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- Rajalin, Mia, 1965-
(författare)
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Distal risk factors, interpersonal functioning & family skills training in attempted suicide
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Suicidal behavior is an important global health problem affecting also significant others. Both genetic and environmental influences play an important role in the development of suicidal behavior. There is a need of interventions for family and friends after a suicide attempt. The aim of this thesis was to assess the impact of family history of suicide (FHS) and early life adversity (ELA) on severity of suicidal behavior and on level of interpersonal problems in suicide attempters. Furthermore it aimed to evaluate a DBT-based skills training program, Family Connections (FC), for relatives and friends of suicide attempters.Methods Studies I and II included 181 suicide attempters. FHS was assessed with the Karolinska Self-Harm History Interview or in patient records. ELA was assessed with the Karolinska Interpersonal Violence Scale (KIVS) measuring exposure to interpersonal violence in childhood. Suicide intent was measured with the Freeman scale. Interpersonal problems were assessed with the Inventory of Interpersonal Problems (IIP).Study III, a pilot study evaluating the effect of FC for family members of suicide attempters, included 13 participants who completed the program with pre- and post-questionnaires. The experience of burden was assessed with the Burden Assessment Scale (BAS), general wellbeing with Brief Symptom Inventory (BSI) and level of depression was assessed with Beck Depression Inventory (BDI). The Swedish scale Questions About Family Members (QAFM) was used to explore the quality of the participants’ relationship with the patient and the Quality of Life Inventory (QOLI) was used to measure satisfaction with life situation.Study IV included 132 family members, and investigated the feasibility and preliminary efficacy of FC in psychiatric care. Participants were assessed pre- and post-intervention with the following self-report questionnaires: BAS, QAFM and Five Facet Mindfulness Questionnaire.Results Male suicide attempters with FHS made more serious and well planned suicide attempts and had higher suicide risk. FHS and exposure to interpersonal violence as a child were independent predictors of suicide in male suicide attempters. Regarding interpersonal problems, suicide attempters with FHS had significantly more often an intrusive personal style, indicating that they might have an impaired ability to create stable, long-lasting relationships. In the pilot study the participants reported a significant reduction in burden, an improved psychic health and an improvement in the relationship with the patient after completing FC. In the fourth study, FC showed to be feasible and effectively implemented in a psychiatric outpatient services clinic. Regarding burden, results were in line with the pilot study, with a significant reduction in all subscales in BAS.Conclusions High-risk patients call for a consideration of both ELA and FHS in clinical suicide risk assessment. In suicide attempters at biological risk, suicide might be prevented with the early recognition of environmental risks. Further, the interpersonal problems associated with FHS may cause difficulties for suicide attempters to accept or benefit from treatment, and caregivers should take into account the characteristics of the suicide attempter´s interpersonal functioning. The results from the pilot study provide support for the need and importance of an educational program addressed specifically to family members of suicide attempters. Preliminary results support the feasibility and potential value of an implementation of FC in psychiatric open care clinics.
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| 2. |
- Herrera Rodríguez, Andrés, 1966-
(författare)
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Heaven can wait : studies on suicidal behaviour among young people in Nicaragua
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In developed countries, suicidal behaviour is recognised as a significant public health problem among young people, but there are few studies from developing countries on this subject. The present thesis aims at estimating the extent of the problem and at exploring factors related to suicidal behaviour among young people in a developing country, Nicaragua, using a combined quantitative and qualitative approach. Three studies were conducted between 1999 and 2006. In the first study, all hospital admitted suicide attempt cases in the area of León were assessed over a three year period. Secondly, a qualitative study using individual in-depth interviews was conducted with eight girls aged between 12 and 19 admitted to hospital after attempting suicide. Thirdly, a study using the Attitudes Towards Suicides (ATTS) questionnaire was conducted in a community based sample of 278 young people aged 15-24 years to assess own suicidal behaviours, attitudes towards suicide as well as exposure to suicidal behaviour among significant others. The hospital surveillance showed that suicide attempt rates were highest among females in the age group 15-19 years with a female rate three times that of males (302.9 versus 98.9 per 100,000 inhabits per year). Drug intoxication and pesticides were the most commonly used methods for the attempts. A consistent seasonal variation with peaks in May-June and September-October was found in each of the three years, possibly related to exam periods in schools. Findings in the qualitative approach led to a tentative model for pathways to suicidal behaviour based on four main categories: Structuring conditions, triggering events, emotions and action taken. Dysfunctional families, lack of confidential and trustworthy contacts and interpersonal conflicts followed by emotions of shame and anger were some important components in the model. The community studies showed that suicidal expressions (life-weariness, death wishes, suicidal ideation, suicide plans and suicide attempts) were common among young people where more than 44.8% of males and 47.4% of females reported some kind of suicidal expression. Gender differences were small. Exposure to suicidal behaviour among others was associated with higher levels of self-reported suicidal behaviour. The attitude study showed that boys had less pro-preventive attitudes than girls, possibly indicating their higher risk for completed suicide. Exposure to suicidal behaviour and own suicidal behaviour showed an association with specific patterns of attitudes. The findings should be taken into consideration when planning for prevention of suicidal behaviour among young people in a developing country like Nicaragua.
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| 3. |
- Kaiser, Niclas, 1973-
(författare)
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Mental health problems among the Swedish reindeer-herding Sami population : in perspective of intersectionality, organisational culture and acculturation
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall objective of the thesis was to investigate aspects of mental health among Swedish Sami reindeer herders and to deepen the understanding of the experience of the living conditions of young Sami reindeer-herding men. Theories of intersectionality, organisational culture and acculturation were used. Methods A questionnaire covering different aspects of mental health was distributed to the Sami population, including the Hospital Anxiety and Depression Scale (HADS), the Alcohol Use Disorder Identification Test, selected parts of the Attitudes Towards Suicide questionnaire (ATTS) and the Job Control Questionnaire (JCQ). 15 interviews with young male reindeer-herders were conducted and analysed according to qualitative content analysis. Results A higher load of anxiety and depression was found in the Sami population, most evident regarding anxiety and among middle aged reindeer-herding men. Regarding alcohol risk consumption reindeer-herding Sami do not in general drink more than a geographically matched reference population, but reindeer-herding men reported a higher proportion of hazardous drinkers, and of teetotallers and periodic drinkers. The reindeer-herding population reported significantly higher exposure to suicide and suicidal behaviour among significant others. Reindeer-herds also reported higher prevalence of different types of suicidal problems. The main theme that emerged in qualitative analysis was ‘Being a young reindeer herder means so many (impossible) dreams and conditions’, and the five subthemes were ‘Being inside or outside is a question of identity’, ‘There is a paradox between being free/unfree’, ‘An experience of different threats and a feeling of powerlessness’, ‘Specific norms for how a ‘real’ reindeer-herder should be’ and ‘The different impacts and meanings of relations’. Conclusions The thesis hypothesizes that the reindeer-herding right as an including, excluding and enclosing historically induced border plays an important part when trying to understand the mental health problems in the group. At present, the situation within reindeer-herding is strained because of practical obstacles and feelings of unfairness and uninfluencability. Furthermore, lack of social support, except from the closest part of the family, and experiences of multi-layered conflicts. This – together with norms of reindeer-herding and reindeer-herders that e.g. say that the reindeer herder is a man who doesn’t show weakness – plays a role in the present mental health problems of the Swedish reindeer-herding population. This applies especially to young and middle-aged reindeer-herding men.
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