In Correctional Institutions of Kosovo (CIK), the rate of suicide and attempted suicide is low (in the last six years have been six suicide).

Disturbing is the fact that during the period October 2007 to January 2009 at the Lipjan Detention Center (LDC) have been nine suicide and three attempted suicide, while in all other correctional institutions has not happened any suicide and only one attempted suicide. This level is to high when we consider the fact that the capacity of LDC is approximately 200 prisoners, while in all other correctional institutions have about 1500 prisoners.

The objective is to find reasons for such a high level of suicide and attempted suicide in LDC.

The aim is to return the low level of suicidal behavior in LDC.

Mapping:

1. 1. Survey documentation

2. 2. Interviews

3. 3. Focus groups

1. 1. Lack of detection of cases at risk for suicide during admission.

2. 2. Inadequate administrative and health management.

3. 3. Insufficient communication between staff and prisoners

Better management in early detection of cases Creation of a multidisciplinary team for management of cases referred as risky for suicide

Behaviour disorders in adolescents are a risk factor associated with suicidal behavior.

To examine the distribution of the Strengths and Difficulties Questionnaire (SDQ) scores in the Spanish sample of adolescents from the “Saving and Empowering Young Lives in Europe” (SEYLE) project and study the differences according to the gender and the relationship with both suicide attempts (SA) and suicidal ideation (SI).

875 pupils from 12 secondary schools sited in Asturias (Spain) [50.7% males; mean age (SD) =14.5 (0.72)] were assessed through the SDQ and Paykel Suicide Scale (PSS).

No significant differences were found in the SDQ total score by gender, but were found (p< 0.001) in some subscales as emotional symptoms (t=-6.769) (women scoring higher), hyperactivity (t=3.283) and prosocial (t=5.260) (men scoring higher). Regarding PSS, 3.1% tried to take their life during past six months. No significant differences were found in SA by gender but were found (p< 0.050) for the thought that life not worth (t=-3.597), women scoring higher, and about wish to be dead (t=-2.630), men scoring higher. Previous SA were significant related (p< 0.001) with SDQ total score (X2=38,437), emotional symptoms (X2=25,528), hyperactivity (X2=13,572) and behaviour disorders (X2=7,505). SI was significant related (p< 0.001) with SDQ total score (X2=38,437), emotional symptoms (X2=31,077), behaviour disorders (X2=33,011), peer problems (X2=35,161) and prosocial behavior (X2=17,978).

SA and SI were related with difficulties (SDQ criteria), mainly on emotional symptoms and behaviour disorders. Prevention strategies in high risk groups are likely to become increasingly important.

Suicide has emerged as one of the most important causes of death in the age group 15–34 and ranks as the second cause of death after traffic accidents and other injuries in the age group 15–19. In Europe, more than 13,000 young men and women aged 15–24 die by suicide each year. Therefore, identifying risk factors for suicidal behavior has become a priority, and suicide prevention in the young population is a major area of interest for public health professionals, stakeholders and researchers.

To actively screen for a range of unhealthy behaviors used as cut-offs in the Romanian SEYLE (Saving and Empowering Young Lives in Europe) sample, and to assess their significance as risk factors for suicidal behavior.

1143 9th grade pupils aged between 14 and 16 from 16 high schools in two counties in North-Western Romania were randomized in the SEYLE protocol. They were screened for suicidal ideation and behavior, depression, anxiety and a number of risk-taking behaviors: non-suicidal self injury, unhealthy eating behavior, sensation seeking & delinquent behavior, substance abuse, increased exposure to media, limited social relationships, bullying, and truancy.

Suicidal behavior in adolescents is commonly associated with anxiety and a number of risk-taking behaviors, which may be used as warning signs while actively screening for suicide risk in adolescent populations. Although a high number of at-risk pupils were identified at baseline, no completed or attempted suicides were recorded in the assessed sample at 3-months follow-up.

The suicide of a patient in ongoing treatment is surely among the most traumatic events in the professional life of a psychiatrist.

