MQ82941 Sample for Project Paper 2015_New1

8/19/2019 MQ82941 Sample for Project Paper 2015_New1

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Result

The results will be presented in the following manner. First, the

demographic characteristics of the participants will be reported, followed by a

summary of the ideoaffective variables reported as occurring within the half hour

prior to the most recent attempt. Second, the descriptive statistics including

means, standard deviations, and intercorrelations between all of the variables

used in the study will be presented. The mean ratings of lethality of the

methods chosen and the time involved for the method to result in death,

provided by both the clinicians and the patients, will be reported. In

addition, the frequency and percent distribution of responses given for items

on the Suicide Intent Scale and the Self-Rated Scale for Suicide Ideation,

and the frequency and percent distribution of the total scores on the

opelessness Scale will be reported. Finally, the results of the predicted

relationships will follow! "# clinician ratings of lethality $i.e., medical lethality

and the %ethality of Suicide

&ttempt Rating# and the intent of the attempters, '# patient ratings oflethality

$i.e., perceived lethality# and their reported sub(ective intent, )# clinician

ratings of lethality $i.e., medical lethality and the %ethality of Suicide &ttempt

Rating# and patient ratings of lethality $i.e., perceived lethality#, *# clinician and

patient evaluations of the time involved for the chosen methods to produce

death $i.e., medical time and perceived time, +# patient reports of suicidal

ideation and suicidal intent, # hopelessness and suicidal intent.


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I. Demographic Characteristics

i) Characteristics of the Sample

Table 1 presents the demographic characteristics of the sample.

A total of23 patients participated in the study, 1 females and ! males. The ages of

the participants ranged from 1! to "" years of age, #ith a mean age of 3! years. Se$enty

percent of the sample #ere single, and not more than 22% #ere regularly employed. The

ma&ority of participants, "2%, had at least one year of post'secondary education. (one of the

participants reported abuse of illicit drugs, and only one participant reported a history of

alcohol abuse.

Previous Psychiatric Diagnoses (DSM-IV)

n terms of lifetime pre$alence ofpsychiatric disorder, 3% of the sample had been

diagnosed #ith depression, 1*% #ith bipolar disorder, and 13% #ith borderline personality

disorder. (ine percent of the sample had a diagnosis of dissociati$e disorder, !% of

schi+ophrenia, !% of other psychosis, and !% of obsessi$e compulsi$e disorder

-

Family History of Psychiatric Disorders & Suicide

Disorders of mental health in first or second degree relati$es #ere reported for *%

/ercent total e0ceeds 1% because of comorbid diagnoses.


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Treatment

(inety'si0 percent of the participants had current or pre$ious psychiatric contact.

T#enty't#o percent of the sample reported recei$ing treatment by a general practitioner, and

% by a social agency. (inety'si0 percent of participants had ongoing psychiatric treatment.

All of the participants reported taing antidepressants at some point in their

psychiatric treatment history, #hile 3!% reported ha$ing taen antipsychotics or neuroleptics.

Previous Suicide ttem!ts

Thirteen participants "*%) had made bet#een 2' attempts, and * 3%) had made

up to 1" attempts. Three indi$iduals 13%) reported attempting 1* or more times. A mean

of ." suicide attempts #ere reported for the entire sample, #ith a standard de$iation of .!.

Method "sed in #ecent ttem!t

In terms ofthe method employed in the attempt they #ere inter$ie#ed for, 1* *%)

of the participants reported taing an o$erdose of pills prescription and4or nonprescription).

5f these self'poisoners, 1*%) reported taing pills in addition to employing other methods

such as cutting and4or ingesting other substances e.g., batteries, bleach). Three 13%) ofthe

participants reported &umping or attempting to &ump from $arious heights.


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ii) deoaffecti$e State

6igure 1 presents the fre7uency distribution of the ideoaffecti$e states reported for the

Table 1 . Demographic Characteristics

(823 6re7. % (823 6re7. %

9ender /sychopharm., current

male ! 3!% ben+odia+epines 2 !%

6emaleAge :83!) 1

1% antipsychotics4

neuroleptics * 3%

s3 1*% antidepressants 22 !%

s 3"% /sychopharm., e$er

s" 3"% ben+odia+epines

s;artial Status

3 13% antipsychotics4neuroleptics ! !

single 1 *% antidepressants 23 23

married 2 !% ;ental Disorders,

di$orced 1*% 12 "2% borderline 3

>at least months) dissociati$e disorder 2

5ccupational Status schi+ophrenia 2

regularly employed " 22% other psychosis 2

disability pension " 22% 5CD 2

unemployed 3% >e0ceeds 1% dueto dual diagnoses)

#elfare * 3%

5ngoing Treatment ? of /re$ious SuicideAttemps

psychiatric 22 !% ;8.")

general practitioner " 22% @ 13 "*%


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social agency 11 % @1" * 3%

/sychiatric npatient, @2 2 !%

/re$iously 22 !% 31 1 %

? of times, inpatient;8".1


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t#enty'one !1%) indi$iduals indicated belief in some form of life'after'death e0perience,

such as the soul li$ing on in hea$en 4/aradise or a reincarnation into another life form. This


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suggests that the e0pected e0perience of relief may ha$e been in anticipation of a form of

continued e0istence after the physical suicide. 6ifteen "%) participants indicated that they

thought they #ould be $ery successful in their attempt to suicide a score of " on a "'point

scale), and the remaining indicated that they thought they #ould more than liely be

successful a score of ).


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Figure ".62

6re7uency Distribution of

deoaffecti$e States

upset4agitated

2 " "' "* " " ' ''

Count


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63

B Descripti$e Statistics

) ;eans and Standard De$iations

The means and standard de$iations for all of the $ariables in the study are presented

in Table 2.

Table 2. ;eans and Standard De$iations for the Sample (823)

ariable / .sn

/sychiatrist


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;ean scores indicated a lo# to moderate le$el on the dimension of lethality as rated

by clinicians. Ghen ased Eo# liely #as the method the patient chose to ha$e caused

his4her deathF medical lethality), on a$erage, clinicians indicated that the most recent

attempt #as not liely to ha$e caused death. Similarly, the mean score for the Bethality of

Suicide Attempt


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The mean scores for the measures of suicidal ideation and hopelessness #ere generally

higher than those obtained in other clinical and nonclinical samples. The mean score obtained

on the Eopelessness Scale #as abo$e the cut'off score of !, #hich is predicti$e of e$entual

suicide.

Similarly, the mean score for the measure of suicidal intent #as generally higher than

mean scores obtained in other studies.


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Table 3. 5riginal and Ad&usted ;eans and Standard De$iations for the 5b&ecti$e and

Sub&ecti$e ;easures of Suicide ntent.

5b&ecti$e

Circumstances

; Sl2

Sub&ecti$e

ntent

; Sl2"

df822)

5riginal Scores .3 2. 12."2 1.

Ad&usted Scores ."3 .1 .! . 1.3>

>[email protected]

The results indicated that there #as statistical e$idence that the mean of the a$erage

response to the sub&ecti$e items #as significantly greater than the mean of the a$erage

response to the ob&ecti$e items. n other #ords, significantly more items #ere endorsed on

the Suicide Intent Scale #hich represent the sub&ecti$e intent to suicide, in comparison to the

items #hich in7uired about the circumstances of the act, such as the amount of planning

in$ol$ed and #hether or not o$ert communication about the attempt #as made prior to the

act


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ii) Hi$ariate ntercorrelations Among the ariables

Table presents the intercorrelations among the $ariables in the study.

Table . ntercorrelations bet#een all of the $ariables in the study.

ariable

1. ;edical Bethality

2. Bethality of Attempt


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pro$iding a measure of lethality for methods of suicide according to clinicians. The

preconceptions held by patients regarding the lethality of the methods employed in their

suicide attempts #ere unrelated to the lethality ratings indicated by clinicians. n other #ords,

the measure of percei$ed lethality #as not significantly correlated #ith either of the t#o

clinician rated scales of lethality medical lethality, BSA


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Table ". Clinician and /atient


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o$erestimate the degree of danger to life associated #ith drug ingestion in comparison to

medical estimates. The difference bet#een the mean lethality ratings for &umping and for drug

o$erdoses #ith cutting #ere nonsignificant.

i$) ;ean Time


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. 6re7uency and /ercent Distributions

) Distribution for Suicidal ntent

n assessing the patient rated intent to suicide SS) associated #ith the attempt for

#hich they #ere inter$ie#ed, the follo#ing results #ere obtained.

