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Lam JSH, Links PS, Eynan R, Shera W, Tsang AKT, Law S, Fung WLA, Zhang X, Liu P, Zaheer J. "I thought that I had to be alive to repay my parents": Filial piety as a risk and protective factor for suicidal behavior in a qualitative study of Chinese women. Transcult Psychiatry 2022; 59:13-27. [PMID: 34928737 PMCID: PMC8859686 DOI: 10.1177/13634615211059708] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Filial piety involves the Confucian view that children always have a duty to be obedient and to provide care for their parents. Filial piety has been described as both a risk and a protective factor in depression and suicide. This qualitative study aimed to explore the role of filial piety in the suicidal behavior of Chinese women. Qualitative interviews were conducted with Chinese women with a history of suicidal behavior living in the Beijing area (n = 29). Filial piety data were extracted and analyzed in accordance with constructivist grounded theory. The women described five specific family and filial piety factors and how they influenced their ability to fulfill family role obligations, which was described as a nexus connecting these factors to depression, suicidal behavior, and recovery. The five factors were: 1) rigidity of parental filial expectations, 2) perception of family relationships as positive/supportive or negative/harsh, 3) whether filial piety is of high or low personal value in the woman's life, 4) any experiences of rebellion leading to punitive consequences, and 5) how much filial piety she receives from her children. These factors could inform suicide risk assessments in this population. They can be harnessed as part of recovery and protect against future suicidal behavior.
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Affiliation(s)
- June Sing Hong Lam
- 7938University of Toronto.,10033The Centre for Addiction and Mental Health
| | | | | | | | | | - Samuel Law
- 7938University of Toronto.,St. Michael's Hospital
| | - Wai Lun Alan Fung
- 7938University of Toronto.,8613Mount Sinai Hospital and North York General Hospital.,Tyndale University
| | | | | | - Juveria Zaheer
- 7938University of Toronto.,The Centre for Addiction and Mental Health
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Gordon E, Kenny M, O'Reilly A, Eynan R. You feel it was written about you: client acceptability of a group intervention for repeat suicide attempts. J Ment Health 2020; 31:479-486. [PMID: 32935603 DOI: 10.1080/09638237.2020.1818705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Repeat attempts increase risk of death by suicide. The Psychosocial/psychoeducational Intervention for People with recurrent Suicide Attempts (PISA)/Skills for Safer Living (SfSL) is a group intervention targeting repeat attempts. AIMS To evaluate the acceptability of PISA/SfSL to clients and identify key model components influencing this. METHODS This exploratory mixed-methods study involved adults who completed PISA/SfSL (N = 16). Participants completed semi-structured interviews and a satisfaction questionnaire post-intervention, and self-report outcome measures of population specific challenges pre and post-intervention and at 6-month follow-up. RESULTS Qualitative themes illuminate three interrelated response processes; connection with each other and the model, taking control of life, and gaining a sense of value. Quantitative outcome measures indicated positive trends in suicidality, hopelessness, alexithymia, and problem-solving. High satisfaction levels indicated its quality, relevancy, applicability and helpfulness. Key components influencing responses were PISA/SfSL's; psychosocial group format and processes, psychoeducational and skill development content, and ethos. Results suggest PISA/SfSL was acceptable to those with repeat suicide attempts. CONCLUSIONS The study highlights the usefulness of group work and the importance of consistency with guidelines in suicide intervention. It supports the view that recovery in suicidality and engagement in treatment are complex processes. It adds to previous research demonstrating acceptability among facilitators.
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Affiliation(s)
- Evelyn Gordon
- School of Nursing, Psychotherapy and Community Health, Dublin City University (DCU), Dublin, Ireland
| | - Maeve Kenny
- Psychology Department, St Vincent's Hospital Fairview, Dublin, Ireland
| | - Aileen O'Reilly
- School of Nursing and Human Sciences, Dublin City University (DCU), Dublin, Ireland
| | - Rahel Eynan
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Canada
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Lam JSH, Links PS, Shera W, Law S, Fung WLA, Tsang AKT, Eynan R, Zhang X, Liu P, Zaheer J. Lessons from a Canada-China cross-national qualitative suicide research collaboration. Glob Public Health 2020; 15:1730-1739. [PMID: 32450777 DOI: 10.1080/17441692.2020.1771394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A cross-national qualitative suicide study was conducted by Tsinghua University and the University of Toronto with two samples of Chinese women in Beijing and Toronto. The aim of this article is to reflect on lessons learned from this collaborative study. A literature review guided the analysis. A focus group was conducted with members of both research teams. A semi-structured interview guide was developed to explore the researchers' experiences of participating in the cross-national study. Focus group transcript data and observations from authors informed the analysis, situated in the existing literature on cross-national qualitative health research and guided by Baistow's cross-national research frame. Our study highlights how cross-national research involves conceptual and practical challenges that require negotiation. Such research also holds many opportunities, including (1) using a different cultural lens to understand differences and clarify similarities cross-culturally; (2) co-constructing knowledge through collaboration; (3) deconstructing one's own assumptions; and (4) engaging in an inspiring and empowering experience in collaboration.
