How to deal with requests for assisted suicide: Some experiences and practical guidelines from the Netherlands.

In the Netherlands, physician-assisted suicide may be justifiable for patients with physical illness as well as for patients with unbearable mental suffering. Explicit requests for physician-assisted suicide are frequently made, but in psychiatric practice they are infrequently granted. In this contribution, some information on the Dutch practices related to assisted death is presented, with emphasis on assisted suicide in patients with unbearable mental suffering. The aim of this contribution is to demonstrate that the Dutch law and jurisprudence permit clinicians to deal effectively with requests for assisted suicide. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Suicide following homicide in the family

Previous research has established that perpetrators of homicide-suicide share more characteristics with those who commit suicide than they do with those who commit homicide without suicide. This article examines the characteristics of victims, perpetrators and the circumstances leading to the homicide of a sample of familial homicide-suicides and familial homicides in southwest British Columbia. A familial homicide was defined as one in which the victim and perpetrator were related directly or indirectly through blood or an intimate relationship. Suicide only occurred following the killing of an intimate partner and/or offspring. Consistent with an evolutionary perspective, homicides followed by suicide were most often attributable to male proprietariness (manifested by killing former intimate partners or offspring following an intimate separation) or mental illness. By contrast, none of the murders which occurred as a result of violence by the victim, child abuse, family conflict, or financial/criminal motives was followed by suicide.     

Psychiatry and physician-assisted suicide

The psychiatric literature on physician-assisted suicide is scant and almost universally opposed to legalization. This opposition stems from the traditional perspective of suicide as a symptom of mental illness and the tendency of psychiatrists to extend their view of suicide in the medically well to the terminally ill. This article examines the basis for and validity of this opposition and makes recommendations about the role of the psychiatrist in physician-assisted suicide.     

Cholinesterase inhibition by derivatives of 2-amino-4,6-dimethylpyridine

Previous studies suggest that many transsexuals evidence an Axis I diagnosis according to the DSM-IV classification (e.g., psychoses, major affective disorder). The current study examined retrospectively the comorbidity between gender dysphoria and major psychopathology, evaluating the charts of 435 gender dysphoric individuals (318 male and 117 female). All had undergone an extensive evaluation, addressing such areas as hormonal/surgical treatment, and histories of substance abuse, mental illness, genital mutilation, and suicide attempts. In addition, a subgroup of 137 individuals completed the MMPI. Findings revealed over two thirds were undergoing hormone reassignment, suggesting a commitment to the real-life cross-gender process. One quarter had had problems with substance abuse prior to entering treatment, but less than 10% evidenced problems associated with mental illness, genital mutilation, or suicide attempts. Those completing the MMPI (93 female and 44 male) demonstrated profiles that were notably free of psychopathology (e.g., Axis I or Axis II criteria). The one scale where significant differences were observed was the Mf scale, and this held true only for the male-to-female group. Psychological profiles as measured by the MMPI were more "normal" in the desired sex than the anatomic sex. Results support the view that transsexualism is usually an isolated diagnosis and not part of any general psychopathological disorder.     

The case against suicide prevention.

Challenges the perspective that suicide is a mental health problem, that mental health practitioners and institutions have a professional duty to try to prevent it, and that it is a legitimate function of the state to empower such professionals and institutions (especially psychiatrists and psychiatric institutions) to impose coercive interventions on persons diagnosed as posing a suicidal risk. Hence, when an individual (formally identified as a patient or client) commits suicide while in the care of mental health clinicians or clinics, the latter may be sued for and found guilty of professional negligence for failing to prevent suicide. A different view of suicide as an act of a moral agent for which that agent himself or herself is ultimately responsible is presented. It is further argued that eschewing suicide prevention and rejecting it as a professional responsibility would not only protect the mental health clinician from being forced into internally conflicting and contradictory roles and the client of mental health services from coercion in the name of suicide prevention, but would also protect the nation from a mental health policy that needlessly undermines the ethic of self-responsibility. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental illness and substance use among sheltered homeless persons in lower-density population areas

OBJECTIVE: The prevalence of mental illness and substance abuse in homeless populations has been studied primarily in large urban areas. This study examines a sheltered homeless population in two counties of lower-density population, Dauphin and Cumberland counties in central Pennsylvania, to assess the prevalence of mental illness and substance abuse. METHODS: A total of 81 homeless adults from nine emergency shelters were interviewed using a structured questionnaire. RESULTS: The estimated lifetime prevalence rate of major depressive disorder was 26.6 percent; 6.4 percent of the sample showed evidence of psychotic thinking. Almost one-third reported previous hospitalization for emotional problems, and about one-third reported a suicide attempt. The estimated lifetime prevalence rate of alcohol or drug abuse or dependence was almost 60 percent. CONCLUSIONS: Although mental illness, especially psychosis, and substance abuse may be somewhat less prevalent among homeless persons in lower-density population areas than in large urban areas, they are nevertheless significant problems.     