Alert to the psychiatrist's reactions to patient suicide.

Review of literature relevant in medline database.

A substantial proportion, estimated to range from 15% to 68%, of psychiatrists has experienced a patient suicide. A significant proportion of psychiatrists show strong negative reactions, affecting professional and personal lives at levels of distress that are frequently comparable with those seen in clinical populations. Psychiatrists develop rather classic symptoms of anxiety, depression, or acute or posttraumatic stress symptoms, and their responses are typical: in the beginning occurs shock, disbelief, denial and depersonalization; and in the second phase takes place: grief, shame and guilt (“did I listen to him?”), anger (toward the patient who did not honor a therapeutic contract), relief (for example, after the suicide of a chronically suicidal patient), and the finding of omens that the psychiatrist considered signs of the coming suicide. But they are predictors of increased distress among psychiatrists who experienced a patient suicide, and the more consistent are age, experience, individual personality and psychiatric history. Recognition of all this combined with an avoidance of isolation is an effective coping mechanism that prevents the structuring of a pathological response to the patient's suicide.

Psychiatrist's reactions to patient suicide are specific but not noted; its recognition is important to help them find appropriate coping mechanisms.

Suicidal behaviours are commonly found at increased rates among individuals with psychiatric disorders.

To identify risk factors of suicide among the population attended in our area, describe the characteristics of the attempt and the management.

Review of the drug overdosings attended in our Hospital from July to December of 2009.

We identified 112 drug overdosings. 80′4% of the patients had psychiatric history: Mood-Anxiety disorders 60′7%, Substance-Related Disorders 41′1%, Personality disorder 30′4% and Psychotic disorder 10′7. Previous attempts were found in 43′8% of the patients. The most common drug used were benzodiacepines (73% of the cases), followed by antypsychotics (17′9%). Up to 32′1% of the patients used non psychiatric drugs. 64′3% of the patients consumed alcohol and 13′4% cocaine. Moreover, 15′2% of the patients took other toxic substances such us bleach, soap and other chemical products.

We did not find significant differences when studying triggers (family, partnership, economical or others)

The most common diagnosis was suicide attempt (41′1%), followed by parasuicide attempt. 41′4% of the drug overdosings were not considered as self injurious behavior. 64% were referred to ambulatory services, 22′5% needed hospitalization in psychiatric units, and 5′4 were hospitalized in medical services. Although those diagnosed of personality disorder were more often diagnosed of parasuicide (50% Vs 32′1%), they needed more hospitalizations (41% Vs 21%)

1. - Self-injurious behavior is one of the most common causes of consulting in the emergency services.

2. - Patients diagnosed of personality disorder are more commonly hospitalized after making a suicide attempt.

Adolescence is a time of developmental shifts that may leave young people especially vulnerable to suicidal behaviour. Suicidal rates in different European countries differ, which may be due to many factors, including cross-cultural differences.

We aimed to explore differences in risk factors for suicidal behaviour (poor subjective health and low life satisfaction, health-related behaviours, including alcohol drinking habits, family and peer factors) between European countries with different suicidal rates.

The data were collected through questionnaires in the survey ‘Health Behaviour in School-aged Children’, 2005/2006, using nationally representative samples of 15 year old students (N = 11,093) from 7 countries (Lithuania, Finland, Ireland, Slovenia, Norway, Italy, Greece).

Principal component analyses were used to characterize how selected risk factors for suicide cluster together into factors. Differences for these factors were compared between 3 groups of countries: countries with low, average and high magnitude of suicidal rates (SDR; suicide death rate per 100 000, 15–29 years). Between group differences on first two factors, loaded by items measuring health-related behaviours, were significant and medium-sized and indicated cultural differences in alcohol use. Youth from Northern European countries - with high SDR, reported greater number of drunkenness occasions, whereas frequency of alcohol intake was greater for youth from Southern European countries - with low SDR.