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Affiliation(s)
- June Sing Hong Lam
- Department of Psychiatry, University of Toronto, Toronto, Canada.,The Centre for Addiction and Mental Health, Toronto, Canada
| | - Paul S Links
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Wes Shera
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Samuel Law
- Department of Psychiatry, University of Toronto, Toronto, Canada.,St. Michael's Hospital, Toronto, Canada
| | - Wai Lun Alan Fung
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Mount Sinai Hospital and North York General Hospital, Toronto, Canada.,Department of Psychology, Tyndale University, Toronto, Canada
| | - A Ka Tat Tsang
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Rahel Eynan
- Lawson Health Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Xiaoqian Zhang
- Department of Psychiatry, Yuquan Hospital, Tsinghua University, Beijing, People's Republic of China
| | - Pozi Liu
- Department of Psychiatry, Yuquan Hospital, Tsinghua University, Beijing, People's Republic of China
| | - Juveria Zaheer
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Health Outcomes and Performance Evaluation (HOPE) Research Unit, Institute for Mental Health Policy Research, The Centre for Addiction and Mental Health, Toronto, Canada
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Heisel MJ, Moore SL, Flett GL, Norman RMG, Links PS, Eynan R, O'Rourke N, Sarma S, Fairlie P, Wilson K, Farrell B, Grunau M, Olson R, Conn D. Meaning-Centered Men's Groups: Initial Findings of an Intervention to Enhance Resiliency and Reduce Suicide Risk in Men Facing Retirement. Clin Gerontol 2020; 43:76-94. [PMID: 31671031 DOI: 10.1080/07317115.2019.1666443] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objectives: To assess the preliminary effectiveness of Meaning-Centered Men's Groups (MCMG), a 12-session existentially-oriented, community-based, psychological group intervention designed to enhance psychological resiliency and prevent the onset or exacerbation of suicide ideation among men who are concerned about or struggling with the transition to retirement.Methods: We recruited 30 men (n= 10 per group), 55 years and older (M= 63.7, SD= 4.1) from community settings to participate in a course of MCMG to be delivered in a community center. Participants completed eligibility, pre-, mid-, and post-group assessments of suicide ideation and psychological risk and resiliency factors.Results: Participants experienced significant increases in attitudinal sources of meaning in life, psychological well-being, life satisfaction, retirement satisfaction, and general health, and decreases in depression, hopelessness, loneliness, and suicide ideation.Conclusions: Preliminary findings suggest that MCMG is a novel men's mental health intervention that may help to enhance psychological well-being and potentially reduce the severity or prevent the onset of symptoms of depression, hopelessness, and suicide ideation.Clinical Implications: Upstream psychological interventions may serve an important role in mental health promotion and suicide prevention with potentially vulnerable individuals facing challenging life transitions.
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Affiliation(s)
- Marnin J Heisel
- Department of Psychiatry, The University of Western Ontario (UWO).,Lawson Health Research Institute, London, ON, Canada.,Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, NY, USA.,Department of Epidemiology & Biostatistics, The University of Western Ontario, London, Canada
| | | | | | - Ross M G Norman
- Department of Epidemiology & Biostatistics, The University of Western Ontario, London, Canada
| | - Paul S Links
- Department of Psychiatry, The University of Western Ontario (UWO).,Lawson Health Research Institute, London, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University
| | - Rahel Eynan
- Department of Psychiatry, The University of Western Ontario (UWO).,Lawson Health Research Institute, London, ON, Canada
| | - Norm O'Rourke
- Department of Public Health and Multidisciplinary Research Center on Aging, Ben-Gurion University of the Negev
| | - Sisira Sarma
- Department of Epidemiology & Biostatistics, The University of Western Ontario, London, Canada
| | | | - Kimberley Wilson
- Department of Family Relations and Applied Nutrition, University of Guelph
| | | | | | | | - David Conn
- Canadian Coalition for Seniors' Mental Health, Baycrest Health Sciences, Department of Psychiatry, University of Toronto
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Eynan R, Shah R, Heisel MJ, Eden D, Jhirad R, Links PS. Last Words: Are There Differences in Psychosocial and Clinical Antecedents Among Suicide Decedents Who Leave E-Notes, Paper Notes, or No Note? Suicide Life Threat Behav 2019; 49:1379-1394. [PMID: 30272376 DOI: 10.1111/sltb.12514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/20/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Only a minority of suicide decedents leave a suicide note. Typically, the notes are handwritten on paper; however, electronic suicide notes have been reported with increasing frequency. This emerging phenomenon remains generally under-researched. The aim of this study was to compare the psychosocial and clinical antecedents of suicide decedents who left E-notes with those who left paper notes or no notes. METHOD The study was embedded in the Southwestern Ontario Suicide Study (SOSS). The SOSS was a three-year case series of consecutive deaths by suicide that occurred in the region between 2012 and 2014. Data on psychosocial and clinical antecedents were collected with a modified version of the Manchester questionnaire used in the UK. RESULTS Of the 476 suicides files reviewed, 45.8% contained a suicide note. A total of 383 separate suicide notes were left: 74.3% were paper notes and 25.7% were E-notes. The results of the multivariate regression analyses indicate that the likelihood of leaving a suicide note was negatively associated with a history of admissions to a mental health unit, while the likelihood of leaving an E-note was negatively associated with age, positively associated with presence of a mental disorder, and negatively associated with history of hospital admissions. CONCLUSIONS Future studies with larger samples need to consider the timing of the text messages, and appraise whether there was the intent of seeking help or rescue in the text messages.
