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R F Diekstra

Publications and source records attributed to R F Diekstra.

At least 37 records · Page 2Linked to original sources
PubMed1993

The epidemiology of suicide and parasuicide.

This article analyses secular trends in suicide and parasuicide and provides support for the hypothesis that a true increase in these phenomena has occurred since the early 1950s up to at least the early or mid-1980s among the adolescent and young adult populations of Europe and North America, particularly young men. One of the potential causal mechanisms for this development, increasing secular trends in and lowering of age of onset for depressive disorders, is examined. Although it is difficult to assess whether the earlier age of onset observed for depressive disorders is reflected in an increase of suicide mortality at a lower age, there is indirect evidence to suggest that this might be the case. Studies show that lifetime parasuicide prevalence rates for the general population do not exceed and sometimes even remain below the rates for adolescents. Assuming that recall of past episodes remains constant throughout the life span, one possible explanation for this finding is an earlier age of the first-ever parasuicidal act. Since parasuicide is an important precursor of suicide, a lowering of age for first-ever parasuicides can be expected to lower the age for suicides and increase the overall lifetime risk.

Adolescent↗
PubMed1993

The epidemiology of suicidal behaviour: a review of three continents.

Suicidal behaviour includes suicidal ideation, parasuicide or attempted suicide, and completed suicide. Assessment and recording of suicidal ideation and parasuicide is most difficult, and the first internationally comparable data on parasuicide are expected from an ongoing WHO-coordinated study in 15 European centres. On the other hand, about 50% of WHO's 186 Member States report suicide as part of their mortality statistics. Although there is no uniformity in definitions of suicidal acts nor in recording procedures, certain patterns of suicidal behaviour emerge across countries. The incidence of parasuicide is 10 to 20 times higher than that of completed suicide; the male/female ratios for suicide and attempted suicide are reciprocal: 3 times more women then men commit parasuicide, while in most countries about 3 times more men than women commit suicide. From a public health point of view, suicide in adolescents and young adults is particularly important: suicide in adolescence and young adulthood ranks among the 5 leading causes of death in many countries. There have been clear and dramatic increases in suicide rates in most WHO Member States which report mortality statistics to the Organization, especially among young men. Suicide in old age, particularly among men, is about 2 to 3 times more frequent than in younger age groups. Although it is not surprising that mortality increases with age, death by suicide is considered in most cultures and by most people as particularly deplorable and unnecessary. The epidemiological analysis of suicidal behaviour globally does not identify clear-cut risk factors amenable to preventive programmes. It does, however, pinpoint countries with "unusual" suicide patterns which, it is hoped, will initiate country-specific research into causes of such behaviour. Particularly promising, from the perspective of suicide prevention, seems to be research into the methods of suicide, and the impact of publicity of suicidal acts, as it has been shown repeatedly that restricting access to the prevailing method of suicide in a country will decrease suicide rates, while wide publicity about suicidal acts will increase them.

Adolescent↗
PubMed1992

A population-based survey of the characteristics of high school students with and without a history of suicidal behavior.

In a sample of 570 15- and 16-year-old normal high school students, the characteristics of those with and without a history of suicidal behavior were compared. In a written inquiry, information was obtained on family background, emotional and behavioral problems, sexual and physical abuse and suicidal thoughts and behavior. Differences between the students with and without a history of suicidal behavior were statistically analyzed for boys and girls separately by a matched control design. The results for both boys and girls indicated that the experience of sexual abuse, feelings of loneliness, depressed mood, low self-esteem and the use of drugs were particularly strongly related to suicidal thoughts and behavior; for girls, physical abuse and for boys, low self-reported academic achievement appeared to be clearly related aspects. Furthermore, the strong interrelations between all of these variables is underlined, suggesting a multi-problem background of youngsters with a history of suicidal behavior.

Achievement↗
PubMed1992

Differences between adolescent suicide attempters and depressed adolescents.

Most of the characteristics differentiating between adolescent attempters and nonattempters do not have discriminative power in comparing 48 adolescents who recently attempted suicide with 66 depressed adolescents. These characteristics may probably be attributed to an affective disorder that is present in most of the suicide attempters. However, suicide attempters, compared with the depressed group, live in more problematic circumstances (such as family disruption or sexual abuse) and have a cognitive style that promotes a more negative evaluation of events and situations. Their depressive symptoms are distinguished from the depressed group by withdrawal and isolation, besides maintaining a hopeless and negative expectation of the future. Furthermore, there are reasons to accept the idea that suicidal behavior is a serious alternative within their behavioral repertoire. Based on these findings, a psychological interpretation is given concerning the dynamics leading to a suicide attempt. Also, intervention strategies are discussed.