Results indicated a possible association of suicidal behaviour and different drinking cultures, arising from different geographical locations and socio-cultural environments. Therefore research and preventive measures should consider specific socio-cultural context.

Suicide represents act of conscious and intentional taking of own life.

According to ICD10 and DSMIV - suicidality and suicidal situations are a part of pathology within different diagnostic categories - most frequently PTSD, mood disorder, schizophrenia, dementia, addiction disease - with common attribute - loss or deterioration of vital instincts. Fifteen years after the war in B&H rise of suicides is evident.

determine number, characteristics, age/sex distribution and specifics of suicidal behaviour of population of subject region, and provide recommendations for preventive action.

it's a retrospective study of 10-year long monitoring of hospitalization by Psychiatry department of RMC DrS. Mujić in Mostar, under a diagnosis of Tentamen suicidii.

Rise of suicide attempts is evident, especially in the period 2007–2009. In the period 2004–2009 threefold increase in share of men, whereby 6,9% pertains to ages 0–19, 37.6% to ages 20–34,23,5% to ages 35–44, and only 4.7% to ages 65+. Intoxication by medicaments is a leading mean.

Statistical processing - Microsoft Excell.

„East Mostar” region is an artificial creation, result of war, segregations, migrations, of predominantly Muslim population, which carries air of specific war trauma and after-war hopelessness, material and spiritual impoverishment, unfulfilled expectations and lack of perspective, and characteristics of suicidal behaviour of its population are therefore - specific.

It's necessary to conduct comprehensive research on state level, form centers with educated teams. Media and influence of religious communities can be critical in the segment of coping strategies.

Pakistan is an Islamic country where religion is considered an important protective factor against suicide. Recent research and media reports identify that suicide and self harm behaviours are increasing in different parts of Pakistan.

To inform public policy debate and suicide awareness education interventions.

To study socio-cultural, political, interpersonal and religious factors that can influence suicide and suicide awareness.

Systematic search of Medline, Embase, PsychInfo, CINAHL, Pakmedinet, TRIP, and electronic searches of Pakistani Medical Journals, using terms Suicide, Self harm, Deliberate Self Harm, Self Poisoning, Non-Accidental Deaths, Undetermined Deaths. Focus Group Discussion, Aga Khan Medical University, Pakistan Consultation with experts in the field.

1. a. Epidemiological evidence confirms an increase in suicide rates with variable figures reported from different parts of Pakistan. Higher rates of suicide rates are reported for men with an association with unemployment and mental health problems. Marital Discord and domestic violence identified as risk factors in female suicides.

2. b. Religion is continued to be identified as an important protective factor against suicide.

However, Pakistan's legal system that criminalizes suicide and self harm is criticized for exercising negative influence through preventing early identification of high risk individuals. A variable pattern of suicide reported from different parts of Pakistan identifies the need for deep cultural understanding and examination of protective and risk factors that operate with in family structures and sub-cultures in Pakistan.

An increase in suicide rates in Pakistan has raised mental health and public policy awareness.

The hypothalamus-pituitary-adrenal (HPA) axis is known to have a role in suicidal behaviors in patients with affective disorders. However, the incomplete overlapping of the genetic factors of suicidal behaviors and the genetic factors of affective disorders suggest that the genes associated with predisposition to suicidal behaviors and affective disorders are different. There is increasing evidence that genes regulating the HPA axis have effects on suicidal behaviors. To test this idea, we examined the association of three HPA axis-related genes (glucocorticoid receptor (NR3C1), mineralocorticoid receptors (NR3C2), and FK506 binding protein 5 (FKBP5)) with suicide.

We selected 3 SNPs of the FKBP5 (rs3800373, rs1360780, rs2395635), 2 SNPs of the NR3C1 (rs6196, rs10052957), and 3 SNPs of the NR3C2 genes (rs5525, rs5522, rs2070951) based on their frequency in the Japanese population. Using Taqman probe assays, we determined these SNPs in 219 completed suicide victims and 228 age- and gender- matched healthy control subjects.

