On Attempted Suicide, with an Analysis of 1,000 Consecutive Cases

1913 ◽  
Vol 59 (246) ◽  
pp. 428-478 ◽  
Author(s):  
W. Norwood East
Keyword(s):  
Medical Staff ◽  
Attempted Suicide ◽  
Mental Condition ◽  
Clinical Material ◽  
A Charge

A considerable number of men are received annually into Brixton prison remanded, or committed for trial, on a charge of attempted suicide. They are all specially examined as to their mental condition, and a large number of them are remanded for that purpose. From the plentiful clinical material thus studied these remarks were prepared whilst I was on the medical staff of that prison, and I have to thank the Prison Commissioners for their permission to publish them.

reports described him as ‘emotionally unstable’ and in a ‘grossly elevated neurotic state’. The judge refused to admit the evidence, and on appeal following conviction it was contended that he was wrong. The primary contention was that the appellant’s pre-existing mental condition made him vulnerable to threats. Held, dismissing the appeal, the duress relied upon was duress by threats, but in some cases a defendant might be able to rely on ‘duress by circumstances’ (see Conway [1989] QB 290; Martin [1989] 1 All ER 652), and although not argued in this way it was proposed to consider whether the medical evidence could have been introduced on the basis that Hegarty might have been able to set up such a defence. Duress by threats provided a defence to a charge of any offence other than murder (see Howe [1987] AC 417), attempted murder (see Gotts [1982] 2 AC 412) and some forms of treason. It was founded on public policy considerations (see AG v Whelan [1934] IR 518). The fact that the defendant’s mind had been ‘overborne’ by the threats did not mean that he lacked the requisite intent to commit the crime (see DPP for Northern Ireland v Lynch [1975] AC 653, 703B). It followed that the law might have developed on the lines that, when considering duress, a purely subjective test should be applied, and it might well develop in this way in the future (see Law Com 218, para 29.14, November 1993, Cmnd 2370 and draft Criminal Law Bill, cl 25(2)). As the law stood however the test was not purely subjective but required an objective test to be satisfied (Howe). The jury had to consider the response of a sober person of reasonable firmness ‘sharing the characteristics of the defendant’. They could take account of age, sex and physical health, but it was open to consideration whether the shared characteristics could include a personality disorder of the kind suffered by the appellant. His counsel argued that the expert evidence was relevant to explain the reaction of a man like him to threats of violence to himself and his family, and admissible because the pathological aspects of his personality and the effect of his disorder on his behaviour were matters which lay outside the knowledge and experience of a judge and jury. Counsel referred to a passage in Emery (1993) 14 Cr App R (S) 394, 398 where Lord Taylor CJ said that: ‘... The question for the doctors was whether a woman of reasonable firmness with the characteristics of [the appellant], if abused in the manner which she said, would have had her will crushed so that she could not have protected her child.’ It was accepted that for the purposes of the subjective test medical evidence was admissible if the mental condition or abnormality was relevant and its effects lay outside the knowledge and experience of laymen. In the present case, the reports before the judge did not go that far, and the judge had to decide on the material before him. There were no grounds for disturbing his decision. As the evidence was not admissible to explain the reaction of the appellant himself, it was clearly not admissible on the objective test. The passage cited could not be read in isolation,

1996 ◽  
pp. 568-568
Keyword(s):  
Northern Ireland ◽  
Criminal Law ◽  
Mental Condition ◽  
Objective Test ◽  
Medical Evidence ◽  
Subjective Test ◽  
Attempted Murder ◽  
The Law ◽  
Set Up ◽  
A Charge

scholarly journals The pattern of crisis calls to a suicide telephone helpline service in Nigeria

2020 ◽  
Vol 6 (3) ◽  
pp. 246-257
Author(s):  
RE Ogbolu ◽  
BO Oyatokun ◽  
K Ogunsola ◽  
TA Adegbite ◽  
T Tade ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Attempted Suicide ◽  
Scale Up ◽  
Mental Condition ◽  
Mental Health Information ◽  
Telephone Helpline ◽  
The Mean ◽  
Telephone Calls

