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    Does treatment method matter? A meta-analysis of the past 20 years of research on therapeutic interventions for self-harm and suicidal ideation in adolescents
    (BioMed Central Ltd, part of Springer Nature, 2020-05-11) Kothgassner OD; Robinson K; Goreis A; Ougrin D; Plener PL
    Background: Self-harm is a clinically relevant and prevalent behaviour which peaks in adolescence. Given the high prevalence of self-harm, the high levels of psychiatric comorbidity, and its role as a risk factor for suicide, delivering evidence-based care is critical. Methods: We conducted a systematic review and meta-analysis of the literature on treating self-harm in adolescents (12-19 years) published in the last 20 years, identifying 25 randomised controlled trials. We calculated the effect of treatment interventions relative to active control conditions in reducing self-harm, suicidal ideation and depressive symptoms. Results: Overall, treatment interventions fared slightly better than active controls in decreasing self-harm (d = 0.13, 95% CI 0.04-0.22, p =.004), suicidal ideation (d = 0.31, 95% CI 0.12-0.50, p =.001) and depressive symptoms (d = 0.22, 95% CI 0.07-0.38, p =.006). Subgroup analysis of specific therapies revealed moderate effects of DBT-A in reducing self-harm (d = 0.51, 95% CI 0.18-0.85, p =.002) and suicidal ideation (d = 0.48, 95% CI 0.17-0.80, p =.003), as well as moderate effects of family-centred therapy in the treating suicidal ideation (d = 0.58, 95% CI 0.01-1.15, p =.049). Conclusions: The findings of our meta-analysis indicate that, overall, currently available treatments are effective in treating self-harm, suicidal ideation, and depressive symptoms in adolescence. Although the treatment intervention conditions showed only small to moderate effects in comparison to active controls, these differences were statistically significant and are clinically important. Further research is needed to understand the reduction in self-harm within active controls, which may arise due to the natural course of self-harm, or the potential efficacy of treatment as usual and enhanced usual care. Given the significant reduction of self-harm in active control conditions, delivering effective care to a large number of adolescents with self-harm may require developing stepped-care models in clinical practice. Expensive and poorly available treatments should be targeted at young people who most need them.
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    How do lay people interpret and respond to suicide warning signs? : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology, School of Psychology, Massey University, New Zealand
    (Massey University, 2017) McAllister, Amber
    Suicide is a worldwide problem with over 800,000 people dying by suicide every year, and many more attempting suicide or thinking of suicide. Despite prevention efforts, suicide rates are increasing. One promising area of prevention is educating the public to recognise and respond to suicidal signs. Yet knowledge of this area is currently lacking in the literature, especially in New Zealand. The aim of this study was to understand and explore how lay people in New Zealand currently interpret and respond to suicidal signs. A second aim was to assess whether there were gender or age group differences. A mixed methods approach was used that included a validated questionnaire and a semi-structured vignette interview developed specifically for the study. Participants were 24 adults from one location in New Zealand, grouped equally by gender and age (20-30 years or 40-50 years). The results reveal a number of psychological, cognitive, and communicative barriers to interpretation and intervention, and a lack of intervention knowledge. Small gender and age group differences are also revealed. These findings have implications and recommendations for suicide prevention strategies in New Zealand.
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    Making sense of youth suicide : exploring young New Zealanders' views : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Wellington, New Zealand
    (Massey University, 2016) Williams, Casey
    Due to its sensitive nature, the suicide of young people can be a complex and difficult issue to address; yet it needs to be better understood in order to reduce the rate of young New Zealanders who die from suicide. While there has been a significant amount of research conducted on youth suicide, the aim of this research was to gain a deeper understanding of youth suicide within New Zealand by exploring why young people think their peers attempt, or die from, suicide. Six focus groups were held with 19 participants aged 16 to 24 years old. Discussions were transcribed and thematic analysis of the transcripts identified five themes and ten subthemes. These were: relationship factors (bullying and intimate relationships), internal factors (depressive disorders and coping skills), gender (kiwi masculinity and rates), external factors (alcohol and other drugs and circumstances), and support services (access and reluctance/barriers). The participants identified that youth suicide can be the result of a variety of factors, particularly noting the relationship between bullying (face to face or cyber-bullying) and suicide. It is recommended that a component which addresses youth suicide and provides young people with positive coping strategies is implemented into the New Zealand educational curriculum. It is anticipated that changes to the education curriculum, and by society challenging and changing common gender stereotypes, will help reduce youth suicide within New Zealand. Given that this research utilised a small sample size, where the majority of participants were female of European or Pakeha descent, future research with a larger more diverse sample would be beneficial.
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    A hermeneutic phenomenological analysis of clinical psychologists' understandings of youth suicide : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 2005) Brown, Hannah
    New Zealand has one of the highest youth suicide rates in the developed world. There are many ambiguities around the risk factors and life events preceding a suicide attempt or completion, despite the vast amount of research done in this area. Clinical psychologists have the ability to add a wealth of knowledge on this topic, and surprisingly there has been little research done with this group. I wanted to find out directly from clinical psychologists about their experiences of working with youth who have attempted or completed suicide. I also wanted the opportunity to explore, from a clinical psychologists' perspective, the questions surrounding prevention and treatment programme efficacy. These topics and ideas are considered to be complex and controversial. Interpretive phenomenological analysis was used to investigate detailed reports of youth suicide from eight participants. Three master themes emerged from the analysis, those being "Client Actions", "Social and Cultural World" and "Psychological Person", as the central features of the phenomenology of suicide. Suicide is often explained in statistical terms, and an extensive amount of research has found many risk factors pertaining to youth suicide. However, the present study found that statistics cannot fully grasp the phenomenon of suicide, and participants were unable to meaningfully relate to suicide in this way. Findings in this study also suggest that one of the biggest gaps in the research is around the psychosocial aspects of youth suicide, particularly the sociocultural specificities of New Zealand youth. More training and research around these areas is recommended, along with inclusion of family in the treatment of youth suicide and mental illness.
