Danuta Wasserman

Background. Much of the interest in hopelessness stems from the key role it plays in the prediction of suicidal behaviour. To measure hopelessness, Beck et al.(1974)developed a 20-item scale (BHS), applied exploratory factor analysis and argued that the scale measures three specific components (affective, motivational and cognitive). Subsequent exploratory factor analyses identified two, three or more factors underlying the scale.Method. Several confirmatory factor analyses (LISREL) were run on data on 324 suicide attempters in Sweden in order to test the hypothesized factorial structures and to investigate the psychometric properties of the individual items.Results. Neither three- nor two-factor models fitted the data. A simpler structure was sufficient to account for the observed correlations between most of the items. This led to the development of several variants of a one-factor model, each a combination of affective, motivational and cognitive items. The number of items varied...

Many countries are developing suicide prevention strategies for which up-to-date, high-quality evidence is required. We present updated evidence for the effectiveness of suicide prevention interventions since 2005. We searched PubMed and the Cochrane Library using multiple terms related to suicide prevention for studies published between Jan 1, 2005, and Dec 31, 2014. We assessed seven interventions: public and physician education, media strategies, screening, restricting access to suicide means, treatments, and internet or hotline support. Data were extracted on primary outcomes of interest, namely suicidal behaviour (suicide, attempt, or ideation), and intermediate or secondary outcomes (treatment-seeking, identification of at-risk individuals, antidepressant prescription or use rates, or referrals). 18 suicide prevention experts from 13 European countries reviewed all articles and rated the strength of evidence using the Oxford criteria. Because the heterogeneity of populations and methodology did not permit formal meta-analysis, we present a narrative analysis. We identified 1797 studies, including 23 systematic reviews, 12 meta-analyses, 40 randomised controlled trials (RCTs), 67 cohort trials, and 22 ecological or population-based investigations. Evidence for restricting access to lethal means in prevention of suicide has strengthened since 2005, especially with regard to control of analgesics (overall decrease of 43% since 2005) and hot-spots for suicide by jumping (reduction of 86% since 2005, 79% to 91%). School-based awareness programmes have been shown to reduce suicide attempts (odds ratio [OR] 0·45, 95% CI 0·24-0·85; p=0·014) and suicidal ideation (0·5, 0·27-0·92; p=0·025). The anti-suicidal effects of clozapine and lithium have been substantiated, but might be less specific than previously thought. Effective pharmacological and psychological treatments of depression are important in prevention. Insufficient evidence exists to assess the possible benefits for suicide prevention of screening in primary care, in general public education and media guidelines. Other approaches that need further investigation include gatekeeper training, education of physicians, and internet and helpline support. The paucity of RCTs is a major limitation in the evaluation of preventive interventions. In the quest for effective suicide prevention initiatives, no single strategy clearly stands above the others. Combinations of evidence-based strategies at the individual level and the population level should be assessed with robust research designs. The Expert Platform on Mental Health, Focus on Depression, and the European College of Neuropsychopharmacology.

Little information is available on the prevalence of depression in Uganda. Given the recent political history of Uganda, depression may be common. The aim was to estimate the point prevalence of probable clinical depressive disorder among the general population in two contrasting districts of Uganda. Translated versions (in Madi and Lusoga) of the 13-item Beck Depression Inventory (BDI) were administered to a systematic sample of adult residents in the Adjumani and Bugiri districts of Uganda. The overall prevalence of probably clinically significant depression (BDI score of 20-39) was 17.4%. Significantly higher rates were found in women and in Adjumani District. Depression is common in Uganda and particularly in the more troubled and less socially cohesive district of Adjumani.

There is little information on the current mental health of University students in Uganda. The present study was carried out to determine the prevalence of depressed mood and suicidal ideation among students at Makerere University. Two student samples participated. Sample I comprised 253 fresh students admitted to all faculties at the University in the academic year 2000/2001, selected by a simple random sampling procedure. Sample II comprised 101 students admitted to the Faculty of Medicine during the academic year 2002/2003. The prevalence of depressed mood was measured using the 13-item Beck Depression Inventory (BDI). The prevalence of depressed mood (BDI score 10 or more) was significantly higher in sample I (16.2%) than sample II (4.0%). Sample I members were significantly more likely than those of sample II to report lifetime and past week suicide ideation. Thus, there is a high prevalence of mental health problems among the general population of new students entering Makerer...