No significant differences in genotypic distribution or allelic frequency of any single SNPs between the completed suicide and control groups were observed. The distributions of TT, TC, and GT haplotypes of the FKBP5 gene (comprised of rs3800373 and rs1360780) between the completed suicide and control groups were significantly different (p < 0.05 for each haplotype). The TC haplotype withstood correction for multiple comparisons (corrected p = 0.034).

Our results suggest that haplotypes in FKBP5 gene are associated with completed suicide. This finding needs to be confirmed using rigorous SNPs selection in a larger sample.

Both Attention Deficit Hyperactivity Disorder (ADHD) and suicidal behaviour are common psychiatric conditions with significant social and emotional morbidity. Although completed suicide in ADHD has been assessed in a previous meta-analysis, other domains of suicidal behaviour such as attempts and ideation have been documented only in individual studies. This review provides a summary of these studies in order to examine the relationship between attention deficit and risk to self.

Electronic and manual literature search of MEDLINE, EMBASE and PSYCHINFO, using a range of search terms around suicidality, attention-deficit and hyperactivity. Articles included both those looking at diagnosis of ADHD in suicidal populations, and those looking at suicidality in pre-diagnosed ADHD populations.

Wide variation was seen in all dimensions, with the main determining factor being co-morbid diagnoses.

In populations completing suicide, ADHD was present in 4 to 25.9%. In suicide attempt and ideation populations, 1.6 to 65% and 10.5–31.8% respectively had ADHD. Attention deficit disorders were diagnosed more frequently in suicidal males than females. Age and location differences were not consistent across groups.

In those with diagnosed ADHD, 9.1–70% had attempted suicide and 15.8–66.3% described suicidal ideation. Higher rates were seen in prison inmates and drug dependent subjects.

Although there is a positive relationship between ADHD and risk to self, the magnitude can vary greatly between different populations. Further research on larger samples is necessary to firmly establish this. The process of risk assessment in ADHD needs to take into account the possibility of intentional self-injury and provide management strategies.

Risk assessment of mentally ill in-patients is an ongoing process in stated time scale. It includes risk of self harm, aggression, violence, self neglect and exploitation and abuse by others. Accurate recording is essential for patient management.

The aim was to assess the practice of risk assessment in our trust. Retrospective data of 50 consecutive admissions were collected from case notes over a period of 6 months.

28 females (56%) and 22 males (44%) of average age 41 were included in the audit. The mean duration of admission was 55 days (range 7–270 days). 11 patients (22%) had schizophrenia and 8 patients (16%) each had a diagnosis of depressive disorder and substance misuse. The other patients had diagnoses of schizoaffective, personality disorder and bipolar illness. Four patients (8%) had no risk assessment forms filled in during the admission. Out of 46 forms completed, the time and date of assessment were not recorded in 8 (17%). Completion date was recorded in 9 forms (20%) and review was done in 11 cases (24%). 45% of forms did not have the name and signature of assessor. Suicide risk, neglect and aggression/violence were documented in most forms (90%), however only 20% cases had a further action plan.

Significant number of risk assessment forms lacked important information which is crucial for risk management. This data was presented to the clinical governance team and was highlighted as a priority for improvement which has been implemented in the trust.

One million people worldwide commit suicide each year; the number of attempters is 20 times larger. The diathesis to suicidal behavior is inherited independently from mental disorders and is most often associated with depression. The importance of serotonergic genes in the genesis of suicidal behavior and depression is assumed. The link between depression and suicidal behavior is hopelessness.

Analyzing the link of certain serotonergic alleles and genotypes with suicidal behavior and depression, as well as with hopelessness.

To analyze the association of chosen serotonergic alleles and genotypes (5HTT LPR, LPR SNP, VNTR2; THP1 A218C, 5HTR1A C1019G; 5HTR2A T102C, C1354 T) with suicidal behavior, depression and hopelessness.

