The aim of this study is to capture the experiences of consultant psychiatrists during lockdown and their perception of it's impact on mental health services.MethodsA questionnaire designed by the Royal College of Psychiatrists was adapted and circulated to consultant members of the College of Psychiatrists of Ireland following the easing of restrictions. The questionnaire assessed the perceived impact on referral rates, mental health act provision, availability of information technology (IT), consultant well-being and availability of personal protective equipment (PPE). Thematic analysis was employed to analyse free-text sections.ResultsResponse rate was 32% (n = 197/623). Consultants reported an initial decrease/significant decrease in referrals in the first month of lockdown (68%, n = 95/140) followed by an increase/significant increase in the second month for both new (83%, n = 100/137) and previously attending patients (65%, n = 88/136). Social isolation and reduced face-to-face mental health supports were among the main reasons identified. The needs of children and older adults were highlighted. Most consultants (76%, n = 98/129) felt their working day was affected and their well-being reduced (52%, n = 61/119). The majority felt IT equipment availability was inadequate (67%, n = 88/132). Main themes identified from free-text sections were service management, relationship between patients and healthcare service and effects on consultants' lives.ConclusionsThe COVID-19 pandemic has placed increased pressure on service provision and consultant wellness. This further supports the longstanding need to increase mental health service investment.
| S-EPMC8503055 | biostudies-literature
Project description:BACKGROUND:A limited number of studies have examined the differences in suicide-related social media use behaviors between suicide ideators and suicide attempters or have sought to elucidate how these social media usage behaviors contributed to the transition from suicidal ideation to suicide attempt. OBJECTIVE:Suicide attempts can be acquired through suicide-related social media use behaviors. This study aimed to propose 3 suicide-related social media use behaviors (ie, attending to suicide information, commenting on or reposting suicide information, or talking about suicide) based on social cognitive theory, which proposes that successive processes governing behavior transition include attentional, retention, production, and motivational processes. METHODS:We aimed to examine the mediating role of suicide-related social media use behaviors in Chinese social media users with suicidal risks. A sample of 569 Chinese social media users with suicidal ideation completed measures on suicidal ideation, suicide attempt, and suicide-related social media use behaviors. RESULTS:The results demonstrated that suicide attempters showed a significantly higher level of suicidal ideation (t563.64=5.04; P<.001; two-tailed) and more suicide-related social media use behaviors, which included attending to suicide information (t567=1.94; P=.05; two-tailed), commenting on or reposting suicide information (t567=2.12; P=.03; two-tailed), or talking about suicide (t542.22=5.12; P<.001; two-tailed). Suicidal ideation also affected suicide attempts through the mediational chains. CONCLUSIONS:Our findings thus support the social cognitive theory, and there are implications for population-based suicide prevention that can be achieved by identifying behavioral signals.
| S-EPMC7218592 | biostudies-literature
Project description:BackgroundThe medical-ethical dilemmas related to euthanasia and physician-assisted suicide (EAS) in psychiatric patients are highly relevant in an international context. EAS in psychiatric patients appears to become more frequent in the Netherlands. However, little is known about the experiences of psychiatrists with this practice. This study aims to estimate the incidence of EAS (requests) in psychiatric practice in The Netherlands and to describe the characteristics of psychiatric patients requesting EAS, the decision-making process and outcomes of these requests.MethodsIn the context of the third evaluation of the Dutch Euthanasia Act, a cross-sectional study was performed between May and September 2016. A questionnaire was sent to a random sample of 500 Dutch psychiatrists. Of the 425 eligible psychiatrists 49% responded. Frequencies of EAS and EAS requests were estimated. Detailed information was asked about the most recent case in which psychiatrists granted and/or refused an EAS request, if any.ResultsThe total number of psychiatric patients explicitly requesting for EAS was estimated to be between 1100 and 1150 for all psychiatrists in a one year period from 2015 to 2016. An estimated 60 to 70 patients received EAS in this period. Nine psychiatrists described a case in which they granted an EAS request from a psychiatric patient. Five of these nine patients had a mood disorder. Three patients had somatic comorbidity. Main reasons to request EAS were 'depressive feelings' and 'suffering without prospect of improvement'. Sixty-six psychiatrists described a case in which they refused an EAS request. 59% of these patients had a personality disorder and 19% had somatic comorbidity. Main reasons to request EAS were 'depressive feelings' and 'desperate situations in several areas of life'. Most requests were refused because the due care criteria were not met.ConclusionsAlthough the incidence of EAS in psychiatric patients increased over the past two decades, this practice remains relatively rare. This is probably due to the complexity of assessing the due care criteria in case of psychiatric suffering. Training and support may enable psychiatrists to address this sensitive issue in their work better.