Si0ty'one percent (81) of the sample reported that although there #as no one

present at the time of the attempt, someone #as #ithin $isual or $ocal contact, #hile 3!%

(8!) indicated that there #as no one nearby or in $isual contact. Gith respect to the timing

of the attempt, "2% (812) reported that inter$ention #as not liely, and 3% (8*)

reported inter$ention #as highly unliely. Si0ty'one percent (81) reported maing no

effort to communicate their intent to suicide, and "% (81") did not lea$e a suicide note.

Almost all ofthe participants !"% (822) reported that the purpose of the attempt #as to

escape or to sol$e their problems, and indicated that they e0pected their attempt to be a fatal

one. All participants 1% (823) reported that they seriously attempted to end their life

and that they truly #anted to die. The ob&ecti$e and sub&ecti$e aspects of intent, and the

fre7uency of their endorsement, are presented in Table *.


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Table *. 5b&ecti$e and Sub&ecti$e Aspects of Suicide ntent at Time of the Attempt ' The

Suicidelntent Scale 6re7uency /ercent

(823 ) 1%)

5b&ecti$e Circumstances items 1')

solation

somebody present .%

somebody nearby 1 .!%

no one nearby ! 3!.1%

Timing

inter$ention #as probable 1*.%

inter$ention not liely 12 "2.2%

inter$ention highly unliely * 3.%

/reLillMtions Against Disco$erN)M

no precautions taen "" *.%

passi$e precautions taen " 21.*%

acti$e precautions taen * 3.%

Acting fLr Eel p Aft r Att mpt

notified potential helper 1 .3%

contacted, but did not notify helper about attempt 2.1%

no contact4no notification 1 !.%

6inal Acts

none 1 3."%

thought about4made some arrangements ' .*%

made defmite arrangements "" *.%

Acti$e /reparation

none 3 13.%

minimal to moderate 13 "."%

e0tensi$e * 3.%


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Suicide (ote

absence of note 1" ".2%

#ritten 0 torn4note thought about 1 .3%

presence of note * 3.%

5$ert Communication

none 1 .!

e7ui$ocal " 21.*%

une7ui$ocal 1*.

6re7uency /ercent

(823) 1%)

%

%

Sub&ecti$e ntent items !'1")

Alleged /urpose

manipulate en$ironment4get attention4re$enge .%

components ofboth " .3%

escape4surcease4sol$e problems 22 !".*%

=0pectations of 6atality

death #as unliely .%death #as possible, not probable " .3%

death #as probable or certain 22 !".*%

Conception of Bethality

did less to self than thought #ould be lethal .%

#asnIt sure if act #ould be lethal 1 .3%

e7ualled4e0ceeded that thought lethal 22 !".*%

Seriousness of Attempt

did not seriously attempt to end life .%

uncertain about seriousness to end life .%seriously attempted to end life 23 1.%

Attitude To#ard Biying4Dying

did not #ant to die .%components of both .%

#anted to die 23 1.%


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;edical


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ii) Distribution for Suicidal deation

The suicidal ideation reported by patients as occurring prior to the attempt for #hich

they #ere inter$ie#ed, and as measured by the Self-#ated Scale for Suicide Ideation SS'

S


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*

6re7uency /ercent

(823) 1%)


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**

6re7uency

(823)

/ercent

1%)

Hecause of family. friends. religion. possible

in&ury from unsuccessful attempt

#ould not ill self "

some#hat concerned about illing self

#as not, or #as only a little concerned

.3%

2.1%

about illing self 1 !.%


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78

6re7uency

(823)

/ercent

1%)

/reparations for Committing Suicide

made no preparations 3

made some preparations ")

almost fmished or completed preparations *

13.%

"."%

3.%

Suicide (ote

not #ritten 1"

thought about4started, but didnIt complete "

completed a note *

".2%

.3%

3.%

Arrangements for Ghat Gould Eappen After Suicide

no arrangements mad thought about only

defmite arrangements made !

2.1%

3.%

3!.1%

Desire to Suicide

had not hidden it from others held bac telling others ""

attempted to hide, conceal, lie about it

1*.%

*.%

3.%

Attempted Suicide /rior to Bast Attempt

none once "

t#o or more 22

.%

.3%

!".*%

Gish to Die During Bast Attempt

lo#

moderate

high

.%

" .3%

22 !".*%


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ill) Distribution of Eopelessness Scores

The total score that can be obtained on the Ho!elessness Scale ES) ranges from '

2, #ith indicating the absence of hopelessness and 2 indicating the highest degree of

hopelessness, and #ith a cut'off score of ! being predicti$e of e$entual suicide. (inety'si0

percent (822) of the sample scored 1 or abo$e on the scale, #ith the ma&ority of

participants "2% (812) obtaining a score of 2. 5nly one indi$idual generally endorsed

those items indicating an absence of hopelessness. Table ! presents the distribution of total

hopelessness scores obtained by the sample.

Table !. 6re7uency and /ercent Distribution of Total Eopelessness Scores

Eopelessness

Score '2)

6re7uency

(823)

/ercent

1%)

1 .3%1 2 .*%

1* 3 13.%1 2 .*%

1! 3 13.%2 12 "2.2%


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)

. Testing the Eypotheses

The follo#ing section presents the results for each of the si0 hypotheses tested.

The first hypothesis suggested that there #ould be a #ea relationship or an absence

of a relationship bet#een the t#o measures assessing the actual lethality of the methods

employed in the suicide attempts medical lethality scale, and the Bethality of Suicide Attempt


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bet#een the $ariables of percei$ed lethality and sub&ecti$e intent. 6or the 23 participants in

the study, #hen ased Eo# liely #as the method you used to ha$e caused your deathF

#ith possible scores ranging from 1 to ), the resulting patient scores ranged from to .

A rating of indicates that the method chosen probably #ould result in death, a rating of

" indicates that death #as liely, and a rating of indicates that the method chosen #ould

defmitely result in death. Those indi$iduals #ho indicated that the lethality of the method

they used in their attempt probably #ould result in death score of ) had an a$erage le$el

of reported sub&ecti$e intent of;8l.", SD8.*1. This #as significantly lo#er than the

a$erage reported sub&ecti$e intent of either those indi$iduals #hose percei$ed lethality #as

liely score of "), ;8l2.. SD8.*), or those indi$iduals #ho indicated that the

method used #ould definitely result in death score of), ;812., SD8.!*), = 2, 2)8

"."*, p. 4 .". This indicates that those indi$iduals #ho report a strong intent to die also

belie$e that the method they use in their suicide attempt #ill pro$e to be fatal.

The ne0t hypothesis to be tested predicted that the participantsI perceptions of

lethality percei$ed lethality) #ould differ significantly from the e$aluations of lethality

pro$ided by clinicians medical lethality), and this #as confirmed in the present study. There

#as no e$idence of a significant correlation bet#een the mean lethality rating pro$ided by

clinicians and the mean lethality rating pro$ided by patients. Eo#e$er, a paired samples t'test

#as calculated on the dimension of lethality and re$ealed a significant difference bet#een

cliniciansI and patientsI estimations of the degree of danger to life associated #ith the $arious

methods employed for the attempts in this study. 5n a$erage, patients rated the lethality of


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the methods employed higher than clinicians, 1 22) 8 .!, p 4 .1. This is consistent #ith

other studies in the suicide literature #hich demonstrate that lay persons tend to o$erestimate

the probability of death associated #ith $arious methods of self'in&ury e.g., Hecet al., 1!*"


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% I

5

N1

&'

Figure '. 3

Comparison of ;edical 0

/ercei$ed Bethality

Eo# liely #as the method chosen to result in deathF

NK ---------- ,,I6 7

8 I I P

,I

+ \I

,99.. I

.: ''

-('P I

,------

I ; 7

il#

37. Q.4RR

/ercei$ed Bethality!!!l7,7,

...4P 2 7- ;7 participants).


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less than one day to produce death and those methods #hich #ere rated as re7uiring at least

one day to produce death. As e0pected, there #as statistical e$idence of a difference bet#een

the cliniciansI ratings and the patientsI ratings of the time re7uired for a gi$en method to

produce death. The ;E""

statistic #as , (823, p@ .1. 5n a$erage, patients under'rated

the time they e0pected the method to tae to produce death, relati$e to the estimates of

clinicians. This fmding of nonsuicidologists underestimating the length of time re7uired for

a method to pro$e lethal is consistent #ith the research literature e.g.


