Older Adults Who Experience Their Lives to Be Completed and No Longer Worth Living: A Systematic Mini-Review Into Used Terminology, Definitions, and Interpretations

In the Netherlands and in Belgium, a political debate emerged regarding the possibility of euthanasia and assisted suicide (EAS) for older adults who experience their lives as completed and no longer worth living, despite being relatively healthy. This mini-review aimed to (1) present an overview of the terms used to denote this phenomenon as well as their definitions and to (2) explore how the underlying experiences are interpreted by the study authors. A systematic search was performed in Web of Science, MEDLINE, PsycINFO, and CINAHL, yielding 35 articles meeting the selection criteria. We selected empirical, English-language articles published in peer-reviewed journals. Participants had to have a first-person experience of the phenomenon or be assessed for it, or have a third-person experience of the phenomenon. Results show that the terms tiredness of life (ToL) and weariness of life (WoL) were used most frequently, also in the broader literature on suicidal expressions across the life span. Many studies mentioned operational definitions or synonyms rather than theoretical definitions. Moreover, inside the EAS debate, the term ToL was more common, its definition incorporated death wishes, and it was regularly framed existentially. Outside of this debate, the phenomenon was generally considered as a part of suicidal ideation distinct from death wishes, and its experience was often associated with underlying psychopathology. We discuss the need to establish consensus definitions and conclude that only a multidimensional view may be suitable to capture the complex nature of the phenomenon.

The Death Wish in the Hebrew Bible

This is the first book to systematically investigate the texts in the Hebrew Bible in which a character expresses a wish to die. Contrary to previous scholarship on these texts that assumed these death wishes were simply a desire to escape suffering, Hanne Løland Levinson employs narrative criticism and conversation analysis, together with diachronic methods, to carefully hear each death-wish text in its literary context. She demonstrates that death wishes embody powerful, multi-faceted rhetorical strategies. Grouping the death-wish texts into four main rhetorical strategies of negotiation, expression of despair and anger, longing to undo one's existence, and wishing for a different reality, Løland Levinson portrays the complex reasons why characters in the Hebrew Bible wish for death. She concludes that the death wishes navigate the tension between longing for death and fighting for survival - a tension that many live with also today as they attempt to claim agency and autonomy in life.

Effects of Educative Materials on Doctors' Intention to Initiate Life-Saving Procedures After a Suicide Attempt: Randomised Controlled Trial

Introduction: The topic of euthanasia, assisted dying, and how to deal with death wishes has received strong public and media attention in many countries. Nevertheless, there is currently no research which has analysed if educative materials that favour or disfavour the initiation of life-saving measures after a suicide attempt impact on attitudes to initiate such procedures among physicians.Materials and Methods: A double-blind randomised controlled trial was conducted to test if educative materials that either support life-saving measures or rather recommend against it after a near-fatal suicide attempt has an effect on intentions to initiate such measures (trial registration: DRKS00024953, www.drks.de). N = 192 doctors from the Medical University Vienna (Austria) participated in the study and either read educative materials not recommending (n = 59), or recommending life-saving measures (n = 64), or were not reading educative materials (n = 69, control group). The primary outcome was intentions to initiate life-saving measures in an open case vignette featuring the case of a terminally ill cancer patient. Other variables assessed were demographics, experiences with terminally ill and dying patients, training or qualification in mental health, specialty, position, whether doctors worked in emergency medicine, and attitudes toward assisted dying. A logistic regression analysis was used.Results: There was no immediate effect of educative materials on intentions to initiate life-saving measures, χ2(2) = 0.94, p = 0.63. The adjusted model including all tested predictors was significant [χ2(15) = 37.82, df = 15, p < 0.001]. Attending position, male gender, low age, and more negative attitudes to assisted dying predicted a decision for life-saving measures. Higher agreement with life-saving measures was reported for a case vignette about a patient with schizophrenia than for a case vignette about a patient with Huntington's disease.Discussion: Educative materials either favouring or disfavouring the initiation of life-saving measures after a suicide attempt do not appear to immediately influence related decision-making processes. Related intentions appear mainly influenced by personal opinions on the topic and by the specific patient case. Good-quality in-depth discussions regarding end-of-life decisions and to develop well-founded and non-opinionated guidelines are highly warranted.

