bluuebunny/crossref_metadata_2025 huggingface dataset:
Hantaviruses
Authors: Vaheri Antti , Mills James N. , Spiropoulou Christina F. , Hjelle Brian
Published: January 2012

Hantaviruses (genus Hantavirus, family Bunyaviridae) are rodent- and insectivore-borne zoonotic viruses. Several hantaviruses are human pathogens, some with 10-35% mortality, and cause two diseases: hemorrhagic fever with renal syndrome (HFRS) in Eurasia, and hantavirus cardiopulmonary syndrome (HCPS) in the Americas. Hantaviruses are enveloped and have a three-segmented, single-stranded, negative-sense RNA genome. The L gene encodes an RNA-dependent RNA polymerase, the M gene encodes two glycoproteins (Gn and Gc), and the S gene encodes a nucleocapsid protein. In addition, the S genes of some hantaviruses have an NSs open reading frame that can act as an interferon antagonist. Similarities between phylogenies have suggested ancient codivergence of the viruses and their hosts to many authors, but increasing evidence for frequent, recent host switching and local adaptation has led to questioning of this model. Infected rodents establish persistent infections with little or no effect on the host. Humans are infected from aerosols of rodent excreta, direct contact of broken skin or mucous membranes with infectious virus, or rodent bite. One hantavirus, Andes virus, is unique in that it is known to be transmitted from person-to-person. HFRS and HCPS, although primarily affecting kidneys and lungs, respectively, share a number of clinical features, such as capillary leakage, TNF-, and thrombocytopenia; notably, hemorrhages and alterations in renal function also occur in HCPS and cardiac and pulmonary involvement are not rare in HFRS. Of the four structural proteins, both in humoral and cellular immunity, the nucleocapsid protein appears to be the principal immunogen. Cytotoxic T-lymphocyte responses are seen in both HFRS and HCPS and may be important for both protective immunity and pathogenesis. Diagnosis is mainly based on detection of IgM antibodies although viral RNA (vRNA) may be readily, although not invariably, detected in blood, urine and saliva. For sero/genotyping neutralization tests/RNA sequencing are required. Formalin-inactivated vaccines have been widely used in China and Korea but not outside Asia. Hantaviruses are prime examples of emerging and re-emerging infections and, given the limited number of rodents and insectivores thus far studied, it is likely that many new hantaviruses will be detected in the near future.
Marburg and Ebola viruses
Authors: Simpson A. , Aarons E. , Hewson R.
Published: January 2012

Infection with Marburg and Ebola viruses cause haemorrhagic fevers that are characterized by organ malfunction, bleeding complications, and high mortality. The viruses are members of the family Filoviridae, a group of membrane-enveloped filamentous RNA viruses. Five distinct species of the genus Ebolavirus have been reported; the genus Marburgvirus contains only one species. Both Marburg and Ebola virus diseases are zoonotic infections whose primary hosts are thought to be bats. The initial human infection is acquired from wildlife and subsequent person-to-person spread propagates the outbreak until it is brought under control. Ebola and Marburg viruses are classified as hazard or risk group 4 pathogens because of the very high case fatality rates observed for Ebola and Marburg virus diseases, the frequency of person-to-person transmission and community spread, and the lack of an approved vaccine or antiviral therapy. This mandates that infectious materials are handled and studied in maximum containment laboratory facilities. Epidemics have occurred sporadically since the discovery of Marburg in 1967 and Ebola virus in 1976. While some of these outbreaks have been relatively large, infecting a few hundreds of individuals, they have generally occurred in rural settings and have been controlled relatively easily. However, the 2013–2016 epidemic of Ebola virus disease in West Africa was different, representing the first emergence of the Zaire species of Ebola in a high-density urban location. Consequently, this has been the largest recorded filovirus outbreak in both the number of people infected and the range of geographical spread. Many of the reported and confirmed cases were among people living in high-density and impoverished urban environments. The chapter summarizes the most up-to-date taxonomic status of the family Filoviridae. It focuses on Marburg and Ebola viruses in a historical context, culminating in the 2013–2016 outbreak of Ebola virus in West Africa. Virus biology of the most well-studied member is described, with details of the viral genome and the protein machinery necessary to propagate viruses at the molecular and cellular level. This information is used to build a wider-scale virus–host perspective with detail on the pathology and pathogenesis of Ebola virus disease. The consequences of cell infection are examined, together with our current understanding of the immune response to Ebola virus, leading to a broader description of the clinical features of disease. The chapter closes by drawing information together in a section on diagnosis, ecology, prevention, and control.
Microsporidiosis
Authors: Weiss Louis M.
Published: January 2012

