Tagsuicide

Reading of the Week: Vulnerable Youth & ‘13 Reasons Why’ — the New Psych Services Paper; Also, Dr. Orford Considers his Brother’s Suicide in JAMA

From the Editor

It’s a hit show. Is it dangerous?

Since its launch, 13 Reasons Why has been highly controversial; the storyline of the Netflix series revolves around a teenager’s decision to suicide – which is graphically depicted over three minutes in one episode.

In this week’s Reading, we look at a new Psychiatric Services paper. University of Michigan’s Dr. Victor Hong and his co-authors consider the impact of the show on youth seeking psychiatric care for suicide-related risk. While other studies have analyzed the response in the larger community (including google searches), this study focuses on a vulnerable population. They find: “For certain youths, watching the series correlated with a perceived nonzero elevation in their suicide risk; identification with the main female character and strong affective reactions may be markers of increased risk associated with viewing the show.”

13-reasons-picBig buzz, big problem?

In the other selection, we look at a short essay recently published in JAMA. In “Grief After Suicide,” Dr. Orford discusses the suicide of his brother. The Deakin University intensivist notes that: “As a physician, I have cared for thousands of patients and families in the last hours and days of life. I have listened, watched, and learned.” The loss of his brother, however, continues to have a major effect on his life, three decades later.

DG

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Reading of the Week: Suicidal? Get a Postcard. The New JCP Paper on Suicide Prevention. Also, Ketamine & Inpatients

From the Editor

Can we do better at suicide prevention?

In recent years, several studies have tried brief contact interventions – that is, interventions aimed at maintaining a post-discharge connection – reporting success. These interventions have been relatively simple, such as handwritten postcards or phone calls for people post-attempt.

In this week’s selection, we look at a new paper from The Journal of Clinical Psychiatry. Involving 23 emergency departments and crisis centres in France, the authors pulled together different interventions, coming up with an algorithm offering patients care informed by the best evidence. So some patients received calls, but others were given crisis cards.

It’s an ambitious project. Did it work? The results weren’t statistically significant.

p1110389Postcards: colourful and pretty – and life-saving?

We consider this paper, the negative result, and ask: what does this say about suicide prevention? And then, looking at the evolving literature on suicide, we briefly consider a paper written by Sunnybook’s Mark Sinyor that uses IV ketamine for suicidal thoughts.

Please note: there will be no Reading next week.

DG
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Reading of the Week: Suicide Notes & Lessons Learned – the New CJP Paper; Also, Mukherjee on Case Reports

From the Editor

Many people didn’t write one. But some did. The notes were usually short, typically only 600 words or so, and were often handwritten. Some talked about their illness; others didn’t.

What lessons can we learn from these suicide notes?

In the first selection, University of Toronto psychiatry resident Dr. Zainab Furqan and her co-authors consider notes left by those who suicided in a paper just published in The Canadian Journal of Psychiatry. They argue that we can learn from them, and offer clinical suggestions.

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In the second selection, Columbia University’s Dr. Siddhartha Mukherjee argues that the obscure is relevant – he notes the decline and fall of the case report, and calls for its return.

DG

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Reading of the Week: On Spade, Suicide, and the New CDC Report

From the Editor

“I didn’t know Kate Spade, who hanged herself with a red scarf in her bedroom on Tuesday at the age of 55, other than through the prism of her insistently cheerful and whimsical accessories. But everything about Ms. Spade and her designs suggested a sunny temperament, from her candy-colored aesthetic to the perky image she projected. We have a hard time squaring a seemingly successful woman — one with a highflying career, a family and heaps of money — with a despondency so insinuating that it led her to end it all. All this helps explain why Fern Mallis, the former director of the Council of Fashion Designers of America and a friend of Ms. Spade’s, called her death ‘so out of character.’ In fact, it turned out that the bubbly girl from Kansas City ‘suffered from depression and anxiety for many years,’ as her husband, Andy, said.”

So writes novelist Daphne Merkin The New York Times. In the essay, Merkin writes about her depression and her own suicidal thoughts.

Kate Spade. Then Anthony Bourdain.

It’s been a remarkable few days.

bourdain-obama-429e2fd0-b412-4a22-804a-acb7a25d8d43Anthony Bourdain with President Barack Obama

In this Reading, we look at the new CDC report on suicide in the United States. Suicide rates south of the 49thparallel have risen nearly 30% since 1999. We consider the paper and its implications.

DG

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Reading of the Week: Suicide & the News – the New CPA Media Guidelines for Reporting on Suicide

From the Editor

“Hemingway Dead of Shotgun Wound; Wife Says He Was Cleaning Weapon.” So reads the headline from the front page of The New York Times reporting the death of author Ernest Hemingway. It quotes Frank Hewitt, the Blaine County Sheriff, who comments that the death “looks like an accident… There is no evidence of foul play.”

It is well known that writer Ernest Hemingway died by suicide – the sheriff didn’t want to say it. As we as a society discuss mental illness more and more, how do we discuss topics like suicide? For years, of course, we didn’t – or, if we did, reporting was often insensitive.