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Affiliation(s)
- Rahel Eynan
- Department of Psychiatry, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Ravi Shah
- Department of Psychiatry, London Health Sciences Centre University Hospital, London, ON, Canada
| | - Marnin Jori Heisel
- Department of Psychiatry, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - David Eden
- Office of the Chief Coroner of Ontario, Toronto, ON, Canada
| | - Reuven Jhirad
- Office of the Chief Coroner of Ontario, Toronto, ON, Canada
| | - Paul S Links
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Links PS, Eynan R, Shah R. Are New Standards for Assessing and Managing Suicidal Patients Needed in Canada? Can J Psychiatry 2019; 64:400-404. [PMID: 30602291 PMCID: PMC6591750 DOI: 10.1177/0706743718821341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Paul S Links
- 1 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Rahel Eynan
- 2 Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Ravi Shah
- 3 Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Heisel MJ, Flett GL, Moore SL, Norman RMG, Links PS, Eynan R, Sarma S, O’Rourke N. INVESTIGATING PERSONALITY MODERATORS OF DECREASED SUICIDE IDEATION IN MEANING-CENTERED MEN’S GROUP PARTICIPANTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M J Heisel
- The University of Western Ontario, London, Ontario, Canada
| | - G L Flett
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - S L Moore
- Athabasca University, Athabasca, Alberta, Canada
| | - R M G Norman
- Department of Psychiatry, The University of Western Ontario, London, Ontario, Canada
| | - P S Links
- McMaster University, Hamilton, Ontario, Canada
| | - R Eynan
- Lawson Health Research Institute, London, Ontario, Canada
| | - S Sarma
- Department of Epidemiology & Biostatistics, The University of Western Ontario, London, Ontario, Canada
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Shah R, Eynan R, Heisel MJ, Eden D, Jhirad R, Links PS. Confidential Survey Into Southwestern Ontario Suicide: Implication for Primary Care Practice. Prim Care Companion CNS Disord 2018; 20. [PMID: 29570962 DOI: 10.4088/pcc.17m02217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/29/2017] [Indexed: 10/17/2022] Open
Abstract
Objective To describe sociodemographic and clinical characteristics of suicide decedents and to explore the pattern of clinical and suicide risk assessment in primary care settings. Methods A 3-year case series of consecutive suicides (January 1, 2012, to December 31, 2014) in Southwestern Ontario, Canada, identified by the Office of the Chief Coroner of Ontario and Ontario Forensic Pathology Service (OCC/OFPS) was conducted. Clinicians who provided care to suicide decedents completed a confidential suicide questionnaire offered online through a secured portal or by hardcopy. Results A total of 476 suicide cases were analyzed using data extracted from the OCC/OFPS files or provided by clinicians who had completed the survey. Hanging (42.8%) was the most common method of suicide, followed by self-poisoning (17.9%). More than half of the decedents (51.8%) used psychotropic medications, and 29.4% used opiates to self-poison. Typically, these self-poisonings involved prescribed medications (70.6%). Over two-thirds (67.4%) of suicide decedents had consulted their primary care physician prior to their deaths, and 63.6% had been seen by a physician within 28 days of their death. Suicide risk assessments were reportedly conducted in 87.1% of these visits. Of those who were assessed, the immediate risk of suicide was deemed to be absent in 39.8%, low in 50.0%, moderate in 8.3%, and high in only 1.9%. Conclusion The findings from this confidential survey may be important for the formulation of recommendations that could improve suicide prevention in primary care practice.
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Affiliation(s)
- Ravi Shah
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, Parkwood Institute Research, Mental Health Care Bldg, 550 Wellington Rd, Room F5-361, London, Ontario N6C 0A7. .,Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Rahel Eynan
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Marnin J Heisel
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - David Eden
- Office of the Chief Coroner of Ontario, Ontario, Canada
| | - Reuven Jhirad
- Office of the Chief Coroner of Ontario, Ontario, Canada
| | - Paul S Links
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
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Eynan R, Shah R, Heisel MJ, Eden D, Jhirad R, Links PS. The Feasibility and Clinical Utility of Conducting a Confidential Inquiry Into Suicide in Southwestern Ontario. Crisis 2017; 39:283-293. [PMID: 29256267 DOI: 10.1027/0227-5910/a000500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Given the effectiveness of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI) in the UK, the present study evaluated this approach in Southwestern Ontario. A systematic confidential examination of suicides in Ontario was developed to guide quality improvement of services and suicide prevention. METHOD A 3-year case series of consecutive suicides in Southwestern Ontario identified by the Office of the Chief Coroner was compiled. Clinicians who provided care to suicide decedents completed an online confidential suicide questionnaire offered through a secured portal. RESULTS A total of 476 suicide cases were analyzed. In all, 270 invitations to clinicians were sent, 237 (87.8%) responded to the invitation and 187 (69.3%) completed the online questionnaire. The majority of the suicide decedents (54.6%, n = 260), were between the ages of 40 and 64 (x = 47.2, SD = 17.1), White (91.4%, n = 416), single (34.2%, n = 439), and male (74.4%, n = 476). Of the 86 cases of self-poisoning, prescription medications were used in 66.3%. Almost two thirds of decedents visited the clinician in the month prior to their death. LIMITATIONS The results of the survey were drawn from suicides in Southwestern Ontario and generalizing these findings should be done with caution. CONCLUSION This study highlights (a) the value of the clinicians' survey to identify gaps in clinical services and (b) the necessity of improvements in suicide risk assessment/management and restriction of prescription medications.