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"

n considering the fre7uency and duration of suicidal thoughts and the nature and

intensity of suicidal desires, it #as hypothesi+ed that there #ould be a positi$e relationship

bet#een suicidal ideation and suicidal intent. As indicated in Table this relationship #as

supported in the current study, in that suicidal ideation #as significantly related to suicidal

intent, #ith the t#o dimensions sharing 1% of the $ariance. This indicates that each

dimension measured different aspects of suicidal beha$ior but they #ere not mutually

e0clusi$e from one another. As the fre7uency and duration of suicidal thoughts increased,

so too did the intensity of #anting to actually commit suicide. Thus, although thining about

suicide and actually attempting it are t#o different dimensions of suicidal beha$ior, in the

present study, those indi$iduals #ho indicated ha$ing a high degree of suicidal ideation prior

to their attempt, also reported a strong tendency to seriously end their li$es. This fmding is

consistent #ith the research literature.

The final hypothesis of the study predicted a significant relationship bet#een

hopelessness and suicidal intent. This relationship has been consistently demonstrated in the

research literature for indi$iduals #ho ha$e engaged in at least one suicide attempt, and it #as

anticipated that the same fmding #ould be reported in the current study among multiple

suicide attempters. t #as e0pected that those indi$iduals #ho indicated a high degree of

hopelessness #ould ha$e also reported a high le$el of suicidal intent at the time of their

attempt. This relationship #as not supported in the current study, in that the measure of

hopelessness #as unrelated to suicidal intent. The failure to statistically confirm the

association bet#een hopelessness and suicidal intent, ho#e$er, #as not surprising considering


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the general lac of $ariability in the hopelessness scores, as can be seen in Table !. The

homogeneity of the sample in terms of the o$erall high le$els of hopelessness reported may

ha$e contributed to the lac of a demonstrated positi$e correlation.

n summary, the results of the current study suggest that for the present sample and

the present test instruments, patients tended to e0hibit high le$els of hopelessness, suicidal

ideation, and suicidal intent. n addition, indi$iduals reported that the method they had used

in their recent attempt #as e0pected to be lethal and in a relati$ely short period of time, and

the ratings of both lethality and time tended to be inaccurately estimated in comparison to

ratings pro$ided by clinicians. n general, it #as demonstrated that patients and clinicians

hold different opinions regarding the dynamics in$ol$ed in suicidal beha$iors.


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Discussion

The problem of fre7uent hospital admissions for attempted suicide is #ell

documented e.g., Alderson, 1!* Appleby, 1!!3 Hille'Hrahe, Schmidte, Oerhof, De Beo,

Bonn7uist, /latt, 0 Sampaio 6aria, 1!!" Ea#ton 0 Catalan, 1!*, /allis 0 Sainsbury, 1!*

Geisman, 1!*). The suicidal patient is often percei$ed as the most common and $e0ing

challenge presented to clinicians. Although it is acno#ledged that not all suicidal beha$ior

is truly the pursuit of a deadly outcome, by the same toen it is important to recogni+e that

a population does e0ist #ithin the suicide subculture in #hich indi$iduals ha$e a strong

intent to suicide, ho#e$er, they remain unsuccessful in their multiple attempts. The

con$entional $ie# #ithin the suicidology literature is that such indi$iduals ' the repeat

attempters ' use potentially self'destructi$e beha$iors as gestures, in order to benefit form the

post'crisis reactions of attention from others. Githin this Icry for helpI hypothesis it is

ad$anced that since the ma&ority of chronic repeaters use methods of lo# lethality, they must

not be serious about their e0pressed desire to suicide. The present research has challenged

this line of reasoning by ree0amining the relationship bet#een lethality and intent.

Specifically, addressing lethality in terms of both medical and percei$ed definitions adds

immeasurably to the understanding of the process of a suicide attempt, by highlighting that

often the clinical $ie# of lethality may differ from a suicidal indi$idualIs understanding of

the conse7uences of his4her attempt.

n the present in$estigation, in comparing cliniciansI ratings of lethality #ith those

of the chronically suicidal, it #as found that patients significantly o$erestimated the $iolence


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associated #ith the methods they chose in their attempts and underestimated the time

re7uired for the method to produce a fatal outcome. n effect, e$en those methods #hich

ha$e traditionally been deemed as lo# lethalII by medical professionals, in this study and

in pre$ious suicide research, #ere rated by patients as being highly liely to result in death.

Since the medical community has commonly relied on the lethality of an act to infer the

intent of the indi$idual to seriously suicide, it is assumed that those attempts in$ol$ing lo#

lethal methods are generally not aimed at producing death. The results of the patient ratings

of lethality in the present study, ho#e$er, suggest that this proposed relationship bet#een the

actual lethality of an act and the original intent of the attempter may be misleading. nstead,

in addition to assessing the medical seriousness of an act of attempted suicide, it may be more

informati$e to also consider the no#ledge held by the attempter of the degree of danger

in$ol$ed in the act. The le$el of accuracy of the attempterIs conception of the lethality of

a suicide attempt has important implications for the assessment and management of suicidal

beha$iors. Those indi$iduals #ho repeatedly engage in potentially self'destructi$e beha$iors

are at ris, particularly if their no#ledge of the actual lethality of $arious methods increases.

n assessing this group of indi$iduals, it is important to determine ho# accurate their

conceptions of lethality are, in addition to e$aluating their le$el of intent. Aspirin, to an

uninformed indi$idual #ho has had neither e0perience nor information about it, might seem

as a lethal mode of self'destructi$e acti$ity. To dismiss such an indi$idual as not being

serious about committing suicide is dangerous, particularly if the indi$idual becomes

informed about the actual lethality of different methods. If clinical inter$ention occurs at that

indi$idualIs first hospital presentation, there may be a greater chance of reducing the


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89

lielihood of that indi$idual repeatedly engaging in further suicidal acti$ity.

To address the potential contention that members of this population purposely

o$erinflate their ratings of lethality in order to decei$e others for their o#n gain, it should be

pointed out that research #hich has used nonsuicidal lay persons to rate the lethality of

$arious methods, has also sho#n that all methods #ere o$errated by lay persons in

comparison to pathologists


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90

In the present sample, the most pre$alent method used for attempted suicide #as an

o$erdose of prescription and4or nonprescription drugs. The traditional e0planation of this

customary finding is that indi$iduals #ith a lo# intent to suicide or those #ho are ambi$alent

about committing an act of suicide, engage in lo# to moderate dosage drug use, to increase

their chances of sur$i$al and subse7uently reinforce their attention'seeing beha$ior. Githin

this perspecti$e, it is argued that those #ho truly are committed to ending their li$es #ill

choose a more lethal method #hich cannot be undone #hich medical inter$ention, such as

#ith the use of firearms. t is suggested here, that perhaps a more utilitarian #ay to $ie# the

predominance of drug o$erdoses is in considering the a$ailability of methods. Although

firearms are rated medically as highly lethal, access to guns is not as permissi$e as it is for

drugs. Githin the present sample, for e0ample, all participants ha$e had medications

prescribed to them at some time by their physicians, and o$er'the'counter drugs remain as

perhaps the most con$enient method for the ma&ority of the population. Smith, Conroy, and

=hler, 1!) suggest that people tend to use the methods that are most readily a$ailable,

#hich in this increasingly drug'oriented society is liely to be drugs. 6urthermore,

concerning the dosage ingested, once indi$iduals secure access to drugs, it has been sho#n

that fe# ha$e an accurate conception of the amount re7uired to produce death and the period

of uninterrupted time re7uired for the method to tae effect. This scenario can therefore

account for a great many of the perple0ing cases in #hich indi$iduals remain highly intent

in illing themsel$es and attempt se$eral times, but are repeatedly sa$ed by timely medical

inter$ention.

Another distincti$e feature amongst repeat attempters is that in addition to their


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fi0ation on attempting suicide, they seem to digress little in the method they use from one

attempt to the ne0t. Jnstructured inter$ie#s #ith the present sample re$ealed that the

ma&ority of indi$iduals #ould engage in the same method for each attempt, or #ould employ

a $ariety of methods all #ithin relati$ely the same grade of lethality. The finding that o$er

eighty percent of participants in the present research sample reported feeling that they had

trouble thining and4or concentrating both before and during their suicide attempt, is

consistent #ith pre$ious findings of suicidal indi$iduals operating from #ithin a $ery narro#

range of cognitions and ha$ing difficulty entertaining ne# ideas or focusing on alternate

beha$ior options (euringer, 1! 1!* Shneidman, 1!*), and, in fact, entering into a

certain uni7ue cogniti$e state (euringer, 1!*). t is e$ident, in re$ie#ing the results of

suicidal ideation among the present sample, that the ma&ority of participants #ere in$ol$ed

in e0tended periods of time thining about suicide and about engaging in suicidal beha$iors.

