The Relationship Between Cumulative Adversity in Childhood and Adolescent Suicide and Accidental Death

On the whole research has concluded that most young people navigate adolescence with few difficulties, but a minority do find this stage of life challenging, and their ways of coping may have negative consequences for both themselves and others. For some the experience of adversity in earlier childhood, and the cumulative impact of multiple adversities has the potential to compromise a young person’s natural resilience. In some cases this may result in an adolescent feeling overwhelmed, and dying through suicide or other high risk behaviours. This article explores these issues with reference to eight young people who died by suicide in Northern Ireland. The article argues that young people exposed to multiple adversities in childhood require earlier, more sustained and better co-ordinated services from professionals if their psychological and emotional well-being is to be promoted.

Legalizing physician-assisted suicide and/or euthanasia: Pragmatic implications

Objective: Despite the availability of palliative care in many countries, legalization of euthanasia and physician-assisted suicide (EAS) continues to be debated-particularly around ethical and legal issues-and the surrounding controversy shows no signs of abating. Responding to EAS requests is considered one of the most difficult healthcare responsibilities. In the present paper, we highlight some of the less frequently discussed practical implications for palliative care provision if EAS were to be legalized. Our aim was not to take an explicit anti-EAS stance or expand on findings from systematic reviews or philosophical and ethico-legal treatises, but rather to offer clinical perspectives and the potential pragmatic implications of legalized EAS for palliative care provision, patients and families, healthcare professionals, and the broader community.

Method: We provide insights from our multidisciplinary clinical experience, coupled with those from various jurisdictions where EAS is, or has been, legalized.

Results: We believe that these issues, many of which are encountered at the bedside, must be considered in detail so that the pragmatic implications of EAS can be comprehensively considered.

Significance of Results: Increased resources and effort must be directed toward training, research, community engagement, and ensuring adequate resourcing for palliative care before further consideration is given to allocating resources for legalizing euthanasia and physician-assisted suicide.

Man-up Against Suicide

Male suicide rates are high in Western countries including the US and Canada. Underpinned by men’s resistance to health help-seeking and challenges diagnosing mental illness including male depression, suicide ends the lives of many men amid inflicting pain and grief on the family and friends who are left behind. Fuelled by the discordant relationship between men’s low rates of depression and high rates of suicide we embarked on a unique and novel photovoice study title Man-Up Against Suicide. Specifically, men who have contemplated suicide in the past, and individuals (men and women) who have lost a male partner, family member or friend to suicide were invited to take photographs representing their experiences with men’s suicide with the ultimate goal of messaging ‘at risk’ men that there are alternatives to taking one’s life. Participants subsequently completed semi-structured individual interviews narrating the photographs and providing captions to accompany their selected images. In this presentation we share the preliminary study findings along with some participant photographs and narratives as a means to discussing; 1) men’s experiences of suicidal behaviours and their management strategies; and, 2) how men’s and women’s experiences of losing a male to suicide can de-stigmatize men’s mental illness and raise public awareness about male suicide.

An exploration of integrated data on the social dynamics of suicide among women

The gender based nature of suicide related behaviour is largely accepted.However, studies which report exclusively on female fatal suicides are rare.Here we demonstrate how female fatal suicide has effectively been ‘othered’ and appears ‘incidental’ in studies which compare female behaviour with that of their male counterparts. We highlight how recent studies of suicide have tended to be dominated by male only approaches,which increasingly link issues of masculinity with male death by suicide.Drawing on data collected from the GP and Coroner’s office, we then apply the Sociological Autopsy approach to a cohort of 78 deaths recorded as suicides in the UK between 2007 and 2009. By focusing on females in isolation from males, we demonstrate that as in male suicide only studies,it is similarly possible to draw out issues associated with the feminine identity which can be linked to death by suicide. We identify that bereavement, sexual violence and motherhood could all be linked to the lives and help-seeking of the females who died. In closing, we suggest are orientation towards sociological analytic approaches of female suicide may help to produce further reductions in the rate of female death by suicide.

Dimensions of Suicide Research: Substance misuse in life and death in a 2-year cohort of suicides

Background
While substance misuse is a key risk factor in suicide relatively little is known about the relationship between lifetime misuse and misuse in suicide.