The study included 30 depressed suicide attempters, 30 depressed patients without attempt and 30 healthy controls. Polymerase Chain Reaction method was used to analyze serotonergic gene polymorphisms. Participants were tested with Beck Depression Inventory, Suicidal Intent Scale, Becks Hopelessness Scale.

Two analyzed polymorphisms are associated with depression, but not with suicidal behavior (5HTTintron 2 alele 10 and A218 of the TPH1 gene). Hopelessness is more prominent in depressed suicide attempters.

The results support the role of two serotonergic genes in the genesis of depression. Hopelessness is an important predictor of suicidal behavior. Further investigation of the role of serotonergic genes in various subtypes of suicidal behavior is suggested.

Evidence suggests a relationship between sleep disturbances and suicidal ideation. The temporal appearance of insomnia has been proposed as a warning sign of imminent suicidal acts. However, there is little information on the temporal relation of insomnia with acts of deliberate self-poisoning (DSP) in particular.

This study aimed to identify the insomnia prevalence in DSP patients and test its predictive value in relation to current psychiatric diagnosis and history of previous DSP acts.

Seventy consecutive patients with DSP admitted from February to September 2010 into three general hospitals had a psychiatric consultation and their sleeping pattern during the week before the DSP act was assessed using the Athens Insomnia Scale.

Patients, with a mean age of 34 ± 2 years, predominantly women (70%), were diagnosed with personality disorders (68%), depression (22%) and psychosis (10%). The overall insomnia prevalence was 69%. A chi-square analysis showed that patients with an Axis I diagnosis were significantly more likely to present insomnia than patients with an Axis II diagnosis. Interestingly, when the number of previous DSP acts was included into the analysis, patients with an Axis I diagnosis with and without previous DSP acts had an equal prevalence of insomnia. On the contrary, in patients with an Axis II diagnosis and previous DSP acts, insomnia was three times more prevalent than in those with no previous DSP acts.

These results suggest that insomnia may be a valid proximal warning sign, particularly in patients with personality disorders and previous DSP acts.

Previous studies have provided evidence on the possible relationship between mental pain (psychache) and suicide. The aim of the present study was to investigate whether more intense psychache is related with higher suicide risk independently of the severity of depression.

Orbach's Mental Pain Scale was administered in 58 women with major depression: 24 inpatients and 34 outpatients. Severity of depressive symptoms was evaluated by the Beck Depression Inventory. Suicide Risk Scale was used for the assessment of suicide risk. Level of physical pain was measured by McGill Pain Questionnaire-Short form. Pearson's correlation was used to examine the relationship between variables and a multiple regression analysis was performed to examine the independent strength of the associations.

Suicide risk was significantly and positively associated with the level of current psychache and the severity of depressive symptoms, and negatively with the age of onset of the illness. The levels of physical pain or worst-ever psychache were also correlated with suicide risk; however, these associations did not remain significant in the multiple regression models.

Higher levels of mental pain may be a factor of vulnerability to suicidal behaviour in major depression. Higher symptom severity and earlier onset of the illness may also contribute to suicide risk. The association between physical pain and suicide risk appears to be mediated by mental pain or other aspects of the illness.

Belarus has one of the worlds’ highest suicide rates (48.5 and 9.1/100,000 for men and women, respectively). The country's first suicide prevention project (2009–2013) focuses on educational courses for all physicians employed in primary health care (N = 120) in two regions of the county of Minsk (Total population: 73,663).

The aim of this paper was to investigate physicians’ knowledge with regard to suicide prevention as well as their experience of suicidal behavior based on findings from the pilot study.

45 physicians (mean age 43.6; 31 women, 14 men; 35% of all physicians) had participated in the first training courses, including two educational seminars (24 hours, 2009–2010). All participating physicians answered the questionnaire with 40 items distributed before the training courses.