Religious life-styles and mental health: An exploratory study.

Conducted an intensive, case-by-case assessment of life-styles of a sample of religious students. We identified differing styles of religiousness and made comparisons by means of tests and interviews between subgroups whose subjects manifested differing religious life-styles. Those subjects with continuous religious development and mild religious experiences appeared to be healthier than those with discontinuous development and intense religious experiences; however, intense religious experiences tended to enhance the adjustment of those who experienced them. There was no evidence in the group as a whole for an overall negative or positive correlation between religiousness and mental health, but some modes of religious involvement appeared to be related to disturbance, whereas other modes appeared to be related to enhanced stability and resilience. Because causality in these relations remains uncertain, we generate hypotheses concerning further studies of life-styles and adjustment. We also discuss implications for student counseling and development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The WHO-EURO Multicentre Study: risk of parasuicide and the comparability of the areas under study

The 15 areas under study in the WHO/Euro Multicentre Study on Parasuicide vary considerably with regard to socio-economic factors, culture, life-styles, etc. In this paper, the authors discuss whether the traditional high risk factors for suicidal behavior (such as unemployment, abuse, divorce, etc.) take on different weights depending on local societal and cultural settings. Results from analyzing covariations between various background factors characteristic of the different areas under study and the frequency of attempted suicide showed weak or insignificant correlations, indicating that high-risk factors can only be identified from international pooled data with great care.     

Transgender and gender variant populations with mental illness: Implications for clinical care.

There is a scarcity of literature on clinical care for transgender and gender variant populations with serious mental illness. At times, gender identity issues among individuals with serious mental illness have been labeled as delusions that should not be reinforced by providers. However, there are significant limitations to attributing gender variance among populations with mental illness solely to a psychotic process. The following case study research demonstrates the variation in gender identity issues among individuals with serious mental illness. These individuals may experience gender dysphoria exclusively in the context of acute psychosis or may have gender identity issues that are distinct from the mental illness. Denial of an individual's gender variant presentation by treatment staff may heighten distress, thus interfering with a collaborative treatment alliance while posing additional barriers to recovery from mental illness. Implications and applications for clinical training and further research will be presented in order to promote awareness and competent care of gender issues when co-occurring with mental illness. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychopathy and suicide: A multisample investigation.

Evidence suggests that behavioral aspects of psychopathy are associated with suicidal behavior, whereas the affective and interpersonal aspects are not. The authors tested the robustness of this bifurcated association across 1,711 persons and 12 samples of adult and juvenile criminal offenders, forensic psychiatric patients, and civil psychiatric patients. The authors observed a small but significant partial correlation (.13) between the behavioral/impulsive lifestyle features of psychopathy and suicidality, but no effect for affective/interpersonal features. Several method and sample features (mental disorder; psychopathy and suicidality measurement format) significantly strengthened or weakened this association. The authors conclude that it is not possible to speak of "the" association between psychopathy and suicide, but that this relationship appears to be partially dependent on methodological (i.e., self-report vs. clinician-administered psychopathy measures) and sample composition (i.e., age; mental illness) factors. Recommendations for practice are provided, including that clinicians should not consider psychopathy a buffer against suicidal behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Staying connected: Young adults’ felt obligation toward parents with and without mental illness.

The present study compares 94 young adults’ self-reported felt obligation toward parents, psychological symptoms, psychological well-being, and interpersonal loneliness in three family types: families where a mother has serious mental illness, families where a father has serious mental illness, and families with nondistressed parents. Results indicated no significant differences in felt obligation toward mothers or fathers as a function of family type. Young adults with a mother with serious mental illness reported significantly more psychological adjustment difficulties than their peers with a father with serious mental illness or nondistressed parents. Young adults’ reports of felt obligation toward both parents were significantly positively correlated with young adults’ psychological adjustment in families with a parent with serious mental illness, but were not significantly correlated in families with nondistressed parents. Study limitations, future directions for research, and implications for clinical practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Who suffers more? Sex differences in health risks of the widowed.