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Affiliation(s)
- Rahel Eynan
- 1 Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,2 Lawson Health Research Institute, London, ON, Canada
| | - Ravi Shah
- 1 Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Marnin J Heisel
- 1 Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,2 Lawson Health Research Institute, London, ON, Canada
| | - David Eden
- 3 Office of the Chief Coroner of Ontario, Toronto, ON, Canada
| | - Reuven Jhirad
- 3 Office of the Chief Coroner of Ontario, Toronto, ON, Canada
| | - Paul S Links
- 1 Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,2 Lawson Health Research Institute, London, ON, Canada
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Bergmans Y, Gordon E, Eynan R. Surviving moment to moment: The experience of living in a state of ambivalence for those with recurrent suicide attempts. Psychol Psychother 2017; 90:633-648. [PMID: 28497887 DOI: 10.1111/papt.12130] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 02/25/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This qualitative study aimed to capture the experience of living in the ambivalent space between life and death for adults with recurrent suicide attempts (RSA). It sought to expand upon an earlier study that explored the processes involved in transitioning away from RSA among adults, which revealed that occupying this ambivalent space is a crucial part of this process. DESIGN Interpretive phenomenological analysis (IPA) was used. This methodology was designed to explore the lived experiences and meaning making and enabled interpretation of the multidimensional subjective experiences of RSA participants. METHODS In-depth semi-structured interviews were conducted with eight adult women with a history of RSA who had participated in a therapeutic intervention at the research site (Skills for Safer Living: A Psychosocial/Psychoeducational Intervention for People with Recurrent Suicide Attempts [SfSL/PISA]). The six stages of IPA were followed to analyse the interview data. RESULTS Analysis revealed the superordinate theme, 'surviving moment to moment', which refers to a precarious state of making decisions about one's life and destiny on a moment-to-moment basis without clear commitment to either life or death. Two subordinate themes were identified: 'deciding not to die in the moment' when the participants were more invested in dying than living and 'deciding to live in the moment' when they were more invested in living than dying. CONCLUSION The study illuminated the complex process of making decisions about ones' destiny on a moment-to-moment basis. It revealed the torment experienced when occupying this state, while paradoxically, also revealing how indecision about life and death provided a lifeline opportunity for those with RSA. Clinicians who recognize the subtle distinctions associated with this in-between state can tailor their interventions accordingly. PRACTITIONER POINTS Surviving moment to moment is characterized by a state of emotional flux and uncertainty about one's destiny, where the person has not fully committed to either life or death. Within this state, there are two interlinked subprocesses, whereby the person is leaning more towards death or life. A critical feature in working with this client group is to recognize their ambiguity and the fragility and temporality of their decisions about their destiny. The practitioner has an opportunity to be a catalyst in the momentum towards life by demonstrating understanding of this survival struggle and tailoring intervention to fit with the nuanced processes within this state.
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Affiliation(s)
- Yvonne Bergmans
- Arthur Sommer Rotenberg Chair in Suicide Studies, St. Michael's Hospital, Toronto, Ontario, Canada.,University of Toronto, Ontario, Canada
| | | | - Rahel Eynan
- Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Abstract
PURPOSE The main purpose of this review was to critically evaluate the literature on psychotherapies for borderline personality disorder (BPD) published over the past 5 years to identify the progress with remaining challenges and to determine priority areas for future research. METHOD A systematic review of the literature over the last 5 years was undertaken. RESULTS The review yielded 184 relevant abstracts, and after applying inclusion criteria, 16 articles were fully reviewed based on the articles' implications for future research and/or clinical practice. CONCLUSION Our review indicated that patients with various severities benefited from psychotherapy; more intensive therapies were not significantly superior to less intensive therapies; enhancing emotion regulation processes and fostering more coherent self-identity were important mechanisms of change; therapies had been extended to patients with BPD and posttraumatic stress disorder; and more research was needed to be directed at functional outcomes.
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Affiliation(s)
- Paul S Links
- Lawson Health Research Institute, Schulich School of Medicine & Dentistry, London, Canada. .,The University of Western Ontario, London, Canada. .,London Health Sciences Centre, Department of Psychiatry, Victoria Hospital-North Tower, Rm B8-132, 800 Commissioners Road East, London, N6A 5W9, ON, Canada. .,St. Joseph's Health Care London, London, Canada.
| | - Ravi Shah
- Lawson Health Research Institute, Schulich School of Medicine & Dentistry, London, Canada.,The University of Western Ontario, London, Canada.,London Health Sciences Centre, Department of Psychiatry, Victoria Hospital-North Tower, Rm B8-132, 800 Commissioners Road East, London, N6A 5W9, ON, Canada.,St. Joseph's Health Care London, London, Canada
| | - Rahel Eynan
- Lawson Health Research Institute, Schulich School of Medicine & Dentistry, London, Canada.,The University of Western Ontario, London, Canada.,London Health Sciences Centre, Department of Psychiatry, Victoria Hospital-North Tower, Rm B8-132, 800 Commissioners Road East, London, N6A 5W9, ON, Canada.,St. Joseph's Health Care London, London, Canada
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Shah R, Nisenbaum R, Classen C, Eynan R, Links PS. Comorbid Depression and Other Predictors of PTSD Severity in Urban Public Transit Employees. Community Ment Health J 2017; 53:224-232. [PMID: 27278665 DOI: 10.1007/s10597-016-0029-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 06/02/2016] [Indexed: 11/26/2022]
Abstract
The purpose of the study was to determine whether post traumatic stress disorder (PTSD) with Major Depressive Disorder (MDD) among urban public transit employees who were exposed to a workplace traumatic event is associated with greater PTSD severity over the 6-month follow-up period compared to PTSD without MDD, and also to identify predictors of PTSD severity among these employees. Information about Axis-I diagnosis and PTSD severity were collected from the SCID-I and the Modified PTSD Symptom Scale (MPSS) respectively. PTSD without MDD (N = 29) and PTSD with MDD (N = 37) groups were not significantly different in terms of PTSD severity. The severity of depression (p = 0.01), female (p = 0.01), non-Caucasian (p = 0.01), perceived high workplace related stress (p = 0.02), and history of lifetime trauma (p = 0.01) were significantly associated with greater PTSD severity after controlling other variables. This study highlights the importance of modifiable variables for reducing PTSD severity after a workplace traumatic event in transit employees.