A similarly composed e0planation is gi$en by Hec,


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cogniti$e sets ' in other #ords the ability to shift to a ne# mental strategy ' and this feature,

in addition to faulty assumptions held about the lethal effecti$eness of certain methods, may

contribute to the chronic and repetiti$e beha$ior of the Ipersistently suicidalI. The fi0ation

on suicide as a solution and the perpetual usage of the same method appear to be clinical

characteristics of this population. It is suggested that treatment strategies focus on the

cogniti$e organi+ation of suicidal indi$iduals and areas of cogniti$e patterning such as

problem'sol$ing.

n assessing the characteristics of the o$erall presuicidal en$ironment for the present

sample, it may be suggested that the ob&ecti$e circumstances of the attempts may not be

entirely informati$e in terms of predicting or inferring intent to suicide. Ghen looing at the

patterns of responses for the ob&ecti$e items, more $ariability #as found, #hereas a greater

homogeneity of responses e0isted for the self'report items of intent. 6or instance, greater

di$ersity #as found amongst responses #ith regards to precautions taen against disco$ery,

maing final arrangements, the presence of a suicide note, and the degree of o$ert

communication made prior to the attempt. /articipants differed #ith respect to these aspects

of the attempt, ho#e$er, greater agreement #as found in assessing the sub&ecti$e intentions

in$ol$ed in each suicidal act. tems such as those in7uiring about the alleged purpose of the

attempt, e0pectations of fatality, conceptions oflethality, the seriousness of the attempt, and

attitudes to#ard li$ing and dying, tended to capture a similar pattern of response. Clinically,

the sample appeared uniform in their sub&ecti$e intent, ho#e$er, the same cannot be said #ith

respect to the circumstances of their attempts. n this regard, fe# parallels could be dra#n

in their beha$iours. n assessing the ob&ecti$e and sub&ecti$e components of the Suicide


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93

Intent Scale #ith psychiatric inpatients #ith a history of suicide attempts, ;iec+o#si and

colleagues 1!!3) similarly concluded that the intent to mae a lethal suicide attempt appears

to be distinct in some #ays from the planning of the attempt.

In e$aluating the medical lethality of the methods chosen by the present sample and

the intent to suicide, the finding of a lac of a significant relationship is consistent #ith

pre$ious research outcomes. This suggests that the customary $ie# held in clinical conte0ts

that indi$iduals #ho use methods of lo# lethality are not serious about committing suicide,

may be misinformed. Ghen patients incorrectly assess the lethality of the methods they use,

their intent cannot be reliably inferred from the actual lethality of the act. ntentionality is

not reflected in the method that the indi$idual chooses for suicidal acti$ity. Hec and

colleagues 1!*") similarly concluded that medical lethality is not a reliable inde0 for

e$aluating the seriousness of intent.

In assessing the preconceptions held by attempters about the lethality of their acts and

ho# serious they #ere about illing themsel$es, an important finding #as made. There #as

no e$idence of a significant relationship bet#een percei$ed lethality and the total intent

scores of the present sample. Eo#e$er, this result #as not entirely une0pected gi$en the

inclusion of ob&ecti$e items in the total intent score. Ghen the ob&ecti$e items #ere remo$ed

from the measure of intent and the relationship #as ree0amined, a significant positi$e

relationship #as found bet#een the participantsI perceptions of lethality and their self

reported sub&ecti$e intent. n other #ords, those participants #hose sub&ecti$e intent

reflected the highest le$els for such items as seriously #anting to die and e0pectations of a

lethal outcome for their attempt, also rated the method they had chosen for their attempt as


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94

being highly lethal, #ith death as the definite outcome. Eence, in determining the

relationship bet#een lethality and intent it has been demonstrated here, as in pre$ious

research, that it becomes necessary to distinguish medical from percei$ed lethality.

The claim that suicidal ideation ser$es as a marer for the ris of more serious

suicidal beha$iors and4or completed suicide, and is positi$ely related to suicide intent, #as

supported in the present in$estigation. The participants in the present study indicated o$erall

high le$els of both ideation and intent. n effect, these indi$iduals had persistent thoughts

of engaging in self'destructi$e beha$iors and e0pressed a strong desire to suicide. These

results are clinically rele$ant, in that they describe a group of indi$iduals #ho confess to

incessant thoughts of illing themsel$es and then repeatedly engage in potentially life

threatening beha$iors. This has implications for both assessment and cogniti$e treatment

strategies.

Although the dimension of hopelessness #as not significantly related to any clinically

distinct aspects #ithin the spectrum of suicidal beha$ior, this may be e0plained in terms of

the specific dynamics of the present sample. The participants in the present in$estigation

$aried little in their reported le$el of hopelessness. =0cept for one indi$idual, the total

hopelessness scores for the participants fell #ithin a narro# four point spread, and #ere in

the high range of hopelessness. Accordingly, the relati$e homogeneity of the sample may

account for the absence of a significant relationship. Although statistical e$idence of the

proposed relationship #as not obtained, the results are clinicaJy informati$e in that they

identify a distinct group that has e0pressed a $ery high le$el of hopelessness and a high le$el

of intent, #ho repeatedly e0press their suicidal tendencies in o$ert attempts. Although, for


41/80

95

the present sample, the le$el of hopelessness cannot be used as a predictor $ariable, results

do support prior research findings that hopelessness is a distinct characteristic among

multiple attempters of suicide. Conse7uently, therapeutic inter$entions #hich reduce

hopelessness most rapidly, may also lo#er suicidal potential Hec, Steer, Oo$acs, 0

9arrison, 1!"). There is e$idence in the suicide literature that cogniti$e therapy acts faster

in lo#ering hopelessness than does pharmacotherapy


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96

Bimitations of the /resent n$estigation and 6uture Directions

The present in$estigation e0amined a limited sample of the spectrum of suicidality,

gi$en the small sample si+e due to the constraints of a$ailability of, and access to, the

population under study), and the finding that most of the participants reported a drug

o$erdose as the chosen method in their attempt. Since the sample #as small and relati$ely

homogeneous, there #ere no e0amples of indi$iduals #ith lo# le$els of intent and percei$ed

lethality for comparison. The results of the present study, ho#e$er, are supported by

pre$ious research findings #hich in$ol$ed larger sample si+es.

Another important limitation to this study, and in most research in suicide, in$ol$es

the possibility that patients may o$er'endorse on many measurement scales as a reflection

of their distress le$els at the time they are being inter$ie#ed. Those in$ol$ed in the

assessment and treatment of suicide attempters can only speculate about ho# oneIs

&udgement is impaired in times of crisis. 6urther, once the immediate crisis situation is o$er,

the le$el of distress e0perienced by the indi$idual may affect their capacity to mae rational

&udgements and assume responsibility for their attempts. Although it is acno#ledged that

distress le$els at the time of the inter$ie# may ha$e affected the responses gi$en by some

indi$iduals in the present study, certain measures #ere included to reduce the effect of this

inherent bias. 6or instance, indi$iduals #ere not inter$ie#ed for the study until they #ere

stable and the medical personnel in$ol$ed in their mental health care ad$ised that they #ere

not at immediate ris of a suicide attempt. In addition, participants #ere ased that they refer

to the time period of the half hour before their most recent attempt in completing the


43/80

97

7uestionnaires, and refer to ho# they #ere feeling at that specific time as opposed to their

ideations and affect during the inter$ie# session. t #as anticipated that these measures

#ould permit a more accurate depiction of the attempt. =$en #ith the inclusion of these

measures, ho#e$er, the design of the present study maes it difficult to differentiate those

#ho may ha$e been influenced by a certain le$el of personal distress at the time of the

inter$ie# from those participants #ho pro$ided a $alid reflection of their intent to suicide.

It is proposed that future research designs be longitudinal to permit the retesting of suicide

attempters at different time periods follo#ing an attempt. This type of design could perhaps

more accurately assess the influence of current distress le$els on response items.

An additional limitation to the present study concerns a current debate #ithin the

suicidology literature in$ol$ing trait $ersus state features amongst repeat attempters of

suicide. To account for the repetiti$e potentially self'destructi$e acts of this population,

se$eral in$estigators ha$e proposed that certain personality traits may precipitate this

beha$ior, such as trait an0iety and trait anger e.g., 9oldstein, Daniel,


44/80

98

a larger sample si+e to capture a greater range of the associated cognitions and beha$iors of

this identified group. Hased on the findings that self'report sub&ecti$e items may

communicate a distinct aspect of intent, it is suggested that the relationship bet#een ob&ecti$e

and sub&ecti$e measures of intent be e0plored in greater detail for this particular population.

