Personal and Professional Knowledge of and Experience With Suicide and Suicide Prevention Among Stakeholders in Clinical and Community Practice

Community-dwelling veterans at risk for suicide may be in contact with a variety of providers in agency-based settings that offer health and human services. The study aim is to describe the perspective of agency-based clinical and community providers who may come into contact with veterans in need of suicide prevention services and to examine the nature of their personal and professional relationships to individuals at risk for suicide among this sample.

This study reports on qualitative data from a sample of Veterans’ Affairs (VA) and community providers serving veterans and military families in one Midwestern state (N = 70). Providers completed a survey assessing exposure to suicide, including contact with and relationship to someone suicidal, and organizational characteristics of the providers’ employing agencies. Semi-structured interview questions probed for the nature of how they would react with suicidal individuals. Most providers (94%) had some prior contact with someone who was suicidal, and nearly three quarters (77%) knew someone who had died by suicide. Providers reported powerful emotional responses of sadness and remorse to suicidal experiences. While these providers interact with veterans and military families as part of their jobs, they may have their own history of being exposed to suicide, both professionally and personally.     

Confronting Cruelty

Abstract

The present article reports on a study of the attitudes and behaviour of young people towards help-seeking during times of emotional distress and, in particular, when contemplating suicide. Twent- one young people aged between 16 and 24 years, as well as six parents and 14 youth service providers who lived in ‘Subcity’, a metropolitan community, were interviewed about their understandings of youth suicide and effective interventions. Nearly all the young people, service providers and parents identified a range of barriers that impede or prevent young people from asking for help when they need it most, including issues related to trust and confidentiality, parental support and fear, stigma and perceived loss of esteem. Implications for social work practice include an emphasis on developing parenting skills and community development related to education about suicide and the provision of appropriate support services.     

Disentangling over-representation of parents with disabilities in the child welfare system: Exploring child maltreatment risk factors of parents with disabilities

The study explores the risk factors for child maltreatment and self-reported child maltreatment among a population-based sample of parents with disabilities. Drawing on a nationally-representative, population-based data file that oversampled people of color, income-adjusted odds ratio tests were conducted to establish population differences among parents with and without limitations in activities of daily living (ADLs). Results suggest that parents with disabilities were more likely to report many of the risk factors associated with child maltreatment than parents without disabilities, including witnessing interpersonal violence as a child; experiencing violence, neglect or a foster care stay as a child; mood or substance use disorders; and engaging in or receiving interpersonal violence as an adult. Before controlling for income, parents with disabilities had only a negligibly higher rate of engaging in violence against their children. After controlling for income, parents with disabilities were 2.5 times more likely to engage in violence against their children. Parents with disabilities who did engage in violence against their children had greater amounts of some of the child maltreatment risk factors in comparison to parents with disabilities who did not engage in violence, particularly their own childhood experiences of maltreatment, witnessing of interpersonal violence as a child, childhood stays in foster care, and experiences with interpersonal violence as an adult. Findings add to the understanding of the risk factors for child maltreatment that are related to the collateral effects of having a disability, and through the use of income-adjusted data, help disentangle why parents with disabilities are over-represented in the child welfare system. The findings highlight the need for the child welfare system to increase its disability competence in working with both children and parents with disabilities.     

An mHealth Approach to Extend a Brief Intervention for Adolescent Alcohol Use and Suicidal Behavior: Qualitative Analyses of Adolescent and Parent Feedback

Abstract

Mobile health (mHealth) tools that supplement inpatient psychiatric care can maintain and enhance intervention effects following hospitalization. Adolescents hospitalized following a suicidal event represent a vulnerable population who could greatly benefit from such an mHealth intervention. In specific, suicidal adolescents who drink alcohol are in need of robust interventions that address the bidirectional relationship between alcohol use and suicidal thoughts and behaviors, because it puts them at especially high risk for suicide upon discharge. The purpose of this study was to conduct qualitative interviews to gather feedback to improve a brief alcohol intervention provided to suicidal adolescents during psychiatric hospitalization, and to develop a mHealth tool to extend care after discharge. Participants, eight adolescents and their parents, identified the need for a smartphone application to deliver intervention content to adolescents and parents during the posthospitalization period. Adolescents sought support in meeting alcohol- and mood-related goals, while parents desired general resources as well as tips for conversations with their adolescent about mood and alcohol use.     

