Attempted suicide : Studies of attitudes and psychiatric care
Sammanfattning: Suicide risk among patients referred to psychiatric care after attempted suicide,attitudes of nursing personnel towards suicidal patients and the impact of a trainingprogram in suicidology for psychiatric nursing personnel were studied in the presentwork. Furthermore, the patients perspective on psychiatric care given to them aftera suicide attempt as well as work environment, suicidal feelings and attempted suicideamong psychiatric nursing personnel were investigated. Survival analysis of suicide risk by sex and age after attempted suicide was performedon 1573 suicide attempters referred to the psychiatric emergency room. Nearly twothirds of the patients were women and most of the suicide attempters were young.The suicide risk after attempted suicide among men was nearly twice the suicide riskamong women. It was concluded that older and younger men are at approximately equaland high risk of suicide and that older women are at higher risk than younger inthis sample of patients referred to psychiatric care after attempted suicide. Inthe interview study of patients' experiences of the in-patient psychiatric care receivedfollowing a suicide attempt most of the patients perceived the time at the hospitalas helpful. Some patients saw it as life-saving. The importance of being well caredfor and experiencing understanding and confirmation was emphasized. The conversationswith the staff were seen as essential for the process of healing and for the desireto go on living. In order to examine the attitudes towards suicidal patients among nursing personnel,a scale, The Understanding of Suicide attempt Patient scale (USP-scale), was developed.Personnel working in psychiatry held more positive attitudes than those working withinsomatic care, older personnel were more favourably disposed than the younger andmore frequent exposure to attempted suicide patients was related to more positiveattitudes. After a training program in suicidology general understanding and willingnessto nurse, as measured by the USP-scale, increased significantly and the suicide riskof the patients described in the case vignettes was estimated more accurately. Suicidal feelings, attempted suicide and aspects of work environment and well-beingin Swedish psychiatric nursing personnel were studied using a questionnaire. Suicidalfeelings "last year" were lower than in the general population but, suicidalfeeling and attempted suicide "earlier than last year" were much more common,and 13 % reported that they had attempted suicide earlier in life. In order to studythe possible association between work environment and suicidal behavior a factoranalysis was performed Four factors were extracted and labelled: Suicidality, Qualityof work, Negative work environment and Burnout/Depression. The correlations betweenthe factors suggest that negative work environment is associated with Burnout/Depression,which in turn is related to suicidality. Keywords: Suicide, attempted suicide, suicide risk, attitudes, psychiatric nursing,work-environment, patient satisfaction. ISBN 91-628-2713-8
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