Background: Suicide is the deliberate killing of oneself. Although it is preventable, suicide accounts for over 800,000 global deaths annually. There is the need to scale-up prevention strategies, and one of these strategies is the provision of suicide telephone helplines. Objectives: To describe the pattern of calls received by a suicide telephone helpline and the types of intervention provided in a Nigerian facility. Methods: This was a descriptive study of the first 100 completed calls received on a 24-hour suicide telephone helpline service by trained responders. Results: All the calls emanated from 14 states of the federation, with the majority (83.0%) from the Southern parts of the country. The reasons for the telephone calls varied from crisis situations (47.0%) to telephone number-verification (27.0%), mental health information (20.0%), and others (6.0%). The mean age of the crisis -situation callers was 25.8 years, with a slight female preponderance (53.2%); most were single in marital status (68.1%) and unemployed (70.2%). A majority (72.3%) of the callers had an underlying mental condition, 68.1% had suicidal ideation while 12.8% had previously attempted suicide. All the crisis callers were offered interventions ranging from phone counselling to linkage to the nearest mental health services. Conclusion: A majority of the crisis callers were offered mental health services, raising the possibility that the availability of telephone helplines may play a role in suicide prevention in Nigeria.

scholarly journals Analysis of the Coping Ability and Mental Health of Medical Staff toward COVID-19 in Henan, China

2020 ◽  
Author(s):  
Songyang Cui ◽  
Lei Yin ◽  
Yuanyuan Shi ◽  
Mengying Fan ◽  
Xiu Yang ◽  
...  
Keyword(s):  
Mental Health ◽  
Psychological Health ◽  
Medical Staff ◽  
Early Stage ◽  
Older Age ◽  
Mental Condition ◽  
Cross Sectional ◽  
Coping Capacity ◽  
Coping Ability ◽  
The Government

Abstract Background Outbreak of COVID-19 imposed great pressure on the professional work and psychological health of medical staff, especially in the early stage. To assess the coping ability and mental health status of medical workers and find influencing factors on them during the early stage of the COVID-19 outbreak.Methods A cross-sectional study was conducted among medical staff in Henan from January 29th to February 4th with a total of 1739 participates involved. A self-made questionnaire used to evaluate the coping ability and mental health condition.Results The majority of the participants (96.8%) had coping ability scores (Median, 81; IQR, 75~87) above the passing line. The mental health scores of all the respondents were 58 (median; IQR, 44~68). Multivariate logistic regression analyses showed that older age, higher education level, and distrust in unofficial information were facilitating factors for better emergency copying ability among medical workers. For mental condition, medical workers had 3 promoting factors: older age, distrust of unofficial information, and not involved in the event. On the other hand, poor physical health was a risk factor. (P<0.05)Conclusions In the early stage, the overall coping ability and mental health of medical workers in Henan were relatively good, but the government needs to pay more attention to the coping capacity and mental health of medical workers who are younger, less educated, blind to unofficial information and in poor physical condition.

The Personality in Psychomotor Epilepsy Compared with the Explosive and Aggressive Personality

1974 ◽  
Vol 125 (586) ◽  
pp. 221-229 ◽  
Author(s):  
Per Kristianson
Keyword(s):  
Personality Traits ◽  
Personality Trait ◽  
High Frequency ◽  
Chronic Alcoholism ◽  
Mental Condition ◽  
Clinical Material ◽  
Normal Character ◽  
Psychomotor Epilepsy ◽  
Aggressive Reactions ◽  
Aggressive Personality

Amark (1951, p. 154) discovered a high frequency of ixoid and ixothymic personality traits resembling those encountered among epileptics in a clinical material (49.5 per cent), and institutional material (38.0 per cent) and a material from the Temperance Board (37.1 per cent). Amark's description of these ‘epileptoid’ personality traits (1951, p. 151)) which also covers normal character variations, is fairly wide and includes a tendency to perseveration, adhesiveness, explosions or dysphoric states of dejection, querulousness and paranoid reactions. In a previous study (Kristianson, 1970, p. 173) it was suggested that Amark probably overestimated the frequencies of ixoid and ixothymic personalities, because alcoholics are so often explosive. But this quite unspecific pattern of behaviour is not sufficient for the diagnosis of ‘epileptoid’ traits, if this concept is to have a reasonable definition. Explosive aggressiveness is scarcely a primary personality trait, but is one of the symptoms of a deterioration in the chronic alcoholic's mental condition. However, it is important to differentiate these explosive aggressive reactions caused by chronic alcoholism from the adequately defined personality traits of epileptics. This problem of differentiation will be analysed in greater detail in this study.