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Affiliation(s)
- Ravi Shah
- Department of Psychiatry, Lawson Health Research Institute, Western University, London, ON, Canada.
| | | | | | - Rahel Eynan
- Department of Psychiatry, Lawson Health Research Institute, Western University, London, ON, Canada
| | - Paul S Links
- Department of Psychiatry, Lawson Health Research Institute, Western University, London, ON, Canada
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Zaheer J, Shera W, Tsang AKT, Law S, Fung WLA, Eynan R, Lam J, Zheng X, Pozi L, Links PS. “I just couldn’t step out of the circle. I was trapped”: Patterns of endurance and distress in Chinese-Canadian women with a history of suicidal behaviour. Soc Sci Med 2016; 160:43-53. [DOI: 10.1016/j.socscimed.2016.05.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 04/18/2016] [Accepted: 05/09/2016] [Indexed: 11/26/2022]
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Shah R, Eynan R, Srivastava A, Reiss L, Sathyanarayana Rao TS, Parkar S, Dutt L, Kadam K, Links PS. Indo-Canadian Collaboration for Suicide Prevention: Training Needs Assessment for Healthcare Professionals in India. Community Ment Health J 2016; 52:511-8. [PMID: 26007647 DOI: 10.1007/s10597-015-9895-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 05/16/2015] [Indexed: 11/27/2022]
Abstract
The main purpose of the study was to conduct a comprehensive needs assessment of primary healthcare professionals in order to develop a training program aimed at enhancing competencies in suicide risk assessment and management. A total of 144 primary healthcare professionals (physicians = 46; primary care workers = 98) completed the needs assessment questionnaire. The majority of healthcare professionals rated their level of comfort and competence in assessing, treating, and referring suicidal patients as medium or high. However, their knowledge about suicide, risk factors for suicide, asking about suicidal behaviour, and helping a suicidal patient was rated low or medium. Overall, the scarcity of qualified healthcare professionals and the existing gaps in core competencies for suicide risk assessment and management was identified. Development of innovative and effective competencies-based suicide specific training for primary care providers in India is urgently required.
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Affiliation(s)
- Ravi Shah
- Department of Psychiatry, Western University, London, ON, Canada.
- Lawson Health Research Institute, 750 Baseline Rd, Suite 105-5, London, ON, N6C 2R5, Canada.
| | - Rahel Eynan
- Department of Psychiatry, Western University, London, ON, Canada
| | | | - Leanna Reiss
- Department of Psychiatry, Western University, London, ON, Canada
| | | | - Shubhangi Parkar
- Department of Psychiatry, Seth G S Medical College and KEM Hospital, Mumbai, India
| | - Lakshman Dutt
- Department of Psychiatry, Indus University, Ahmedabad, India
| | - Kranti Kadam
- Department of Psychiatry, Seth G S Medical College and KEM Hospital, Mumbai, India
| | - Paul S Links
- Department of Psychiatry, Western University, London, ON, Canada
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Bender A, Eynan R, O’Grady J, Nisenbaum R, Shah R, Links PS. Best practice intervention for post-traumatic stress disorder among transit workers. Work 2016; 54:59-71. [DOI: 10.3233/wor-162263] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ash Bender
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rahel Eynan
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - John O’Grady
- Department of Safety and Environment, Toronto Transit Commission Toronto, ON, Canada
| | | | - Ravi Shah
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Paul S. Links
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Links PS, Bender A, Eynan R, O’Grady J, Shah R. Facilitators and barriers to doing workplace mental health research: Case study of acute psychological trauma in a public transit system. Work 2016; 54:73-8. [DOI: 10.3233/wor-162264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Paul S. Links
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Ash Bender
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rahel Eynan
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | | | - Ravi Shah
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Eynan R, Reiss L, Links P, Shah R, Sathyanarayana Rao TS, Parkar S, Dutt L, Kadam K, De Souza A, Shrivastava A. Suicide prevention competencies among urban Indian physicians: A needs assessment. Indian J Psychiatry 2015; 57:397-402. [PMID: 26816429 PMCID: PMC4711242 DOI: 10.4103/0019-5545.171848] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION India accounts for the highest estimated number of suicides in the World. In 2012, more than 258,000 of the 804,000 suicide deaths worldwide occurred in India. Early identification and effective management of suicidal ideation and behavior are paramount to saving lives. However, mental health resources are often scarce and limited. Throughout India, there is a severe shortage in mental health professions trained, which results in a treatment gap of about 90%. A comprehensive needs assessment was undertaken to identify the nature of the deficits in suicide prevention training for physicians in three Indian cities: Mumbai, Ahmedabad, and Mysore. MATERIALS AND METHODS The study was carried out in several concurrent phases and used a mixed-method approach of converging quantitative and qualitative methodologies. Data were collected using survey questionnaires, focus groups, consultations, and environmental scans. A total of 46 physicians completed the questionnaire. Focus groups were conducted in Mumbai and Ahmedabad with 40 physicians. Consultations were carried out with psychiatrists and psychiatric residents from hospitals and clinics in Mumbai, Ahmedabad, and Mysore. RESULTS Training gaps in suicide prevention exist across the health care professions. Existing training lacks in both quality and quantity and result in critical deficits in core competencies needed to detect and treat patients presenting with suicidal ideation and behavior. Only 43% of the surveyed physicians felt they were competent to treat suicidal patients. The majority of surveyed physicians believed they would greatly benefit from additional training to enhance their suicide risk assessment and intervention skills. CONCLUSIONS There is a dire need for medical schools to incorporate suicide prevention training as a core component in their medical curricula and for continuing medical education training programs for physicians to enhance competencies in early detection and management of suicidal behavior.
