SUICIDE PREVENTION. Department of Psychogeriatrics, Institute of Neurology and Psychiatry, University of Padua, Italy

Transcription

1 SUICIDE PREVENTION

2 SUICIDE PREVENTION A Holistic Approach Edited by D. DE LEO Department of Psychogeriatrics, Institute of Neurology and Psychiatry, University of Padua, Italy A. SCHMIDTKE Department of Clinical Psychology, Institute of Psychiatry, University of Würzburg, Germany and R. F. W. DIEKSTRA Community Mental Health Center, Leiden and Municipal Health Authority, Rotterdam, The Netherlands Kluwer Academic Publishers NEW YORK / BOSTON / DORDRECHT / LONDON / MOSCOW

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4 Table of Contents Preface 1. Reflections on the State of Suicidology 1 R. F. W. Diekstra 2. Suicidal Ideation and Suicide Attempts: The Role of Comorbidity 15 with Depression, Anxiety Disorders, and Substance-use Disorder T. Bronisch and H. U. Wittchen 3. Depression, Hopelessness and Suicide Intent in Attempted Sui- 27 cide: A Hospital-based Study of 201 Patients A. T. Davison 4. Suicide Attempters who Attribute their Problems to Interpersonal 37 Difficulties K. Michel and L. Valach 5. Suicide among Psychiatric Hospital Inpatients 45 A. Roy and R. Draper 6. Twin Research Perspective on Suicide and Suicidal Attempts 53 N. L. Segal and A. Roy 7. The WHO/EURO Multicentre Study on Parasuicide: State of the 63 Art and Future Directions J. G. Sampaio-Faria 8. Suicide and Suicide Attempt Rates in Europe, : Rates, Changes and Epidemiological Results of the WHO/EURO Multicentre Study on Parasuicide A. Schmidtke, S. Fricke, B. Weinacker, U. Bille-Brahe, D. DeLeo, A. Kerkhof, T. Bjerke, P. Crepet, C. Haring, K. Hawton, J. Lönnqvist, K. Michel, A. Philippe, X. Pommereau, I. Querejeta, E. Salander-Renberg, B. Temesváry, D. Wasserman and J. G. Sampaio-Faria 67 ix

5 vi Table of Contents 9. Relevance of Diagnostic Setting in Predicting the Outcome of Suicide Attempters P. Scocco and D. De Leo Gender Differences in Adolescent Suicide 93 M. J. Marttunen, M. M. Henriksson, H. M. Aro, M. E. Heikkinen, E. T. Isometsä and J. K. Lönnqvist 11. The Suicidal Process in Young Suicides 105 B. S. Runeson 12. Childhood Conceptions of Death and Suicide: Empirical Investigations and Implications for Suicide Prevention 111 B. L. Mishara 13. What do we Know about Media Effects on Imitation of Suicidal Behaviour: State of the Art A. Schmidtke and S. Schaller 14. The Aftermath of Kurt Cobain s Suicide 139 A. L. Berman, D. A. Jobes and P. O Carroll 15. Media Reports on Suicide in Hungary, Austria, Germany and Lithuania in 1981 and Reflection, Mediation and Changes of Sociocultural Attitudes Towards Suicide in the Mass Media S. Fekete, A. Schmidtke, E. Etzersdorfer and D. Gailiene Shame and Guilt in Suicide and Survivors 157 N. L. Farberow 17. Shame The Unbearable Legacy of Suicide 163 O. Grad and A. Zavasnik 18. The Erwin Ringel Memorial Lecture: On Suicide and Mental 167 Illness: How Right was Ringel? J. Lönnqvist 19. A Critical Evaluation of Psychotherapy in the Treatment of Depression 173 and in Suicide Prevention D. Wasserman 20. Applications of Solution-Focused Brief Therapy in Suicide 185 Prevention H. Fiske 21. Pharmacological Treatment of Suicidal Behavior 199 F. Schifano and D. de Leo 121

6 Table of Contents vii 22. Risk Factors for Non-Compliance with Outpatient Aftercare: 211 Implications for the Management of Attempted Suicide Patients C. van Heeringen, C. Jannes, W. Buylaert and H. Henderick 23. Implementation of the Suicide Prevention Strategy in Finland: 219 First Follow-up M. Upanne 24. Venlång: The Swedish National Programme for Suicide 225 Prevention J. Beskow and D. Wasserman 25. England s Policy on Severe Mental Illness 235 R. Jenkins

7 Preface Suicide prevention is still sadly neglected today by governments and public health authorities, despite the fact that in several Western countries the phenomenon has become the first cause of death among the younger age groups, with a higher mortality rate than for road accidents. The World Bank and the World Health Organization deem that suicide causes at least 800,000 deaths per year throughout the globe and that the number of attempted suicides is probably ten times higher. It follows that the people involved each year in suicidal behaviour are several million in number, often leaving a long-term legacy of emotional, social and economic distress. These data, nonetheless, have not so far managed to provide backing for preventive schemes of the same magnitude as the ones developed to tackle other public health problems of much lower epidemiological dimensions, such as AIDS. Some years ago, the European Office of the World Health Organization set up a wide-scale multicentre study with a view to sensitizing national government authorities to the problem of suicide prevention, yet to date only a very limited number of countries have actually promoted national programs. Amongst these are Finland, Sweden, Norway and England. This apparently contrasts with the multitude of existing national associations for suicide prevention (although to be truthful, they are often composed of very few active members) or supranational associations, such as the International Association for Suicide Prevention (IASP), Befrienders International and the International Academy for Suicide Research (IASR), the latter group addressing in particular the promotion of high standard scientific study. Man s only true philosophical problem, to quote Camus, is, however, so complex to prevent any attempt at comparison with other public-health issues, such as road accidents. Consequently, strategies to counteract the spread of the phenomenon must, by necessity, be highly integrated. In other words, suicide prevention cannot be limited to psychosocial, or by contrast, to biological considerations alone. Yet in spite of the many researchers in the field of suicidology, only a handful of culturally equipped research teams adopt a truly multidisciplinary orientation, with obvious repercussions on the development of the effective prevention measures the international community still awaits. In June 1995, under the auspices of the International Association for Suicide Prevention, and sponsored by the World Health Organization and the D. De Leo, A. Schmidtke and R.F.W. Diekstra (eds.), Suicide Prevention, 1998 Kluwer Academic Publishers. Printed in the Netherlands. ix x.

8 x Preface European Economic Community, a congress was organized in Venice with the aim of promoting this very type of integrated approach to suicide prevention. This volume is derived from that event and contains some of the contributions which best express the need for a holistic viewpoint in suicide management: from the above-mentioned WHO multicentre study on parasuicide to the role of the media, from the special type of psychotherapeutic approach required to the most recent guidelines in pharmacological treatment, from a homage to the memory of Erwin Ringel (founder of IASP and undoubtedly one of the fathers of suicide prevention), to the presentation of specific national prevention schemes. This book is dedicated to public health workers, doctors, psychologists and social workers, as well as voluntary staff and their organizations, and all those who make suicide prevention one of their primary interests. D. De Leo A. Schmidtke R. F. W. Diekstra