Adoptions by Single Parents

Adoptions by single parents are thought by the public and by adoption professionals to be a plan for children needing adoption which is less advantageous for the child than a two parent adoption. For this reason, children who are difficult to find homes for are often placed with single parents; these are usually older children whose experiences have led to emotional and behavioral problems. Single persons who wish to parent an infant often adopt a child from another country. A review of the literature concerning single parent adoptions, and examination of the findings of a longitu- dinal study, indicate that the single persons who adopt are well able to carry out the responsibilities of parenting. They handle the special issues of adoption competently. Because children placed with single parents are frequently children with complex needs, and because single parents do not have a partner to share the responsibilities of parenting, continuing support from family and friends, the commu- nity, and from the adoption agency are important. Children adopted by single parents are as well adjusted as children adopted into two parent homes. There is some evidence that single parent homes may have unique strengths and be the placement of choice for some children.     

The role of psychological factors on teenagers who become parents out-of-wedlock

This paper presents the role of psychological factors in teenagers who become parents out of wedlock. It talks on the normative adolescent psychological development, emphasizing the developmental thrust towards separation, but juxtaposes the deviant psychological development of teenagers who are unable to gain control of their childbearing. The different experiences of female and male teenagers and the meaning of parenthood are cited. The pre-existing, intrinsic, psychological dynamics that predispose these vulnerable teenagers to early childbirth includes unmet early dependency needs; the desire to appear as adults, while simultaneously wanting to remain as children; denial of parenthood risk; and denial of the demands of babies. Furthermore, male teenagers perceive fatherhood as an attainment of some psychological sense of manhood. While for both males and females, the unconscious acceptance of dependency on the government to provide for the basic needs of their children and themselves can be a way of psychologically gratifying their own needs. The impact of early childhood experiences, role of parents as models, family experiences, social class, changing societal sexual mores, urban living, education and a sense of future are explicated. The influence of cognitive challenges and of specific psychiatric illness is also discussed. This study concludes that social policy integrate an understanding in the crafting of domestic policy on teenage parenthood.     

Childhood trauma and risk for suicidal distress in justice-involved children

Justice-involved children (JIC) have higher rates of trauma exposure and suicidality than the general population. The Childhood Trauma Model predicts that children can accumulate multiple traumatic experiences that can be more harmful than a single traumatic event. The purpose of this study is to investigate the individual and cumulative effects of childhood trauma on suicidal distress among JIC. The study employs logistic regression to analyze panel data on 2367 12–16 year-olds from the Florida Department of Juvenile Justice (FLDJJ). The study shows that 9 types of individual traumatic experiences increased risk for suicidal ideation from 22 to 180%. For one unit increase in the trauma score, the risk for suicidal distress increased 25%, so that JIC who experienced 5 types of traumas were 2.4 times more likely to experience suicidal distress as JIC who experienced a single trauma. These findings illustrate the need to invest mental health services and suicide prevention resources in populations in the juvenile justice system. Intervention must be tailored to serve children who suffered specific traumatic events, as well as those who experience multiple types of trauma. Further, policies that manage JIC as kid criminals rather than as traumatized children may exacerbate their suicidality and problematic behavior.     

Promoting effective working with parents with learning disabilities

The children of parents with learning disabilities are increasingly coming to the attention of child protection and children in need services. The current framework within which services are delivered identi?es the need to work cooperatively both across agencies and with parents themselves. The decisions taken by practitioners in the course of their assessment and support work should be in?uenced by a recognition of where the risks to this group of children lie and which factors are most likely to be associated with positive outcomes. This paper outlines risks to children associated with the parents' dif?culty in accessing appropriate antenatal care and the risk of developmental delay arising from both genetic and environmental in?uences. This group of children are also more likely to experience behaviour problems and language delay. Research has indicated a risk of neglect, but abuse, where it does occur, is more likely to be associated with partners or relatives. It is also clear that some children are more at risk than others, and intellectually able children, as well as those with high levels of dependency, may be the most vulnerable. Risks can be reduced when parents have access to good family and social support networks and professional support which is acceptable to them. Maintaining a small family size can also be helpful. If parents have had positive childhood emotional experiences, their chances of successful parenting are increased. Copyright © 2004 John Wiley & Sons, Ltd.     