In addition, an e0ploration of the aspects of ideation and intent for this particular population

may produce a more accurate portrayal of the dynamics in$ol$ed in their repetiti$e beha$ior.

The present e0amination has highlighted the importance of rele$ant operational definitions

#ithin the suicide discourse, especially in distinguishing medical and percei$ed lethality, for

pre$ention rests on assessment assessment rests of definition Shneidman, 1!" p. $i).

(ot#ithstanding the abo$e ca$eats, it is proposed that the present findings add to the

clinical depiction of the persistently suicidal. t may be argued, at least for the present sample

of indi$iduals and the present test instruments, that the actual $iolence associated #ith

certain methods of suicide is not a reliable measure of the seriousness of intent, and that the

main factor to consider #hen assessing suicidal intent, in this respect, is to #hat e0tent the

indi$idual #as a#are of the liely medical conse7uences of the attempt.

t is recogni+ed that the moti$es leading to suicide are both numerous and nebulous.

It is often unclear as to #hy indi$iduals repeatedly inflict self'in&uries or engage in potentially

life'threatening beha$iors, and as such, it becomes more difficult to help such indi$iduals.

Commonly belie$ed notions ha$e included the idea that certain people lac appropriate

coping resources to o$ercome their difficulties and may continually engage in suicidal

beha$iors in order to a$oid confronting their problems. An associated idea is that the actual

self'in&urious beha$iors are used to deal #ith intolerable feelings of tension. Alternately,


45/80

99

there is the $ie# that a fe# indi$iduals appear to obtain a le$el of e0citement from the ris

taing entailed Ea#ton 0 Catalan, 1!*). 6inally, and perhaps the most #idely e0pressed

opinion, is that indi$iduals #ho repeat se$eral times may feel they need the attention of

family, friends, or the hospital staff that each episode brings. Although it is recogni+ed that

not all suicide attempts are seriously aimed at producing death, and that certain indi$iduals

do use suicidal beha$iors for manipulati$e purposes, it is asserted that this should not ser$e

as a unitary e0planation of repeated suicide attempts. It is argued that a distinct group does

e0ist in #hich indi$iduals ha$e a strong suicidal tendency and desire to suicide, ho#e$er, the

lethality of the methods they choose to employ is often misconcei$ed, or the circumstances

of their attempts permit timely inter$entions. Differences in moti$ation bet#een the

indi$idual #ho taes a handful of barbiturates and the one #ho pulls the trigger of the gun

placed at his4her head cannot readily be assumed. The importance of e0amining the aspect

of percei$ed lethality is reflected in the attitudes held by mental health professionals. The

findings of the present study are not challenging the use of medical estimates of lethality in

assessing suicidal indi$iduals.


46/80

100

suicide regarding the nature and intensity of their suicidal desires, #ould add immeasurably

to understanding the process of a suicide attempt. Jnless consideration is gi$en to the uni7ue

dynamics in$ol$ed #ithin this group, there is a danger that medical settings #ill not percei$e

the attempts as serious ones and #ill ineffectually treat these indi$iduals. The real ris

in$ol$ed is that the repetition of attempted suicide #ill increase the chances that an

indi$idual #ill subse7uently die from suicide.

Ghile se$eral competing theories ha$e been ad$anced to account for the actions of

multiple attempters of suicide, consensus does e0ist on the point that suicide is epidemic

/ec, 1!). ne$itably, the myriad of $ariables in$ol$ed #hich moti$ate an indi$idual to

continually self'harm, necessitate an analysis at a $ariety of le$els, including both the

epidemiological ' or population ' le$el, and at the clinical ' or indi$idual ' le$el, in addition

to the possible self'reinforcing nature of suicidal beha$ior. 6uture in$estigations #ould

undoubtedly benefit from a comprehensi$e assessment of the o$ert beha$iors, thoughts, and

feelings of those #ho deliberately self'harm, in an effort to understand the parameters of

repeated suicide. Jntil a better understanding is reached concerning the dynamics in$ol$ed

#ith the persistently suicidal, #ithin clinical settings the suggestion of Shneidman 1!*)

should be heeded in that suicide attempts, #hate$er their lethality, ought to be taen

seriously.


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48/80

102

Hec, AT., Hec,


49/80

13

Hec, AT., Geissman, A, Bester, D., 0 Tre0ler, %. 1!*). The measurement of

pessimismN The Eopelessness Scale. Kournal of Consulting and Clinical /sychology, 2, 1'

".

Hec, A. T., Geissman, A, Bester, D., 0 Tre0ler, %. 1!*). Classification of

suicidal beha$iors N Dimensions of suicidal intent. Archi$es of 9eneral /sychiatry, .13., 3"'3*.

Hedrosian,


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104

Huglass, D., 0 ;cCulloch, ?. G. 1!*). 6urther suicidal beha$iourN The

de$elopment and $alidation of predicti$e scales. Hritish Kournal of /sychiatry, lli,3'!1.

Cantor, /. 1!*). 6re7uency of suicidal thought and self'destructi$e beha$ioramong females. Suicide and Bife'Threatening Heha$ior, ., !2'1.

Card, K. K. 1!*). Bethality of suicidal methods and suicide risN T#o distinct

concepts. 5mega, .i.l)., 3*'".

Ca$an, R. 1!2). Suicide. ChicagoN Jni$ersity of Chicago /ress.

Dorpat, T. B., 0 Hos#ell, K. G. 1!3). &n e$aluation of suicidal intent in suicide

attempts. Comprehensi$e /sychiatry , N1N, 11*'12".

Dublin, B., 0 Hun+el, H. 1!33). To He or (ot to HeN A Study of Suicide . (e#orN


51/80

105

6arnham'Diggory, S. 1!). Self'e$aluation and sub&ecti$e life e0pectancy among

suicidal and non'suicidal psychotic males. Kournal of Abnormal 0 Social /sychology, .2,2'3.

6a#cett, l 1!). /redictors of early suicideN dentification and

appropriate inter$ention. Kournal of Clinical /sychiatry , 1N,2, *'.

6a#cett, K., Scheftner, G., Clar, D.,


52/80

10

9oldstein, D. H., Daniel, S.,


53/80

10

Oo$acs, ;.,


54/80

10

;enninger, O 1!3). ;an Against Eimself . (e# orN Earcourt.

;ichel, O 1!*). Suicide ris factorsN A comparision of suicide attempters #ithsuicide completers. Hritish Kournal of /sychiatry, 1", *'2.

;iec+o#si, T. A., S#eeney, K. &, Eaas, 9. B., Kuner, H. G., Hro#n, R. /., 0

;ann, K. K. 1!!3). 6actor composition of the suicide intent scale. Suicide and Bife

Threatening Heha$ior , 21C.l), 3*'".

;inoff, O., Hergman, =., Hec, A T., 0 Hec, R. 1!*3). Eopelessness,

depression, and attempted suicide. American Kournal of /sychiatry, DL, ""'"!.

;otto, K.A. 1!"). Suicide attemptsN A longitudinal $ie#. Archi$es of 9eneral

/sychiatry, B., "1'"2.

(eanda'Trepa, C. ?. S., Hishop, S., 0 Hlacburn, I. ;. 1!3). Eopelessness and

depression. Hritish Kournal of Clinical /sychology, 22, !'.

(euringer, C. 1!).


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1!

/ayel, =. S., ;yers, K. O., Bindenthal, ?. K., 0 Tanner, K. 1!*). Suicidal feelings

in the general population. A pre$alence study. Hritish Kournal of /sychiatry, 12, '!.

/ec, D. %. 1!). Completed suicidesN Correlates of choice of method. 5;=9A,1), 3!'323.

/ierce, D. G. 1!**). Suicidal intent in self'in&ury. Hritish Kournal of /sychiatry,

13, 3**'3".

/lutchi,


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11


57/80

11

Shneidrnan, =.S., 0 9reenblatt, ;. 1!*). SuicidologyN Contemporary

De$elopments. (e# orN 9rune 0 Stratton, nc.

Sifneos, /. 1!). ;anipulati$e Suicide. /sychiatric Luarter ly,. "2"'"3*.

Sil$er, ;., Hohnert, ;., 0 Hec, AT. 1!*1).


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11

Geiss, K. ;.A., (une+, (., 0 Schaie, O. G. 1!1). Luantification of certain trends

in attempted suicide. n The /roceedings of the Third Gorld Congress of /sychiatry.

;ontreal.

Geissman, ;. ;. 1!*). The epidemiology of suicide attempts 1! to 1!*1.

Archi$es of 9eneral /sychiatry, K.L, *3*'*.