Analysis of Deliberate Self-Wrist-Cutting Episodes Presenting to the Emergency Department

Crisis ◽  
2016 ◽  
Vol 37 (2) ◽  
pp. 155-160 ◽  
Author(s):  
Jin Kim ◽  
Han Joon Kim ◽  
Soo Hyun Kim ◽  
Sang Hoon Oh ◽  
Kyu Nam Park
Keyword(s):  
Emergency Department ◽  
Medical Records ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Psychiatric Interview ◽  
Clinical Variables ◽  
Completed Suicide ◽  
Number Of Patients ◽  
Group A ◽  
Efficacy Of Treatment

Abstract. Background: Previous suicide attempts increase the risk of a completed suicide. However, a large proportion of patients with deliberate self-wrist cutting (DSWC) are often discharged without undergoing a psychiatric interview. Aims: The aims of this study were to investigate the differences in the characteristics and outcomes of patients with DSWC and those with deliberate self-poisoning (DSP) episodes. The results of this study may be used to improve the efficacy of treatment for DSWC patients. Method: We retrospectively reviewed the medical records of 598 patients with DSWC and DSP who were treated at the emergency department of Seoul Saint Mary's Hospital between 2008 and 2013. We assessed sociodemographic information, clinical variables, the reasons for the suicide attempts, and the severity of the suicide attempts. Results: A total of 141 (23.6%) patients were included in the DSWC group, and 457 (76.4%) were included in the DSP group. A significantly greater number of patients in the DSWC group had previously attempted suicide (p = .014). A total of 63 patients (44.7%) in the DSWC group and 409 patients (89.5%) in the DSP group underwent psychiatric interviews. Conclusion: More DSWC patients had previously attempted suicide, but fewer of them underwent psychiatric interviews compared with the DSP patients.

Emergency Department Admission and Mortality Rate for Suicidal Behavior

Crisis ◽  
2014 ◽  
Vol 35 (6) ◽  
pp. 406-414 ◽  
Author(s):  
Raimondo Maria Pavarin ◽  
Angelo Fioritti ◽  
Francesca Fontana ◽  
Silvia Marani ◽  
Alessandra Paparelli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Metropolitan Area ◽  
Suicidal Behavior ◽  
Mortality Risk ◽  
Illicit Drugs ◽  
Attempted Suicide ◽  
Cox Model ◽  
Emergency Department Admission ◽  
Completed Suicide

Background: The international literature reports that for every completed suicide there are between 8 and 22 visits to an Emergency Department (ED) for attempted suicide/suicidal behavior. Aims: To describe the characteristics of admission to emergency departments (EDs) for suicide-related presenting complaints in the metropolitan area of Bologna; to estimate the risk for all-cause mortality and for suicide; to identify the profiles of subjects most at risk. Method: Follow-up of patients admitted to the EDs of the metropolitan area of Bologna between January 2004 and December 2010 for attempted suicide. A Cox model was used to evaluate the association between sociodemographic variables and the general mortality risk. Results: We identified 505 cases of attempted suicide, which were more frequent for female subjects, over the weekend, and at night (8:00 p.m./8:00 a.m.). The most used suicide methods were psychotropic drugs, sharp or blunt objects, and jumping from high places. In this cohort, 3.6% of subjects completed suicide (4.5% of males vs. 2.9% of females), 2.3% within 1 year of the start of follow-up. The most common causes of death were drug use and hanging. In the multivariate analysis, those who used illicit drugs 24 hr prior to admission to the ED (hazard ratio [HR] = 3.46, 95% CI = 1.23–9.73) and patients who refused the treatment (HR = 6.74, 95% CI = 1.86–24.40) showed an increased mortality risk for suicide. Conclusion: Deliberate self-harm patients presenting to the ED who refuse treatment represent a specific target group for setting up dedicated prevention schemes.

Epidemiological Trends in Attempted Suicide in Adolescents and Young Adults Between 1996 and 2004

Crisis ◽  
2009 ◽  
Vol 30 (3) ◽  
pp. 115-119 ◽  
Author(s):  
Stephanie De Munck ◽  
Gwendolyn Portzky ◽  
Kees Van Heeringen
Keyword(s):  
Young Adults ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Epidemiological Studies ◽  
Adolescents And Young Adults ◽  
University Hospital ◽  
International Studies ◽  
Suicide Attempters ◽  
Increased Risk ◽  
Epidemiological Trends

Background: Notwithstanding the epidemiological studies indicating an increased risk of attempted suicide among adolescents and young adults, there is a scarcity of international studies that examine long-term epidemiological trends in rates and characteristics of this vulnerable group. Aims: This article describes the results of a 9-year monitoring study of suicide attempts in adolescents and young adults referred to the Accident and Emergency Department of the Gent University Hospital (Belgium). Methods: Between January 1996 and December 2004, trends, sociodemographic, and methodrelated characteristics of suicide attempts were assessed by a psychiatrist on data sheets. Results: Attempted suicide rates declined from 1996 to 2001 and then rose until 2004, but did not exceed previous rates. During the 9 years of monitoring, there was a preponderance of female suicide attempters, except for 1997. Rates of attempts and of fatal suicide were negatively correlated. Significantly more males than females deliberately injured themselves. Younger attempters, especially females, significantly more often poisoned themselves with analgesics. In nearly one in five attempts, alcohol was used in combination with other methods, and alcohol intake was more commonly observed in older suicide attempters. Nearly half of the adolescents were identified as repeaters. Conclusions: The results of this study warrant further monitoring of trends and characteristics of young suicide attempters.

