Suicide prevention in military organizations

Summary

Alzheimer's disease (AD) is a heterogeneous neurodegenerative disorder characterized pathologically by amyloid-beta plaques, neurofibrillary tangles and neuronal loss. Its fundamental cause(s) and the pathological cascades leading to clinical symptoms remain unknown. Lipids and lipid peroxidation products have important roles in the homeostasis of the central nervous system. As well, lipid transport genes and vascular changes associated with peripheral dyslipidemia have been associated with an increased risk of AD. The present review discusses ways in which lipids may be involved in the pathogenesis of AD-associated neurodegeneration through their roles as neuronal structural components, cell modulators, or second messengers. Given the many possibilities through which lipids may be directly involved in or contribute to the pathogenesis of AD, the use of lipids as biomarkers for disease progression is discussed, as are other avenues for future research.     

Suicide in children and the prevention]

There have been studied on suicide in children and adolescents in Western countries, literature review was carried out for the forth coming needs of protective intervention for suicidal children in Japan. Suicide is very rare in children with gradual increase towards adolescents. Suicide in children has association with family history, psychiatric disorders of both children and parents, especially depression and addictive disorders, cognitive and emotional disturbance in children, demographic characteristics, family discord, family psychopathology and child abuse, accessibility of lethal suicide methods. Identification of risk factors as foci for intervention is important for suicide prevention. Although there are some programs for prevention, their theoretical bases have been hardly presented and their efficacy are not acceptable. Future evaluative research is essential, and at moment, network of medical, educational and child welfare professionals is important to support children and family at risk where there is much to do with psychiatry to take role.     

Suicide risk and prevention in bipolar disorder

Bipolar disorders are prevalent and severe illnesses that are associated with a high risk of suicide. Patients with bipolar disorder who have had prior suicide attempts are at a substantially higher risk for future suicidality, even after controlling for other risk factors. Despite the magnitude of this problem, there is a paucity of controlled prospective data to guide clinical care, most likely due to the difficulties inherent in such studies. The most robust literature supports the use of lithium as a suicide-protective agent in bipolar disorder, but a definitive controlled study in a generalizable population is warranted. As in other areas of psychiatry, a careful assessment of the individual patient risk is of paramount importance.     

Suicide prevention in Japan in contrast to overseas

In 1996, the United Nations (UN) and the World Health Organization (WHO) published guidelines for developing suicide prevention measures at national level. In Japan, the Basic Act on Suicide Prevention was promulgated in June 2006 and a Comprehensive Suicide Measures Framework was formulated in June 2007, which announced that suicide prevention is an official concern and that entire societies should be engaged in such suicide prevention efforts. One of the fundamental principles moving forward is to place emphasis on coordination between medical and community models of care. The medical model is based on the notion that mental disorders that could lead to suicide should be diagnosed at earlier stages and addressed through appropriate psychiatric treatment. The community model, which concerns awareness activities that emphasize earlier detection and attentive social support, is also important. Implementing policies with a long-term perspective that maintain close linkages between these models is a critical strategy for suicide prevention. This presentation investigates the current conditions and issues around Japanese suicide prevention with reference to the UN/WHO guidelines for suicide prevention, and compares the situation to that in other countries.     

Suicide note themes and suicide prevention

OBJECTIVE: The aim was to determine if suicide note themes might inform suicide prevention strategies. METHOD: The themes of 42 suicide notes from the Northern Ireland Suicide Study (major psychological autopsy study) were examined. RESULTS: The commonest themes were "apology/shame" (74%), "love for those left behind" (60%), "life too much to bear" (48%), "instructions regarding practical affairs post-mortem" (36%), "hopelessness/nothing to live for" (21%) and "advice for those left behind" (21%). Notes of suicides with major unipolar depression were more likely than notes of suicides without major unipolar depression to contain the themes "instructions regarding practical affairs post-mortem" (67% versus 19%, p = 0.005) and "hopelessness/nothing to live for" (40% versus 11%, p = 0.049). Notes of suicides with a previous history of deliberate self-harm were less likely than notes of suicides without a history of deliberate self-harm to contain the theme "apology/shame" (58% versus 87%, p = 0.04). Notes of elderly suicides were more likely than non-elderly notes to contain the theme "burden to others" (40% versus 3%, p = 0.03). CONCLUSIONS: The fact that three quarters of suicide notes contained the theme "apology/shame" suggests that the deceased may have welcomed alternative solutions for their predicaments. Scrutiny of suicide note themes in the light of previous research findings suggests that cognitive therapy techniques, especially problem solving, may have an important role to play in suicide prevention and that potential major unipolar depressive (possibly less impulsive) suicides, in particular, may provide fertile ground for therapeutic intervention (physical and psychological). Ideally all primary care doctors and mental health professionals working with (potentially) suicidal people should be familiar with basic cognitive therapy techniques, especially problem solving skills training.     