Adolescent↗
PubMed1992

The relationship between adolescent suicidal behavior and life events in childhood and adolescence.

OBJECTIVE: Although the relationship between experience of problematic life events and adolescent suicidal behavior has frequently been recognized during the past decade, few studies of life events have been initiated that discriminated between adolescent suicide attempters and depressed adolescents. Therefore, the authors compared adolescent suicide attempters with both depressed and nondepressed adolescents who never attempted suicide with respect to life events that happened in two periods: childhood (defined as the period up to age 12 years) and adolescence (age 12 and older). METHOD: Using a semistructured interview, the authors gathered life event data about childhood and adolescence from three groups of adolescents: 48 suicide attempters, 66 depressed adolescents who had never made a suicide attempt, and 43 nondepressed adolescents who had never made a suicide attempt. RESULTS: The group of adolescents who attempted suicide differed from both of the other groups in that they had experienced more turmoil in their families, starting in childhood and not stabilizing during adolescence. During adolescence, they were more often sexually abused. During the last year before the attempt, further social instability, such as changes in residence and having to repeat a class, occurred. CONCLUSIONS: For suicidal adolescents, the suicide attempt seems embedded not just in the problems every adolescent has to deal with but in greater turmoil in their families, rooted in childhood and not stabilizing during adolescence, in combination with traumatic events during adolescence and social instability in the year preceding the attempt.

Adolescent↗
PubMed1991

Construction of an index for predicting suicide attempts in depressed adolescents.

A group of 48 adolescents who recently attempted suicide and 66 depressed adolescents were compared on sociodemographic, behavioural, psychological and relational variables. The variables which proved significant were used in different combinations in stepwise logistic regression analyses, resulting in seven variables which served as the content of an index of risk. The sensitivity of the index was 90% and the specificity 83%. At one-year follow-up the occurrence of a suicide attempt correlated with score on the instrument.

Adolescent↗
PubMed1991

The prevention of suicide among older people in The Netherlands: interventions in community mental health care.

About one third of all suicides in the Netherlands are committed by elderly people. Yet, until recently no discernible initiatives have been taken to prevent suicide among the elderly. One of the possibilities that has not yet been considered is the use of mass media. In this article some thoughts are presented on the use of television and other media for communicating messages designed to identify depressive symptoms and to counter suicidal tendencies by mobilizing relatives and friends. Epidemiological findings on suicide among elderly persons in the Netherlands are presented, along with data on the role of the general practitioner and the mental health care system in suicide prevention. It is stressed that because of a number of unfortunate circumstances many depressed elderly people do not receive adequate treatment: Because they survived many major life events, their relatives wrongly consider them to be strong enough to cope with yet another major life event, loss or threatening condition. Relatives may think of depressed symptoms as a natural reaction, and may not consider these to be alarming. If they are alarmed, relatives may not know that depression is a treatable condition, or where they may be able to seek psychological assistance. Depressed elderly people might not be willing to share depressed feelings or thoughts concerning death and dying, or admit having suicidal ideation. Symptoms of depression may be confused with the normal aging process, both by the person him- or herself and by his or her relatives and friends.

Adolescent↗
PubMed1990

Characteristics of suicide attempters in a population-based sample of Dutch adolescents.

The characteristics of suicide attempters were ascertained in a sample of 9393 Dutch students aged 14-20. Broken homes and use of drugs and alcohol were found more often among attempters. Attempters more frequently lived with a single parent, in children's homes or foster homes, were disproportionately of female sex, reported more deaths of friends or relatives, and more often had an unemployed father. Thoughts of suicide and of death were reported more frequently, they were more depressed and hopeless, and had less self-esteem. They were less rational and perceived relationships with parents as poor.

Adolescent↗
PubMed1990

The predictability of suicidal behavior: the results of a meta-analysis of published studies.

Using a method of literature review known as meta-analysis, 81 articles were selected describing comparative research into possible differences between two or more of the following groups: nonsuicidals, suicide ideators, first-ever attempters, nonlethal repeaters, and suicides. Differential characteristics are described per comparison category. On the basis of their review, the authors conclude that, generally speaking, suicide prediction research has made little headway over the past 25 years. The many problems in this field of research are discussed and suggestions for improvements are offered; for example, a uniform definition and standardized measurement of variables are outlined, and standard requirements for designs of studies on suicide prediction are formulated.

Humans↗
PubMed1990

Self-reported suicidal behavior in Dutch secondary education students.