Letter to the Editor: On Suicide and Attempted Suicide During Pregnancy

Crisis ◽  
1999 ◽  
Vol 20 (1) ◽  
pp. 22-22 ◽  
Author(s):  
G Vaiva ◽  
E Teissier ◽  
O Cottencin ◽  
P Thomas ◽  
M Goudemand
Keyword(s):  
Attempted Suicide ◽  
Letter To The Editor

Stakeholder Perspectives on the Stigma of Suicide Attempt Survivors

Crisis ◽  
2017 ◽  
Vol 38 (2) ◽  
pp. 73-81 ◽  
Author(s):  
Lindsay L. Sheehan ◽  
Patrick W. Corrigan ◽  
Maya A. Al-Khouja ◽  
Keyword(s):  
Suicide Attempt ◽  
Health Professionals ◽  
Attempted Suicide ◽  
Community Based Participatory Research ◽  
Public Stigma ◽  
Suicide Method ◽  
Community Based ◽  
Stakeholder Perspectives ◽  
Personal Experiences ◽  
Prejudice And Discrimination

Abstract. Background: Past scholarly efforts to describe and measure the stigma surrounding suicide have largely viewed suicide stigma from the perspective of the general public. Aims: In the spirit of community-based participatory research (CBPR), the current study brought together a diverse stakeholder team to qualitatively investigate the suicide stigma as experienced by those most intimately affected by suicide. Method: Seven focus groups (n = 62) were conducted with suicide attempt survivors, family members of those who died by suicide, and suicide loss therapists. Results: Themes were derived for stereotypes (n = 30), prejudice (n = 3), and discrimination (n = 4). People who attempted suicide were seen as attention-seeking, selfish, incompetent, emotionally weak, and immoral. Participants described personal experiences of prejudice and discrimination, including those with health professionals. Conclusion: Participants experienced public stigma, self-stigma, and label avoidance. Analyses reveal that the stigma of suicide shares similarities with stereotypes of mental illness, but also includes some important differences. Attempt survivors may be subject to double stigma, which impedes recovery and access to care.

Outreach Psychiatric Emergency Service

Crisis ◽  
2020 ◽  
Vol 41 (5) ◽  
pp. 375-382
Author(s):  
Remco F. P. de Winter ◽  
Mirjam C. Hazewinkel ◽  
Roland van de Sande ◽  
Derek P. de Beurs ◽  
Marieke H. de Groot
Keyword(s):  
General Practitioner ◽  
General Hospital ◽  
Suicidal Behavior ◽  
Emergency Service ◽  
Attempted Suicide ◽  
Emergency Services ◽  
Psychiatric Emergency ◽  
Psychiatric Emergency Services ◽  
Psychiatric Emergency Service ◽  
Suicidal Patients

Abstract. Background: Outreach psychiatric emergency services play an important role in all stages of a suicidal crisis; however, empirical assessment data are scarce. This study describes characteristics of patients assessed by these services and involved in suicidal crises. Method: During a 5-year period, detailed information from psychiatric emergency service assessments was recorded; 14,705 assessments were included. Characteristics of patients with/without suicidal behavior and with/without suicide attempts were compared. Outcomes were adjusted for clustering of features within individual patients. Results: Suicidal behavior was assessed in 32.2% of patients, of whom 9.2% attempted suicide. Suicidal behavior was most commonly associated with depression or adjustment disorder and these patients were referred to the service by a general practitioner or a general hospital, whereas those who attempted suicide were less likely to be referred by a general practitioner. Those who attempted suicide were more likely to be female and have had a referral by a general hospital. Self-poisoning by medication was the most common method of attempting suicide. Limitations: Bias could be due to missed or incomplete assessments. Primary diagnoses were based on clinical observation at the time of the assessment or on the primary diagnosis previously recorded. In addition, suicidal behavior or attempted suicide might have been underestimated. Conclusions: Suicidal behavior is commonplace in assessments by psychiatric emergency services. Suicidal patients with/without a suicide attempt differed with respect to demographic features, primary diagnoses, and referring entities, but not with respect to treatment policy. About 40% of the suicidal patients with/without an attempt were admitted following assessment.

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