Routledge International Handbook of Clinical Suicide Research

John R. Cutcliffe, José Santos, Paul S. Links, Juveria Zaheer, Henry G. Harder, Frank Campbell, Rod McCormick, Kari Harder, Yvonne Bergmans, Rahel Eynan

• Publisher: Routledge
• Year: 2013
• Print ISBN: 9780415530125
• eBook ISBN: 9781134459360
• Topic: Medicine
• Subtopic: Health Care Delivery

Suicide remains one of the most pressing public health concerns across the world. Expensive in terms of the human cost and associated suffering, the economic costs, the social costs and the spiritual costs, it affects millions of people every year.

This important reference work collects together a wide range of research around suicide and suicide prevention, in order to guide future research and provide guidance for professionals about the best way to respond meaningfully to suicidal patients. Responding to the need for multi-disciplinary and international research to deepen our understanding of suicide, it demonstrates where our knowledge is firmly evidence-based and where new areas for research are emerging, as well as highlighting where we know little.

Divided into six parts, each with its own editorial introduction and commentary, it explores research with and about survivors of suicide and indigenous populations. The remaining sections look at suicide-focused research in psychiatric nursing, psychiatry, psychology, and social work and allied health. It is of interest to all advanced students, practitioners and scholars interested in suicide and its impact and prevention.

1 Introduction

Suicide as a significant and growing public health concern: coalescing and building our understanding through interdisciplinary and international scholarship

John R. Cutcliffe

DOI: 10.4324/9780203795583-1

Data collected from a variety of international sources show that suicide continues to be one of the most imposing contemporary public health issues facing many nations of the world today (AGDHA, 2000; Associate Minister of Health, 2006; White, 2003; World Health Organization, 2002). Despite our best efforts, the global rate of suicide has continued to rise since the 1950s. Suicide is expensive in terms of the human cost and associated suffering (Shneidman, 1997, 2004), the economic costs (Institute of Medicine, 2002), the social costs (CASP, 2004; Maris, 1997) and the spiritual costs (Jobes et al., 2000). The international epidemiological picture is equivocal with some countries showing a recent downward trend in suicide rates, such as in the United Kingdom (Department of Health, 2005), Australia (AGDHA, 2000), New Zealand (Associate Minister of Health, 2006) Hungary, Switzerland, Denmark, Belgium and others. Inversely, other countries show alarming upwards trends, such as Ireland, China and former Soviet Bloc countries, such as Lithuania, Russian Federation and the Ukraine.

It is also may be noteworthy that trends in both Canada and the United States¹ also indicate increases in suicide rates; indeed, the Blueprint for a Canadian National Suicide Prevention Strategy (CASP, 2004) indicates that Canada has a higher suicide rate than many other industrialized countries. As a result, though epidemiological evidence should always be treated with a degree of caution (given the epistemological and methodological limitations), the clear trend in this evidence is that suicide remains a significant public health problem and in many parts of the world — is actually on the increase.²

What do we know? The significant gaps in the literature

It is reasonable to state that a substantial literature exists that focuses on suicide, nevertheless, it is also accurate to point out that:

1. This literature remains significantly under-developed (see, for examples, Leenaars’ 2010 statement that much of the current understanding and research in suicide is at least half-paralyzed).
2. There remain large and highly significant gaps in the literature and our current understanding (see Maris et al., 2000).
3. The literature contains a great deal of repetition (see Rogers and Lester’s 2009 comments that recent suicide-focused research has not served to advance our understanding of suicidal behaviour but tends to repeat older research).
4. There is a particular need for inter- (or multi-) disciplinary and international efforts to deepen our understanding of suicide.

The calls for increased inter/multi/trans-disciplinarity and internationality

Several key international calls further indicate the need for evidence-based literature to inform the care of the suicidal person. The American Association of Suicidology (AAS), for example, has urged researchers to produce more ‘book-length’ manuscripts of research pertaining to care of the suicidal person. Concomitantly, within the substantive area of suicidology, there is a growing requirement for research that gives voice to service users’ experiences and thus the associated need for service user involvement in the research process; including the dissemination of research findings (see, for example, Andriessen, 2004). The International Association for Suicide Prevention established a taskforce (as long ago as 1999), to increase awareness of issues concerning suicide survivors and postvention activities. Furthermore, repeated exhortations have been delivered to urge greater international research efforts vis-à-vis studying suicide. The National Academy of Sciences (2002) document, for instance, has argued: ‘Extending the (increased multi-disciplinary research efforts) into the international arena where cultural differences are large and may provide new information…can be fostered.’

Alongside such encouragements, numerous conferences have been held in recent years where the explicit goals of such multi-disciplinary gatherings include the need to unite stakeholders to advance efforts to impact the high suicide rate. In such conferences, researchers, clinicians, bereaved families, and passionate advocates are encouraged to work together to address the critical public health problem of suicide and suicide attempters.

The necessity and benefits of international collaboration

According to Adams et al. (2007), international research collaboration is a rapidly growing component of core research activity for all countries; it is encouraged at a policy level because it provides access to a wider range of facilities and resources. Adams et al., continue that international collaboration enables researchers to formulate and participate in networks of cutting-edge and innovative activity. For researchers, collaboration provides opportunities to move further and faster by working with other leading people in their field; collaborative research is also identified as contributing to some of the highest impact activity. Other gains include access to knowledge and facilities and the establishment of longer-term relationships. It should not be surprising then that the scholarly output from international (and especially multi-disciplinary) teams can provide ‘added value’.