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    Predicting further suicidal behaviour in attempted suicide patients : a thesis presented in partial fulfilment of the requirements for the degree Doctor of Philosophy in Psychology at Massey University
    (Massey University, 1983) Petrie, Keith James
    This study examined the psychological determinants of future suicidal behaviour and ideation in attempted suicide patients. The approach taken was to identify personality variables that insulated the suicide attempter against further attempts and suicidal thoughts. Three specific areas were focused on. Firstly, past research has shown attempters to be under considerable stress both before their attempt and up to two years afterwards. Self esteem was tested here as a potential insulator against stress, and in particular, low self esteem as an indicator of future suicidal behaviour. Secondly, many studies have noted the intimate relationship between depression and suicide. Beck (1967) postulated that the cognitive variable of hopelessness moderates the relationship between depression and suicide. While hopelessness has been implicated in past studies of suicidal intent, the present research tested hopelessness as a predictor of suicidal behaviour and ideation. A further cognitive variable, rigidity, has been found previously to be a characteristic of suicidal individuals. This study predicted rigidity is more a function of the depressed condition of attempters, rather than being directly involved in suicidal behaviour. Thirdly, the fact that suicidal individuals lead socially isolated lives has been noted by many researchers. The suicide attempter's social relationships are generally unsatisfying and a major source of interpersonal friction. This study examined the role of social skills in the development of suicidal behaviour, predicting low social skill would be associated with future suicidal behaviour and ideation. Overall, the research investigated the influence of cognitive, social skill and self esteem variables on the development of suicidal behaviour. As well as the above theoretical questions, the study also examined the predictive validity of the Zung Index of Potential Suicide. This scale uses clinical factors as opposed to the traditional demographic approach to predicting suicidal behaviour. The subjects were 67 attempted suicide patients admitted to three New Zealand general hospitals. Each completed personality measures within two days of their admission to hospital. All subjects were contacted six months after their discharge and 46 completed a follow-up questionnaire. This questionnaire measured current level of depression, suicidal ideation and whether any further suicide attempts had been made. The results showed 37% of attempters to have made at least one further attempt and 17% to have been admitted to hospital for a repeat attempt. Both low self esteem and high hopelessness significantly distinguished repeaters from first time attempters at admission, and those patients making a repeat attempt over the six month follow-up period. Hopelessness was significantly related to suicidal ideation on admission, while self esteem was related to both suicidal ideation and depression at follow-up. Poor social skills did not predict future depression, suicidal ideation or attempting. The relationship between depression and the variables of suicidal ideation and the number of previous suicide attempts, was largely explained by hopelessness. As predicted, cognitive rigidity was significantly related to depression at admission but not to suicidal behaviour or ideation. The Zung Index of Potential Suicide, while significantly related to suicidal ideation and the number of previous suicide attempts, was a very poor predictor of future suicidal ideation or behaviour. The results suggest psychological variables offer considerable potential over demographic factors in assessing suicidal risk. The differential effects of hopelessness and self esteem imply a division in terms of long and short term suicidal risk is appropriate, with different variables involved over the two periods. The task for future research is to identify the specific components of hopelessness and self esteem as well as other psychological variables involved in suicidal behaviour.
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    Whakamomori : Māori suicide prevention : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Māori Studies at Massey University, Turitea Campus, New Zealand
    (Massey University, 2005) Coupe, Nicole Michelle
    Suicidal behaviour is a major public health issue globally. The incidence of suicide and attempted suicide internationally is excessive, particularly among indigenous populations. The Māori (indigenous people of New Zealand) suicide and attempted suicide rates have exceeded the non-Māori rates in New Zealand. In an attempt to address the high incidence of Māori suicidal behaviour an epidemiological case control study was initiated. Method: 250 consecutive cases of Māori who attempted suicide who were admitted to one of the three Auckland public hospitals were compared to 250 random, Māori community-based controls (found through door knocking). Participants were compared on a variety of measures including the General Health Questionnaire-28 (GHQ-28), Hospital Anxiety and Depression Scale (HADS), CAGE Alcohol Screening Test; Composite International Diagnostic Interview (CIDI-suicidality), Beck's Scale of Suicide Intent (SIS); and cultural identity validated questionnaires. Results: Response rates were high for both cases (85.6%) and controls (81.2%). The multivariate analysis revealed that poor general health status was the key risk factor associated with attempted suicide among Māori. Once the health indicator is taken out of the analysis, cultural identity, marijuana utilisation and interpersonal abuse are the next major risk factors in attempted suicide among Māori. Conclusion: Suffering from poor general health can increase attempted suicide among Māori. Having a notional identity and not being connected to Māoritanga (those things Māori; Māori culture) is associated with the risk of suicidal behaviour.