BackgroundThe nurses working in psychiatric hospitals and wards are prone to encounter completed suicides. The research was conducted to examine post-suicide stress in nurses and the availability of suicide-related mental health care services and education.MethodsExperiences with inpatient suicide were investigated using an anonymous, self-reported questionnaire, which was, along with the Impact of Event Scale-Revised, administered to 531 psychiatric nurses.ResultsThe rate of nurses who had encountered patient suicide was 55.0%. The mean Impact of Event Scale-Revised (IES-R) score was 11.4. The proportion of respondents at a high risk (≥ 25 on the 88-point IES-R score) for post-traumatic stress disorder (PTSD) was 13.7%. However, only 15.8% of respondents indicated that they had access to post-suicide mental health care programmes. The survey also revealed a low rate of nurses who reported attending in-hospital seminars on suicide prevention or mental health care for nurses (26.4% and 12.8%, respectively).ConclusionsThese results indicated that nurses exposed to inpatient suicide suffer significant mental distress. However, the low availability of systematic post-suicide mental health care programmes for such nurses and the lack of suicide-related education initiatives and mental health care for nurses are problematic. The situation is likely related to the fact that there are no formal systems in place for identifying and evaluating the psychological effects of patient suicide in nurses and to the pressures stemming from the public perception of nurses as suppliers rather than recipients of health care.

The purpose of the present paper was to investigate the distribution of Zung Self-rating Depression Scale (SDS) scores in a general population and its factor structure. Questionnaires on SDS items were sent to 7136 randomly selected residents aged 20-79 years who lived in districts in Japan with high rates of suicide. Valid responses were received from 5547 residents (response rate: 77.7%). Factor analysis of the SDS scores was conducted. The SDS scores of the male subjects were significantly lower than those of the female subjects in all age groups. A reverse-J-shaped relationship was found between age groups and mean SDS scores for the male and female subjects. The highest mean score was in the age group of 20-39 years, and the lowest mean score was in the age group of 60-69 years for the male and female subjects. In factor analysis, two factors consisting of 12 items were extracted, and 10 of those 12 items covered six Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) criteria describing psychological disturbances of depression. The distribution of SDS scores differed depending on the age group. Major components of SDS in the subjects covered the DSM-IV criteria for psychological disturbances of depression.

Questionnaire surveyA questionnaire survey was carried out from February through June in 2002. For the survey, we selected four of six municipalities in the Kuji District, and three of seven municipalities in the Miyako District, which is located south of the Kuji District. Among the seven municipalities selected for the study, three (two in Kuji and one in Miyako) are in coastal areas and four (two in Kuji and two in Miyako) are located inland. A total of 7,136 people, aged 20 to 79 years, were randomly selected from the Basic Resident Register of each of the seven municipalities. Random sampling was done by city workers of the municipalities with the aid of our research members, and in one of the municipalities subjects were randomly selected from those aged 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 69, 74 and 79 years.

BackgroundThe allocation of outcome of suicide attempters is extremely important in emergency situations. Following categorization of suicidal attempters who visited the emergency room by outcome, we aimed to identify the characteristics and potential needs of each group.MethodsThe outcomes of 1348 individuals who attempted suicide and visited the critical care center or the psychiatry emergency department of the hospital were categorized into 3 groups, "hospitalization in the critical care center (HICCC)", "hospitalization in the psychiatry ward (HIPW)", or "non-hospitalization (NH)", and the physical, mental, and social characteristics of these groups were compared. In addition, multiple logistic analysis was used to extract factors related to outcome.ResultsThe male-to-female ratio was 1:2. The hospitalized groups, particularly the HICCC group, were found to have biopsychosocially serious findings with regard to disturbance of consciousness (JCS), general health performance (GAS), psychiatric symptoms (BPRS), and life events (LCU), while most subjects in the NH group were women who tended to repeat suicide-related behaviors induced by relatively light stress. The HIPW group had the highest number of cases, and their symptoms were psychologically serious but physically mild. On multiple logistic analysis, outcome was found to be closely correlated with physical severity, risk factor of suicide, assessment of emergent medical intervention, and overall care.ConclusionThere are different potential needs for each group. The HICCC group needs psychiatrists on a full-time basis and also social workers and clinical psychotherapists to immediately initiate comprehensive care by a medical team composed of multiple professionals. The HIPW group needs psychological education to prevent repetition of suicide attempts, and high-quality physical treatment and management skill of the staff in the psychiatric ward. The NH group subjects need a support system to convince them of the risks of attempting suicide and to take a problem-solving approach to specific issues.

Reminiscence therapy workshops for health-care professionals (total, n = 105: four trainees in their 20, seven in their 30s, 13 in their 40s, 30 in their 50s, 41 in their 60, five in their 70s, one in their 80s, and four of unknown age) were held, and group work with reminiscence therapy was provided to local residents (total, n = 151; mean age, 73.6 Ϯ 10.6 years). Comparison of pre-and post-workshop questionnaires showed that rates of interest and understanding of trainees increased after the workshop. Concerning group work, 89.2% of the participants felt that reminiscence therapy would prove helpful in their life. Reminiscence therapy may be useful in improving mental health in local residents.

Background: Most suicide attempters suffer from psychiatric disorders, which are often comorbid with personality disorders. The effects of intervention on patients who have attempted suicide with comorbid Axis I and II diagnoses have not been fully elucidated. We evaluated whether assertive case management can reduce the repetition of suicidal behaviours in patients who had attempted suicide with comorbid Axis I and II diagnoses. Methods: This study was a secondary analysis of a randomised controlled trial investigating whether assertive case management could reduce the repetition of suicide attempts, compared with enhanced usual care. Subjects were divided into those who had comorbid Axis I and II diagnoses (Axis I + II group), and those who had an Axis I diagnosis without Axis II comorbidity (Axis I group). Outcome measures were compared between patients receiving a case management intervention and patients receiving enhanced usual care, as allocated. The primary outcome measure was the incidence proportion of the first episode of recurrent suicidal behaviour at 6 months after randomisation. We calculated risk ratios (RR) with 95% confidence intervals (CI) at 6 months and 12 months after randomisation of patients in the Axis I and Axis I + II groups. Results: Of 914 enrolled patients, 120 (13.1%) were in the Axis I + II group, and 794 (86.9%) were in the Axis I group. Assertive case management was significantly effective for the Axis I group on the primary outcome at 6 months (risk ratio [RR] 0.51, 95% confidence intervals [CI] 0.31 to 0.84). The RR of the Axis I + II group was 0.44 (95% CI 0.14 to 1.40). Conclusions: Assertive case management not only had an effect on patients who had attempted suicide with only Axis I disorders but may also have a similar effect on patients with comorbid Axis I and II disorders.

No abstract