A qualitative analysis of suicide risk factors,preferred means,and means restriction feasibility within a homeless shelter environment

Suicide completion rates among homeless individuals are approximately nine times higher than the general population. The purpose of this study was to capture the state of social support among homeless individuals, understand how homeless community members support peers in crisis, examine the awareness of suicidal ideation, identify common methods for suicide, and generate strategies for means restriction within a shelter. Twenty individuals residing at an emergency shelter were interviewed. Participants were of diverse cultural identities overrepresented in the sample relative to the general population. Interviews revealed that 40% of participants lacked social support. However, the majority indicated that if they encountered someone at risk for suicide, they would provide support and encouragement to the at-risk individual. Almost half of participants reported knowing of an individual in the shelter who had previously attempted suicide and/or was currently or previously feeling suicidal. Overdose was identified as a primary method for suicide; however, the majority of participants were unable to generate strategies for means restriction. The present study offers a glimpse into the experience of homeless individuals and provides valuable information regarding risk factors for suicide within this highly marginalized and underserved population.     

Grandmas' hands rocked the cradle

A considerable number of women find themselves serving as surrogate parents for their grandchildren. This issue is particularly salient for African-American women. This article highlights the experiences of African-American grandmothers who are rearing their grandchildren in a rural southern community. Data collection included in-depth interviewing, observation, and document review. Findings from the study underscore the need for policy makers and practitioners to understand the structural and cultural context in which grandparent caregiving occurs. Grandmothers serving as surrogate parents should have access to a comprehensive array of services some of which include financial, psychological, medical, and legal services. In addition to these services grandparent caregivers should be empowered to engage in activities which encourage support and self-care. Study findings generate ideas that will be of interest to those responsible for practice and policy decisions.     

Detecting suicide risk in adolescents and adults in an emergency department: a pilot study

The investigators conducted a pilot study to detect suicide risk in adolescents and adults seeking treatment in an emergency department, as well as to test the reliability and validity of the 4-item Risk of Suicide Questionnaire (RSQ). This study expanded the implementation of the RSQ beyond its initial use with children and adolescents with psychiatric symptoms who were seeking treatment in a pediatric emergency department to include adolescent and adult patients in a Level I trauma center. An advanced practice psychiatric nurse verbally administered the RSQ to a convenience sample of 104 emergency department patients ages 12 to 82. Psychometric analysis demonstrated an adequate degree of reliability and criterion-related validity for the RSQ. Approximately 30% of all patients who participated screened positive for suicide risk. The results support the continued use of the 4-item RSQ with all adolescents and use of a reduced 2-item form of the RSQ with adults exhibiting psychiatric chief complaints to determine imminent risk of suicide in patients who seek treatment in the emergency department. Nurses in all health care settings need to initiate suicide screening and implement nursing interventions directed toward suicide prevention.     

Family and Household Formations and Suicide in the United States

Family support systems have been theoretically linked to suicide risk. But no research to date has investigated the effects of detailed living arrangements on individual risk of suicide. Using data on 825,462 adults from the National Health Interview Survey Linked Mortality File reveals that living in families with stronger sources of social support and integration decreases risk of suicide. These effects persist despite controls for important individual level characteristics. Risk of suicide decreases for persons in married as well as unmarried families when children are present and risk increases for persons living with unrelated adults. These results reveal the structural importance of family formation on the social integrative forces that contribute to an individual's risk of suicide.     