One of the aims of the inter-European study on parasuicide, which was initiated by WHO/Euro in the mid-1980s, was to try and identify social and personal characteristics predictive of future suicidal behavior. A follow-up interview study (the Repetition-Prediction Study) was designed, and so far 1145 interviews have been carried out at nine research centers, representing seven European countries. The study and the instrument used (the European Parasuicide Study Interview Schedules, EPSIS I and II) are described here. Some basic characteristics of the material from the various centers are presented and compared, and the representativeness of the samples are discussed. There were differences between the centers in several respects. Results from analyses based on pooled data have to be treated with some caution because of the possible lack of representativeness.

The WHO/EURO multicentre study on parasuicide is a new, coordinated, multinational, European study that covers two broad areas of research: monitoring trends in the epidemiology of parasuicide (epidemiological monitoring study); and follow-up investigations of parasuicide ...

Background and aim: The Nordic countries provide a suitable setting for comparing trends in suicide mortality. The aim of this report is to compare suicide trends by age, gender, region and methods in Denmark, Finland, Iceland, Norway and Sweden 1980 – 2009.
Methods: Suicide statistics 1980 – 2009 were analyzed for men and women aged 15 years and above and the age group 15 – 24 years. Regional suicide rates in 2009 were presented in maps.
Results: The suicide rates across the Nordic countries declined from 25 – 50 per 100,000 in 1980 to 20 – 36 in 2009 for men and from 9 – 26 in 1980 to 8 – 11 in 2009 for women. The rates in Finland were consistently higher than those of the other countries. A significant increase of suicides in young women in Finland and Norway and a lack of a decline among young women in Sweden were noted. The male – female ratio of suicide converged to approximately 3:1 across the region during the study period. Rural areas in Finland, Norway and Sweden saw the highest suicide rates, whereas the rates in the capital regions of Denmark, Norway and Sweden were lower than the respective national rates. Conclusions: We hold that the overall decline of suicide rates in the Nordic countries reflects the socio-economic development and stability of the region, including the well-functioning healthcare. The increasing rates in Finland and Norway and the unchanged rate in Sweden of suicide in young women are an alarming trend break that calls for continued monitoring.

The aim of this study was to investigate patterns of contact made with GPs by subjects in two cities prior to attempting suicide, in order to determine whether differences in the health care systems could be a possible factor influencing the help-seeking behaviour of people experiencing suicidal crises. Structured interviews were conducted with suicide attempters from geographically defined catchment areas in two countries with private and national health care systems, respectively. The subjects were suicide attempters, admitted consecutively, aged > or = 15 years and living either in Stockholm (n=202) or in Bern (n=66). Patients living in Bern had seen their GPs more regularly and more frequently throughout the year. There was an increase in the number of visits to the GP prior to the suicide attempt in both cities, but it was greater in Stockholm than in Bern. However, in Stockholm fewer patients who saw their GP in the week before the attempt talked about their suicidal thoughts. The differences in help-seeking behaviour between the two patient samples may be related to the higher number of practising GPs and a more personal and consistent patient-doctor relationship in Bern. It is possible that the private medical care system in Switzerland lowers the threshold enabling patients to talk to their GP about their suicidal plans. The results suggest that in both cities there is scope for improving communication of the suicidal patient with his or her doctor.

As part of a WHO project on parasuicide, the medications used for self-poisoning in the Stockholm area were studied. The prescribing rates of the medications were estimated from an independent survey of prescriptions. Anxiolytics, hypnotics, and analgesics were the drugs most commonly used for parasuicide. Related to prescribing rates, antipsychotics and anxiolytics represented an increased risk for parasuicide compared to the average for psychotropics. Analgesics, on the other hand, showed a lower risk for parasuicide. The low number of self-poisonings with antidepressants may reflect that suicidal individuals are seldom prescribed antidepressants and/or that antidepressants actually prevent suicidal acts. As we have shown earlier for completed suicides, underprescribing and therapeutic failure seem to be greater problems with antidepressants than their use for self-poisoning.

Background The Awareness program was designed as a part of the EU-funded Saving and Empowering Young Lives in Europe (SEYLE) intervention study to promote mental health of adolescents in 11 European countries by helping them to develop problem-solving skills and encouraging them to self-recognize the need for help as well as how to help peers in need.