Geissman, A. D., 0 Gorden, K. G. 1!*2).


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&ppendiC & 113

E5 S/)TAB

1 Gellesley Street =N st

Toronro. DE I6"* "G)

i Cnu'IL"'"111.\Inf Tarunto T tJCbtn§ Ho:fi'JU:Jl

Commrltf'd to ItS Commw1u11r.r

>DES@ET TD H&RTI>IH&T@

Investigators! Br. Ron eslegrave, $*"# '-33+

Br. Haul %in1s, $*"# '-++) eCt. )3'HolyCeni 2arta1is

The study in which you have been as1ed to participate is intended to assess the circumstancessurrounding suicide.

The study is concerned with better understanding the factors that may or may not influence

suicide and self-harm behaviors. ou will be as1ed to complete a series of questions regarding your

views about suicide and your thoughts and feelings around the time of your visit to The Jellesley

>entral ospital. The time as1ed of you to complete the interview and questionnaires will be less than

one hour. Je will also gather some information about your visit to The Jellesley >entral ospital from

hospital records. This will include your hospital diagnosis, information about your treatment at the

hospital, and details on the reasons surrounding your visit to The Jellesley >entral ospital.

&ny informat"on that you provide will be held in strict confidence, and will only be used by the

investigator for the purpose of the present study. owever, if during the course of the interview

session there is any concern about your health by either you or the interviewer. a member of theJellesley >risis Team will be notified. This measure wiKl necessarily be ta1en for your protection. ouwill never be identified in any resulting presentation or publication.

our participation in this study is voluntary, and you are free to withdraw from the study at any

time. If you refuse to participate in the study it will not influence your current or future health care8 you

will continue to have access to quality care at The Jellesley >entral ospital. =y signing this form you

are agreeing to participate in the study. &s we will be conducting research in this area in the future,

we would li1e your permission to contact you at a later time.

Than1 you for your time and cooperation.

I have read and understand the above conditions. I hereby consent to participate in the study.

Harticipant7s Signature Hrint Eame Bate

I. the undersigned, ha,,e fully eCplained the relevant details of this study to the participant

named above and bel"eve that he9she understands the nature of the study.

Investigator7s Signature Hrint Eame Bate


60/80

'''''''

". Lender!

/- "

F-'

'. &ge!

). /arital Status!single....................."

married....................2

cohabiting................3divorced...................

widowed..................."

*. @ducation!

ementary................"

highschool.................2

college9university.......3

ear s completed!

Appendi0 Hl""*

Bate!'''''''Eumber!

JellesleyM! N

.IE!'''''''

+. Dccupational Status!

regularly employed.... " $Oocation! --.# $full timeN8 part timeN(

student......................'

disability pension.......3

unemployed.............. .*

welfare....................... "

. Dngoing Treatment

psychiatric.................. "

general practitioner....2

social agency............. 3

other .......................... .*

3 Hsychiatric inpatient treatment, previously

Eo............................... "

es .............................' $Eumber of times 8


61/80

Appendi0 H2

. Hsychiatric treatment, ever

Eo............................."

es...........................2 Bescribe----------------------

. Hsychopharmacological treatment, currently

=enPodiaPepines......"

&ntipsychotics9

Eeuroleptics.......2

&nti-depressal5lts......3Dther....................... .

". Hsychopharmacological treatment, ever

=enPodiaPepines......"

&ntipsychotics9

Eeuroleptics.......2

&nti-depressants......3

Dther ....................... .*

"". /ental disorders in relatives

i!!?o............................"

es..........................2 Bescribe ----------------------

"'. Suicide in relatives

Eo............................ "

es..........................2 Relation---------------------

"). Hrevious psychiatric diagnosis

Eo..........................."

es.........................2 Biagnosis -------------------

"*. Hrevious suicide attempts

Eo........................... "

es.........................2

$a# ow manyQ--------$b# Jhen was the last attemptQ

$c# Treatment received for itQ

Eo......"es....' Bescribe N

11"


62/80

Appendi0 Cl 11

Bate! N

Eumber! N

IE!''''''''

JellesleyM! N

For each item mar1ed $a# in questions "-+, please circle the number

which represents your choice, according to the following scale!

the least the most

I7ve ever felt

this wayI7ve ever felt

this way

2 3 "

For each item mar1ed $b#. please circle the number which represents

your choice, according to the following scale!

all day- "

one wee1- '

two wee1s- )

one month- *siC months - +

more than siC months -

". Bid you feel upset9agitatedQ esN Eo

$a# In the "9' hour before you hurt yourself, how would you rate this

feelingQ .............................................................................1 2 3 "

$b# Dverall, how long were you feeling this

wayQ......................................................................... " 2 3 "

'. Bid you feel ashamedQ FesN EoN

$a# In the "9' hour before you hurt yourself, how would you rate this

feeling.................................................................................. 1 2 3 * +


wayQ.........................................................................I ' 3 +


63/80

11Appendi0 C2

For each item mar1ed $a# in questions "-+, please circle the number

which represents your choice. according to the following scale!

the least the mostI7ve ever felt

this way

I7ve ever felt

this way

2 3 "

For each item mar1ed $b#, please circle the number which represents

your choicaccording to the following scale!

all day- "

one wee1- '

two wee1s- )

one month- *siC months - +

more than siC months -

). Bid you feel that you hated yourselfQ es Eo

$a# In the "9' hour before you hurt yourself, how would you rate

this feeling..........................................................................." 2 3 * "


wayQ........................................................................" 2

*. Bid you feel that you were to blame for anythingQ

es Eo

3 * +


this feeling.........................................................................." 2 3 "


wayQ........................................................................" 2

+. Bid you feel that you had trouble concentrating9thin1ingQ

esN Eo

3 * +


this feeling..........................................................................." ' 3 "


wayQ........................................................................" ' 3 * "


64/80

11Appendi0 C3

. $a# ow much relief did you thin1 you would feel by attempting to hurt yourselfQ

very little

relief eCcessive

relief

2 3 "


wayQ........................................................................" 2 3 +

3. $a# In the "9' hour before you hurt yourself, to what eCtent had you been thin1ing

abouplanning to hurt yourselfQ

very little

planningeCcessive

planning

' 3 "


wayQ........................................................................" 2 3 * +

. $a# ow impulsive did you feel in the "9' hour before you hurtyourselfQ

not at all

impulsivevery

impulsive

' 3 +

(b) Dverall, how long were you feeling this

wayQ.........................................................................." 2 3 +

ow successful did you thin1 you would beQ

not very

successfulvery

successful

2 3 "


65/80


66/80

12Appendi0D2

S=?@>T! M3

/@TDB! (umped off bridge $* feet high#, with traffic below

$re ulting in(uries! shattered 1nee, bro1en elbow, fractured pelvis, loss of

consciousness#

S=?@>T! M

/@TDB! Dverdose S=ST&E>@!

anti-anCiety meds BDS&L@! approC.

"-"' pills total >DRS@! approC.

' hours

S=?@>T! M

/@TDB! Dverdose

S=ST&E>@! antidepressants

BDS&L@! approC. )-)+ pills total

>DRS@! approC. "-' hours

S=?@>T! M"

/@TDB! Dverdose X >utting

S=ST&E>@! HroPac, =enadryl $cold med#, aspirin

BDS&L@! approC. ' pills total

>DRS@! approC. ' hours8 wo1e up after * hours and cut both wrists with raPor blade

S=?@>T! M""

/@TDB! stabbed self with 1nife- lower chest, above abdomen

S=?@>T! M"'

/@TDB! Dverdose

S=ST&E>@! benPodiaPepines, antidepressants $has asthma 0 was aware of

depressing effect of antidepressants on respiratory system#

BDS&L@! approC. ' pills total

>DRS@! approC. "-' hours

S=?@>T! M")

/@TDB! (umped onto subway trac1s


67/80

Appendi0 D3"'"

S=?@>T! M"*

/@TDB! Dverdose 0 >utting 0 Swallowed batteries

S=ST&E>@! Tylenol $eCtra strength#

BDS&L@! approC. ' pills

>DRS@! approC. ) hours

>ut both wrists X throat with raPor blade

Swallowed ' batteries

S=?@>T! M"+/@TDB! Dverdose 0 >utting 0 Ingested bleach

S=ST&E>@! antipsychotics, antidepressantsBDS&L@! approC. +- pills total

>DRS@! approC. '-) hours >ut

both wrists with 1nife Ingested

small amount of bleach

S=?@>T! M"