The class or order Microsporidia was elevated in to the phylum Microspora by Sprague and Vavra (1997) and Sprague and Becnel (1998) subsequently suggested that the term Microsporidia instead be used for the phylum name. Miicrosporidia, i.e. Nosema bombycis, were first described about 150 years ago as the cause of the disease pebrine in silkworms. In 1922, there were descriptions of gram-positive spores consistent with microspordiosis in the brain of rabbits that were being used for investigations on poliomyelitis (Wright and Craighead 1922). From 1923 to 1926, Levaditi and colleagues studied the organisms seen by Wright and Craighead, which they named Encephalitozoon cuniculi, recognizing them as Microsporidia and demonstrating their lack of host specificity by transmitting infections from rabbits to mice, rats and dogs (Levaditi et al. 1923). Microsporidia were clearly confirmed of being a cause of human disease in 1959 (Matsubayashi et al. 1959), when they were isolated from the cerebrospinal fluid of a 9 year old boy with encephalitis with seizures, coma, and fever lasting about 25 days. Bergquist et al. (1984) reported a 2 year old child with encephalitis and seizures who had Encephalitozoon spores in urine and Margileth et al. (1973) isolated the microsporidium Anncaliia (Nosema) connori from a 4 month old athymic male infant who died with severe diarrhoea and malabsorption. Microsporidia can produce a wide range of clinical diseases. A diarrhoeal syndrome associated with microsporidiosis and HIV infection was reported by Desportes et al. (1985) and the number of articles describing human disease increased rapidly after 1990. In addition to gastrointestinal tract involvement, it has been recognized that Microsporidia can infect virtually any organ system; and patients with encephalitis, ocular infection, sinusitis, myositis, and disseminated infection are well described in the literature.
Cysticercosis and taeniosis: Taenia solium, Taenia saginata and Taenia asiatica
Authors: Flisser Ana , Craig Philip S. , Ito Akira
Published: January 2012

The pork and beef tapeworms, Taenia solium and Taenia saginata respectively, are taeniid cestodes and major food-borne or meat-borne zoonoses. Human tapeworms and swine cysticerci have been known since Egyptian and Greek cultures. Nevertheless their association as part of the life cycle of the same parasite was only demonstrated during the nineteenth century. Kuchenmeister fed convicts with cysticerci excised from pork meat and found adult tapeworms in the intestine after autopsy, while van Beneden fed T. solium eggs to pigs and found numerous cysticerci in muscles after slaughter (Grove, 1990).

T. solium is the only causative agent of neurocysticercosis in humans and is, therefore, the more important of these species in public health. This chapter describes classical aspects of the morphology of the parasites as well as clinical aspects of the diseases they cause. Most importantly, detailed explanations of taxonomic aspects, specially related to the newly recognized Taenia asiatica are given. Furthermore, the epidemiology and transmission dynamics of the parasites, as well as intervention measures such as health education, mass drug treatment and vaccination, are described in detail. The chapter concludes with considerations on the surveillance and a discussion on prospects for the control of these cestode zoonoses.
Cystic echinococcosis
Authors: Torgerson, Paul R. , Macpherson C. N. L. , Vuitton D. A.
Published: January 2012

Cystic echinococcosis (CE)\cystic hydatid disease is one of the most widespread and important global helminth zoonoses. The parasite Echinococcus granulosus is maintained in a wide spectrum of intermediate hosts, including sheep, goats, camels, cattle, pigs and equines. A number of wild intermediate hosts occur, including cervids in the northern part of the North American continent and Eurasia, marsupials in Australia and wild herbivores in East and southern Africa. The application of a range of molecular techniques to the characterization of the parasite has confirmed the existence of mostly host-adapted strains and genotypes of the parasite and several new species have been proposed. The ubiquitous domestic dog serves as the most important definitive host for the transmission of the parasite throughout its wide geographical range.

A wide range of diagnostic techniques, including necropsy, arecoline purgation, coproantigen ELISA and DNA based tests are available for detecting E. granulosus infection in the definitive host. In intermediate animal hosts, diagnosis at post mortem still remains the most reliable option. In humans, imaging techniques including ultrasound, nuclear magnetic resonance (NMR) or computer aided tomography (CAT-scan provide not only a method of diagnosis but also reveal important clinical information on the location, condition, number and size of the hydatid cysts in man. Of these ultrasound is the most widely used diagnostic technique and is the only imaging technique for screening of populations in rural areas, where the disease is most common. A classification system has been developed which can be used to assess the likely development of a cyst and hence guide the clinician in treatment options for the patient. Treatment relies on surgery and/or percutaneous interventions, especially ‘Puncture, Aspiration, