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Distal risk factors, interpersonal functioning & family skills training in attempted suicide
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Suicidal behavior is an important global health problem affecting also significant others. Both genetic and environmental influences play an important role in the development of suicidal behavior. There is a need of interventions for family and friends after a suicide attempt. The aim of this thesis was to assess the impact of family history of suicide (FHS) and early life adversity (ELA) on severity of suicidal behavior and on level of interpersonal problems in suicide attempters. Furthermore it aimed to evaluate a DBT-based skills training program, Family Connections (FC), for relatives and friends of suicide attempters.

Methods Studies I and II included 181 suicide attempters. FHS was assessed with the Karolinska Self-Harm History Interview or in patient records. ELA was assessed with the Karolinska Interpersonal Violence Scale (KIVS) measuring exposure to interpersonal violence in childhood. Suicide intent was measured with the Freeman scale. Interpersonal problems were assessed with the Inventory of Interpersonal Problems (IIP).

Study III, a pilot study evaluating the effect of FC for family members of suicide attempters, included 13 participants who completed the program with pre- and post-questionnaires. The experience of burden was assessed with the Burden Assessment Scale (BAS), general wellbeing with Brief Symptom Inventory (BSI) and level of depression was assessed with Beck Depression Inventory (BDI). The Swedish scale Questions About Family Members (QAFM) was used to explore the quality of the participants’ relationship with the patient and the Quality of Life Inventory (QOLI) was used to measure satisfaction with life situation.

Study IV included 132 family members, and investigated the feasibility and preliminary efficacy of FC in psychiatric care. Participants were assessed pre- and post-intervention with the following self-report questionnaires: BAS, QAFM and Five Facet Mindfulness Questionnaire.

Results Male suicide attempters with FHS made more serious and well planned suicide attempts and had higher suicide risk. FHS and exposure to interpersonal violence as a child were independent predictors of suicide in male suicide attempters. Regarding interpersonal problems, suicide attempters with FHS had significantly more often an intrusive personal style, indicating that they might have an impaired ability to create stable, long-lasting relationships. In the pilot study the participants reported a significant reduction in burden, an improved psychic health and an improvement in the relationship with the patient after completing FC. In the fourth study, FC showed to be feasible and effectively implemented in a psychiatric outpatient services clinic. Regarding burden, results were in line with the pilot study, with a significant reduction in all subscales in BAS.

Conclusions High-risk patients call for a consideration of both ELA and FHS in clinical suicide risk assessment. In suicide attempters at biological risk, suicide might be prevented with the early recognition of environmental risks. Further, the interpersonal problems associated with FHS may cause difficulties for suicide attempters to accept or benefit from treatment, and caregivers should take into account the characteristics of the suicide attempter´s interpersonal functioning. The results from the pilot study provide support for the need and importance of an educational program addressed specifically to family members of suicide attempters. Preliminary results support the feasibility and potential value of an implementation of FC in psychiatric open care clinics.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2017. , 64 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1871
Keyword [en]
suicide, suicide attempt, family history of suicide, early life adversity, DBT skills training
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
URN: urn:nbn:se:umu:diva-129648ISBN: 978-91-7601-634-3 (print)OAI: oai:DiVA.org:umu-129648DiVA: diva2:1062555
Public defence
2017-02-03, Föreläsningssal A, Psykiatriska kliniken, Målpunkt F, Plan O, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-01-13 Created: 2017-01-06 Last updated: 2017-01-27Bibliographically approved
List of papers
1. Family history of suicide and exposure to interpersonal violence in childhood predict suicide in male suicide attempters
Open this publication in new window or tab >>Family history of suicide and exposure to interpersonal violence in childhood predict suicide in male suicide attempters
2013 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 148, no 1, 92-97 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Family studies, including twin and adoption designs, have shown familial transmission of suicidal behaviors. Early environmental risk factors have an important role in the etiology of suicidal behavior. The aim of the present study was to assess the impact of family history of suicide and childhood trauma on suicide risk and on severity of suicide attempt in suicide attempters.

METHODS: A total of 181 suicide attempters were included. Family history of suicide was assessed with the Karolinska Suicide History Interview or through patient records. Childhood trauma was assessed with the Karolinska Interpersonal Violence Scale (KIVS) measuring exposure to violence and expressed violent behavior in childhood (between 6 and 14 years of age) and during adult life (15 years or older). Suicide intent was measured with the Freeman scale.

RESULTS: Male suicide attempters with a positive family history of suicide made more serious and well planned suicide attempts and had a significantly higher suicide risk. In logistic regression, family history of suicide and exposure to interpersonal violence as a child were independent predictors of suicide in male suicide attempters.

LIMITATIONS: The information about family history of suicide and exposure to interpersonal violence as a child derives from the patients only. In the first part of the inclusion period the information was collected from patient records.

CONCLUSIONS: The results of this study imply that suicides among those at biological risk might be prevented with the early recognition of environmental risks.

