Suicidal Behaviour: Assessment of People-at-Risk

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Edited by: Updesh Kumar & Manas K. Mandal

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    Dedication

    Dedicated to Dr (Mrs) Sanjukta Mandal and Mrs Anju Walia

    List of Tables

    • 1.1 A summary of Baumeister's (1990) suicide as escape from self model 06
    • 1.2 Psychological risk and protective factors associated with suicidal risk 11
    • 2.1 Eight empirically supported areas for suicide risk assessments 28
    • 2.2 Categories of suicide risk 35
    • 2.3 Suicide risk continuum with indicated responses 37
    • 4.1 UCL dimensions and Their items 78
    • 7.1 Gender differences of suicide attempters (multivariate logistic regression model) 145
    • 12.1 Factors contributing to increased suicide risk in cases of comorbid substance abuse disorder and bipolar disorder 261
    • 12.2 A check-list of risk factors for suicidal behaviour in bipolar disorder 263
    • 13.1 Psychiatric disorders, especially depressive disorders and suicide in a community-based study using psychological autopsy 281
    • 13.2 Major depressive disorder and suicide: Comparison of depressive suicide versus depressive non-suicide controls 285
    • 13.3 Suicidal versus non-suicidal depressed inpatients of the Weissenau Depression Treatment Unit Therapist's assessment at admission (significantly discriminating variables of a patient's questionnaire) 287
    • 13.4 Symptoms significantly differentiating suicides and non-suicides in studies with depressive disorder patients 289
    • 13.5 The depressed patient with suicide risk—clinical psychopathological picture in the presuicidal situation 290
    • 15.1 Suicide rates in alternate years among 15- to 24-year-old adolescents per 100,000 of the population in selected Asian countries/regions (1990–2006) 326

    List of Figures

    • 1.1 An overarching biopsychosocial model of suicidal behaviour 5
    • 1.2 Cry of Pain model 8
    • 1.3 Positive future thinking as a moderator of the SPP-distress relationship 15
    • 2.1 Biopsychosocial model of suicide 24
    • 3.1 A stress-diathesis model of suicide 58
    • 7.1 Suicide rates by age groups in Hungary (per 100,000 inhabitants) 146
    • 7.2 Suicide attempts by age groups (per 100,000 inhabitants) 146

    List of Abbreviations

    ACEAngiotensin converting enzyme
    AMPAdenosine monophosphate
    APAAmerican Psychiatric Association
    APOE4Apolipoprotein E4
    ARISEAdaptive regression in service of ego
    ASIQAdult Suicidal Ideation Questionnaire
    AtYSAttitude towards Youth Suicide scale
    BDBipolar disorder
    BDIBeck Depression Inventory
    BDNFBrain-derived neurotrophic factor
    BHSBeck Hopelessness Scale
    BPDBorderline personality disorder
    BSSIBeck Scale for Suicide Ideation
    CAMSCollaborative Assessment and Management of Suicidality
    CAPSChild and Adolescent Perfectionism Scale
    CBTCognitive-behavioural therapy
    CCKCholecystokinin
    CDCCentre for Disease Control
    CDIChildren's Depression Inventory
    CDRS-RChildren's Depression Rating Scale
    CDSCollaborative Depression Study
    CIConfidence interval
    COMTCatechol-O-methyltransferase
    CoPCry of pain
    CREBCyclic AMP response element binding protein
    CSFCerebro-spinal Fluid
    CSF-5HIAACerebrospinal fluid 5 hydroxyindoleacetic acid
    CSPSChild Suicide Potential Scale
    CSRPCentre for Suicide Research and Prevention
    DBTDialectical Behaviour Therapy
    DHCR77-Dehydrocholesterol reductase
    DRD2Dopamine D2 receptor
    DSHDeliberate self-harm
    DSMDiagnostic and Statistical Manual
    DZTsDizygotic twins
    EARSEpigenetic Assessment Rating System
    EASQExtended Attributional Style Questionnaire
    ECAEpidemiologic Catchment Area
    ECTElectroconvulsive therapy
    EFAEgo Function Test
    EFA-MEgo Function Assessment Scale-Modified
    EPQEysenck Personality Questionnaire
    EPSEscape Potential Scale
    ESEMEDEuropean Study on the Epidemiology of Mental Disorders
    FACESFamily Adaptability and Cohesion Evaluation Scales
    FASTFirestone Assessment of Self-Destructive Thoughts
    FDAFood and Drug Administration
    FTTFuture Thinking Task
    FVTFluid vulnerability theory
    GADGeneralised Anxiety Disorder
    GSK-3Glycogen synthase kinase-3-β
    HDRSHamilton Depression Rating Scale
    5-HIAA5-Hydroxy indole acetic acid
    HPA axisHypothalamic-pituitary-adrenal axis
    HPLSHopelessness Scale For Children
    HRSDHamilton Rating Scale for Depression
    IASPInternational Association for Suicide Prevention
    ICD-10International Classification of Diseases 10
    IESImpact of Events Scale
    LESLife Experience Survey
    LHPAAxis Limbic-Hypothalamus-Pituitary-Adrenal Axis
    LHPTAxis Limbic-Hypothalamus-Pituitary-Thyroid Axis
    LSLethality Scales
    LSILife Style Index
    MAOAMonoamine oxidase A
    MDDMajor Depressive Disorder
    MDEMajor depressive episode
    MINIMini International Neuropsychiatric Interview
    MLDAMinimum legal drinking age
    MMPIMinnesota Multiphasic Personality Inventory
    MPQMotives for Parasuicide Questionnaire
    MPSMultidimensional Perfectionism Scale
    MSSIModified Scale for Suicide Ideation
    MUPMultiple Preanalysis
    MZTsMonozygotic twins
    NIMHNational Institute of Mental Health
    NOSNitric oxide synthase
    NSSINon-suicidal self-injurious behaviour
    PANASPositive and Negative Affect Scale
    PANSIPositive and Negative Suicide Ideation Inventory
    PBIParental Bonding Instrument
    PDPersonality Disorder
    PETPositron emission tomography
    PFCPre-frontal cortex
    PNQPsychache Needs Questionnaire
    PROSPECTPrevention of Suicide in Primary-care Elderly: Collaborative Trial
    PSIPaykel Suicide Items
    PSTGroup Interpersonal Problem-Solving Skills Training programme
    PTSPost-traumatic stress
    PTSDPost-traumatic stress disorder
    RADS-2Reynolds Adolescent Depression Scale-2
    RASQReasons for Attempting Suicide Questionnaire
    RCTRandomised Clinical Trial
    RFLReasons for Living Inventory
    RRRelative risk
    RRRRisk-Rescue Rating Scale
    RSICRorschach Suicide Index Constellation
    SATSeparation Anxiety Test
    SBQSuicide Behaviours Questionnaire
    SCICSuicide Crisis Intervention Centre
    SEESASequential Emotion and Event Form for Suicidal Adolescents
    SI-IATSelf Injury Implicit Association Test
    SISSuicide Ideation Scale
    SISSuicide Intent Scale
    SIS-QSuicidal Ideation Screening Questionnaire
    SIISFSelf-Inflicted Injury Severity Form
    SMASISudden mass assault by a single individual
    SMRStandard mortality rate
    SMSISelf Monitoring Suicide Ideation Scale
    SNPSingle nucleotide polymorphisms
    SPECTSingle Photon Emission Computed Tomography
    SPPSocially prescribed perfectionism
    SPRCSuicide Prevention Resource Center
    SPSSuicide Probability Scale
    SSFSuicide Status Form
    SSIScale for Suicide Ideation
    SSI-WScale of Suicide Ideation-Worst
    SSRISelective serotonin reuptake inhibitor
    STSerotonin transporters
    TATThematic Apperception Test
    TAUTreatment as usual
    TEMPS-A-RomeTemperament Evaluation of Memphis, Pisa, Paris and San Diego autoquestionnaire-Rome
    THTyrosine hydroxylase
    TPH1Tryptophan hydroxylase 1
    TSHThyroid Stimulating Hormone
    UCLUtrecht Coping List
    VNTRVariable number tandem repeats
    WHOWorld Health Organization
    ZDIZung Depression Scale

    Foreword

    The problem of suicide is important and intriguing. It is important because it is surprisingly widespread—so widespread, in fact, that it constitutes a legitimate health hazard. It is also important because it often involves talented people in key positions in government and industry, and when it involves these people, key resources disappear forever. The problem is intriguing because it is counter-intuitive from an existential, phenomenological and evolutionary perspective—it is a kind of behaviour that seems to defy the most basic tendencies in human nature, those that concern survival.

    Properly considered, science is a two-step process which I call prediction and explanation. In the first step, researchers try to detect co-variations in nature, to determine what goes with what, to establish reliable empirical relationships. The second step involves trying to explain why the covariations occur, what the dynamics are that generate the reliable empirical relationships. This is a good description of how science actually develops, but it is a perspective that was badly out of favour among psychologists and philosophers of science for perhaps 50 years; for the behaviourists and the logical positivists, prediction and explanation were identical. They were wrong, and by confusing prediction and explanation, they confused rather than clarified a lot of problems.

    In psychology, prediction is largely accomplished using assessment—valid psychometric procedures—we use assessment to predict outcomes. Explanation is accomplished by linking the empirical co-variations (the predictions) to underlying biological, physiological and neurological processes.

    This book has several strengths, perhaps the first of which is the degree to which it implicitly honours the distinction between prediction and explanation. The chapters divide rather neatly into psychometric assessment methods and explanatory models based on a variety of plausible perspectives, including neurophysiology, cognitive processes, and cultural and social influence models.

    The second strength of the book is its ecumenical focus; the contributors come from different countries, cultures and disciplinary backgrounds. They include psychiatrists, psychologists, sociologists, epidemiologists and suicidologists. The authors include Americans, Germans, Indians, Italians, Australians, Norwegians, Chinese, Irish, Hungarians and English scholars. The book is neither parochial nor partisan.

    Third, the contributions are sensitive to epidemiological, cultural and gender influences. Suicide is examined from a fully rounded perspective.

    Finally, the book makes clear that psychological assessment has a crucial role to play in applied psychological and social research. Modern measurement research seems often to have lost its way as it pursues item response theory, structural equations modelling, and latent variable analyses for their own sake. This book makes it abundantly clear that ‘assessment concerns predicting consequential outcomes, not measuring abstract entities’. Assessment remains the most important contribution psychology has so far made to the world of practical affairs.

    This book is a very useful, balanced and comprehensive introduction to the best modern thinking on the prediction, explanation and potential amelioration of suicide, and the editors and authors are to be congratulated for putting it together.

    RobertHogan, PhD Hogan Assessment Systems Amelia Island, Florida

    Preface

    The increasing suicide rates around the globe have drawn immense attention of psychologists, mental health professionals, policy-makers and researchers towards the dynamics of suicidal behaviour. Suicide constitutes a major public health problem across the world. The United Nations has estimated that between 500,000 and 1.2 million people die by committing suicide each year worldwide. According to the World Health Organization estimates, in the year 2000, approximately 1 million people died by committing suicide, and 10 to 20 times more people attempted suicide worldwide. In most countries, suicide is now one of the leading causes of death among people aged 15–34 years. Indeed, suicide is the most frequently encountered emergency situation in mental health care programmes. Moreover, the trauma of suicide does not end with the individual, but gets reflected in feelings of loss and suffering in the lives of family members and friends for years after the suicide.

    Innumerable publications are available on the subject of suicidal behaviour, although most of these revolve around the epidemiological or theoretical descriptions of suicide. Utilising empirical evidence in active clinical practice and translating insights gained from clinical experience into empirical data, however, still remains a challenge. Most of the available literature focuses on the clinical symptomatology of suicide and its sociological development and influences. There is a paucity of literature with a strong psychometric basis that explains suicidal behaviour in normal population across lifespan. The present volume attempts to fill this void by following a psychometric approach to outline suicide risk assessment and, in turn, to comprehensively understand the suicidal personality/behaviour. This volume includes 15 chapters from experts in the field encompassing the suicide research carried out globally, and the diverse aspects of this problem in various socio-cultural contexts.

    Suicidal behaviour constitutes a vast area for empirical psychological research. The abundance of research on various aspects of suicide has led to an improved understanding of the behaviour, although accurate assessment still remains a challenge. The chapters of the volume are divided into two sections—‘theoretical issues related to assessment of suicidal behaviour’ and ‘assessment of people at suicide risk’. The first section includes nine chapters on topics related to risk assessment: theoretical issues. The section begins with the chapter by O'Connor that provides an overview of the ‘psychological perspectives on suicidal behaviour’. Suicidal behaviour is described as reaction to a situation that has three components—defeat, no escape and no rescue. The author contextualises the psychological factors implicated in the aetiology of suicidal behaviour with a biopsychosocial model. Clinical implications derived from empirical research are discussed and the need for longitudinal as well as experimental research is emphasised in order to expand the theoretical evidence base on the basis of which effective psychological interventions can be developed.

    The overview of psychological perspectives on suicidal behaviour is followed by the chapter on ‘empirically based assessment of suicide risk’, which reviews and integrates empirically based strategies for the assessment of suicide risk. The authors, Morrow, Bryan and Appolonio, differentiate between risk assessment and prediction and emphasise the importance of establishing a collaborative relationship with the suicidal patient. A biopsychosocial model of suicide is also presented, along with a continuum of suicidality for risk assessment that addresses both the chronic and acute dimensions of suicide risk. The chapter concludes with recommendations for clinical decision-making and practice that are based on current scientific evidence and standards of care.

    Trivedi and Varma, in their chapter on ‘neurobiological basis of suicidal ideation’, point out the inadequacy of the standardised assessment and prediction scales available and emphasise the need to better understand and utilise the neurobiological basis of suicidal ideation for prediction purposes. They delineate upon the neurobiological basis of suicide and try to identify the biological markers of suicide. They further support their notions with transmitter non-specific as well as transmitter specific neuroendocrine studies. A detailed discussion is presented regarding the genetic basis of suicidal behaviour and role played by different neurotransmitters.

    The chapter on ‘problem-solving ability and repeated deliberate self-harm’ by McAuliffe posits that deliberate self-harm has a strong association with difficulties in problem-solving. Empirical evidence to establish a link between repeated acts of deliberate self-harm with motives of escape and revenge and a passive-avoidant approach to problem-solving is discussed. The chapter also includes a valuable discussion on the efficacy of cognitive-behavioural interventions to reduce suicidal behaviour, including aspects of problem-solving skills training.

    The chapter ‘Suicide and Homicide: Theoretical Issues’ discusses violence as the common thread underlying both suicide as well as homicide. The authors, Mukherjee, Kumar and Mandal, discuss the evidence in the light of the recent research findings that bring out the cognitive and personality factors placing the two behaviours on a continuum. The chapter highlights the theoretical issues involved and elaborates upon the neurological, sociological and psychological perspectives. Based on the theoretical underpinnings, an attempt is made to draw a profile of individuals likely to engage in such violent behaviours towards self or others.

    Erminia Colucci delves into ‘cultural issues in suicide risk assessment’ in the next chapter. She emphasises the significance and relevance of culture and ethnicity in promoting our understanding of suicidal behaviour, suicide risk assessment and suicide prevention. The chapter includes an overview of cross-cultural research on youth suicide, and of the role that religion and spirituality may play at each step along the suicidal path. The need to pay more attention to the meaning and interpretation of suicide in suicide risk assessment and the necessity to establish culture-sensitive prevention strategies is also addressed.

    Gender is a pertinent issue of consideration in the assessment of suicidal risk. Osvath, Voros and Fekete, in their chapter on ‘gender issues in suicide risk factor assessment’, discuss the role of gender in determining various aspects of the suicidal behaviour and summarise epidemiological and socio-cultural research evidence identifying protective and risk factors for suicide in males and females. The higher suicide mortality among males in the Western countries is explained in terms of higher lethality of male suicide methods, the reluctance of men to seek help, the higher rate of substance abuse, and some socio-cultural differences. The authors urge the need for further research in the area of gender differences and point out how the insights gained can be utilised for suicide prevention in both genders. The chapter concludes by highlighting gender-specific treatment possibilities/clinical implications.

    Suicidal vulnerability and risk factors pertinent to different life stages are discussed by Van Orden and Miller in their chapter on ‘developmental issues in risk factor assessment’. The authors examine the ways in which developmental issues impact clinical decision-making in the process of assessing and managing suicide risk across the lifespan ranging from childhood to late adulthood. They discuss four aspects of suicide risk assessment where developmental issues may play a role: the content of information collected during risk assessments, the process of conducting risk assessments, the context surrounding risk assessments and the decisions generated regarding crisis management. The factors unique to particular developmental stages and the way in which these factors manifest differently at different ages are elaborated upon in a sequential manner.