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Affiliation(s)
- Rahel Eynan
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Leanna Reiss
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Paul Links
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Ravi Shah
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - T S Sathyanarayana Rao
- Department of Psychiatry, JSS Medical College Hospital, JSS University, Mysore, Karnataka, India
| | - Shubhangi Parkar
- Department of Psychiatry, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Lakshman Dutt
- Department of Psychiatry, Indus University, Ahmedabad, Gujarat, India
| | - Kranti Kadam
- Department of Psychiatry, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Avinash De Souza
- Consultant Psychiatrist and Research Coordinator, Mental Health Resource Foundation, Mumbai, Maharashtra, India
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Eynan R, Bergmans Y, Antony J, Cutcliffe JR, Harder HG, Ambreen M, Balderson K, Links PS. The Effects of Suicide Ideation Assessments on Urges to Self-Harm and Suicide. Crisis 2014; 35:123-31. [DOI: 10.1027/0227-5910/a000233] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Participants’ safety is the primary concern when conducting research with suicidal or potentially suicidal participants. The presence of suicide risk is often an exclusion criterion for research participants. Subsequently, few studies have examined the effects of research assessments on study participants’ suicidality. Aims: The purpose of this research was to examine the patterns of postassessment changes in self-harm and suicide urges of study participants who were recently discharged from an inpatient psychiatric service. Method: Study participants (N = 120) were recruited from patients with a lifetime history of suicidal behavior admitted with current suicidal ideation or suicide attempt to an inpatient psychiatric service and/or a crisis stabilization unit. Participants were assessed for suicidal ideation with the Suicide Ideation Scale at 1, 3, and 6 months following their discharge from hospital. The risk assessment protocol was administered at the start and at the end of each of the study follow-up assessments. Results: Changes in self-harm and suicide urges following study assessments were small, infrequent, and were most likely to reflect a decrease in suicidality. Similarly, participants rarely reported worsening self-control over suicidal urges, and when they did, the effect was minimal. By the end of the 6-month follow-up period, increases in self-harm and suicidal urges postassessment were not seen. Conclusion: The inclusion of suicidal participants in research interviews rarely increased suicide risk. Research involving suicidal individuals is possible when study protocols are well planned and executed by trained assessors and clinicians who are able to identify participants at risk and provide intervention if necessary. The few participants that required intervention had high levels of suicide ideation and behavior at baseline and almost all reported symptoms of posttraumatic stress disorder. Further study is needed to better characterize this subgroup of participants.
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Affiliation(s)
- Rahel Eynan
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | | | | | | | | | | | | | - Paul S. Links
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Bance S, Links PS, Strike C, Bender A, Eynan R, Bergmans Y, Hall P, O'Grady J, Antony J. Help-seeking in transit workers exposed to acute psychological trauma: A qualitative analysis. Work 2014; 48:3-10. [DOI: 10.3233/wor-131650] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sheena Bance
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Canada
| | - Paul S. Links
- Department of Psychiatry, the Schulich School of Medicine and Dentistry, The University of Western Ontario in London, Ontario, Canada
| | - Carol Strike
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ash Bender
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Rahel Eynan
- Department of Psychiatry, the Schulich School of Medicine and Dentistry, The University of Western Ontario in London, Ontario, Canada
| | - Yvonne Bergmans
- Arthur Sommer Rotenberg Chair in Suicide Studies, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Peter Hall
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | | | - Jesmin Antony
- Arthur Sommer Rotenberg Chair in Suicide Studies, St. Michael's Hospital, University of Toronto, Toronto, Canada
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McMain S, Links PS, Guimond T, Wnuk S, Eynan R, Bergmans Y, Warwar S. An exploratory study of the relationship between changes in emotion and cognitive processes and treatment outcome in borderline personality disorder. Psychother Res 2013; 23:658-73. [DOI: 10.1080/10503307.2013.838653] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Abstract
The purpose of this review is (a) to study and systematically review the recent literature examining the co-occurrence and relationships between Axis I psychiatric disorders and Axis II personality disorders, specifically the six originally proposed for the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, and (b) to consider the clinical utility of the current Axis I and Axis II approach in the DSM-IV-TR and apply findings to state a position on the issue of collapsing together Axis I and Axis II. Community surveys or prospective cohort studies were reviewed as a priority. Our review indicates that the associations between clinical disorders and personality disorders clearly varied within each disorder and across the six personality disorders. Our understanding has advanced, particularly related to the clinical utility of comorbidity, and there may be sufficient evidence to support moving borderline personality disorder to Axis I. However, it seems premature to conclude that comorbidity is best conceptualized by having all disorders in a single category or by deleting disorders so that comorbidity is reduced. Our review suggests some priorities for future research into comorbidity, such as including personality disorders in future multivariate comorbidity models.
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Affiliation(s)
- Paul S Links
- Department of Psychiatry, The University of Western Ontario, London, ON N6A 5W9 Canada.
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Cutcliffe J, Links P, Harder H, Bergmans Y, Balderson K, Eynan R, Ambreen M, Neibaum R. Understanding the Risks of Recent Discharge: The Phenomenological Experiences. Crisis 2012; 33:265-72. [DOI: 10.1027/0227-5910/a000132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Evidence indicates that people whose mental health problems lead them to require psychiatric hospitalization are at a significantly increased risk of suicide, and the period of time immediately following discharge after such hospitalizations appears to be a particularly high-risk time. Aims: This paper reports on phenomenological findings from a federally funded, mixed-methods study that sought to better understand the observed increased risk for suicide following discharge from an inpatient psychiatric service. Methods: A purposive sample of 20 recently discharged former suicidal inpatients was obtained. Data were collected from the participants in hermeneutic interviews lasting between 1 h and 2 h and analyzed according to van Manen’s (1997) interpretation of hermeneutic phenomenology. Results: Two key themes were induced: “Existential Angst at the Prospect of Discharge” and “Trying to Survive While Living Under the Proverbial ‘Sword of Damocles’.” Each of these was comprised of five themes with the second key theme – the focus of this paper – encompassing the following: “Needing Postdischarge Support,” “Feeling Lost, Uncertain and Disorientated,” “Feeling Alone and Isolated,” “Suicide Remains an Option,” and “Engaging in Soothing, Comforting Behaviors.” Conclusions: The authors conclude that early exploration of and reconciling patients’ expectations regarding inpatient care for their suicidality would appear to be an empirically based intervention that could diminish the postdischarge risk for further suicide attempts.