Aim
To examine the relationship between a history of substance misuse and misuse at the time of a suicide.

Method
Linkage of Coroner reports of 403 suicides occurring over two years with associated primary care records. History of substance misuse was defined as alcohol misuse and/or prescription or illicit drug misuse, for which medical help was sought.

Results
With alcohol misuse: 65% of the cohort had previously sought help and 42% were intoxicated at the suicide (with 30% of these seeing their GP in the previous year). With misuse of other substances: 54% of the cohort were tested for blood toxicology (37% of these tested positive) - with positive toxicology defined as an excess of prescription drugs over the therapeutic minima and/or detection of illicit substances. Those tested were more likely to be young and have a history of drug abuse.

Conclusion
Understanding the links between substance misuse and the use of substances in conjunction with the act of suicide is discussed in light of the study results and current pathology and coroner practices.

Suicide and parasuicide: a selected review of the literature.

The increase in adolescent suicides has prompted the World Health Organization to set targets to reduce the incidence of deaths by the year 2000. In order to achieve this target further investigation into the perceptions of adolescent parasuicidal individuals is required to reduce the number of suicide attempts. Statistical evidence shows that parasuicidal individuals are commonly females who attempt suicide by taking an overdose. In the majority of cases help has been sought within the month prior to the attempt. Following an attempt many individuals feel isolated or ignored by health professionals. It appears that communication difficulties and negative attitudes by health professionals often reinforce the stigma associated with suicide. Nurses can contribute to the prevention of parasuicide/suicide by actively providing therapeutic care and counselling parasuicidal individuals to help them deal with major life events.

"Things I did not know”: Retrospectives on a Canadian rural male youth suicide using an instrumental photo voice case study

In Canada, it is young rural based men who are at the greatest risk for suicide. While there is no consensus on the reasons for this, evidence points to contextual social factors including isolation, lack of confidential services and pressure to uphold restrictive norms of rural masculinity. In this article we share findings drawn from an instrumental photo voice case study to distil factors contributing to the suicide of a young Canadian rural based man. Integrating photo voice methods and in-depth qualitative we conducted interviews with 7 family members and close friends of the deceased. The interviews and image data were analyzed using constant comparative methods to discern themes related to participants’ reflections on and perceptions about rural male suicide. Three inductively derived themes, “Missing the signs”, “Living up to his public image” and “Down in Rural Canada ” reflect the challenges that survivors and young rural men can experience in attempting to be comply with restrictive dominant ideals of masculinity. We conclude that community based suicide prevention efforts would benefit from gender-sensitive and place specific approaches to advancing men’s mental health by making tangibly available and affirming an array of masculinities to foster the well-being of young rural based men.

Men’s depression and suicide literacy: A nationally representative Canadian survey

Background: Male suicide prevention strategies include diagnosis and effective management of men’s depression. Fundamental to suicide prevention efforts is public awareness, which in turn, is influenced by literacy levels about men’s depression and suicide.

Aim: To examine sex differences in mental health literacy with respect to men’s depression and suicide among a cohort of Canadian respondents.

Methods: 901 English-speaking Canadian men and women completed online survey questionnaires to evaluate mental health literacy levels using 10-item D-Lit and 8-item LOSS questionnaires, which assess factual knowledge concerning men’s depression and suicide. Statistical tests (chi-square, z-test) were used to identify significant differences between sex sub-groups at 95% confidence.

Results: Overall, respondents correctly identified 67% of questions measuring literacy levels about male depression. Respondents’ male suicide literacy was significantly poorer at 53.7%. Misperceptions were especially evident in terms of differentiating men’s depressive symptoms from other mental illnesses,
estimating prevalence and identifying factors linked to male suicide. Significant sex differences highlighted that females had higher literacy levels than men in regard to male depression.

Conclusions: Implementing gender sensitive and specific programs to target and advance literacy levels about men’s depression may be key to ultimately reducing depression and suicide among men in Canada.

Supporting Mothers Bereaved by Suicide in Northern Ireland:Integrating Research and Practice