    Research has established that the manners of reporting suicide stories have a significant influence on suicidal behaviour and suicide-prevention strategies and policies. Kidwai elaborates upon this emerging area of suicide research in her chapter ‘Reporting Suicide: Impact on Suicidal Behaviour’. She discusses the role of cognitive and arousal processes as mediators that affect suicidal behaviour. The author elaborates upon the contagion and cultivation effects of suicidal behaviour that are probable after media coverage of suicidal acts. It is argued that the portrayal of suicides in the media has an impact on suicidal behaviour, and it is, therefore, essential to educate reporters, editors, film-television producers about suicide contagion and related phenomena. The author conclusively assumes that media's positive role while reporting suicide stories, based on certain basic guidelines which she proposes in the end, can go a long way in preventing such behaviour.

    Accurate assessment and prediction of suicidal behaviour is of utmost importance for effective prevention, which is the primary motive of any mental health programme. The lacunae often experienced by clinicians in predicting suicidal behaviour through the use of psychometric assessment tools are filled up by their clinical experience. The second section of the present volume—‘Assessment: People-at-Risk’—includes six chapters. This section opens with Mukhopadhyay's chapter titled Suicide: Its Assessment and Prediction. In this chapter, the author argues that the psychological and psychosocial risk factors that lead to suicidality require systematic psychological evaluation. She lists and critically reviews the available suicide risk assessment tools for varied parameters ranging from suicidal thoughts to completed suicide and other related psychological domains. The tools are evaluated in terms of their psychometric properties and the readers are provided with ample information for choosing the assessment tool that match their requirement. Given multifactor origin of suicide, the author argues the use of battery of tests for the evaluation of direct factors related to suicidal behaviour and indirect potential factors that contribute to it, so as to ensure the understanding of phenomenon in totality.

    In their chapter on ‘substance use and suicidal behaviour’, Misra, Sabharwal and Kumar present an overview of the research on the incidence of suicidal behaviour in conjunction with substance use. The chapter includes an outline of the possible role of personality, cognitive and neurobiological factors to predict suicidal behaviour among substance users. The comorbidity of substance use with other psychiatric disorders, particularly depression and personality disorders, and the demographic variables and life events that further complicate the assessment of suicide risk among substance users are also discussed. Finally, prevention and intervention measures specific to substance users are listed.

    Suicide is also the major source of mortality in the patients of bipolar disorder. Bipolar disorder is known to increase suicide vulnerability manifold. Pompili and associates, in their chapter on ‘suicide risk in bipolar disorder’, comprehensively reviews the relevant literature. The authors emphasise the high risk of suicide associated with bipolar disorder and discuss the efficacy of various short and long-term intervention measures for managing suicidality. Schaller and Wolfersdorf extend the issue on similar line in their chapter on ‘depression and suicide’. They elaborate upon the association between depression and suicidal behaviour on the basis of epidemiological data. With adequate support of community-based and clinically-based updated studies, the authors discuss the prevalence of suicides in depressive disorders focusing on clinical signs, risk factors and symptoms differentiating suicidal and non-suicidal depressed patients. Furthermore, they also discuss about suicide prevention in depressed patients.

    Discussing the issues involved in suicide prevention, Mehlum and Nrugham describe the emergence, maintenance and prevention of suicidal behaviour in military settings and examine the environmental and individual risk factors, protective factors and assessment issues. Their chapter titled The Suicidal Soldier focuses on the suicidal phenomena in the Norwegian Armed Forces and discusses these in the light of the research findings and the personal experiences of the authors with the armed forces.

    The final chapter in this volume focuses on adolescence, a life stage that is marked with maximum suicide vulnerability. The chapter on ‘suicidal ideation and behaviour among Asian adolescents’, by Leung, Fong and McBride-Chang, summarises the trends, risk factors, warning signs and preventive measures for Asian adolescents' suicidal behaviour. Although majority of the available researches in the area are from Western countries, in this chapter, risk factors for adolescent suicide categorised into psychological, environmental and socio-cultural are discussed in light of sufficient research evidence across major Asian countries. The authors also highlight the warning signs for suicide, and propose preventive measures and treatment options.

    The theoretical issues elaborated upon in the first part of this volume along with the applied and practical issues of the second part are an effort to put the readers' insight into the psychometrically sound suicide risk assessment. Varied paradigms of suicidal behaviour along with the suggested prevention strategies are discussed in an effort to provide a scope for widening the horizon of the mental health professionals and researchers working in this area so as to reduce the suicidal behaviour across the world. The issues being raised in the volume are supposed to promote more researches in this area that will certainly prove beneficial in service of humanity.

    Suicide and suicidal behaviour constitute a vast and varied area of research, and editing a volume on the issue has undoubtedly been a Herculean task. It would not have been possible to come up with the volume in the present form without the help and understanding of the people around us, who provided constant support and encouragement. We extend our gratitude to one and all who facilitated our endeavours in however small manner.

    We express our gratitude towards our organisation, the Defence Research and Development Organisation for providing us with infrastructural support. We are indebted to our mentors, Shri M. Natarajan (Scientific Advisor to Raksha Mantri, Secretary, Department of Defence Research and Development, and Director General Research and Development) and Dr W. Selvamurthy, Distinguished Scientist, Chief Controller Research and Development (LS & HR) for their encouragement and benevolence.

    It has indeed been a rewarding experience to work with researchers who are dedicated to this field of research. Their varied ideas stemming from their diverse professional and cultural backgrounds have not only enhanced our knowledge and understanding of the phenomenon of suicide, but have also made the experience of editing this volume very fascinating. We sincerely thank all the authors for their contributions and look forward to future opportunities to work together. We are also obliged to acknowledge the painstaking efforts put in by the reviewers, Emeritus Prof. (Retd.) Sagar Sharma (Punjab University, Chandigarh) and Prof. (Retd.) G.P. Thakur (Mahatma Gandhi Kashi Vidyapith, Varanasi). Without their involvement it would not have been possible to come up with the volume in its present form.

    We would also like to extend our gratitude to our colleagues at the Defence Institute of Psychological Research, Defence Research and Development Organisation, for their help and co-operation in our endeavour to bring out this volume on suicidal behaviour.

    UpdeshKumar, Manas K.Mandal
  • About the Editors and Contributors

    The Editors

    Updesh Kumar, PhD, Scientist ‘F’ is Head of the Mental Health Division, Defence Institute of Psychological Research (DIPR), Defence R&D Organisation (DRDO), Ministry of Defence, Government of India, Delhi. Dr Kumar obtained his doctorate degree from Panjab University, Chandigarh. He specialises in the area of suicidal behaviour and personality assessment. Starting with his doctoral thesis in the area of suicidal behaviour, Dr Kumar, as principal investigator, has carried out many major research projects related to suicidal behaviour. As Head, Mental Health Division, he has psychologically analysed many suicide incidents of defence personnel and followed the performance of cadets in various training academies, namely National Defence Academy, Indian Military Academy, Officers Training Academy, Air Force Academy, Air Force Technical College and Naval Academy. With more than 18 years of service as scientist, Dr Kumar has been the psychological assessor (Psychologist) in various Services Selection Boards for eight years for the selection of officers in Indian Armed Forces. Dr Kumar has developed many psychological tests and assessment tools for the selection of officers and recently the psychological test battery and manual for the selection of Other Ranks (PBOR) in Indian Armed Forces. Dr Kumar has authored a field manual on ‘Suicide and Fratricide: Dynamics and Management’ for defence personnel, ‘Managing Emotions in Daily Life & at Work Place’ for general population and ‘Overcoming Obsolescence & Becoming Creative in R&D Environment’ for R&D organisations. Dr Kumar has conducted many workshops and a National conference on the theme of psychology related topics. Dr Kumar has edited a book, Recent Developments inPsychology, along with many other academic publications in the form of journal articles and chapters in books.

    Manas K. Mandal, PhD, Scientist ‘H’, Outstanding Scientist, is Director, Defence Institute of Psychological Research (DIPR), Delhi. Dr Mandal has obtained his Postgraduate and doctorate degrees from Calcutta University in 1979 and 1984, respectively. He has completed his post-doctoral research programme at Delaware University (Fulbright Fellow), USA in 1986–87 and at Waterloo University (Shastri and Natural Sciences and Engineering Research Council [NSERC] Fellow), Canada, in 1993–94. Dr Mandal was a Professor of Psychology at IIT Kharagpur. He was also a visiting professor at Kyushu University, Japan in 1997. During 2003 he was a Fulbright Visiting Lecturer, Harvard University, USA. He has been awarded various research fellowships and scientific awards at national and international levels, such as International Scientific Exchange Award (Canada), Fulbright Fellowship (USA), Shastri Fellowship (Canada), Seymour Kety grant (USA), Career Award (India), University Gold Medal. Recipient of four prestigious awards from the prime ministers of India, Young Scientist Award (1986), Agni award for excellence in self-reliance (2005), Scientist-of-the-Year Award (2006), Technology Spin-off award for DIPR (2007), Dr Mandal has to his credit six books, and over 100 research papers/chapters in books (80 international and 25 national) published in peer-reviewed journals/books. These researches are cited in 125 international journals and books with more than 500 citations.

    The Contributors

    Kathryn Kanzler Appolonio, Psy.D., is an active-duty USAF staff psychologist for the Mental Health Clinic and the Clinical Health Psychology Service at Lackland Air Force Base, Texas. She trains clinical psychology interns in empirically-based treatments in her role as a core faculty member in the Department of Psychology at Wilford Hall Medical Center's APA-accredited psychology internship programme. Dr Appolonio received her doctorate in clinical psychology from La Salle University and completed her internship at Wilford Hall Medical Center. Dr Appolonio's clinical and research interests involve clinical health and primary care psychology, as well as clinical suicidology.

    Craig J. Bryan, Psy.D., is the Chief of Primary Care Psychology Services at Kelly Family Medicine Clinic, and Suicide Prevention Program Manager for Lackland Air Force Base, Texas. He is also a core faculty member in the Department of Psychology at Wilford Hall Medical Center's APA-accredited psychology internship programme, where he trains clinicians in the primary care behavioural health model. Dr Bryan received his doctorate in clinical psychology from Baylor University, and completed his clinical psychology internship at Wilford Hall Medical Center. Dr Bryan's primary areas of research include clinical suicidology and behavioural health effectiveness research for integrated primary care clinics.

    Erminia Colucci holds a Diploma in Education, and a first class honours degree in Clinical Psychology from the University of Padua (Italy), Erminia (Emy). She was trained as a researcher at The Australian Institute for Suicide Research and Prevention (AISRAP), Griffith University, Brisbane. In 2003 she won the Australian International postgraduate research scholarships (University of Queensland International Postgraduate Research Scholarship [UQIPRS] and International Postgraduate Research Scholarship [IPRS]), which supported her PhD project ‘The Cultural Meaning of Suicide: A Comparison between Italian, Indian and Australian Students’ at The University of Queensland, where she was awarded a PhD in Cultural Psychiatry. Her project was awarded the 2004 UQ Travel Award and the 2005 Dr Helen Row–Zonta Memorial Prize. Since the last few years she is a Research Fellow in the Centre for International Mental Health (School of Population Health, The University of Melbourne), where she is the Research Program Coordinator. She has also given lectures in universities in India, Japan, Italy and Australia. Erminia has presented papers on the cultural aspects of suicide, spirituality, gender issues, qualitative research and arts-based research/prevention nationally and internationally. She has also authored journal papers, book chapters and other publications on these topics.

