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Diego De Leo, Vita Poštuvan (Eds.): Resources for suicide prevention

Reviewed by Prof. Dr. phil. Norbert Erlemeier, 2017-07-31
Translated from German version by Claudia Mehlmann

Cover Diego De Leo, Vita Poštuvan (Hrsg.): Resources for suicide prevention ISBN 978-0-88937-454-6

Diego De Leo, Vita Poštuvan (Eds.): Resources for suicide prevention. Bridging research and practice. Hogrefe Publishing GmbH (Göttingen) 2017. 158 pages. ISBN 978-0-88937-454-6. 29,95 EUR. CH: 39,90 sFr.
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Subject

Suicide risk, suicide and suicide prevention remain a challenge for the health care system, clinical therapeutic practice, the community-promoting forces in society as well as for individuals, groups and institutions, that provide stability, support and understanding, which can not be underestimated.

The present volume comprises contributions from numerous authors who have been invited to participate in scientific conferences, held annually since 2009 by the Slovenian Center for Suicide Research. The conferences are named TRIPLE i. This stands for the threefold concern of the conferences to demonstrate and promote intuition, imagination and innovative ideas in theory and practice of suicide. The intention of the editors is to provide food for thought to lay people, practitioners, researchers and all those 'who come in contact with the tragedy of suicide'. A little pathetic the preface reads as follows: New ideas and interventions should be stimulated, 'which can be useful in the difficult fight against suicidal behaviour, a struggle that requires the active participation of everyone'.

Note: The book is written in English. It presupposes a linguistic reader who does not hesitate to familiarize him-/herself with the respective specialist terminology, arguments and phrases. All translations into German are from the reviewer.

Editors

The editirs are: Dr. Diego De Leo, emeritus Professor of Psychiatry, Griffith University, Australia, and Director of the Slovenian Center for Suicide Research. He is one of the longstanding and world famous suicide and prevention researchers, who was among others President of the International Association for suicide prevention (IASP) and consultant for the World Health Organization (WHO).

Dr. Vita Poštuvan is an Assistant Professor of psychology and Assistant Director of the aforementioned Research Centre in Slovenia.

At this point it would lead too far to mention here all the other authors. They can be accessed through the table of contents at the Deutsche Nationalbibliothek.

Structure

The anthology is divided into four main sections with respective chapters.

To Part 1

The main part is titled 'What have we achieved so far?'

In chapter 1 Enrique Baca-Garcia and Victoria de Leon-Martinez, both teaching and researching at Spanish and American universities, give an overview of contents of suicidological theory, research and practice, from a quantitative perspective under the title 'Translating research into practice'.

One focus of most contributions, that should already be mentioned here, is the treatment of results and developments in suicide prevention.

In chapter 2, Heidi Hjelmeland, from Trondheim (Norway), discusses the same topic as in chapter 1 from a qualitative perspective. She criticizes the inadequacy of purely quantitative research in long explanatory chains and opposes it to the advantages of the qualitative research. These are mainly that the intentional, meaningful aspects of suicidal events can be recorded. Quantitative methods need to be supplemented by qualitative ones, not least because this makes it easier to translate research into suicide prevention practice.

To Part 2

Main part 2 turns to the "interventions".

Chapter 3, written by Maurizio Pompili from Rome, is closely connected with the topic 'Investigation of the Phenomenology of the Suicide' in chapter 2. The essence of the article is the conclusion that a psychiatric disorder diagnosis alone is not sufficient to understand the emergence of suicidality. The angle must be extended to other components, especially to that of unbearable 'psychological pain' (according to Shneidman) as the deep reason for suicide.

Chapter 4 proposes the topic 'Investigating the Effectiveness of Suicide Prevention Programmes' in a concise and unambiguous manner. It was writen by Ella Arensman from Cork (Irland). After reviewing the literature, she succinctly concludes that no significant effect of the programmes for men and women in the 'working age group' was found. There are some indicators of the effectiveness of suicide prevention programmes for young and old people (p. 57/58). Also in individual areas of prevention, e.g. in the restriction of suicide, in awareness and training camps related to depression and suicidal behaviour, moderate improvements occur. It is generally recommended not only to rely on the results analysis, but to focus more strongly on the process evaluation than in the past.