/@TDB! Dverdose

S=ST&E>@! antidepressants, antiseiPure meds

BDS&L@! approC. 3 pills total>DRS@! approC. '-) hours

S=?@>T! M"3

/@TDB! attempted to (ump off bridge $approC. ) feet high#

$passerby notified police#

S=?@>T! M"

/@TDB! Dverdose X >utting

S=ST&E>@! antidepressants

BDS&L@! approC. "+-' pills total

>DRS@! approC. " hour

>ut both wrists with dinner 1nife

S=?@>T! M"

/@TDB! Dverdose

S=ST&E>@! antidepressants, Tylenol )

BDS&L@! approC. +- pills total

>DRS@! approC. '-) hours


68/80

"''Appendi0 D

S=?@>T! M'

/@TDB! Dverdose

S=ST&E>@! antidepressants, Tylenol $reg. strength#

BDS&L@! approC. "-"' pills total

>DRS@! approC. ' hours

S=?@>T! M'"

/@TDB! >utting

>ut both arms in several places with raPor - over * cuts total

S=?@>T! M''

/@TDB! Dverdose

S=ST&E>@! neuroleptics, antidepressants, Tylenol $reg. strength#, Lravol

BDS&L@! approC. pills total

>DRS@! approC. )-* hours

S=?@>T! M')

/@TDB! Dverdose

S=ST&E>@! Tylenol $reg. strength#, antidepressants, antihistamines, herbal pills,heartburn liquid

BDS&L@! approC. 3+ pills total8 half bottle of heartburn med>DRS@! approC. '-) hours


69/80

123Appendi0 =l

'''''''

DateN

''''''' (umberNGellesley?N Q

(N Q

6or each item, try to thin bac to the 7lP hour before you attempted to hurt yourself and circle

the ans#er #hich best describes ho# you felt at that time.

1. .

".

2.

'. .

1.

had a moderate to strong #ish to li$e.

had a #ea #ish to li$e.

had no #ish to li$e.

had no #ish to die.

had a #ea #ish to die.

2. had a moderate to strong #ish to die.

3. .

".)

. .

I.5#

+. .

1.

;y reasons for li$ing out#eighed my reasons for dying.

;y reasons for li$ing or dying #ere about e7ual.

;y reasons for dying out#eighed my reasons for li$ing.

r had no desire to ill myself.

had a #ea desire to ill myself. had a moderate to strong desire to ill myself.

) #ould try to sa$e my life ifl found myself in a life'threatening situation.

) #ould tae a chance on life or death if found myself in a life'threatening

situation.

2. P$ould not tae the steps necessary to a$oid death if found myself in a life

threatening situation.

f you ha$e circled the +ero statements in both 9roups

and " abo$e, then sip do#n to 9roup 2. f you ha$e

mared a 1 or 2 in either 9roup or ", then open here

and go to 9roup .

Subtotal /art 1


70/80

12Appendi0 =2

. 0.

1.

N2.

3. 0.

1.

2.

. 0.

1.N2.

!. 0.

l.

2.

10. 0.

l.

1

ll. 0.

Y.

'.

12. 0.

1.1

13. 0.

".

1

had brief periods of thining about illing myself #hich passed 7uicly.

had periods of thining about illing myself #hich lasted for moderate amounts

of time.

had long periods of thining about illing myself

rarely or only occasionally thought about illing myself

had fre7uent thoughts about illing myself.

continuously thought about illing myself.

did not accept the idea of illing myself.

neither accepted nor re&ected the idea of illing myself accepted the idea of illing myself.

could ha$e ept myself from committing suicide.

#as unsure as to #hether could ha$e ept myself from committing suicide.

could not ha$e ept myself from committing suicide.

#ould not ill myself because of my family, friends, religion, possible in&ury

from an unsuccessful attempt, etc.

#as some#hat concerned about illing myself because of my family, friends,

religion. possible in&ury from an unsuccessful attempt, etc.

#as not. or #as only a little concerned about illing myself because of my

family, friends, religion, possibly in&ury from an unsuccessful attempt, etc.

;y reasons for #anting to commit suicide #ere primarily aimed at influencing

other people, such as getting e$en #ith people, maing people happier, maing

people pay attention to me. etc.

;y reasons for #anting to commit suicide #ere not only aimed at influencing

other people. but also represented a #ay of sol$ing my problems.

;y reasons for #anting to commit suicide #ere primarily based upon escaping

from my problems.

had no specific plan about ho# to ill myself.

had considered #ays of illing myself, but had not #ored out the details.

had a specific plan for illing myself.

did not ha$e access to a method or an opportunity to ill myself.

The method that ) #anted to use for committing suicide taes time, and really

did not ha$e a good opportunity to use this method.

) had access or anticipated ha$ing access to the method that chose for

illing myself and also had the opportunity to use is.


71/80

12Appendi0 =3

"*. .

1.

'.

1". .

1.J

1. .

1.

2.

"3. .

1.

1. .

1.

J

K. .

".

'. .

".

did not thin that had the courage or the ability to commit suicide.

#as unsure as to #hether had the courage or the ability to commit suicide.

I had the courage and the ability to commit suicide.

i did not e0pect to mae a suicide attempt.

) #as unsure as to #hether or not to mae a suicide attempt.

#as sure that 1 #ould mae a suicide attempt.

had made no preparations for committing suicide.

had made some preparations for committing suicide.

had almost finished or completed my preparations for committing suicide.

had not C$Titten a suicide note.

had thought about $riting a suicide note or had started to C$Tite one, but did

not complete it. R

had completed a suicide note.

had made no arrangements for #hat #ould happen after had committed suicide.

had thought about maing some arrangements for #hat #ould happen after had

committed suicide.

had made definite arrangements for #hat #ould happen after had committed

suicide.

had not hidden my desire to ill myself from people.

had held bac telling people about #anting to ill myself.

had attempted to hide. conceal, or lie about #anting to commit suicide.

) had ne$er attempted suicide.

) had attempted suicide once.

r had attempted suicide t#o or more times.

f you ha$e pre$iously attempted suicide. please continue #ith the ne0t statement group.

'". .

l.J

;y #ish to die during the last suicide attempt #as lo#.

;y Pish to die during the last suicide attempt #as moderate.

;y #ish to die during the last suicide attempt #as high.

Subtotal /art 2

Total Score


72/80

Appendi0 6l 12

ame---------------------------------------------------------- Dace

For all items in this scale, use code number "8" for " ot applicable." "S'sare not counted hen

calculatin the total score.

!. "b#ecti$e %ircumstances &elated to Suicide tt ot

l. !solation0. Somebod( present

1. )Somebod( nearb(, or in $isual or $ocal contact2. *o one earb( or in $isual or $ocal contact

2. +imin

0. !nter$ention is probable

1. !nter$ention is not liel(

2. !nter$encion is hihl( unliel(

3. recautions aainst Disco$er(/!nter$ention0. *o precautions I1. assi$e precautions as a$oidin others but, doin nothin to pre$ent their

inter$ention alone in room ith unloced door32. cti$e precautions as loced door3

4. ctin to 5et elp Durin/fter ttempta. *ot#fied potential helper reardin attempt1. %ontacted but did not specificall( notif( potential helper reardin att pt7. Did not contact or notif( potential helper

. Fi al Aces in Anticipation of Death (e.g. vill gifts, insurance)

a. *one-) +houht about or ade some arran ents2. 9ade definite plans or completed arran ents

6. cci$e reparation for tt pt0. *one

1. 9inimal to moderate2. :;tensi$e

i, Suicide *ote0. bsence of note

1. *ote ritten, but torn up note thouht about

2. resence of note

8. $ert %ommunication of !ntent ne=ui$ocal c munication

Self &eoort

?. lleed urpose of ttempt0. +o manipulace en$ironment, ee actention, re$ene

l. %mponents of "0" and "2"2. +o escape, surcease, sol$e proble s


73/80

10. @;pectations of

Fatalit(

Appendi0 6212*

0. +houht chat death as unliel(

l. +houht chat death as possible but not, pArobable

2. +houht that death as probable or cercain

11. %oncepcion of 9ethod's @ethalit(

0. Did less to self than he thouht ould be lethall. Basn't sure if 2hat he did 2ould be lethal2. :=ualed or e.-....,ceeded 2hat he thouht ould be lethal

12. Seriousness of ttempt0. Did not seriousl( attempt to end life1. >ncertain about seriousness to end life2. Seriousl( attempced to end life

1C. ttitude +oard @i$in/D(in0. Did not, ant co die

l. %omponencs of DD and D2D

Z. Banced to die

14. %onception of 9edical &escuabilit(

0. +houht that deach ould be unliel( if he recei$ed medical attention1. Bas uncertain 2hether death could be a$erted b( medical attention2. Bas certain of death e$en if he recei$ed medical attention

