Pompili / Tatarelli Evidence-Based Practice in Suicidology
1. Auflage 2010
ISBN: 978-1-61676-383-1
Verlag: Hogrefe Publishing
Format: PDF
Kopierschutz: 1 - PDF Watermark
A Source Book
E-Book, Englisch, 388 Seiten
ISBN: 978-1-61676-383-1
Verlag: Hogrefe Publishing
Format: PDF
Kopierschutz: 1 - PDF Watermark
An innovative and long overdue book by the world’s leading researchers and practitioners, describing what really works in suicide prevention, the evidence for particular approaches, where the gaps are in our knowledge, and how we can fill them.
Suicide rates have increased by 60% worldwide in the past 45 years, with deaths by suicide projected to reach 1.5 million by the year 2020. Despite millions being spent on suicide prevention activities, little is known about their effectiveness: As the US Suicide Prevention Action Network (SPAN) reported, “The single greatest obstacle to the effective prevention of suicide is the lack of evaluation research.”
Evidence-based medicine involves the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients – which means integrating individual clinical expertise with the best available external clinical evidence from systematic research.
This substantive and authoritative volume shows for the first time how evidence-based approaches can be used in suicide prevention – as well as where evidence is lacking and how we might obtain it. Leading researchers and practitioners describe what really works in suicide prevention, the evidence for and against particular approaches, both in general terms (such as by means of hotlines, restriction of means, psychopharmocology) and for specific disorders (such as schizophrenia, personality disorder), and make specific recommendations about where we go from here.
Autoren/Hrsg.
Fachgebiete
Weitere Infos & Material
1;Table of Contents;6
2;Foreword;8
3;The Framework;10
3.1;Evidence-Based Practice in Suicidology: What We Need and What We Need to Know;12
3.2;Evidence-Based Medicine in Mental Health: General Principles;36
3.3;Improving Suicide Risk Assessment With Evidence-Based Psychiatry;54
3.4;The World Health Organization: Approach to Evidence-Based Suicide Prevention;64
4;Evidence-Based Strategies for Suicide Prevention;74
4.1;Evidence-Based Suicide Prevention Strategies: An Overview;76
4.2;Evidence-Based Psychotherapy With Suicidal People: A Systematic Review;98
4.3;Evidence-Based Psychosocial Interventions for Suicidal Behavior: What Is the Evidence?;134
4.4;Evidence-Based Suicide Prevention by Helplines: A Meta-Analysis;148
4.5;Suicide Prevention Programs Through Education in the Community and in the Frame of Healthcare;162
4.6;Evidence-Based Interventions for Preventing Suicide in Youths;180
4.7;Suicide Prevention in Late Life: Is There Sound Evidence for Practice?;220
4.8;Evidence-Based Suicide Prevention by Lethal Methods Restriction;242
4.9;Psychopharmacology for Suicide Prevention;252
5;Evidence-Based Approaches for Specific Disorders and Behaviors;274
5.1;Risk Is Not Static Over the Lifespan: Accurately Accounting for Suicide Prevalence in Major Mental Illness;276
5.2;Evidence-Based Approaches for Reducing Suicide Risk in Major Affective Disorders;284
5.3;Evidence-Based Treatment for Reducing Suicide Risk in Schizophrenia;326
5.4;Evidence-Based Approach to Suicide Risk in First-Episode Psychosis;338
5.5;Reducing Suicide Risk in Personality Disorders: The State of Current Evidence;348
6;Where Do We Go From Here?;358
6.1;Perspectives in Suicide Research and Prevention: A Commentary;360
6.2;Where Is More Evidence Needed? Research Priorities in Suicidology;368
7;Index;380
Choron (1972) cites Gaupp’s work (1910) as the milestone for understanding suicide from the biopsychological point of view; that is, there are forces that do not rise to the consciousness of individuals and thus cannot constitute motives, and forces that are related to race, age, sex, work, and social status. This perspective has been challenged by psychiatry that relates individuals who die by suicide to abnormal mental states. Ringel (1953) considered suicide as ‘‘the conclusion of a pathological psychic development.’’ Weisman (1971) wondered whether suicide was a disease and proposed that ‘‘Suicide is neither a moral dilemma nor a mental disease but a form of life-threatening behavior resembling a declaration of war of a petition for bankruptcy.’’ There is ‘‘suicidal sickness,’’ but no evidence of an organic ‘‘disease’’ to explain it. However, the concept of ‘‘disease’’ is a cultural abstraction that excludes other dimensions of sickness, such as conflict and crisis. Esquirol (1838) said that suicide was a symptom of insanity and, therefore, those who commit suicide are psychiatrically disturbed. Esquirol developed the perspective that suicide is a psychiatric problem and wrote:
All that I have said up to now, the facts which I have reported, proves that suicide presents all the characteristics of insanity of which it is but a symptom; that there is no point for a unique source of suicide, since one observes it in the most contradictory circumstances, and because it is symptomatic or secondary, be it in acute delirium, or chronic, besides, the autopsy of suicides made so far did not throw much light on the subject of pathological changes (p. 639).