Breaking the silence: parentally suicide-bereaved youths’ self-disclosure on the internet and the social responses of others related to stigma

‘Suicide stigma’ contributes to the silencing of parental suicide within family and social networks. This article departs from a narrative theoretical framework on grief and identity to analyse suicide-bereaved youths ‘breaking the silence’ through self-disclosure in self-initiated chat threads on the Internet, which is their way of actively seeking social support, telling of their experiences and opening up space for a renegotiation of the meanings around suicide. The article investigates which narrative frameworks for the interpretation of suicide are operating in these contexts, and whether and, if so, how stigma is reproduced or counteracted. Two frameworks are identified: ‘Who is to blame for suicide?’; and ‘What caused the suicide?’. The former is utilized by the newly bereaved chat-initiators, who attribute blame for suicide to the parent and/or themselves in accordance with stigmatizing discourses. These are reproduced in the responses first and foremost of the non-suicide-bereaved, who construct a dichotomy between the deceased parent as ‘perpetrator’ and the child as ‘victim’ in order to relieve blame. A lack of contact with other suicide-bereaved youths can reinforce feelings of otherness. Identities, however, can potentially be de-stigmatized by the meanings drawn from the latter framework.     

The war at home: affective economics and transnationally adoptive families in the United States

The question of how to best conduct post-placement interventions for transnationally adoptive families at risk of dissolution (legal annulment) is an emerging issue in the United States. The current popular trend for adoptive families to pursue biomedical post-placement interventions, despite a lack of proof that such interventions actually work to keep the adoptive family intact, suggests the need for a more phenomenological approach to understanding both adoptive parents’ and transnational adoptees’ post-placement experiences. This study examines the empirical experiences of adoptive families at risk of dissolution in the United States who attempt to define and navigate the path toward family stability after adopting. From the coding of this data set emerge some routes through and by which emotions circulate between adoptive parents and transnational adoptees through the family body and the family social. Particularly, it investigates one post-placement “affective economy” at work in which adoptive parents attempt, through the expression of particular forms of parental love, to align adoptees as subjects of the private, nuclear American family, while adoptees more often attempt to create space for more heterogeneous forms of family, ones that include birth parents and other kin-like relations in their countries of origin. Ultimately, it illuminates some vastly different and sometimes contradictory ways that adoptive parents and adoptees can interpret family through emotional lenses, ones that can prevent a smooth post-placement transition for adoption actors. An understanding of these differences and how they shape, and are shaped by, the post-placement affective economy within families at risk of dissolution may aid in locating indicators for adoption dissolution, and possibly, designing more effective post-placement interventions for families struggling in the aftermath of adoption. It may also help scholars begin to think about the construction and impact of affective economies in the realm of adoption more generally.     

New Voices in Iceland. Parents and Adult Children: juggling supports and choices in time and space

This paper deals with parents' perspectives and experiences of bringing up children with a variety of impairments in Iceland, and how they impact the young disabled adults' approach to the status of adulthood. The paper is based on a qualitative study that explored perspectives and experiences of 36 young disabled adults (16-24 years old), their parents, friends and teachers. The purpose of this paper is to share themes related to patterns of parents' reactions and choices when coming to terms with parenting a disabled child, the support they found from their social network and professionals, and their sons or daughters' subsequent views of themselves and their prospects as young adults. The paper includes different perspectives on adulthood and the extent to which the young disabled people expect to reach that status or remain as 'eternal youth' enmeshed in segregated services. Findings show that the type and nature of early support for parents of disabled children is critical for the young adults' approaching adulthood in regular society or expecting to remain in the limbo of 'eternal youth' within segregated settings. Early 'betrayals' may, however, be revisited at each subsequent transition point. Furthermore, parents and their disabled children who struggled for social inclusion could obtain full active membership in society, even against social and physical barriers, and medically defined disability labels.     

Intergenerational Patterns of Maltreatment in Families at Risk for Foster Care

Few qualitative studies have investigated the process of parental efforts to break intergenerational patterns of maltreatment. A grounded theory approach was used to understand how 24 parents who had been identified by CPS as being at‐risk of having their children removed from their homes due to allegations of abuse and/or neglect, perceived and connected their own experiences of childhood abuse in light of their experiences as alleged perpetrators of child maltreatment. Three major categories were identified: patterns, beliefs, and behaviors. A majority of the parents stated that they recognized intergenerational patterns, most expressed that they wanted to be different from their own parents, yet many described parenting actions that were “destructive.” We suggest that it is the interrelationship amongst patterns, beliefs, and behaviors that may offer opportunities for parents and therapists to enact change.     