Scholarly output from international, multi-disciplinary teams, it can be argued, has more potential impact and utility than uni-disciplinary and/or uni-national scholarly outputs. Internationally focused books such as this text have many times the potential applicability of uni-national focused books; if well written, they reflect the context, culture and experiences of all the contributing authors and editors, thus broadening the appeal of the book. Furthermore, suicide is a global phenomenon; it impacts on people in all nations. And there are both commonalities across individual nations and idiosyncratic elements of the ‘problem of suicide’ in individual nations. As a result, there is much to be learned from studying the problem in different contexts and cultures, and much to be gained by sharing these findings and insights across international boundaries.

Similar arguments have been made regarding the extra or added value of having multi-disciplinary or inter-disciplinary studies and associated scholarly outputs. It is extremely rare in today’s health and social care system(s) that problems exist entirely within the boundaries of one academic/clinical discipline or another. Almost inevitably, these major public health problems transcend and straddle the boundaries of individual disciplines; the range of different disciplinary groups involved in the care of individuals who present with these problems is, again, wide and deep. Suicide and the care of the suicidal person are a case in point. It is well recognized that suicide is influenced by intra- and inter-personal phenomena such as the person’s physiology (e.g., biochemistry, genetics); psychology (e.g., personality traits, coping skills); spirituality (e.g., theological views); social connectivity and interactions (e.g., degree of loneliness, degree of connection/engagement); and behaviour (e.g., suicide as an acquired, learned behaviour). Similarly, suicide is also clearly linked to and influenced by extra-personal matters of social policy and economics (e.g., unemployment rates, access to health care). Accordingly, improving the care of suicidal people, creating more efficacious suicide prevention programmes and ultimately preventing deaths by suicide require the input of many disciplinary groups. It is with these very specific issues in mind that the authors have constructed a book that:

1. is clearly international in focus and composition;
2. is clearly multi- or inter-disciplinary in focus and composition;
3. collects contemporary, leading-edge suicide-focused research.

We believe that this is the first book of its kind. This book brings together a collection of eminent suicidology scholars, each of whom has an established track record of publishing in this substantive area or/and engaging in federally funded research that focuses on suicide (or/and issues related to suicide). Our collection of editors includes:

• two former holders of Professorial Endowed Chairs (Dr. Cutcliffe and Dr. Links);
• the former president of the American Association for Suicide Prevention (Dr. Campbell);
• the former president of the Canadian Association for Suicide Prevention (Dr. Links);
• the former president of the Portuguese Association for Suicide Prevention (Dr. Santos);
• two former international representatives to the International Association for Suicide Prevention (Dr. Cutcliffe and Dr. Links);
• several members of numerous journal editorial boards, including suicide-specific journals such as Crisis — the journal of the International Association for Suicide Prevention.

The book’s editorial team is, for the first time, a purposeful collection of scholars/clinicians from the wide range of disciplines involved in the direct/indirect care of the suicidal person (and/or suicide survivors). Moreover, the editorial team is again intentionally international in composition. These two important design choices were incorporated as an attempt to have the book reflect the global and professional/disciplinary reality of the problem of suicide. Suicide is not restricted to one country or another; it is not restricted to the developing world or the developed world; it is not limited to one ethnic group. All the countries that report data to the World Health Organization show that suicide is a global phenomenon and, moreover, in many places/countries, it is a growing problem. Similarly, the problem of suicide and care of the suicidal person are not restricted to one disciplinary group or another. At the same time, it should be acknowledged that the ‘answers’ to the problem of suicide are unlikely to exist within the artificial, ‘man-made’ boundaries of one discipline or another. The logical position is that in order to address the problem of suicide, we ought to draw upon the wisdom, knowledge, experiences, theories and empirical findings from all the groups/disciplines involved (either directly or indirectly) in the care of suicidal people.

The book is divided into six discrete (yet linked) Parts, with each Part focusing on the research work emanating from (and focusing on) the individual disciplines (groups) involved in the care of suicidal people. Not to overstate the unique nature of this book, but no other book that focuses on suicide and suicidology has been written with such a format and clear emphasis on highlighting the multi-disciplinary contributions to the extant knowledge base.

Each Part of the book is a collection of ‘cutting-edge’ research studies³ that have focused on suicide and care/management of suicidal people that relates to the particular disciplinary group. Accordingly, by way of an example, Part I, ‘Nursing’ includes five research reports of studies involving psychiatric/mental health nurses as part of the research teams and/or focusing on psychiatric/mental health nursing care of the suicidal person. Similarly, Part II, ‘Psychiatry’ includes five research reports of studies involving psychiatrists as part of the research teams and/or focusing on psychiatric care of the suicidal person issues.

Each of these Parts has been edited by key figures from their respective disciplines; they have made previous substantive contributions to the literature in their area and have undertaken research focusing on their particular substantive group. Each Part is buttressed by an introductory editorial and a commentary section where the salient threads and themes that are evident in the research have been highlighted; in some cases, possible future directions for research are highlighted.

Why have we included these issues/parts and not others?

As stated previously, four sections of this book are driven by professionals who belong to the clinical groups (disciplines) who have frequent contact with suicidal people, perhaps most commonly in mental health care settings: psychiatric nurses, psychiatrists, psychologists and social workers (though Part IV also includes contributions from other disciplines). As to which studies/issues to include in the five chapters in each of these Parts, we have deliberately deferred to the expertise of the Editors of these sections in making these choices. In putting together a book that focuses on current and key research act...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of figures
• List of tables
• Notes on contributors
• Foreword: A view from a suicide survivor
• Foreword: A view from a member of the canadian parliament
• Foreword: A view from a member of the world health organization: europe office
• Preface
• 1 Introduction: suicide as a significant and growing public health concern: coalescing and building our understanding through interdisciplinary and international scholarship
• Part I Nursing
• Part II Psychiatry
• Part III Psychology
• Part IV Social work and allied health care disciplines
• Part V Suicide survivors
• Part VI Indigenous peoples
• Index