Attempted suicide : studies of attitudes and psychiatric care

Abstract

Suicide risk among patients referred to psychiatric care after attempted suicide, attitudes of nursing personnel towards suicidal patients and the impact of a training program in suicidology for psychiatric nursing personnel were studied in the present work. Furthermore, the patients perspective on psychiatric care given to them after a suicide attempt as well as work environment, suicidal feelings and attempted suicide among psychiatric nursing personnel were investigated.

Survival analysis of suicide risk by sex and age after attempted suicide was performed on 1573 suicide attempters referred to the psychiatric emergency room. Nearly two thirds of the patients were women and most of the suicide attempters were young. The suicide risk after attempted suicide among men was nearly twice the suicide risk among women. It was concluded that older and younger men are at approximately equal and high risk of suicide and that older women are at higher risk than younger in this sample of patients referred to psychiatric care after attempted suicide. In the interview study of patients' experiences of the in-patient psychiatric care received following a suicide attempt most of the patients perceived the time at the hospital as helpful. Some patients saw it as life-saving. The importance of being well cared for and experiencing understanding and confirmation was emphasized. The conversations with the staff were seen as essential for the process of healing and for the desire to go on living.

In order to examine the attitudes towards suicidal patients among nursing personnel, a scale, The Understanding of Suicide attempt Patient scale (USP-scale), was developed. Personnel working in psychiatry held more positive attitudes than those working within somatic care, older personnel were more favourably disposed than the younger and more frequent exposure to attempted suicide patients was related to more positive attitudes. After a training program in suicidology general understanding and willingness to nurse, as measured by the USP-scale, increased significantly and the suicide risk of the patients described in the case vignettes was estimated more accurately.

Suicidal feelings, attempted suicide and aspects of work environment and well-being in Swedish psychiatric nursing personnel were studied using a questionnaire. Suicidal feelings "last year" were lower than in the general population but, suicidal feeling and attempted suicide "earlier than last year" were much more common, and 13 % reported that they had attempted suicide earlier in life. In order to study the possible association between work environment and suicidal behavior a factor analysis was performed Four factors were extracted and labelled: Suicidality, Quality of work, Negative work environment and Burnout/Depression. The correlations between the factors suggest that negative work environment is associated with Burnout/Depression, which in turn is related to suicidality.