1. Deree of remeditation0. *one impulsi$e

1. Suicide contemplaced for three hours or less prior to attempt2. Suicide contemplated for more than three hours prior t,o attempt

!!!. ther sDects 0*ot !ncluded in +otal

Score3

l6. eaccion to ttempt0. Sorr( that he made attempt feels foolish, ashamed circle hich one3l. ccepts both attempt and its failure2. &erets failure of attempt

1*. Eisualiation of Death0. @ife-after-death, reunion ith decedentsl. *e$er endin sleep, darness, end-of-thins

2. *o conceptions of, or thouhts about death

1. iu,nber of ,,-e$ious tce.mpts

. ,-lone

-; Dne or 5o2. +hree or more

1?. el tionship beceen lcohol !ntae and ttempt

0. Some alcohol intae prior eo but not relaced to attempt, reportedl( not enouhto impair #udment, realit(

testin

:nouh alcohol incae to impair #udment, realit( testin and diminishresponsibil

2. !ntentional intae of alcohol in order to facilitate implementation of attempt

20. elationship beteen Dru !ntae and ttempt 0narcotics, hallucinoens, etc.,hen dru is not the method used eo suicide30. Soce dru intae prior co but not related to attempt, reportedl( not enouh

to i pair #udment, realit( tescin1. :nouh dru intae to impair #udment, realit( tesrin and diminish responsibili

!ntentional dru intae in order to facilitate implementation of attempt


74/80

12Appendi0 63

%@!*!%!*'S :S+!9+: F &:@!

:stimated reliabilit( of patient

0. >ncertain

l. oor2. Fair

C. 5ood

EI @ u %!*5 &:@!


75/80

12 &ppendiC F*

S>@:9:*+ + !*+:*+ S%@:

Bn( did the patient choose this particular methodK :nter patient's

$erbatim response and then enter appropriate cateor(3

atient's &esponse,---------------------------------- -------------

0. ost immediatel( accessible.l.


76/80

&ppendiC LDate

13

lease indicate a ratin of the ob#ecti$e

.lethalit(

%@T&%IT DF SI>IB@ &TT@/HT R&TIEL S>&%@

''''''*unber

'''''Bellesle( ? N''''''%linician

'''''

B@&T IS &%/DST &

>@RT&IET.

B@&T IS & IL%

HRD=&=%@ DT>D/@

" Cutting: >uts as severe as in . eCcept that the li1elihood of intervention

is even more remote. =lood loss is severe and quic1.

Ingestion: =ecause of the time involved before a toCin can la1e effect,

there are few eCamples- furniture polish, paint thinner.

Other: e.g. (umping off a tall building, in front of cars, gunshot to the head.

Cutting: Severe, usually multiple cuts with severe blood loss.

Ingestion: >learly lethal doses e.g. drin1ing several ounces of acetone.

Other: ighly lethal means e.g. plastic bag tied over head, gunshot to chest.

B@&T JD%B DRBIE&RI% =@ >DESIB@R@B

T@ DT>D/@

Cutting: Severe gashes with ma(or 0 quic1 blood loss.Ingestion: >learly lethal doses with no communication made.

Other: &cts which may not succeed, but are done so that a calculated chance

of intervention could interrupt.

B@&T IS T@ HRD=&=%@ 3 Cutting: >uts are severe e.g. slashing nec1 with raPor, but see1s medical help.

DT>D/@ E%@SS T@R@ Ingestion: Hotentially lethal medications X quantities.

IS I//@BI&T@ IET@RO@ETIDE Other: lethal actions performed in a way that maCimiPes chances of intervention.

B@&T IS & +-+

HRD=&=I%IT

B@&T IS I/HRD=&=%@

SD %DEL &S FIRST &IB

IS &B/IEIST@R@B

+ Cutting: Severe cutting resulting in siPable blood loss $more than "cc#.

Ingestion: n1nown quantities of drugs that are lethal in small doses.

Other: Hotentially lethal acts e.g. putting bare wires into electrical outlet with

others present.

)+ Cutting: Beep cuts involving tendon damage 0 possible nerve9vessel damage

=lood loss is usually less than "cc.

Ingestion: Significant overdose e.g. fewer than &S& or D>B7s

Other: Hossibly serious actions that are quic1ly brought by the patient to the

staffs attention e.g. tie shoelace tightly around nec1 but wal1 over to

staff immediately.

B@&T IS I/HRD=&=%@ '

&S &E DT>D/@ DF T@ &>T

B@&T IS O@R IL% "

I/HRD=&=%@

B@&T IS &E I/HDSSI=%@

R@S%T DF T@ 5SI>IB&%=@&OIDR5

Cutting: Relatively superficial cuts. /ay receive, but does not require medical

intervention to survive.

Ingestion: /ay receive, but does not require medical intervention to survive.e.g. '+ Regular Strength Tylenol, " laCatives

Other: Eonlethal, usually impulsive 0 ineffective methods e.g. inhaling deodorant.

Cutting: Shallow cuts without tendon9nerve9vessel damage8 very little blood loss.

Ingestion: Relatively mild overdoses or swallowing of non-sharp glass.

Other: Tying a thread, string, or yarn around nec1 and then showing to others.

Cutting: light scratches that do not brea1 the s1in.

Ingestion: /ild overdoses and swallowing ob(ects li1e paper-clips X money.Other: >learly ineffective acts which are usually shown to others.


77/80

Appendi0 E 1C1

'''''''

Bate! N

Eumber!JellesleyM! N

IE!'''''''

Hlease circle the number which best represents your choice.

". ow li1ely was the method you used to have caused your deathQ

very unli1ely would definitely result in death

" 2 3 "

'. ow long did you eCpect this method to ta1e to result in your deathQ

a few seconds................................. I

a few minutes ..................................'

less than one hour ...........................3a few hours......................................*

one day............................................+

a few days....................................... "6" 6e6tta.6..............................................

$Hlease describe! --7


78/80

Appendi0 ) 132

'''''''Bate!Eumber! N

JellesleyM! N >linician! N

Hlease circle the number which best represents your choice.

". ow li1ely was the method the patient chose to have caused his9her deathQ

very unli1ely would definitely result in death

2 3 +

'. ow long would you eCpect this method to ta1e to result in his9her deathQ

a few seconds................................."

a few minutes..................................'

less than one hour ...........................)

a few hours......................................

one day............................................+

a few days........................................

E,ot6

l.e.P.'.h..o...l......................................... $Hlease describe! N,


79/80

Appendi0 11133

Bate! N

Eumber! N

JellesleyM! N

IE!'''''''

There are t#enty statements belo#. /lease read each statement and circle True if you

agree. or 6alse if you do not agree.

. ) loo for#ard to the future #ith hope and enthusiasm ...........................True

* might as #ell gi$e up because canIt mae things better

for myself ................................................................................................ True

3. Ghen things are going badly, am helped by no#ing they

canIt stay that #ay fore$er...................................................................... True

. canIt imagine #hat my life #ould be lie in 1 years.......................... True

". ) ha$e enough time to accomplish the things most #ant to do.............True

. n the future, ) e0pect to succeed in #hat concerns me most...................True

*. ;y future seems dar to me..................................................................... True

. ) e0pect to get more of the good things in life than the a$erage

person ....................................................................................................... True

!. Z&ust donIt get the breas, and thereIs no reason to belie$e #ill

in the future.............................................................................................. True

1. ;y past e0periences ha$e prepared me #ell for my future.....................True

11. All ) can see ahead to me is unpleasantness rather than

pleasantness........................ ............................ .......................... ............... .True

12. Z don Dt e0pect to get #hat reallyR Pant.................................................... True

13. Ghen loo ahead to the future. ) e0pect to be happier than

am noP$................................................................................................. True

6alse

6alse

6alse

6alse

6alse

6alse

false

6alse

6alse

6alse

6alse

6alse

6alse


80/80

Appendi0 0/

1. Things &ust #onIt #or out the #ay I #ant them to................................True

1". ha$e great faith in the future................................................................. True

1. ) ne$er get #hat ) #ant so itIs foolish to #ant anything..........................True

M*. t is $ery unliely that 1 #ill get any real satisfaction in the

future.........................................................................................................True

1. The future seems $ague and uncertain to me............................................ True

+ !. Zcan loo for#ard to more good times than bad times.............................True

2. ThercRs no use in really trying to get something #ant because

) probably PonIt get it..............................................................................True

13

6alse

6alse

6alse

6alse

6alse

6alse

6alse

Documents

MQ82941 Sample for Project Paper 2015_New1