In last month’s Canadian Journal of Psychiatry, Sunnybrook Hospital’s Mark Sinyor and his co-authors, including other psychiatrists and journalists, suggest guidelines for the reporting of suicide. The effort provides an update of a past report, and includes recommendations for social media.

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In this Reading we look at the guidelines, and consider the opportunities and problems of the Twitter era.

DG

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Reading of the Week: “13 Reasons Why” – Is This TV Show Glamorizing Suicide?

From the Editor

Is a popular TV show glamorizing suicide?

13 Reasons Why is a Netflix series in which the main character suicides – depicted graphically in the show. We will leave it to critics to judge the value of the show as a cultural contribution. Here’s a relevant question for those of us in mental health: is this show promoting suicide?

San Diego State University John W. Ayers and his co-authors consider google searches after the show’s premiere aired, bringing data to this discussion.

13 Reason Why: Popular Show, Problematic Effect?

In this Reading, we consider their research letter and an editorial responding to it – and the larger debate about the series.

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Reading of the Week: Do Suicide Barriers Work? Sinyor et al. on the Bloor Viaduct and Toronto Suicides

From the Editor

Do suicide barriers really work, or do they cost money that could have been better spent elsewhere?

This debate raged in Toronto about a decade and a half ago when some argued that a suicide barrier must be added to the Bloor Viaduct. That bridge, which connects downtown Toronto with its east end, was considered a “suicide magnet” – a place that proved popular for suicide attempts. In North America, only the Golden Gate Bridge in San Francisco had more suicides associated with it. Media coverage of the debate included an article in The New York Times; it ran with the dramatic headline: “A Veil of Deterrence for a Bridge With a Dark Side.”

And in 2003, the barrier went up.

So did the suicide rate go down?

This week, we look at a new paper just published by Sunnybrook’s Mark Sinyor et al. Drawing on years of data, they consider the utility of the Bloor Viaduct suicide barrier. They find that it has saved lives. The paper obviously has implications for other bridges and cities.

The Bloor Viaduct: big debate, big outcome?

The authors also looked at media reporting on suicide.

DG Continue reading

Reading of the Week: Can We Reduce Suicide in the Emergency Department Population? Also, Drugs & Crime

From the Editor

He presents to the Emergency Department a few days after a suicide attempt. What can we do to help keep this man safe today – and moving forward?

Emergency Departments: noisy, busy, and an opportunity for suicide prevention?

It’s a scenario that repeats itself at EDs across the country with regularity. This week, in our first selection, we consider a new JAMA Psychiatry paper that has just been published looking at suicide prevention in the ED population. The authors claim “this study is the largest suicide intervention trial ever conducted in the United States,” and they show that, with an intervention, they can reduce suicides and suicide attempts.

And, in the other selection, we look at a short New York Times essay in which economist Austin Frakt argues that substance programs pay for themselves in crime reduction.

DG Continue reading

Reading of the Week: Guest Contribution – Dr. David Goldbloom on Locked Doors and Hospitalizations

From a Contributing Editor, Colleague and Friend of the Editor

This week’s reading is a provocative companion piece to the recent review of efforts to reduce involuntary admission to hospital. It is the environmental expression of the legal deprivation of freedom of movement: the locked door. Locked doors have a powerful symbolic meaning in psychiatry; outpatients coming for elective consultations sometimes tell me they are afraid if they “say the wrong thing” that I will “lock them up”. Asylum superintendents carried large rings of keys that embodied power and control.

Locked doors, better outcomes?

Having spent half my career working on inpatient units, I am, like almost all of you, familiar with the locked doors that distinguish our wards from all others found in a hospital. And I know the reasons for their justification: prevention of elopement by people at risk of harm to themselves and others. And that prevention is intended to serve not only the patient and family but also the clinicians and the institution in terms of risk management. And yet…people do elope. Sometimes they return and sometimes they do not. Sometimes they attempt or complete suicide and sometimes they do not.

There is, as always, a tension between safety and risk, between freedom and protection, between autonomy and control. Locks are ubiquitous but not universal on psychiatric wards. What do we know about whether they make a difference? And what would be the ethically acceptable methodology for determining it?

– David Goldbloom, OC, MD, FRCP(C) Continue reading

Reading of the Week: Guest Contribution – Dr. David Goldbloom on Lithium and Self Harm

From a Contributing Editor, Colleague and Friend of the Editor

Sixty-seven years ago, Australian psychiatrist John Cade published his case series on manic patients treated with lithium – truly the dawn of the modern era in psychopharmacology. Two decades passed before lithium came to Canada, and almost three before it came to the United States. In the treatment of mania, it was the first significant drug alternative to the only other enduring treatment from that time – electroconvulsive therapy.

Dr. John Cade (and Lithium)

Today, however, lithium suffers from under-promotion (there is no money to be made on it by the pharmaceutical industry) and under-exposure in the training of residents despite the evidence of its benefit that continues to emerge.

Here is a new paper that looks at suicide and self-harm during maintenance treatment of people with bipolar disorder treated with lithium, valproate or the increasingly popular second-generation antipsychotic drugs. And here is an old paper that reminds us what a difference lithium had already made in the economics of mental illness by 1980.

– David Goldbloom, OC, MD, FRCP(C) Continue reading