    Enrica De Simoni, MD, is a resident in psychiatry at II Faculty of Medicine, Sapienza University of Rome, Italy. She is interested in studying the role of religion in mediating suicide risk. She recently carried out a number of review studies dealing with suicide risk related to sport activities, religion and smoking.

    Ilaria Falcone, MD, is a resident in psychiatry at II Faculty of Medicine, Sapienza University of Rome, Italy. She is interested in studying the role of impulsivity and aggression in mediating suicide risk. She has been involved in the prevention of suicide in primary care. She carried out studies dealing with suicide and pharmacological treatment.

    Sandor Fekete, MD, PhD, is Professor and Head of the Department of Psychiatry and Psychotherapy, University of Pecs, Hungary. He is a psychiatrist, psychotherapist and neurologist as well as senior lecturer in graduate/postgraduate education at the university, principal investigator of collaborative studies on suicidal behaviour, and national focal point in the WHO/EURO Network of Suicide Prevention and Research.

    Cathy Yui-chi Fong obtained her Bachelor's degree in psychology from The Chinese University of Hong Kong. She was to begin her PhD studies with a specialisation in educational psychology at the University of Hong Kong in fall 2009. She has been involved in a number of research studies on Chinese children's reading development and impairment, including co-authoring a chapter on this topic for a forthcoming book entitled The Handbook of Chinese Psychology. Her interests include school readiness and language and reading development, particularly in young children.

    Marco Innamorati, Psy.D., is cognitive and behavioural psychotherapist and Professor of Clinical Psychophysiology at Università Europea di Roma. He collaborated at the validation for the Italian population of the Beck Hopelessness Scale. He works for the prevention of suicide in high risk groups such as youths and elderly.

    Farah Kidwai holds a PhD in ‘Emotional Intelligence and Leadership’. She specialises in the field of Applied Social Psychology and Personality Assessment. She has a number of research studies to her credit and has conducted several workshops in the area of interpersonal relations, emotional intelligence and leadership in diverse organisations. A Scientist ‘E’ in the Defence R&D Organisation, she is the recipient of a number of scholarships and awards including Scientific Advisor's Award for the year 2001 by DRDO and Vice Chief of Army Commendation in 2008 by Indian Army. She was also recommended for the Award of Commonwealth Scholarship for Doctorate Degree in 1999 in Psychology by the Government of India.

    Angel Nga-man Leung obtained her Bachelor's degree in Social Sciences from the University of Hong Kong and her M.Phil. degree in psychology from The Chinese University of Hong Kong. She is now a PhD candidate in the Psychology Department of The Chinese University of Hong Kong specialising in developmental psychology. Her major research interests are parenting, adolescent depression and suicide ideation, and the influences of online gaming on the social development of early adolescents.

    Carmel McAuliffe is a Senior Researcher with the National Suicide Research Foundation (NSRF) in Cork, Ireland. She is a psychology graduate of University College Cork and has worked in suicide research since 1996 when she joined the NSRF as a Research Psychologist under the direction of the late Dr Michael J. Kelleher. She has worked on several projects relating to people who engage in deliberate self-harm including the WHO/EURO Multicentre Study on Suicidal Behaviour and a randomised controlled trial of Group Interpersonal Problem-Solving Skills Training for medically treated deliberate self-harm patients. She has published in a number of scientific peer-reviewed journals. She is currently working on a pilot Suicide Support and Information System in the Cork region which aims to better understand the causes of suicide and to improve the provision of support to families bereaved by suicide.

    Catherine Alexandra McBride-Chang is a Professor in the Psychology Department of the Chinese University of Hong Kong specialising in developmental psychology. She has published journal articles on a variety of topics, including adolescent suicide ideation, parenting, child abuse, peer relations, creativity, and reading development and impairment. She has also edited one book on Chinese children's reading development and authored a book entitled Children's Literacy Development. She currently serves as the Director of the Developmental Centre at The Chinese University of Hong Kong.

    Lars Mehlum, MD, PhD, is the founding director of the National Centre for Suicide Research and Prevention at the Institute of Psychiatry, University of Oslo, Norway. He completed his medical training at the University of Bergen in 1982, and his PhD at the University of Oslo in 1995. He is a board specialist of psychiatry in Norway and trained in psy-chodynamic psychotherapy and dialectical behaviour therapy. He has been a coordinator of the National Strategy for Suicide Prevention in Norway since 1993, established a master's degree on suicide prevention at the University of Oslo, established a suicide preventive programme in the Norwegian Armed Forces, headed a national suicide preventive training programme for gate keepers, and co-founded the Norwegian Association for Suicide Survivors. He has been actively supporting a number of international suicide preventive initiatives throughout the years and was president of the International Association for Suicide Prevention (IASP) from 2003 to 2005. He has acted as an advisor for national suicide preventive strategies in several countries. He is member of the Scientific Advisory Council of the American Foundation for Suicide Prevention, member of IASP, International Academy of Suicide Research and the American Association of Suicidology. Apart from being the founding editor of the journal Suicidologi published since 1996, he is also a member of the editorial board of Suicide & Life-Threatening Behaviour and Archives of Suicide Research. With his research group he focuses on the clinical course of suicidal behaviour with respect to aetiological and prognostic factors such as stressors and negative life events, major psychiatric illness and the effectiveness of interventions, among them Dialectical Behaviour Therapy. He has also conducted studies of the epidemiology of deliberate self-harm and completed suicide in the general population and various non-clinical populations. He has published several empirical papers in scientific journals, book chapters and books. He has received several national and international awards in recognition of his work.