The preliminary findings indicate that half of the participating doctors (N = 22) considered mental disorders as being the main risk factor for suicide and equally many defined suicide as an expression of “spiritual weakness”. 48% considered that asking patients about suicidal thoughts can stimulate the act. As many as 47% (21 physicians) had experienced a patients’ suicide during their professional practice (14 of them more than once). About half of the doctors (N = 24) have been confronted with a patient's suicide attempt and 20 participants (44%) experienced suicidal behavior of close friends and relatives. 17 (38%) and 2 doctors reported suicidal thoughts and suicide attempts ever in life, respectively.

Improved suicidological knowledge is badly needed, particularly in the light of the frequent confrontation with suicidal patients.

The study of near fatal suicide attempters may provide insight into the minds of persons who die by suicide. Such attempts are characterized by high suicide intent, together with high medical lethality. The ability to fully understand the specific psychological profiles associated with severe of suicide intent can provide insights for suicide prevention.

The objective of the present study was to investigate the relationship of suicide intent to lethality among medically serious suicide attempters. Our aim was to examine specific psychological variables related to the subjective and objective components within suicide intent.

102 suicide attempters belonged to one of two groups: 35 subjects who made medically serious suicide attempts were compared with 67 non- medically serious suicide attempters. All were interviewed and completed questionnaires covering mental pain, communication difficulties, and seriousness of the suicide intent.

The objective component of the suicide intent scale (SIS) was highly correlated the lethality, as well as to communication difficulties, such as self disclosure while the subjective component of the SIS was related to mental pain variables such as depression and hopelessness. A significant interaction between mental pain and communication difficulties was found to predict severity of the objective suicide intent.

The suicidal person whom suffers from depression and hopelessness and cannot signal his pain to others because of communication difficulties can be a risk for a serious suicide attempt - which is more planned, with more precautions against discovery and without communication before or during the attempts.

Individuals grieving a suicide death (suicide survivors) may be at risk for psychiatric complications and suicidal behaviors. Support groups may provide valuable resource for survivors, who often do not seek out mental health treatment. Social support and self regulation which are at the nature of the support groups can facilitate growth from crisis.

The objective of the present study was to investigate the effectiveness of support groups for suicide survivors. The specific aims were to assess the relationship between group participation and stress related growth and to assess the role of self regulation and social support as mediating variables.

74 suicide survivors belonged to one of two groups: 32 survivors who participate in a support group, compared with 42 survivors who did not participate. All participants completed questionnaires covering of self regulation, social support and stress related growth.

Survivors who participated in a support group showed better recovery from stress than those who didn’t participate. The effect was stronger in survivors who lost their offspring. A hierarchical regression indicates that time past from the event as well as self regulation and social support explained more than 33% of the variance of stress related growth.

Support groups for suicide survivors are a helpful intervention tool and can serve as a powerful form of primary and secondary prevention. Social support as well as self disclosure to other survivors can facilitate growth from crisis and diminish feelings of guilt, shame and other psychiatric complications.

In 2009, 8 Romanians committed suicide every day. Suicide risk assessment and management remains difficult for psychiatrists worldwide and requires further study and a better implementation of prevention strategies.

To identify the relationship between demographic and clinical data in a sample of psychiatric patients admitted after a suicideattempt and voluntary self-harm (VSH-SA) to our hospital between 2008 and 2010.

The purpose of this study is to determine which factors, if any, influence suicidal behavior.

A retrospective review of patients aged 10–84 with VSH-SA (coded by ICD-10), admitted during a three year period. The cases were sorted by age, gender, year of admission, seasonal pattern, mechanism of injury and associated psychiatric pathology. The mechanisms of injury were both violent and non-violent.

59% of cases were female and 41% male, 18% under the age of 18 (82% female). 31,5% were in the 18-29 years of age interval. A large difference between the year 2008 (16 cases) and 2009 (51 cases) was registered in the male group. Most cases were registered during spring (34%). Drug and substance ingestion was the most common method. Violent methods were used by 25% of men and only 9,5% of women. The most frequent diagnosis was major depression.

Our results show that a large number of VSH-SA were committed by young, active members of the population and a significant number of children was noticed. These findings emphasize the importance of identifying suicide risk factors and developing prevention strategies.