Euthanasia and physician-assisted suicide in amyotrophic lateral sclerosis: a prospective study.

The objective of this study is to determine if quality of care, symptoms of depression, disease characteristics and quality of life of patients with amyotrophic lateral sclerosis (ALS) are related to requesting euthanasia or physician-assisted suicide (EAS) and dying due to EAS. Therefore, 102 ALS patients filled out structured questionnaires every 3 months until death and the results were correlated with EAS. Thirty-one percent of the patients requested EAS, 69 % of whom eventually died as a result of EAS (22 % of all patients). Ten percent died during continuous deep sedation; only one of them had explicitly requested death to be hastened. Of the patients who requested EAS, 86 % considered the health care to be good or excellent, 16 % felt depressed, 45 % experienced loss of dignity and 42 % feared choking. These percentages do not differ from the number of patients who did not explicitly request EAS. The frequency of consultations of professional caregivers and availability of appliances was similar in both groups. Our findings do not support continuous deep sedation being used as a substitute for EAS. In this prospective study, no evidence was found for a relation between EAS and the quality and quantity of care received, quality of life and symptoms of depression in patients with ALS. Our study does not support the notion that unmet palliative care needs are related to EAS.

Self-burning – A rare suicide method in switzerland and other industrialised nations – A review

News items reporting self-immolation by Tibetans have been on the increase in recent years. After examining the corpse of a Swiss man who had committed suicide by deliberate self-burning, we wondered how often this occurs in Switzerland. The Federal Statistics Office (FSO) does not register self-burning specifically so no official national data on this form of suicide are available. However, we had access to the data from a Swiss National Science Foundation (SNSF) project Suicides in Switzerland between 2000 and 2010, which collected information on all (4885) cases of suicide investigated by the various institutes of forensic medicine. From this data pool we extracted 50 cases (1.02%) of suicide by selfburning, in order to determine the details and to identify the possible reasons for choosing this method. To look at our results in the light of studies from other countries, we searched the literature for studies that had also retrospectively examined suicide by self-immolation based on forensic records. Our results showed that, on the whole, personal aspects of selfburning in Switzerland do not differ from those in other industrialised nations. Some data, including religious and sociocultural background, were unfortunately missing – not only from our study but also from the similar ones. In our opinion, the most important prevention strategy is to make healthcare professionals more aware of this rare method of suicide.

Suicide tourism: a pilot study on the swiss phenomenon

While assisted suicide (AS) is strictly restricted in many countries, it is not clearly regulated by law in Switzerland. This imbalance leads to an influx of people —‘suicide tourists’—coming to Switzerland, mainly to the Canton of Zurich, for the sole purpose of committing suicide. Political debate regarding ‘suicide tourism’ is taking place in many countries. Swiss medicolegal experts are confronted with these cases almost daily, which prompted our scientific investigation of the phenomenon. The present study has three aims: (1) to determine selected details about AS in the study group (age, gender and country of residence of the suicide tourists, the organisation involved, the ingested substance leading to death and any diseases that were the main reason for AS); (2) to find out the countries from which suicide tourists come and to review existing laws in the top three in order to test the hypothesis that suicide tourism leads to the amendment of existing regulations in foreign countries; and (3) to compare our results with those of earlier studies in Zurich. We did a retrospective data analysis of the Zurich Institute of Legal Medicine database on AS of on-Swiss residents in the last 5 years (2008–2012), and internet research for current legislation and political debate in the three foreign countries most concerned. We analysed 611 cases from 31 countries all over the world. Non-terminal conditions such as neurological and rheumatic diseases are increasing among suicide tourists. The unique phenomenon of suicide tourism in Switzerland may indeed result in the amendment or supplementary guidelines to existing regulations in foreign countries.

Volitional processes and daily smoking: Examining inter- and intraindividual associations around a quit attempt

The Health Action Process Approach (HAPA) assumes that volitional processes are important for effective behavioral change. However, intraindividual associations have not yet been tested in the context of smoking cessation. This study examined the inter- and intraindividual associations between volitional HAPA variables and daily smoking before and after a quit attempt. Overall, 100 smokers completed daily surveys on mobile phones from 10 days before until 21 days after a self-set quit date, including self-efficacy, action planning, action control, and numbers of cigarettes smoked. Negative associations between volitional variables and daily numbers of cigarettes smoked emerged at the inter- and intraindividual level. Except for interindividual action planning, associations were stronger after the quit date than before the quit date. Self-efficacy, planning and action control were identified as critical inter- and intraindividual processes in smoking cessation, particularly after a self-set quit attempt when actual behavior change is performed.

Beyond Symptoms: Typical Plans and Motives of Suicide Attempters Compared to Non-Suicidal Depressive Individuals

Aim: A major depressive episode is still a frequently discussed risk factor of suicidal behaviour. However, current studies suggest that depression is predictive of suicidal ideas but much less of suicidal act (Nock et al., 2009). This implies that suicidal behaviour should not only be seen as a symptom of a depressive disorder, but should be understood as an independent behaviour, which must be examined separately. The present qualitative study focuses on typical Plans and motives of suicide attempters compared to non-suicidal depressive individuals.Methods: Plan Analysis (Caspar, 2007), a clinical case conceptualization approach was used to analyze the instrumental relations between participants' behaviours and the hypothetical Plans and motives "behind" this behaviour. Video taped narrative interviews of 17 suicide attempters and intake interviews of 17 non‐suicidal depressive patients were investigated with the Plan Analysis procedure and a Plan structure was developed for each participant. These were used for establishing a prototypical Plan structure for each clinical group.Results: Results indicate that suicidal behaviour serves various Plans and motives only found in suicide attempters. Furthermore depressive patients pursue interpersonal control strategies which may serve as a protective factor for not evolving suicidal behaviour.Discussion. Findings are discussed with respect to current theoretical models of suicidality as well as implications for suicide prevention.