    Alec L. Miller, Psy.D., is Professor of Clinical Psychiatry and Behavioural Sciences, Chief of Child and Adolescent Psychology, Director of the Adolescent Depression and Suicide Program, Director of Mental Health Services at P.S. 8 School-Based Mental Health Program, and Associate Director of the Psychology Internship Training Program at Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. Dr Miller has published widely on adolescent suicide, Dialectical Behaviour Therapy (DBT), and borderline personality disorder, and has trained thousands of mental health professionals in DBT. He is co-author of Dialectical Behavior Therapy for Suicidal Adolescents.

    Nishi Misra is Scientist ‘D’ at Defence Institute of Psychological Research, Delhi. She obtained her postgraduation from Allahabad University and M.Phil. in Medical & Social Psychology from Central Institute of Psychiatry, Ranchi. She specialises in the area of Clinical Psychology and has also served as an assessor in Services Selection Board, Allahabad. She has worked extensively in the area of suicides and fratricides, job stress and post-traumatic stress in Armed Forces. She is the co-author of the popular field manual for the officers of the Indian Armed Forces titled ‘Suicide and Fratricide: Dynamics and Management’. She counsels DRDO personnel as well. She has to her credit number of research projects and publication's.

    Chad E. Morrow, Psy.D., is currently a captain and psychologist in the United States Air Force. He is stationed at Maxwell AFB in Montgomery where he serves as the Chief of the Mental Health Element, Alcohol and Drug Abuse Prevention and Treatment (ADAPT) program manager, Traumatic Stress Response program manager, Drug Demand Reduction program manager and the Suicide Prevention program manager. Dr Morrow received his doctorate in clinical psychology from La Salle University, and completed his clinical psychology internship at Wilford Hall Medical Center. Dr Morrow's current research involves garnering empirical support for managing risk/suicide in different settings, for certain models of suicidal behavior, for the efficacy of integrated primary care, and for the modification and use of empirically supported protocols in primary care settings.

    Swati Mukherjee is Scientist ‘C’ at Defence Institute of Psychological Research, Delhi. She has obtained her M.Phil. degree from Delhi University. She has been a gold medalist throughout her undergraduate and postgraduate study in applied psychology. She is involved in many major research projects of the institute. She has to her credit a few research publications. She has edited a volume on ‘Recent Development in Psychology’ and has published a manual on ‘Suicide & Fratricide’. She is currently working in the area of personality assessment for personnel selection. Her areas of interests are Social Psychology and Peace Psychology.

    Pritha Mukhopadhyay is Professor in the Department of Psychology at University of Calcutta, teaching both postgraduate and M.Phil. (Clinical Psychology) courses and regularly renders services to the community as a mental health professional. She has research experience of above 25 years in clinical psychology from psychophysiological and psychoendocrinological perspectives. She has published over 40 research papers in national and international journals and has authored four book chapters. She was awarded Fulbright post doctoral fellowship and was fellow in Indian Council of Medical Research (ICMR) projects, and has conducted UGC, All India Council for Technical Education (AICTE) and Department of Science and Technology (DST) projects for research programmes, including intervention in problem behaviour of children, using biofeedback in clinical population and industrial personnel along with detection of neuropsychological impairment in psychiatric disorders through neuroimaging and neuropsychological techniques. Her recent research interest is on academic readiness in children from Piagetian perspective and shared dysfunction in Autistic sibship. She has supervised Doctoral thesis on neuropsychological research in brain lesions and psychiatric illness, endophenotypes in obsessive compulsive disorder and psychopathology in personality disorders including psychosocial and neuropsychological approaches.

    Latha Nrugham is currently working as Researcher with the National Centre for Suicide Research and Prevention at the Institute of Psychiatry, University of Oslo, Norway. She is also a Research Fellow at the Norwegian University of Science and Technology (NTNU), pursuing her Doctorate in Philosophy (PhD) in community medicine on attempted suicide among Norwegian youth. She completed her M.Phil. in Psychiatric Social Work from the National Institute of Mental Health and Neurosciences (NIMHANS), India in 1994 and Master of Arts (MA) in Social Work from the Tata Institute of Social Sciences (TISS), India in 1988 after finishing her graduation in science from the University of Mumbai in 1986.

    She has worked as Project Social Worker and Researcher with the field-projects of TISS and University of Mumbai, and has been a Fellow of Child Relief and You (CRY) and Consultant to Department for International Development (DFID) in India. She has also worked as Clinical Social Worker in hospital and outpatient settings in India and Norway. She has published empirical papers in scientific journals and book chapters on attempted suicide.

    Rory C. O'Connor is Professor of Psychology at University of Stirling and a chartered health psychologist. He leads the Suicidal Behaviour Research Group at Stirling which is the only dedicated suicide research group in Scotland. He has an international reputation for his work on the risk and protective factors associated with suicide and self-harm. Over the past 14 years he has co-authored some 70 peer-reviewed publications on the psychological factors associated with suicide, self-harm and well-being. He is the co-author of the book Understanding Suicidal Behaviour and is one of the co-editors of the forthcoming book the International Handbook of Suicide Prevention: Research, Policy and Practice (Wiley Blackwell). He is a member of the American Association of Suicidology, the International Academy for Suicide Research and the International Association for Suicide Prevention. He is also the UK National Representative of the International Association for Suicide Prevention (IASP).

    Peter Osvath, MD, PhD, is an associate professor, psychiatrist and psychotherapist. He presently works in the Department of Psychiatry and Psychotherapy, University of Pecs, Hungary. He is also a senior lecturer in graduate/postgraduate education at the university, and participant in many collaborative studies on suicidal behaviour.

    Gaspare Palmieri, MD, is a psychiatrist and psychotherapist at Casa di Cura Villa Igea, Modena, Italy. He has been involved in studies dealing with the Reasons for Living Inventory in various clinical and non-clinical populations. He is engaged in research projects dealing with suicide risk among psychiatric patients.

