University dissertation from Dept of Clincial Sciences, Psychiatry

Abstract: In order to increase the understanding of suicidal behaviour, the general aim of the thesis is to gain a profound knowledge of the suicidal individual, and hence to find and ensure a preventive strategy. This will be accomplished by finding and trying new methods for evaluation of suicide risk. The Suicide Assessments Scale, SUAS, and a new self-rating version, SUAS-S were tested. These scales are sensitive to change of suicidality over time, and both of them seem to be valid and reliable suicide rating scales, which might aid the clinician in the assessment of suicide risk. A time-geographic life charting was invented and tested. This model promotes systematic descriptions of the patient’s life events (social and burdensome) over time, and geographical sites are used as anchors for autobiographical memories. A so called lifeline follows each individual and provides information on the person’s social capacity, as well as information on predisposing, stressful or precipitating life events. Vulnerability for adverse life events by measuring biological stress markers among suicide attempters was tested. High catecholaminergic markers in CSF (MHPG) and urine (NA/A) were found in suicide attempters, who had been sexually abused in childhood, and we found low urine-cortisol in suicide attempters who felt neglected by parents during childhood and adolescence. A variety of factors have been identified as being risk factors for suicidal behaviour, and one of them is the handling of stressful events (coping). The coping-strategies used by suicide attempters and comparison groups were investigated. Suicide attempters at long term follow up and healthy controls used more adaptive problem solving strategies than patients, who had recently made a suicide attempt, or psychiatric controls, who both used more maladaptive coping strategies. A person’s suicidal intent is often difficult to understand, so therefore an investigation of a time geographic life charting, in combination with a survey of coping capacities during life, and degree of suicidality (SUAS-S) by the time of a suicide attempt, was made. The combination of these methods offered a firm and comprehensive picture of the patient’s life situation, which in our opinion, facilitates an assessment of suicidal intent. By using multidisciplinary methods, ranging from biological investigations to psychosocial as well as environmental approaches, we suggest three typical pathways to a suicide attempt, the first where the involved persons mainly use adaptive coping and rate low scores on the SUAS-S, the second where both maladaptive and adaptive coping are used, and where the SUAS-S scores are on a moderate level, and third where maladaptive coping is the common way of handling stressful events, and where SUAS-S scores are high.

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