Exploring the factors associated with coronaphobia among physicians during the COVID-19 outbreak in Egypt

Background Coronaphobia refers to intensified and persistent fears of contracting COVID-19 virus infection. This study aimed to evaluate the newly termed phenomenon, coronaphobia, and address its associated correlates among Egyptian physicians during the outbreak. A cross-sectional study, including a total of 426 Egyptian physicians working during COVID-19 outbreak, was conducted between March 1st and May 1st, 2020. The Fear of COVID-19 Scale (FCV-19S) and Hospital Anxiety and Depression Scale (HADS) were utilized for assessment of coronaphobia, and comorbid anxiety and depressive symptoms among physicians, respectively during the outbreak. Results Moderate-to-severe symptoms of anxiety and depression were reported by 28% and 30% of physicians, respectively. Physicians experiencing higher levels of coronaphobia were more likely to be females, nonsmokers, having death wishes and/or self-harming thoughts, receiving insufficient training, dissatisfied with their personal protective equipment (PPE), and had colleagues infected with COVID-19 virus infection. Coronaphobia was positively correlated with anxiety (r = 0.59, P < 0.001) and depressive symptoms (r = 0.47, P < 0.001). Conclusions Egyptian physicians experienced higher levels of coronaphobia, anxiety, and depressive symptoms during the COVID-19 outbreak. Yet, frontline physicians did not differ from their second-line counterparts regarding the aforementioned symptoms. Routine mental and physical assessment measures of medical staff should be implemented.

Suicidal Ideations and Behavior in Patients With Young and Late Onset Dementia

Background and Objectives: Data on suicidal ideation, behavior and the risk factors in patients with dementia is scarce. To evaluate the prevalence of death wishes, suicidal ideation, and suicidal behavior of young (YOD) and late onset dementia (LOD) and to identify risk factors for suicidal ideation and behavior.Methods: We interviewed 157 family caregivers of patients with advanced dementia using questions from the Columbia-Suicide Severity Rating Scale to gather information about suicidal ideation and behavior before the onset of symptoms of dementia, after the onset of dementia and within 30 days prior to the interview. At the time of the interview, we also assessed disease severity, cognitive function, and other psychological, behavioral and physical symptoms of the patients as well as the caregivers' psychological well-being.Results: Forty four (28%) of the patients expressed suicidal ideation or behavior at some time after the onset of symptoms, and 14 (9%) of these within the month prior to the assessment. Two patients had attempted suicide after the onset of dementia. There were no statistically significant differences between patients with and without suicidal ideations or behavior with regards to demographics or age at onset of dementia. In patients with advanced dementia, Alzheimer's disease (rather than frontotemporal lobar degeneration), better cognitive function, more severe psychological, behavioral, and physical symptoms, and a reduced quality of life were associated with the expression of suicidal ideation.Conclusions: According to caregivers' reports, majority of patients with dementia did not express suicidal ideation or show suicidal behavior. Patients who expressed suicidal ideation during early stages of dementia often stopped expressing them in advanced stages. It remains unclear if this was due to reduced communication abilities, a reduction of disease awareness, and/ or an adjustment to their situation.

A Study to Assess the Suicide Risk of Patients Admitted in t Psychiatric Ward with a View to Develop a Guideline for Staff Nurses on the Nursing Care of Patients with Suicide Risk, in a Tertiary Hospital, Kochi

Background: Everyone in the mental health system may be at one time or the other, at risk for self harm and suicide. This study was done to assess the suicidal risk of patients who are admitted in psychiatric ward of a tertiary care hospital at Kochi, Kerala and to develop a guidelines for suicidal prevention for staff nurses. Materials and Methods: The research design adopted for this study was non-experimental descriptive design. The sample for the present study consisted of 30 patients who are admitted in psychiatry ward of Amrita Institute of Medical Science, Kochi. The sampling technique used is convenience sampling. The researchers developed a suicide risk assessment scale. The validity and reliability of the tool was tested. The method used in this study was interview with structured questionnaire. Result: Results shown that 100% did not have suicidal plan as such, but 13.3% of them had death wishes. Majority of the subjects i.e 96.6% had symptoms such as guilt, hopelessness, helplessness, shame, impaired problem solving. In 69%of the subjects there were more than 4 symptoms, 90% of the subjects had significant life events such as financial loss, loss of loved one, love failure, failure in examination, majority of them i.e 74.1% had at least 2 events. History of suicide attempt is seen only in 6.7% of the subjects, 93.3% of them didn’t have any such attempts. Moreover 16.7% of them have family history of suicide and 83,3% of them didn’t have any significant history. There was a significant association between suicidal risk and educational level. Conclusion: Many patients had expressed the depressive symptoms and also it has been observed that there was a significant association between suicidal risk and educational level. A guideline for suicidal prevention has been distributed to all staff nurses working in the psychiatric ward after getting validated from experts. Keywords: Suicidal risk, Staff nurses guidelines, psychiatric patients, nursing care of suicidal risk.