Chapter 5 following chap. 4 deals with a programme launched by Hegerl (Leipzig) and other contributors across Europe. It is called 'The European Alliance Against Depression' (EAAD) and intends to provide improved care for depressed patients and a community-based suicide prevention on four levels. The project is based on the well-known competence network depression and suicidality, initiated in Nuremberg and Würzburg as a control region (more details can be found in the bibliography). The EAAD is accompanied by a study on suicide prevention programmes and their implementation in Europe (OSPI-Europe). The basic assumption, represented by Hegerl and his circle, is not unimportant for the reconstruction of all projects, that suicidal acts mainly occur in the context of psychiatric disorders, especially in connection with depression. An important element for suicide prevention is therefore the improved treatment of depression and other psychiatric disorders (p. 66).

In the next chapters two target groups for suicide prevention will be brought into focus.

In chapter 6, Merike Sisak (Tallin, Estonia) deals with 'Suicide Prevention in Adolescents'. A multidimensional approach to preventing suicide among young people is presented after groundwork by epidemiological data, specified under the headings of: Background – What helps? – Who helps? (graph, p. 77). Prevention of suicide among adolescents should take advantage of the synergy effects between three pillars in the lives of young people, such as family, school and friends. This approach is exemplified in a project called 'Gaining and Strengthening Young Lives in Europe' (SEYLE). Among the interventions, young people's awareness training with regard to mental health, healthy lifestyle and crisis management proved particularly promising (further details p. 78-80).

Chapter 7 turns to 'Suicide in Old Age'. It was written by Diego De Leo. First basic aspects such as epidemiological foundations, falsehoods and prejudices against suicide in old age are discussed, as well as a tabular overview of age-related suicide rates in an intercultural comparison. Subsequently, characteristics of the suicidal tendencies in old age are derived. It also tackles the difficulties arising in the context of elderly people seeking help, for example in encounters with doctors and health services. Besides depression and physical disorders, other (cultural, socioeconomic and psychosocial) risks for older people's suicides are also to be considered. The intercultural differences in the age-related suicide rates speak for this. According to the author, the detection of suicide risks in the elderly and their prevention are by no means easier than in other age groups (p. 96).

In chapter 8, Diego De Leo treats the issue of 'Suicide Prevention and the Elderly' in a very practical and application-oriented manner from the aspect of 'clinical management'. These include particularly the items of psychopathology and suicidal behavior in old age, methods of clinical assessment and clinical interventions. Amid all criticism, devices for investigating the suicidality of elderly people, such as the geriatric depression scale, are presented. The author considers it a myth that 'the suicide could be reduced if there were increased risk investigations and corresponding treatment' (p. 106). Standard procedures are not sufficient. The clinical interview remains indispensable. As an aid to discussions he gathers examples of narratives by suicidal people, e.g. 'suicide is the only option I have (tunnel vision)' in a graph (p. 108). In his own practice, the author prefers a proven step-by-step plan for the clinical-anamnestic examination (p. 109). A 'safety plan' completes the article which serves to recognize the acute danger of a suicide and to reduce it.

To main part 3

The main part 3 is titled „Postvention“. It involves the important topic of suicide survivors with their difficulties in the grieving and social (re)integration process in several chapters.

Onja T. Grad from Ljubljana (Slowenia) summarizes important results in chapter 9 'Suicide Survivors in Cultural Comparison'. The intercultural studies predominantly favour reprimand, avoidance and other negative reactions towards the suicide surviving dependants. This applies as well to the ascribed causes for a suicide depending on culture, on demons and bad minds up to biological and psychodynamic explanations.

Annette Erlangsen (Denmark; USA) contributes to chapter 10 with 'Evidence-based findings to grieve after suicide'. Here she refers to big administrative data supplies on this subject in comparison to data from the general population. Especially studies on grief of children, of parents and partners after suicide are focused. A dual process model is presented, according to which grief oscillates between the poles 'loss-oriented' and 'restoration-oriented'. This model favours a coping where grief of the surviving relatives can easier be overcome.