Considering suicide risk as a symptom impairs the opportunity to fully investigate and understand this aspect. If a patient has fever or headache, and if this ailment were thought to be part of pneumonia or cancer, clinicians would treat the disease as a whole rather than each symptom separately.
This phenomenological approach promises to aid our understanding of suicide, helping us understand rather than explain the behavior. Jaspers’ (1959) assumption that we can explain a phenomena without understanding it at all is of particular interest here. Jaspers separated the study of subjective phenomena as experienced by the patients from the study of other psychological data. He introduced the difference between explanation and understanding and focused on the latter. Jaspers distinguished two types of psychiatric entities: developments that we can come to understand and processes that can be explained, even though they are not understandable. For instance, reactive depression is understood insofar as we can put ourselves in the place of the sufferer; most often, this is also true for suicidal behavior. On the other hand, we owe our emphasis to Kraepelin (1921) on documenting the longitudinal course of psychiatric disorders. As for suicide, he stated that: ‘‘The patients, therefore, often try to starve themselves, to hang themselves, to cut their arteries, they beg that they may be burned, buried alive, driven out into the woods and there allowed to die’’; however, he did not emphasize on what was happening in their tormented mind, a feature often neglected when only DSM-Kraepelinian diagnostic criteria are taken into account.
The lack of association between suicide and psychiatric disorders has been dealt with in various studies (e.g., De Leo, 2004), and scholars have come to believe that alternative solutions must be found because the vast majority of depressed, schizophrenic, alcoholic, or organically psychotic patients do not commit or even attempt suicide (Leenaars, 2004; Lester, 1987, 1989). Hopelessness as a psychological construct has been reported to be a more important mediator of suicide risk than depression. Studies involving the Beck Hopelessness Scale (Beck, Weissman, Lester, & Trexler, 1974) found that the extent of negative attitudes about the future (pessimism) was a better predictor of suicidal intent than depression (Beck & Steer, 1988). This indicates that it is not necessarily important how you feel right now, for example, being depressed, but it is important to trust whether the future would bring changes in your condition. This is particularly true for suicidal individuals experiencing the uniqueness of their suffering that, for them, has no escape and no future solution. It was suggested that:
The interest in classifying populations of suicidal patients by their psychiatric diagnoses is being supplemented by an interest in understanding what makes a minority of patients within any given diagnostic category suicidal while the majority are not suicidal (Hendin, 1986).
These observations are reinforced by the response of patients to psychiatric treatment. For instance, Ahrens and Mu ¨ller-Oerlinghausen (2001) investigated a group of high-risk patients with recurrent affective disorders (n = 167) who had made one or more suicide attempts before the start of lithium prophylaxis within a collaborative project. According to their recurrence-related response to long-term lithium prophylaxis, patients were classified into three groups: excellent (n = 45), moderate (n = 81), and poor responders (n = 41). Only depressive episodes leading to hospitalization were considered. With regard to suicidal behavior in this select group of high-risk patients, there was a significant decrease in the rate of suicide attempts as compared to the prelithium figures. This was the case not only in those patients with excellent treatment outcome, but also in those patients with moderate or even poor response to lithium prophylaxis, suggesting an effect on the suicidal dimension independent of the effect on psychiatric symptoms.
A similar finding emerges from a study by Prudic and Sackeim (1999) using electroconvulsive therapy (ECT). They found that ECT responders and nonresponders showed a large decrease in scores on the suicide item of the Hamilton Rating Scale for Depression, and this decrease was greater than the average improvement on other items.
Moreover, recent studies on the role of antidepressants in reducing suicide risk have failed to provide strong evidence with regard to their possible role in increasing or decreasing suicide risk. Pooling trials of antidepressants (including both tricyclics and SSRI versus placebo) might have yielded a nonsignificant result that was not in favor of one or the other (Baldessarini et al., 2006; Baldessarini, Pompili, & Tondo, 2006).
A psychological autopsy helps clarify an equivocal death by interviewing people who knew the deceased individual (spouse, grown-up children, neighbors, employers, or physicians) and by analyzing his or her clinical records. The psychological autopsy focuses on what is usually the missing element: The intention of the deceased in relation to his or her own death
• Time interval between death and interviews
• Interviewers
• Biases related to informants
• Control groups.
The current emphasis on psychiatric disorders in published research needs to be balanced by a better study of the socioenvironmental contributors to suicide, particularly by focusing attention on conceiving and adopting standardized instruments and/or structured interviews that may favor the appropriate weighting of these variables. Efforts in this direction will promote a truly ecological approach for understanding suicide and will assist in the development of better preventive strategies (Pouliot & De Leo, 2006).