Keyword
Suicide, Suicide attempters, Family history of suicide, Interpersonal violence, KIVS, Freeman scale
National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-92359 (URN)10.1016/j.jad.2012.11.055 (DOI)000318563000013 ()23273935 (PubMedID)
Available from: 2014-08-26 Created: 2014-08-26 Last updated: 2017-02-23Bibliographically approved
2. Family history of suicide and interpersonal functioning in suicide attempters
Open this publication in new window or tab >>Family history of suicide and interpersonal functioning in suicide attempters
Show others...
2017 (English)In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 247, 310-314 p.Article in journal (Refereed) Published
Abstract [en]

Difficulties in interpersonal relationships are associated with a wide range of psychiatric diagnoses and have been reported as a trigger for suicidal behavior, too. The aim of this study was to examine the relationship between interpersonal problems and family history of suicide in suicide attempters and to describe relevant patterns of interpersonal problems in this patient group. The study involves 181 patients having their clinical follow-up after a suicide attempt. Family history of suicide was assessed by using the Karolinska Self Harm History Interview or retrieved in patient records. The Inventory of Interpersonal Problems was used to assess personal style in an interpersonal context. Suicide attempters with a family history of suicide had significantly more often an intrusive personal style. The results remained significant after adjustment for personality disorder. The specific interpersonal patterns associated with family history of suicide may interfere with the ability to create stable, long-lasting relationships. In regards to treatment, these personal qualities could cause difficulties in the alliance with health care personnel and make it harder for suicide attempters to accept or benefit from treatment. Attention to suicide attempters’ interpersonal problems is of importance to lower their distress.

Keyword
Inventory of Interpersonal Problems, Interpersonal functioning suicide attempt, Familial transmission of suicidal behavior, Suicide
National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Psychiatry
Identifiers
urn:nbn:se:umu:diva-129645 (URN)10.1016/j.psychres.2016.11.029 (DOI)000392772400049 ()27951478 (Scopus ID)
Available from: 2017-01-06 Created: 2017-01-06 Last updated: 2017-02-27Bibliographically approved
3. Dialectical Behavior Therapy-Based Skills Training for Family Members of Suicide Attempters
Open this publication in new window or tab >>Dialectical Behavior Therapy-Based Skills Training for Family Members of Suicide Attempters
2009 (English)In: Archives of Suicide Research, ISSN 1381-1118, E-ISSN 1573-8159, Vol. 13, 257-263 p.Article in journal (Refereed) Published
Abstract [en]

This pilot study evaluated the effect of Family Connections (FC), a Dialectical Behavior Therapy-based manualized skills training program, for family members of suicide attempters. The DBT-based skills training program aims to enhance the knowledge of wide range research based aspects of suicidal behavior and treatment recommendations. Furthermore it includes skills training for interpersonal relationships and also offers family members an opportunity to share their experiences. Thirteen participants completed the 9-week program with pre- and post selfreport questionnaires. The results showed significant reduction in burden, improved psychic health and an increase in well-being regarding the relation with the patient. These results provide support for the need and importance of a DBT-based skills training program addressed specifically to family members of suicide attempters.

Keyword
DBT-based skills training, Family Connections, family members, prevention, suicide attempt
National Category
Psychiatry Other Health Sciences
Research subject
Psychiatry
Identifiers
urn:nbn:se:umu:diva-129646 (URN)10.1080/13811110903044401 (DOI)
Available from: 2017-01-06 Created: 2017-01-06 Last updated: 2017-01-10Bibliographically approved
4. DBT-based skills training for family members of suicidal patients: open clinical feasibility trial in a psychiatric outpatient context
Open this publication in new window or tab >>DBT-based skills training for family members of suicidal patients: open clinical feasibility trial in a psychiatric outpatient context
(English)Manuscript (preprint) (Other academic)
Abstract [en]

The involvement of significant others is an objective in suicide prevention and there is a need for development of interventions for this group. The aim of this open naturalistic study was to evaluate the feasibility and the preliminary efficacy of Family Connections (FC) for significant others of suicidal patients, a nine-week manualized skills training program based on dialectical behavior therapy (DBT) in a clinical context.

The intervention program aims to enhance the knowledge of symptoms and behaviors connected with attempted suicide. Furthermore it introduces stress-coping strategies and emotion regulation skills. Out of 132 participants in total, 104 (79%) completed the program. Included in the analysis were the 86 (65%) participants who completed the program, and who also had both pre- and post-intervention assessments. The Burden assessment scale, BAS, the Questions About Family Members scale, QAFM, and the Five Facet Mindfulness Questionnaire, FFMQ, were used to assess perceived burden, relationship climate and five facets of mindfulness respectively.

The results showed a significant reduction in perceived burden, measured by BAS, and a significant change in the mindfulness scale FFMQ subscale Acting with Awareness, which indicates an enhanced ability to be present in the moment. None of the four subscales in QAFM showed significant changes between the pre- and post-intervention assessments.

The results support the feasibility and potential value of the implementation of an intervention for family members and friends of suicidal patients in psychiatric care. Randomized controlled studies are needed to generate further evidence.

Keyword
suicide attempt, suicide prevention, family psychoeducation, DBT skills training, family connections, burden
National Category
Psychiatry Other Health Sciences
Identifiers
urn:nbn:se:umu:diva-129647 (URN)
Available from: 2017-01-06 Created: 2017-01-06 Last updated: 2017-02-23

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