| S-EPMC6381744 | biostudies-literature
Project description:BACKGROUND:The main causes of suicide and how suicide could and should be prevented are ongoing controversies in the scientific literature as well as in public media. In the bill on public health from 2008 (Prop 2007/08:110), the Swedish Parliament adopted an overarching "Vision Zero for Suicide" (VZ) and nine strategies for suicide prevention. However, how the VZ should be interpreted in healthcare is unclear. The VZ has been criticized both from a philosophical perspective and against the background of clinical experience and alleged empirical claims regarding the consequences of regulating suicide prevention. This study is part of a larger research project in medical ethics with the overarching aim to explore whether the VZ is ethically justifiable. The aim is to enrich the normative discussion by investigating empirically how the VZ is perceived in healthcare. METHODS:Interviews based on a semi-structured interview guide were performed with 12 Swedish psychiatrists. The interviews were analysed with descriptive qualitative content analysis aiming for identifying perceptions of the Vision Zero for Suicide as well as arguments for and against it. RESULTS:Though most of the participants mentioned at least some potential benefit of the Vision Zero for Suicide, the overall impression was a predominant skepticism. Some participants focused on why they consider the VZ to be unachievable, while others focused more on its potential consequences and normative implications. CONCLUSIONS:The VZ was perceived to be impossible to realize, nonconstructive or potentially counterproductive, and undesirable because of potential conflicts with other values and interests of patients as well as the general public. There were also important notions of the VZ having negative consequences for the working conditions of psychiatrists in Sweden, in increasing their work-related anxiety and thwarting the patient-physician relationship.
| S-EPMC5894210 | biostudies-literature
Project description:Background: Major Depressive Disorder (MDD) represents a major social and economic health issue and constitutes a major risk factor for MDD suicide. The molecular pathology of suicidal depression remains poorly understood, although it has been hypothesized that regulatory genomic processes are involved in the pathology of both MDD and suicidality. Methods: Genome-wide patterns of DNA methylation were assessed in depressed MDD suicide completers (n=20) and compared to non-psychiatric, sudden-death controls (n=20) using tissue from two cortical brain regions (Brodmann Area 11 (BA11) and Brodmann Area 25 (BA25)). Analyses focussed on identifying differentially methylated regions (DMRs) associated with suicidal depression, and epigenetic variation was explored in the context of polygenic risk scores for major depression and MDD suicide. Weighted gene co-methylation network analysis was used to identify modules of co-methylated loci associated with depressed MDD suicide completers and polygenic burden for MDD and MDD suicide attempt. Results: We identified a DMR upstream of the PSORS1C3 gene, subsequently validated using bisulfite-pyrosequencing and replicated in a second set of MDD suicide samples, which is characterized by significant hypomethylation in both cortical brain regions in MDD MDD suicide cases. We also identified discrete modules of co-methylated loci associated with polygenic risk burden for MDD suicide attempt, but not major depression. MDD suicide-associated co-methylation modules were enriched among gene networks implicating biological processes relevant to depression and suicidality, including nervous system development and mitochondria function. Conclusions: Our data suggest there are coordinated changes in DNA methylation associated with MDD suicide that may offer novel insights into the molecular pathology associated with depressed MDD suicide completers.