Assessing the Determinants of the Wish to Die among the Elderly Population in Ghana

Background: A wish to die is common in elderly people. Concerns about death wishes among the elderly have risen in Ghana, where the ageing transition is comparable to other low-and middle-income countries. However, nationally representative research on death wishes in the elderly in the country is not readily available. Our study aimed to assess the determinants of the wish to die among the elderly in Ghana. Methods: We analysed data from the World Health Organisation Global Ageing and Adult Health Survey, Wave 1 (2007–2008) for Ghana. Data on the wish to die, socio-demographic profiles, health factors and substance abuse were retrieved from 2147 respondents aged 65 and above. Ages of respondents were categorised as 65–74 years; 75–84 years; 85+ to reflect the main stages of ageing. Logistic regression models were fitted to assess the association between these factors and the wish to die. Results: Age, sex, place of residence, education, body mass index, hypertension, stroke, alcohol consumption, tobacco use, income, diabetes, visual impairment, hopelessness and depression had statistically significant associations with a wish to die. Older age cohorts (75–84 and 85+) were more likely to have the wish to die (AOR = 1.05, CI = 1.02-1.16; AOR = 1.48, CI = 1.22–1.94), compared to younger age cohorts (65–74 years). Persons who felt hopeless had higher odds (AOR = 2.15, CI = 2.11–2.20) of experiencing the wish to die as compared to those who were hopeful. Conclusions: In view of the relationship between socio-demographic (i.e., age, sex, education and employment), hopelessness, anthropometric (body mass index), other health factors and the wish to die among the elderly in Ghana, specific biopsychosocial health promotion programmes, including timely identification of persons at risk, for appropriate intervention (e.g., psychotherapy, interpersonal support, alcohol-tobacco cessation therapy, clinical help) to promote their wish for a longer life is needed.

International study of definitions of English-language terms for suicidal behaviours: a survey exploring preferred terminology

ObjectivesExplore international consensus on nomenclatures of suicidal behaviours and analyse differences in terminology between high-income countries (HICs) and low/middle-income countries (LMICs).DesignAn online survey of members of the International Organisation for Suicide Prevention (IASP) used multiple-choice questions and vignettes to assess the four dimensions of the definition of suicidal behaviour: outcome, intent, knowledge and agency.SettingInternational.ParticipantsRespondents included 126 individuals, 37 from 30 LMICs and 89 from 33 HICs. They included 40 IASP national representatives (65% response rate), IASP regular members (20% response rate) and six respondents from six additional countries identified by other organisations.Outcome measuresDefinitions of English-language terms for suicidal behaviours.ResultsThe recommended definition of ‘suicide’ describes a fatal act initiated and carried out by the actors themselves. The definition of ‘suicide attempt’ was restricted to non-fatal acts with intent to die, whereas definition of ‘self-harm’ more broadly referred to acts with varying motives, including the wish to die. Almost all respondents agreed about the definitions of ‘suicidal ideation’, ‘death wishes’ and ‘suicide plan’. ‘Aborted suicide attempt’ and ‘interrupted suicide attempt’ were not considered components of ‘preparatory suicidal behaviour’. There were several differences between representatives from HICs and LMICs.ConclusionThis international opinion survey provided the basis for developing a transcultural nomenclature of suicidal behaviour. Future developments of this nomenclature should be tested in larger samples of professionals, including LMICs may be a challenge.

Yiddish Phraseology: Ill Wishes

The present research featured Yiddish idioms of ill-wishing, which can be considered as both phraseological units and micro-texts. The study featured semantic and stylistic analysis, analysis of dictionary definitions, and the traditional descriptive method. The authors tried to answer some current issues using the case of Yiddish ill wishes. The paper focuses on cultural, mythological, religious, and universal foundations of phraseology, as well as the functions of the idioms in question. It introduces some thematic and semantic characteristics of Yiddish ill wishes, e.g. get-ill wishes, death-wishes, ill wishes per se, cursing one’s family, etc., as well as their lexical and grammatical stylistic features. Yiddish ill wishes proved to form a specific component of the Yiddish lexicon, motivated by both popular and less obscure religious, historical, and cultural archetypes and scenarios. It is their external and internal form that makes these phraseological units ill wishes: stylistically and pragmatically, they represent humorous and sarcastic phraseological units of reproachful character and interjective nature. The research results can be used for further linguistic and cultural studies.