    Maurizio Pompili, MD, psychiatrists and psychotherapist, is Professor of Suicidology, II Faculty of Medicine, Sapienza University of Rome, Italy. He is part of the community of the McLean Hospital—Harvard Medical School, USA. He is a dedicated researcher of suicidology with more that 200 scientific publications in the field. He was the recipient of the American Association of Suicidology's 2008 Shneidman Award for outstanding early career contributions to Suicidology. He is the National Representative to the International Association for Suicide Prevention.

    Amri Sabharwal is presently working as a Research Investigator at the Defence Institute of Psychological Research, New Delhi. She completed her M.Sc. degree in Cognitive Neuropsychology from the University of Essex, UK in 2006, with a dissertation on the dual process theory of recognition memory. For her Bachelor's degree from Osmania University in 2005, she was awarded the gold medal for best overall performance in psychology. She has been involved in defence-related research pertaining to mental health, personality assessment and test development for personnel selection, as well as other non-defence projects on cerebral lateralisation and emotion recognition. Her area of research includes Cognitive Psychology and Neuropsychology.

    Laura Sapienza, MD, is a resident in psychiatry at II Faculty of Medicine, Sapienza University of Rome, Italy. She is a member of the International Association for Suicide Prevention. She is involved in suicide prevention among psychiatric outpatients. She carried out researches dealing with suicide risk among military personnel, psychiatric patients and non-clinical populations.

    Eva Schaller is psychologist and cognitive-behavioural orientated psychological psychotherapist. At the State Mental Hospital Bayreuth, Academic Hospital for Psychiatry of the University of Erlangen-Nuremberg, she works at a unit for major depression, and also in outpatient care for patients suffering form depressive and bipolar affective disorders. She was born in Muenchberg, Bavaria, Germany. She studied psychology at the University of Wuerzburg; after graduation she worked as a research associate at the professorship for clinical psychology at the University of Wuerzburg. Her focuses were anxiety disorders, especially specific phobias and panic disorders. Her research topics are treatment of depressive disorders, suicidal behaviour and outpatient care.

    Roberto Tatarelli, MD, is Full Professor of Psychiatry and Chairman of the Residency Training in Psychiatry at II Faculty of Medicine, Sapienza University of Rome, Italy. He is the chairman of the Department of Neuroscience at Sant'Andrea Hospital in Rome, Italy. He is a leading expert on suicide and full member of the International Academy of Suicide Research. He is author of more than 400 scientific publications.

    Jitendra Kumar Trivedi is a Professor in the Department of Psychiatry, Chhatrapati Shahuji Maharaj Medical University, Uttar Pradesh (formerly King George Medical University, Lucknow), India, since 1995. He has taken the charge of Head, Department of Psychiatry recently. He has done his medical graduation (MBBS) from the King George's Medical College, Lucknow University, Lucknow in 1973 and later MD in Psychiatry from the same institute in 1977. He was appointed in the faculty in the Department of Psychiatry, K.G. Medical College, Lucknow in 1978 and since then is working at the same institution in various positions. He has been a principal investigator for more than 25 multinational clinical trials as well as ICMR and WHO sponsored projects. He has more than 200 publications in national and international journals as well as chapters in books. He has made presentations on various aspects of mental health in both national and international conferences. He has been the editor of Indian Journal of Psychiatry (IJP) for six years and has been associated with IJP for more than 18 years in various capacities. He was President of Indian Psychiatric Society for the year 2004. He has been Zonal Representative for Southern Asia—Zone-XVI of World Psychiatric Association from year 2005 to 2008.

    Kimberly A. Van Orden, MS, is a doctoral candidate in clinical psychology at Florida State University and is completing her pre-doctoral internship at Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. Kim has a primary interest in suicide risk assessment and has co-authored numerous papers on suicidal behaviour. She is also a co-author of The Interpersonal Theory of Suicide: Guidance for Working with Suicidal Clients. She received the American Association of Suicidology's Student Research Award, a Dissertation Research Award from the Melissa Institute for Violence Prevention and Treatment, an APF/COGDOP Graduate Research Scholarships, and a Scholar Award from P.E.O. International.

    Sannidhya Varma is currently pursuing his Master's degree in Psychiatry from the Department of Psychiatry, CSM Medical College, Lucknow, India. He has done his MBBS from Government Medical College and Hospital, Chandigarh, and has been a meritorious student throughout. He is academically and clinically oriented and has been active participant in various zonal and national conferences. During his tenure of residency, he has got training in the fields of general adult, child and adolescent, geriatric, sex clinic and de-addiction psychiatry.

    Viktor Voros, MD, psychiatrist, Assistant Professor at the Department of Psychiatry and Psychotherapy, University of Pecs, Hungary. Besides clinical work, he is also a lecturer in graduate and postgraduate education at the university, and participant in many collaborative studies on suicidal behaviour.

    Manfred Wolfersdorf, Professor, Dr med. Dr h. c., is psychiatrist and psychodynamic orientated psychotherapist. He is medical director of State Mental Hospital Bayreuth, Academic Hospital for Psychiatry of the University of Erlangen-Nuremberg, head of the clinic for psychiatry, psychotherapy and psychosomatic medicine and docent for ethics in psychiatry at the University of Ulm and for psychiatry at the Stradins University of Riga, Latvia. Professor Wolfersdorf was born in Amberg, Bavaria, Germany, studied medicine at the University of Erlangen-Nuremberg and got his medical education to become a psychiatrist at the University of Ulm. In 1985 and 1987 he worked at the Institute on Self-Destructive Behaviour and Suicide Prevention at the USC in Los Angeles, USA. His research topics are depression treatment, severe depression and suicidal behaviour.

    Author Index


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