Suicide in classical mythology: cues for prevention

OBJECTIVE: To compare well established antecedents and correlates of completed suicide with the motives and the mechanics reported in Greek mythology. METHOD: A well-known collection of Greek myths, the Book of fables by Hyginus, was explored to investigate the mechanics driving an individual to imagine, design and carry out a suicide attempt. RESULTS: Females outnumber males in the mythographer's list, their favourite methods to die being drowning, hanging, self-burning and throwing themselves down from on high. Some kind of familial recurrence of suicide was accounted for, and a large percentage of these suicides was connected to incest. Shame, sense of guilt and grief for the death of a loved one are the most frequently reported psychological correlates of the act, whereas defeat, failure or a catastrophic change in living conditions and, among females, an unfortunate love affair figure as the main antecedents of suicide. CONCLUSION: Negative life events and emotional reactions to the severing of social ties frequently occur as antecedents of suicide in Greek mythology.     

Suicide prevention: a public health approach

This article proposes a model for developing a national or regional suicide prevention strategy. Suicide is examined from the perspectives of stress, coping behaviours, lethality and multiple causation. Public health concepts of primary, secondary and tertiary prevention are applied to suicide with minor modifications. This exercise facilitates clarity with respect to planning strategies. Conceptual clarity may improve prospects for success but ultimately evaluation will elucidate the outcome.     

Suicide,suicidality and suicide prevention in affective disorders

OBJECTIVE: It is well known that functional psychiatric disorders are one of the main causes of suicidal behaviour. This paper discusses the epidemiology and risk factors of suicidal behaviour in affective disorders and goes on to describe the treatment and prevention of such suicidal behaviour. METHOD: A narrative overview of relevant epidemiological and drug studies. RESULTS: About 60-70% of patients with acute depression experience suicidal ideas. There is a high incidence of suicide (10-15%) in depressive patients. Psychopharmacological treatment with antidepressants and/or mood stabilizers is the most successful approach to avoid the risk of suicidal behaviour. In addition, psychotherapeutic and psychosocial interventions are of importance. CONCLUSION: Suicidal behaviour and suicide must be considered when treating patients with affective disorders. The complex causation of suicidality has to be borne in mind when considering methods of suicide prevention. In order to obtain the best results, psychosocial, psychotherapeutic and psychopharmacological approaches should be combined, depending on the risk factors of each individual patient.     

Suicide and its prevention among older adults.

OBJECTIVE: To review the research on the epidemiology, risk and resiliency, assessment, treatment, and prevention of late-life suicide. METHOD: I reviewed mortality statistics. I searched MEDLINE and PsycINFO databases for research on suicide risk and resiliency and for randomized controlled trials with suicidal outcomes. I also reviewed mental health outreach and suicide prevention initiatives. RESULTS: Approximately 12/100,000 individuals aged 65 years or over die by suicide in Canada annually. Suicide is most prevalent among older white men; risk is associated with suicidal ideation or behaviour, mental illness, personality vulnerability, medical illness, losses and poor social supports, functional impairment, and low resiliency. Novel measures to assess late-life suicide features are under development. Few randomized treatment trials exist with at-risk older adults. CONCLUSIONS: Research is needed on risk and resiliency and clinical assessment and interventions for at-risk older adults. Collaborative outreach strategies might aid suicide prevention.