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Affiliation(s)
- John Cutcliffe
- University of Maine, USA; University of Ulster, UK; University of Coimbra, Portugal, and University of Malta, Malta
| | - Paul Links
- University of Toronto and St. Michaels Hospital, Toronto, Canada
| | | | - Yvonne Bergmans
- University of Toronto and St. Michaels Hospital, Toronto, Canada
| | - Ken Balderson
- University of Toronto and St. Michaels Hospital, Toronto, Canada
| | | | | | - Rosanne Neibaum
- University of Toronto and Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada
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Cutcliffe JR, Links PS, Harder HG, Balderson K, Bergmans Y, Eynan R, Ambreen M, Nisenbaum R. Understanding the risks of recent discharge: the phenomenological lived experiences--“existential angst at the prospect of discharge”. Crisis 2012; 33:21-9. [PMID: 21940246 DOI: 10.1027/0227-5910/a000096] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Evidence indicates that people whose mental health problems lead them to require psychiatric hospitalization are at a significantly increased risk of suicide, and that the time immediately following discharge after such hospitalizations is a particularly high-risk time. AIMS This paper reports on phenomenological findings from a federally funded, mixed-methods study that sought to better understand the observed increased risk for suicide following discharge from an inpatient psychiatric service. METHODS A purposive sample of 20 recently discharged former suicidal inpatients was obtained. Data were collected in hermeneutic interviews lasting between 1 h and 2 h and analyzed according to van (1997) interpretation of hermeneutic phenomenology. RESULTS Two key themes, "existential angst at the prospect of discharge" and "trying to survive while living under the proverbial 'sword of Damocles'" were induced. Each of these was comprised of five themes with the first key theme (which is the focus of this paper) encompassing the following: "Feeling scared, anxious, fearful and/or stressed," "Preparedness," "Leaving the place of safety," "Duality and ambivalence," and "Feel like a burden." CONCLUSIONS Early exploration of and reconciling of patients' expectations regarding inpatient care for their suicidality would be empirically based interventions that could diminish the postdischarge risk for further suicide attempts.
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Links P, Nisenbaum R, Ambreen M, Balderson K, Bergmans Y, Eynan R, Harder H, Cutcliffe J. Prospective study of risk factors for increased suicide ideation and behavior following recent discharge. Gen Hosp Psychiatry 2012; 34:88-97. [PMID: 21997244 DOI: 10.1016/j.genhosppsych.2011.08.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 08/10/2011] [Accepted: 08/12/2011] [Indexed: 10/16/2022]
Abstract
OBJECTIVE The purpose of this study is to prospectively examine the association between predictors from the three thematic areas - suicidality, personal risk factors and patient care factors - and the occurrence of postdischarge suicide ideation and behavior in recently discharged patients. METHODS The design is a prospective cohort study of all patients admitted to an inner city inpatient psychiatric service with a lifetime history of suicidal behavior and current suicidal ideation. Predictors of suicide ideation at 1, 3 and 6 months following discharge and suicide behavior over the 6 months of follow-up were examined. RESULTS The incidence of death by suicide during the study period was 3.3% [95% confidence interval (CI)=0.9%-8.3%], and 39.4% (95% CI=30.0%-49.5%) of the surviving participants reported self-injury or suicide attempts within 6 months of hospital discharge. Risk factors such as recent suicide attempts, levels of depression, hopelessness and impulsivity were predictive of increased suicide ideation or behavior after discharge from the inpatient service. CONCLUSIONS The high risk of suicide ideation, suicide attempts and suicide demonstrated in these recently discharged patients supports the need to develop selective prevention strategies.
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Affiliation(s)
- Paul Links
- Suicide Studies Research Unit at St. Michael's Hospital, Toronto, Ontario, Canada.
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Nisenbaum R, Links PS, Eynan R, Heisel MJ. Variability and predictors of negative mood intensity in patients with borderline personality disorder and recurrent suicidal behavior: Multilevel analyses applied to experience sampling methodology. Journal of Abnormal Psychology 2010; 119:433-9. [DOI: 10.1037/a0018696] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bergmans Y, Spence JM, Strike C, Links PS, Ball JS, Rufo C, Rhodes AE, Watson WJ, Eynan R. Repeat substance-using suicidal clients-how can we be helpful? Soc Work Health Care 2009; 48:420-431. [PMID: 19396710 DOI: 10.1080/00981380802592013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Care of clients with mental health and substance abuse problems accounts for a significant proportion of all emergency department (ED) visits. This qualitative research project sought to understand the ED experiences of men with a history of suicidal behavior and substance abuse and those of the emergency personnel who work with them. Understanding the unique positions of care providers and this client population in the ED setting can assist the social worker to advocate for this highly vulnerable group of clients and to assist an interprofessional team to develop better crisis interventions.