Chapter 11 completes the main part 3 'Postvention' with an intervention model for the reintegration of suicide survivors. It was developed and practiced in the context of a PhD thesis at the Slovenian Centre for suicide research. It is reported by Vita Poštuvan (just there), called the 'Growing Flower Model' and has been tested in a qualitative study. Starting with the grieving person in the center, different levels of reintegration are differentiated, with the implementation of different circles of helpers involved.

To main part 4

The compilation completes main part 4 under the heading 'Future' with the contribution of 'Future orientations of the suicide research and prevention' by de Leo (chapter 12). In his function as an overview and summary, the contribution attaches a special importance within the framework of the entire concept of the work. The author begins with a survey of previous achievements in suicide prevention. It is distinguished according to achievements in research, policy and practice. On the one hand, this is about the effect of national suicide prevention programmes (with 'unclear evidence', p. 146) and on the other about therapeutic effects with different methods for suicidal behaviour. Derived from the survey, the question arises 'which targets should be achieved in the foreseeable future in suicide prevention.' In research it is the improvement of the review mechanisms such as the standardisation of terminology (nomenclature), the validity and reliability of data registers, and in particular the study of protective factors as a counterweight to the one-sided investigation of risk factors in suicide prevention. According to the author, the improvement of the collection of protective data is 'imperative' for future etiological suicide research, as is the rigorous evaluation of promising suicide prevention programmes. In a diagram (p.151), the author summarizes his conceptions of progress in suicide research again in a condensed form. De Leo is also working on other future directives in the sense of suicide prevention within the fields of politics and practice. The general health policy is addressed as an element of general suicide prevention and the importance of the internet with its risks and potentials.

Discussion

The collection encompasses a wide range of thematic aspects regarding suicide research and suicide prevention. It is based on a selection of congress contributions by international authors, which not only present empirical data and findings that are largely known in the professional world, but also critically comment on methodological questions of suicide research, on the efficiency of previous suicide prevention programmes and projects, especially on future tasks, that in research and prevention practice require more precise and improved processing and verification. This is mainly done in the last contribution by De Leo with prudence and many years of experience. Too narrow diagnosis and treatment practices, which perceive mental disorders as a preformed cause for suicidal actions, are subjected to a critical examination in several contributions. This also applies to an overemphasis on risk factors in purely quantitatively defined suicide research, which is inadequately approaching the depth layers and the subjectively shaped process character of suicidal behaviour. The research and the inclusion of protective effects that have to be taken into account in prevention strategies more strongly than before are being considered.

The work is of excellent quality both in terms of form and classification. A detailed and up-to-date bibliography is added to each contribution. As to be expected from a work of this kind, the text provides a good and multiple record of data, scientific findings, and sources of literature.

Remark: It is also to be observed once more in this collection, that only scientific publications in the English language have the opportunity to be internationally recognized and processed. Apart from the fact that the circle around Hegerl and the Viennese research group, who are published in English, are therefore also quoted, there is no place of citation in the text that goes back to a German-language publication. Thus it appears that research and prevention in German-speaking countries are only taken into account when dealing with suicide problems, if they appear in English-speaking specialist publications.

Summary

Altogether the anthology provides a lot of interesting and instructive aspects, which can be of great interest for the research of suicide and practice of suicide prevention and can have a stimulating effect on the future. The diversity of topics and scientific approaches becomes evident. Certainly, the main title is true if one speaks of 'Resources for suicide prevention'. The demand in the subtitle, that the results and arguments in the contributions may lead to a 'bridging between research and practice', can essentially be followed. However, one critical fact is, that the work has been written (regarding language and content) and was designed primarily for people already familiar with the topic. Whether the intention is true that the book 'food for thought to lay people ..', which is given in the preface of De Leo in the first place, is provided, may be doubted according to the reviewer's opinion.

Review by
Prof. Dr. phil. Norbert Erlemeier
Ehem. Mitglied und Sprecher der AG Alte Menschen im Nationalen Suizidpräventionsprogramm für Deutschland
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Cite this publication
Norbert Erlemeier, 2017. Review of: Diego De Leo, Vita Poštuvan (Ed.): Resources for suicide prevention. Bridging research and practice. Hogrefe Publishing GmbH 2017. ISBN 978-0-88937-454-6. In: socialnet Reviews, 2017-07-31. ISSN 2190-9245. Retrieved 2022-09-29 from https://www.socialnet.de/en/reviews/23055.php.


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