Explores whether differences in health risks after conjugal bereavement vary systematically with the sex of the widowed spouse. A review of the literature shows that differences in the effects of loss are substantial. Whereas some people recover from grief on the death of a partner relatively unscathed, for others bereavement is associated with extremely debilitating mental and physical effects that may persist for years. Opinions differ greatly on the relation of these effects to sex. The empirical evidence reviewed covers investigations of all major manifestations of normal and pathological grief: psychological distress and depression, mental illness, physical illness, mortality, and suicide. Evidence from both cross-sectional and longitudinal studies is considered. Although few studies are really strong, there is a convergence of evidence from both types of investigations across all areas reviewed: If there is a sex difference in conjugal bereavement reactions, it is the men who suffer more. Interpretations of these findings in terms of selectivity, stress theory, role theory, and interpersonal protection theory are discussed. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A process model for assessing adolescent risk for suicide

As the incidence of adolescent suicide within our society continues to rise, it becomes increasingly important for the mental health professional to be able to accurately assess suicide risk in adolescents who seek help. This process model discusses primary risk factors (previous attempt, affective disorders, and hopelessness), secondary risk factors (substance abuse and personality or behavioral disorders), situational risk factors (family functioning, suicide exposure, social support, life stressors, and homosexuality), and their combined implications and significance in determining an adolescent's level or risk for suicide. Use of both empirical data and clinical intuition are integrated to form a working client model that is continuously reassessed in four stages, guiding the mental health professional through a comprehensive assessment process.     

Beliefs about mental illness as a functon of psychiatric status and psychiatric hospitalization.

Beliefs about mental illness were assessed among psychiatric inpatients at a VA hospital, the mental health staff responsible for their treatment, and a group of medical and surgical (control) patients. Results indicated that: (a) Psychiatric and nonpsychiatric patients generally hold similar opinions regarding mental illness. Severely disturbed psychiatric patients, however, view mental illness in more moralistic terms than do "normals." (b) Psychiatric hospitalization is generally accompanied by a change in the patient's beliefs concerning mental illness, toward those held by the staff. (c) Psychiatric patients whose beliefs about mental illness are most strikingly influenced by the staff tend to respond most favorably to treatment, as measured by length of hospital stay and gains in self-esteem during the 1st month of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality of life: A review of theory and practice implications for individuals with long-term mental illness.

Reviews quality of life (QOL) models and findings applied to individuals with long-term mental illness as an illustration of approaches to QOL methodologies and models. Gap-discrepancy theories are discussed, and life satisfaction and adaptive functioning models of QOL and measurement instruments related to these models are described. QOL represents a viable means of investigating the subjective well-being of individuals with chronic mental illness. Despite psychiatric symptomatology, measuring QOL or subjective well-being represents a viable means of measuring client change or program outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in the pattern of drug overdoses

OBJECTIVE: To describe changes in the pattern of patients with drug overdoses hospitalized over the past two decades. DESIGN: Retrospective data review. SETTING: A 719-bed university-affiliated hospital. PATIENTS: All adults admitted to the hospital with drug overdoses in 1968, 1979, and 1989. PRIMARY OUTCOME MEASURES: Changes in demographics, drugs used, and discharge disposition. RESULTS: A majority of patients admitted with drug overdoses have had previous suicide attempts; and while women predominate, they make up a decreasing proportion of admissions over time (76% in 1968 to 52% in 1989 (p = 0.003). Benzodiazepines were the drugs most commonly used in 1979 and 1989, and cocaine has shown a marked increase in use over time, while barbiturate overdoses have progressively decreased. The use of two or more drugs is common and has been consistent over time, as has been the concomitant use of alcohol. The mortality rate has remained low at 1%, but mean length of stay has decreased dramatically from 6.6 days in 1979 to 3.2 days in 1989 (p < 0.001) and discharge disposition has shifted from out-patient to inpatient psychiatric care. CONCLUSIONS: The majority of patients admitted to a general acute care hospital following a drug overdose have a history of previous suicide attempts and are followed by a mental health professional. The changing pattern of drugs used over two decades reflects trends in drugs used in the community in general and by patients with mental illness in particular. Discharge disposition has changed over time and is related to patients' insurance status.     