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Strike C, Rufo C, Spence J, Links P, Bergmans Y, Ball J, Rhodes AE, Watson W, Eynan R. Unintended Impact of Psychiatric Safe Rooms in Emergency Departments: The Experiences of Suicidal Males With Substance Use Disorders. ACTA ACUST UNITED AC 2008. [DOI: 10.1093/brief-treatment/mhn007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Links PS, Eynan R, Heisel MJ, Nisenbaum R. Elements of affective instability associated with suicidal behaviour in patients with borderline personality disorder. Can J Psychiatry 2008; 53:112-6. [PMID: 18357929 DOI: 10.1177/070674370805300206] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To identify elements of affective instability associated with an increased likelihood of impulsivity and then to determine whether these elements characterize patients with borderline personality disorder (BPD) and suicidal behaviour. METHOD We prospectively followed 82 individuals with BPD and a history of recurrent suicidal behaviour who recorded their current mood states, impulsivity, suicide ideation, and environmental stressors (triggers) 6 times daily over 3 weeks. RESULTS Our results suggested that mood amplitude was correlated with impulsivity and that 4 subgroups defined by mean scores on mood amplitude and negative mood intensity significantly differed in the number of suicidal behaviours reported in the last year. CONCLUSIONS A subgroup of BPD patients appears to be at elevated risk for suicidal behaviour based on high mood amplitude and mean negative mood intensity. Clinicians might target this group for monitoring and interventions to reduce the likelihood of suicidal behaviour.
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Affiliation(s)
- Paul S Links
- Suicide Studies Unit, St Michael's Hospital, Toronto, Ontario.
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Abstract
Suicide on subway systems is a public health challenge that has been reported in urban centers worldwide. Our objective was to analyze studies of suicide on subway systems, develop a profile of characteristics that are suggestive of association with suicides or attempts, and show how this profile can inform prevention. A literature review involving epidemiology studies and studies relating to subway suicide was conducted. Twenty-eight studies were included in this review. Across studies, characteristics were not often assessed for risk factor status, although several characteristics were remarkably similar. Those attempting suicide on the subway appear to be affected by serious mental illness and have contact with mental health services before the suicidal behavior. Several characteristics may be shared among this population, emphasizing the potential for prevention in clinical and public health domains. Well-designed studies that utilize robust data collection and statistical methods are needed to establish the risk status associated with these characteristics.
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Affiliation(s)
- Ruwan Ratnayake
- Suicide Studies Unit, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Links PS, Eynan R, Heisel MJ, Barr A, Korzekwa M, McMain S, Ball JS. Affective instability and suicidal ideation and behavior in patients with borderline personality disorder. J Pers Disord 2007; 21:72-86. [PMID: 17373891 DOI: 10.1521/pedi.2007.21.1.72] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study employed an Experience Sampling Methodology (ESM) to test whether various elements of affective instability can predict future suicide ideation in patients with borderline personality disorder (BPD) and a history of recurrent suicidal behavior. Eighty-two individuals with BPD and a history of recurrent suicidal behavior were followed prospectively for one month during which time they recorded their current mood states, 6 times daily over three weeks. Accounting for a set of robust suicide risk factors in multiple regression analyses, only negative mood intensity was significantly related to intensity of self-reported suicide ideation and to number of suicidal behaviors over the past year. Other elements of affective instability examined (e.g., mood amplitude, dyscontrol, and reactivity) were not associated with future suicide ideation or with recent suicidal behavior. Affective instability in patients with BPD is highly variable from one individual to another and is characterized by high levels of intense negative mood. These negative mood states, versus other aspects of mood variability, seem to be more closely tied to the occurrence of suicidal ideation and behavior.
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Links PS, Eynan R, Ball JS, Barr A, Rourke S. Crisis occurrence and resolution in patients with severe and persistent mental illness: the contribution of suicidality. Crisis 2006; 26:160-9. [PMID: 16485841 DOI: 10.1027/0227-5910.26.4.160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Assertive community treatment appears to have limited impact on the risk of suicide in persons with severe and persistent mental illness (SPMI). This exploratory prospective study attempts to understand this observation by studying the contribution of suicidality to the occurrence of crisis events in patients with SPMI. Specifically, an observer-rated measure of the need for hospitalization, the Crisis Triage Rating Scale, was completed at baseline, crisis occurrence, and resolution to determine how much the level of suicidality contributed to the deemed level of crisis. Second, observer-ratings of suicidal ideation, the Modified Scale for Suicide Ideation, and psychopathology and suicidality, Brief Psychiatric Rating Scale, were measured at baseline, crisis occurrence, and resolution. A self-report measure of distress, the Symptom Distress Scale, was completed at baseline, crisis occurrence, and resolution. Finally, the patients' crisis experiences were recorded qualitatively to compare with quantitative measures of suicidality. Almost 40% of the subjects experienced crisis events and more than a quarter of these events were judged to be severe enough to warrant the need for hospitalization. Our findings suggest that elevation of psychiatric symptoms is a major contributor to the crisis occurrences of individuals with SPMI; although the risk of suicide may have to be conceived as somewhat separate from crisis occurrence.
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Affiliation(s)
- Paul S Links
- Suicide Studies Unit, Department of Psychiatry, University of Toronto, Canada.
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Eynan R, Langley J, Tolomiczenko G, Rhodes AE, Links P, Wasylenki D, Goering P. The association between homelessness and suicidal ideation and behaviors: results of a cross-sectional survey. Suicide Life Threat Behav 2003; 32:418-27. [PMID: 12501966 DOI: 10.1521/suli.32.4.418.22341] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study was carried out with three goals: (1) to determine the prevalence of suicidal ideation and suicide attempts among the homeless; (2) to determine what aspects of homelessness predict suicidality, and (3) to determine which aspects remain predictive after controlling for key covariates, such as mental illness. A sample of 330 homeless adults were interviewed. Sixty-one percent of the study sample reported suicidal ideation and 34% had attempted suicide. Fifty-six percent of the men and 78% of the women reported prior suicidal ideation, while 28 percent of the men and 57% of the women had attempted suicide. Childhood homelessness of at least 1 week without family members and periods of homelessness longer than 6 months were found to be associated with suicidal ideation. Psychiatric diagnoses were also associated with suicidality in this sample.
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Affiliation(s)
- Rahel Eynan
- St. Michael's Hospital, Toronto, Ontario, Canada.
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