From nearly 10,000 secondary education students in The Netherlands, aged 14-20, data were collected on the prevalence of suicide attempts and recent thoughts about suicide and death. In this sample, 3.3% of the girls and 1.3% of the boys indicated that they had attempted suicide. The youngest students already reported as many attempts as the eldest, which is remarkable. Differences between boys and girls and between various types of schools were not substantial. We also found that 5.2% of the girls and 2.2% of the boys currently had thoughts of suicide. Again, there was no substantial difference as regards sex, type of school, and age. There was, however, a (small) difference between boys and girls concerning thoughts of death--namely, 9.3% of the girls versus 4.8% of the boys.

Adolescent↗
PubMed1989

Suicide and the attempted suicide: an international perspective.

This article reviews the scope of suicide and attempted suicide as public health problems from an international perspective. Socio-demographic trends are analyzed and explanatory theories for international differences proposed. Suicide and attempted suicide can be prevented, but the development and evaluation of effective large-scale prevention programs is still in its infancy. Inadequacies in current programs across the world has promoted the establishment of national Task Forces on Suicide Prevention in the United States, Canada and The Netherlands, as well as a WHO strategy on suicide prevention. These groups have formulated comprehensive strategies for the prevention of suicide. The main components of these strategies are: Design and implementation of national research programs; The improvement of services; The provision of information and training on suicide prevention to relevant professional groups, organizations and the general public; and Formulation of strategies and techniques to deal with special risk groups. The added recommendations are seen as important steps in translating a comprehensive national plan to prevent suicide into clinical and research programs that can be effectively implemented to prevent these tragedies around the world.

Adolescent↗
PubMed1989

Suicide and attempted suicide in general practice, 1979-1986.

Using data from the Continuous Morbidity Registration Sentinel Stations over the period 1979-1986, the authors tried to determine the incidence and the characteristics of patients in general practice who attempted or committed suicide. Almost half of the suicide attempts and suicides had contacted their general practitioner (GP) shortly before the suicidal act. A minority of these cases were recognized by the GP as having a high suicide risk. In almost 70% of the suicides and 58% of the suicide attempters the GPs reported the existence, currently or previously, of a depressive episode. About half of both the suicides and the suicide attempters had been treated or seen by mental health professionals or social workers. Given the fact that suicide and suicide attempt are relatively rare events in general practice, and given the fact that for the patients who contact their GP shortly before the suicidal act, it is not at all certain whether they present clearly recognizable signs of suicide risk at that time, the authors conclude that GPs cannot play an important role in the prevention of suicidal behaviour.

Adolescent↗
PubMed1989

Suicidal behavior and depressive disorders in adolescents and young adults.

This paper analyzes and explains trends in mortality by suicide over the period 1960-1986 for the countries that report mortality data to the World Health Organization and is divided in two parts. In the first part it is shown that the rise in overall rates in the majority of countries is to a large extent due to the increase in suicide among adolescents and young adults. For a subsample of 19 European countries the correlation between changes on a number of social indicators and changes in suicide rate is reported. Based on the results a social profile of suicide-prone communities is drawn, which suggests that many developing countries will witness a sharp rise in self-destructive behaviors in the near future. In the second part the relationship between depressive disorders, attempted suicide and suicide is investigated both by review of the literature as well as by a study on the association between national suicide and attempted suicide rates and depressive mood disturbance (population sample survey data) in one particular country (The Netherlands). The results indicate that socioeconomic correlates of (changes in) suicide rates and attempted suicide rates largely coincide and that a hierarchical response model of suicidal behavior provides a satisfactory explanation of the relationships between social disruption or anomie, depressive disturbance, attempted suicide and suicide.

Adolescent↗
PubMed1989

Prevention of suicidal behavior in adolescents: the role and training of teachers.

In order to prevent suicide (attempts) among adolescents, special programs have been developed for secondary school teachers. Such programs inform teachers about the epidemiology, aetiology, symptomatology, and treatment possibilities of severe depression and suicidality of young people, and train them to recognize, handle, and refer such students. In this paper, the rationale is given for involving teachers in suicide prevention. A review of several training programs is presented, and some evaluative findings on the effects of training teachers about the facts of suicidal behavior are presented.

Adolescent↗
PubMed1989

Suicidal behavior in adolescents and young adults: the international picture.

This chapter has reviewed the scope of suicide and attempted suicide among the young from an international perspective. Socio-demographic trends have been analyzed and explanatory theories for international differences proposed. An international strategy for prevention is discussed and specific recommendations are presented. Efforts are to be made to translate international strategies to prevent youth suicide into community, clinical, and research programs that can be effectively implemented around the world.

Adolescent↗