Daily negative affect and smoking after a self-set quit attempt: The role of dyadic invisible social support in a daily diary study

Objectives Social support receipt from one's partner is assumed to be beneficial for successful smoking cessation. However, support receipt can have costs. Recent research suggests that the most effective support is unnoticed by the receiver (i.e., invisible). Therefore, this study examined the association between everyday levels of dyadic invisible emotional and instrumental support, daily negative affect, and daily smoking after a self-set quit attempt in smoker–non-smoker couples. Methods Overall, 100 smokers (72.0% men, mean age M = 40.48, SD = 9.82) and their non-smoking partners completed electronic diaries from a self-set quit date on for 22 consecutive days, reporting daily invisible emotional and instrumental social support, daily negative affect, and daily smoking. Results Same-day multilevel analyses showed that at the between-person level, higher individual mean levels of invisible emotional and instrumental support were associated with less daily negative affect. In contrast to our assumption, more receipt of invisible emotional and instrumental support was related to more daily cigarettes smoked. Conclusions The findings are in line with previous results, indicating invisible support to have beneficial relations with affect. However, results emphasize the need for further prospective daily diary approaches for understanding the dynamics of invisible support on smoking cessation.

Effects of depressive symptoms on antecedents of lapses during a smoking cessation attempt: an ecological momentary assessment study

AIMS: To investigate pathways through which momentary negative affect and depressive symptoms affect risk of lapse during smoking cessation attempts. DESIGN: Ecological momentary assessment was carried out during 2 weeks after an unassisted smoking cessation attempt. A 3-month follow-up measured smoking frequency. SETTING: Data were collected via mobile devices in German-speaking Switzerland. PARTICIPANTS: A total of 242 individuals (age 20-40, 67% men) reported 7112 observations. MEASUREMENTS: Online surveys assessed baseline depressive symptoms and nicotine dependence. Real-time data on negative affect, physical withdrawal symptoms, urge to smoke, abstinence-related self-efficacy and lapses. FINDINGS: A two-level structural equation model suggested that on the situational level, negative affect increased the urge to smoke and decreased self-efficacy (β = 0.20; β = -0.12, respectively), but had no direct effect on lapse risk. A higher urge to smoke (β = 0.09) and lower self-efficacy (β = -0.11) were confirmed as situational antecedents of lapses. Depressive symptoms at baseline were a strong predictor of a person's average negative affect (β = 0.35, all P < 0.001). However, the baseline characteristics influenced smoking frequency 3 months later only indirectly, through influences of average states on the number of lapses during the quit attempt. CONCLUSIONS: Controlling for nicotine dependence, higher depressive symptoms at baseline were associated strongly with a worse longer-term outcome. Negative affect experienced during the quit attempt was the only pathway through which the baseline depressive symptoms were associated with a reduced self-efficacy and increased urges to smoke, all leading to the increased probability of lapses.

ASSIP Attempted Suicide Short Intervention Program. A Manual for Clinicans

Attempted Suicide is the main risk factor for suicide. The Attempted Suicide Short Intervention Program (ASSIP) described in this manual is an innovative brief therapy that has proven to be highly effective in reducing the risk of further attempts. ASSIP is the result of the authors' extensive practical experience in the treatment of suicidal individuals. The emphasis is on the therapeutic alliance with the suicidal patient, based on an initial video-recorded narrative interview and the development of personalized safety strategies. The three to four therapy sessions are followed by continuing contact with patients by means of regular letters.

Workshop: ASSIP - Attempted Suicide Short Intervention Program. Theory, Practice, and 24 Months Follow-up RCT.

Background: ASSIP is a manualized brief therapy based on a model of suicide as goal-directed action, aimed at establishing a therapeutic alliance in a patient-oriented, collaborative approach. The main goals of the three-session program ASSIP are for patients to understand, from an observer’s position, patterns leading to a suicidal crisis, recognize triggers and warning signs, and to establish individual safety strategies for future suicidal crises. An ongoing therapeutic support is provided with regular letters over 24 months. Method: The study was conducted in a naturalistic setting. 120 Patients were randomly assigned to an intervention group (60 participants) treated with ASSIP combined with follow-up contact through letters, and a control group (60 participants) receiving a single session of clinical assessment. Both groups had treatment as usual. Patients completed a set of psychosocial and clinical questionnaires every six months over a period of 24 months. Results: In the ASSIP group 5 patients made a total of 5 reattempts, compared to 15 patients with 41 reattempts in the control group. The survival analysis yielded a significant difference with a Wald Chi2 of .000003. The ASSIP group had significantly lower suicidal ideation and fewer days of inpatient treatment compared to the control group. Higher scores in the Penn Helping Alliance Questionnaire were associated with lower suicidal ideation during follow-up. Conclusions: ASSIP is a highly effective brief therapy for patients with recent suicide attempts. Forming a strong therapeutic alliance is considered to be a major factor for outcome. ASSIP can be used with minimal training by experienced therapists. An English version of the manual will be published in May 2015.