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      Tensions in perspectives on suicide prevention between men who have attempted suicide and their support networks: Secondary analysis of qualitative data

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          Abstract

          Background

          Men generally have higher rates of suicide, despite fewer overt indicators of risk. Differences in presentation and response suggest a need to better understand why suicide prevention is less effective for men.

          Objective

          To explore the views of at‐risk men, friends and family about the tensions inherent in suicide prevention and to consider how prevention may be improved.

          Design

          Secondary analysis of qualitative interview and focus group data, using thematic analysis techniques, alongside bracketing, construction and contextualisation.

          Setting and participants

          A total of 35 men who had recently made a suicide attempt participated in interviews, and 47 family and friends of men who had made a suicide attempt took part in focus groups. Participants recounted their experiences with men's suicide attempts and associated interventions, and suggested ways in which suicide prevention may be improved.

          Results

          Five tensions in perspectives emerged between men and their support networks, which complicated effective management of suicide risk: (i) respecting privacy vs monitoring risk, (ii) differentiating normal vs risky behaviour changes, (iii) familiarity vs anonymity in personal information disclosure, (iv) maintaining autonomy vs imposing constraints to limit risk, and (v) perceived need for vs failures of external support services.

          Conclusion

          Tension between the different perspectives increased systemic stress, compounding problems and risk, thereby decreasing the effectiveness of detection of and interventions for men at risk of suicide. Suggested solutions included improving risk communication, reducing reliance on single source supports and increasing intervention flexibility in response to individual needs.

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          Most cited references 30

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          A brief measure for assessing generalized anxiety disorder: the GAD-7.

          Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
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            The PHQ-9: A New Depression Diagnostic and Severity Measure

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              The interpersonal theory of suicide.

              Suicidal behavior is a major problem worldwide and, at the same time, has received relatively little empirical attention. This relative lack of empirical attention may be due in part to a relative absence of theory development regarding suicidal behavior. The current article presents the interpersonal theory of suicidal behavior. We propose that the most dangerous form of suicidal desire is caused by the simultaneous presence of two interpersonal constructs-thwarted belongingness and perceived burdensomeness (and hopelessness about these states)-and further that the capability to engage in suicidal behavior is separate from the desire to engage in suicidal behavior. According to the theory, the capability for suicidal behavior emerges, via habituation and opponent processes, in response to repeated exposure to physically painful and/or fear-inducing experiences. In the current article, the theory's hypotheses are more precisely delineated than in previous presentations (Joiner, 2005), with the aim of inviting scientific inquiry and potential falsification of the theory's hypotheses. PsycINFO Database Record (c) 2010 APA, all rights reserved.
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                Author and article information

                Affiliations
                [ 1 ] Black Dog Institute and Faculty of Medicine University of New South Wales Sydney NSW Australia
                [ 2 ] Faces in the Street St Vincent's Hospital St Vincent's Urban Mental Health Research Institute Sydney NSW Australia
                [ 3 ] School of Psychiatry University of New South Wales Sydney NSW Australia
                Author notes
                [* ] Correspondence

                Andrea Fogarty, Black Dog Institute and University of New South Wales, Sydney, NSW, Australia.

                Email: a.fogarty@ 123456unsw.edu.au

                Contributors
                ORCID: http://orcid.org/0000-0002-2939-7027, a.fogarty@unsw.edu.au
                Journal
                Health Expect
                Health Expect
                10.1111/(ISSN)1369-7625
                HEX
                Health Expectations : An International Journal of Public Participation in Health Care and Health Policy
                John Wiley and Sons Inc. (Hoboken )
                1369-6513
                1369-7625
                14 August 2017
                February 2018
                : 21
                : 1 ( doiID: 10.1111/hex.2018.21.issue-1 )
                : 261-269
                HEX12611
                10.1111/hex.12611
                5750756
                28806484
                © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                Counts
                Figures: 0, Tables: 0, Pages: 9, Words: 6720
                Product
                Funding
                Funded by: Movember Foundation
                Funded by: beyondblue
                Categories
                Original Research Paper
                Original Research Papers
                Custom metadata
                2.0
                hex12611
                February 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.2.8 mode:remove_FC converted:15.01.2018

                Health & Social care

                intervention, behaviour, male, prevention, suicide, treatment

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