“We Have Closed Our Eyes and Sealed Our Lips”: Black Women’s Accounts of Discussing Suicide within the Black Community

Conversing about suicide with an at-risk individual can be enough to save a life. Given the rise of suicidal behavior among African American subgroups (i.e., youth and male), advocates are urging blacks to have candid conversations about the issue. The current study highlights black women’s experiences discussing suicide. Findings suggest that widespread beliefs that suicide is an insignificant issue among blacks make conversing about suicide especially challenging. These findings reveal problematic implications for African Americans contemplating suicide in their communities. Suicide may be a phenomenon for which communal support is less prevalent.     

Children of problem gamblers

An anonymous 37-item Health Survey was administered to 844 randomly selected ninth- to twelfth-grade students in four Southern California public high schools. Systematic information was gathered about their general health, quality of life, school and work adjustment, involvement with a range of potentially addictive substances and activities, and indications of psychosocial maladjustment, including difficulties with the law and suicide attempts. A series of self-ratings of students who characterized one or both of their parents as having a compulsive gambling problem (N=52) were contrasted with those of their classmates who reported no gambling problem among their parents (N=792). Findings have been grouped into three major areas: (a) comparative levels and reported effects of involvement with health-threatening behaviors (i.e., smoking, drinking, drug use, overeating, and gambling); (b) comparative incidence of psychosocial risk indicators (i.e., broken home, unhappy childhood and teenage years, legal action pending, overall quality of youth rated as poor); and (c) comparative incidence of dysphoria, school and work problems, and suicide attempts. Across each of these areas children of parents said to gamble excessively were found to be at consistently greater risk than their classmates who did not describe their parents as having a problem with compulsive gambling. These findings strongly suggest that without early and competent intervention, children of parents who gamble excessively: (a) will be seriously disadvantaged when attempting to solve their present adolescent and future adult problems of living; and (b) as a consequence are, themselves, high-risk candidates for developing one or another form of dysfunctional adjustment, including an addictive pattern of behavior.     

Factitious Illness by Proxy: Understanding Underlying Psychological Processes and Motivations

Children are put at risk of emotional and physical harm when parents seek unnecessary medical care. Understanding why parents seek medical interventions that create risk for their children requires us to consider how past experiences, and the mental representations of these experiences influence current behaviour. Past experiences of danger affect how parents interpret ‘dangerous’ situations in the present and how they organise protection of their child. This article demonstrates how the notion of mental representations (that dispose parents to act in particular ways) can assist in engaging, assessing and treating parents who display factitious illness by proxy behaviour. When classified using the Dynamic‐Maturational Method, the Adult Attachment Interview (AAI) allows both assessment of implicit and explicit representations and also understanding of the developmental process through which parents have learnt to attribute meaning to information and to organise their behaviour. In this case study, psychosocial assessment of the family included an AAI with each parent. The use of this assessment tool both aided the therapy team in the process of case formulation and intervention planning, and had therapeutic value in and of itself. We argue that treatment is more likely to be effective if the parents and professionals have a shared understanding of the parents' intentions and the developmental process that led to unsafe behaviour, which requires change.     

Reconsidering Worlds of Pain: Life in the Working Class(es)

This paper focuses on the early goals, past educational experiences, familial support, and current career goals of a sample of 80 White middle-class and working-class parents in a medium-sized northeastern city in the United States. The research will help determine whether members of the working class have lived in or still live in worlds of pain. Middle-class parents overwhelmingly report having had high goals and aspirations in high school, positive experiences in school, and supportive parents and role models in their families. Moreover, they report being satisfied in their current occupational positions. The working-class parents present a more complex pattern: For each of the areas studied—early goals, schooling, familial support, and job satisfaction and future goals—some of the working-class respondents report better experiences than the others. A more inclusive sampling strategy proved useful in this study in documenting the varied life experiences and attitudes found among members of the working class. These findings provide support for and modification of Rubin's (1976, 1994) portraits of the working class.