A total of 2,611 calls to 14 helplines were monitored to observe helper behaviors and caller characteristics and changes during the calls. The relationship between intervention characteristics and call outcomes are reported for 1,431 crisis calls. Empathy and respect, as well as factor-analytically derived scales of supportive approach and good contact and collaborative problem solving were significantly related to positive outcomes, but not active listening. We recommend recruitment of helpers with these characteristics, development of standardized training in those methods that are empirically shown to be effective, and the need for research relating short-term outcomes to long-term effects.
To determine the relative effectiveness of telephone intervention styles with suicidal callers, researchers listened unobtrusively to 617 calls by suicidal persons at two suicide prevention centers and categorized all 66,953 responses by the 110 volunteer helpers according to a reliable 20-category checklist. Outcome measures showed observer evaluations of decreased depressive mood from the beginning to the end in 14% of calls, decreased suicidal urgency ratings from the beginning to the end in 27% of calls, and reaching a contract in 68% of calls, of which 54% of contracts were upheld according to follow-up data. Within the context of relatively directive interventions, a greater proportion of "Rogerian" nondirective responses was related to significantly more decreases in depression. Reduction in urgency and reaching a contract were related to greater use of Rogerian response categories only with nonchronic callers.
Models of telephone crisis intervention in suicide prevention and best practices were developed from a literature review and surveys of crisis centers. We monitored 2,611 calls to 14 centers using reliable behavioral ratings to compare actual interventions with the models. Active listening and collaborative problem-solving models describe help provided. Centers vary greatly in the nature of interventions and their quality according to predetermined criteria. Helpers do not systematically assess suicide risk. Some lives may have been saved but occasionally unacceptable responses occur. Recommendations include the need for quality assurance, development of standardized practices and research relating intervention processes to outcomes.
Background: Police suicides are an important problem, and many
police forces have high rates. Montreal police suicide rates were slightly
higher than other Quebec police rates in the 11 years before the program began
(30.5/100,000 per year vs. 26.0/100,000). Aims:
To evaluate Together for Life, a suicide prevention program for the Montreal
police. Methods: All 4,178 members of the Montreal police
participated. The program involved training for all officers, supervisors, and
union representatives as well as establishing a volunteer helpline and a
publicity campaign. Outcome measures included suicide rates, pre-post
assessments of learning, focus groups, interviews, and follow-up of supervisors.
Results: In the 12 years since the program began the
suicide rate decreased by 79% (6.4/100,000), while other Quebec
police rates had a nonsignificant (11%) increase (29.0/100,000).
Also, knowledge increased, supervisors engaged in effective interventions, and
the activities were highly appreciated. Limitations: Possibly
some unidentified factors unrelated to the program could have influenced the
observed changes. Conclusions: The decrease in suicides appears
to be related to this program since suicide rates for comparable populations did
not decrease and there were no major changes in functioning, training, or
recruitment to explain the differences. Comprehensive suicide prevention
programs tailored to the work environment may significantly impact suicide
rates.
This review focuses on suicide in patients with Autism Spectrum Disorders (ASD) as well as risk factors and comorbidities of persons with ASD who have attempted suicide. Research was conducted by searching PubMed and Psychinfo for articles. Suicide in ASD is largely understudied. Although suicide is common in clinical samples, we have little knowledge of suicide in persons with ASD in the general population. Comorbidity, particularly with depression and other affective disorders or schizoid disorders and psychotic symptoms, is often reported, so it is difficult to determine if suicidality is associated with ASD or the comorbid disorder. Clinical samples suggest that suicide occurs more frequently in high functioning autism. Physical and sexual abuse, bullying, and changes in routine are precipitating events associated with suicide risk. Persons with ASD present risk factors inherent to their diagnosis (deficit in expression of feelings and thoughts), along with risk factors pertaining to the general population (abuse, depression, anxiety, etc.). The inability of persons with Pervasive Developmental Disorder (PDD) to express emotions and thoughts makes the diagnosis of suicidal ideation difficult and demands important adjustments to traditional psychotherapeutic interventions. More research is needed to determine the incidence of suicidal behaviors in persons with ASD, to identify risk and protective factors, as well as to assess the effectiveness of prevention strategies and interventions.
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