2016-11-01 | GSE88890 | GEO
Project description:Because it has been associated with significant increases [through the Werther Effect (WE)] or decreases [through the Papageno Effect (PE)] of suicide rates, media coverage of suicide-related events is recognized as a prevention leverage. Unfortunately, the recommendations that the World Health Organization (WHO) has published to help journalists reporting on suicide remain poorly applied. The Mini Media Training (MMT) is a short media training session designed to increase psychiatrists' ability to communicate about suicide during interviews. We aimed at assessing the effect of the MMT on psychiatrists' ability to help journalists complying with the WHO recommendations. From June 2017 to December 2019, 173 physicians and residents in psychiatry were recruited during French national congresses. At baseline (T0) and 1 and 3 months later (T1), participants received the MMT, which consisted in a simulated interview where they we asked to answer a journalist about a mock suicide. Communication skills were measured with a score summing the number of delivered pieces of advice in relation to the WHO recommendations, with a maximum score of 33. A weighted score was also derived based on the degree of directivity needed for the participant to provide these items, again with a possible maximum of 33. A total of 132 psychiatrists participated in the study at T0 and T1. Both the weighted and unweighted score significantly increased from T0 to T1 (d = +2.08, p < 0.001, and d = +1.24, p < 0.001, respectively). Having a history of contacts with journalists, a short professional experience (<3 years) and prior knowledge of the WE, PE, and WHO recommendations were significantly associated with greater unweighted and weighted scores at baseline. The latter two variables also predicted greater T0-T1 improvement of the weighted score. These results suggest that the MMT could be effective for improving the ability of psychiatrists to guide journalists toward more responsible media coverage of suicide. As a short, easy to implement educational activity, the MMT could therefore be considered in association with other measures to help media professionals mitigating the WE and promoting the PE.
| S-EPMC8481656 | biostudies-literature
Project description:The aim of this study was to examine the sensitivity and specificity of the suicide item on the 9-item Patient Health Questionnaire (PHQ-9) when compared to a structured interview (the Structured Clinical Interview for DSM-IV; SCID-I mood module) in primary care patients with elevated depression symptoms. In this cross-sectional study, we analyzed data from 166 patients from 2 primary care clinics, 1 in Rhode Island and 1 in Massachusetts, who were enrolled in studies that focused on depression in primary care. Of the total participants, 101 were enrolled in the survey study, and 65 were screened for or enrolled in either an open trial or a pilot randomized controlled trial. Data were collected between May 2004 and May 2009. We found that the specificity of the PHQ-9 suicide screening item was 0.84 and sensitivity was 0.69 for the sample as a whole. This study suggests that the routine use of the PHQ-9 may be useful in primary care practice in that it may identify individuals at risk for suicide who would not otherwise have been identified. However, denial of suicidality on the PHQ-9 should be probed further if there are other risk factors for suicide present. clinicaltrials.gov Identifier: NCT00541957.
| S-EPMC3121214 | biostudies-literature
Project description:BackgroundObserver rating scales are necessary to evaluate the risk of suicide because individuals at risk for suicide are often unwilling to seek help on their own. Reliability and validity were evaluated for the newly developed Suicide Screening Questionnaire-Observer Rating (SSQ-OR).MethodsPreliminary items were assessed by 251 experts online and 25 questions were selected. 328 individuals at high-risk and 661 controls from 12 Crisis Response Centers and 5 university counseling centers were recruited to complete SSQ-OR, Beck Scale for Suicide Ideation (BSSI) and Patient Health Questionnaire-9 (PHQ-9). In a 6 months follow-up, we reached out to 176 participants to ask whether they had experienced a suicidal thought, plan, or attempt since the baseline assessment. Cronbach's α, Mann-Whitney U test, Spearman's correlation, factor analyses, Receiver operating characteristic (ROC) analysis and logistic regression analysis were used to verify the SSQ-OR.ResultsStructural validity was supported by a two-factor solution using exploratory and confirmatory factor analyses. Excellent model fit indices for the two-factor structure using exploratory factor analysis were confirmed (RMSEA = 0.033, TLI = 0.980, CFI = 0.983). The SSQ-OR demonstrated strong internal consistency. The concurrent validity based on the correlations with other self-reported indicators of suicidal potential-BSSI and PHQ-9- revealed substantial relationships. The high-risk group was effectively characterized by a cut-off point of 4, with a sensitivity of 0.73 and a specificity of 0.79. The SSQ-OR scores were significant predictors of suicidal thoughts and behaviors within 6 months.ConclusionsThe SSQ-OR exhibits sound psychometric properties, and could be used as a complement to a self-report or clinical-administered scale to screen suicide risk comprehensively.
| S-EPMC9411983 | biostudies-literature