Review of Pure Types are Rare.

Reviews the book, Pure Types Are Rare by Irwin Silverman. This is a provocative book. In it, Silverman, with ambitious abandon, sets out to denude the "medical model of mental illness" of its Emperor's Clothing. Unceremoniously, Silverman strips away the clothing of the medical model: psychiatric diagnoses are unreliable and invalid, labels are applied at the whim of the psychodiagnostician; mental illness bears no resemblance to physical disease, mental "illness" is a myth; biological causes of mental illness do not exist; biological treatments serve only to mask the real social and psychological causes of madness; psychotherapy is no treatment at all, there are no "treatment" principles or methods. What remains after Silverman's assault on the medical model? The medical model as Emperor remains, albeit naked. Silverman views the medical model and the entire mental health enterprise as an Emperor indeed: it is a political ideology that serves to control the socially and economically impoverished. Silverman goes on to offer an alternative to the medical model, a social psychological perspective on madness. He favours a view of madness as a social role which may be adopted by a person in the process of coping with life conflict. Silverman attacks practically all of the important assumptions and practices of psychiatry and clinical psychology. His radical social perspective on mental illness is at such odds with the common psychological perspective that, obviously, most psychologists, be they practitioners or researchers, will not like this book. Silverman insists on too radical a departure from our common beliefs. Despite the reviewer's disagreement with Silverman's radical social perspective on mental illness, he thinks that this is a worthwhile book. While the reviewer disagrees with his premise that clinical practices are exclusively or primarily political in essence, the reviewer does agree that there are essential social and political functions served by our practices. Silverman relentlessly and effectively uncovers important social and political meanings of diagnostic and treatment practices. This, according to the reviewer, is the strength of the book. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Help-seeking tendencies in Asian Americans with suicidal ideation and attempts.

Among rising concerns surrounding heightened suicide in certain subgroups of Asian Americans, it is important to understand the help-seeking rates and pathways among Asian Americans experiencing suicidality. This study examined perceived need for care, help-seeking behavior, and chosen sources of care among Asian Americans compared with Latinos in the National Latino and Asian American Study who reported a history of lifetime suicidal ideation, suicide attempts, or mental disorders without history of suicide. Consistent with existing literature in Caucasians, suicide attempts in Asian Americans and Latinos were related to greater help seeking and perceived need beyond that of mental disorders only. However, Asian Americans with suicide attempts still reported lower perceived need and help-seeking behaviors compared with Latinos. In contrast to both the existing literature and Latinos in this study, Asian Americans with suicidal ideation were no more likely to perceive a need for help or seek help than Asian Americans with a mental disorder without history of suicide and were less likely to seek and perceive a need for help than Latinos with suicidal ideation. These findings point to the idea that Asian Americans who have serious suicidal ideation or attempts may underestimate the importance of their condition and do not receive the level of attention and support needed. Findings also show that Asian Americans with suicidal ideation and attempts prefer seeking help from nonprofessional rather than professional sources of help, other than medical professionals. Clinical implications for outreach, assessment, and management of suicide are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Suicide among gifted women: A prospective study.

The longitudinal data from the Terman Genetic Studies of Genius (L. M. Terman, 1925; Terman and M. Oden, 1947, 1959) were used to predict suicide in 40 women: 8 suicides, 15 Ss who were matched with the suicides on age of death, and 17 Ss who were still living in 1964. The Terman studies covered 60 yrs and followed 1,528 gifted individuals (IQs over 135) from childhood into the retirement years. Seven variables from the Ss' files were assessed as possible predictors of suicide: S's physical health, early loss of the father, stress in the family of origin, problems with alcohol, and 3 indices of mental health ("signatures" [e.g., suicide attempts, alcohol abuse, depression]; self-reports of temperament; and a cumulative mental health rating developed by Terman). A discriminant function analysis was able to differentiate the women who committed suicide from the 2 control groups. A 7-variable function predicted 100% of the suicides. A 4-variable function predicted 75% of the suicides. It is concluded that suicide risk factors can be identified in women and that certain signatures of suicide are as useful in predicting female suicide as male suicide. (49 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)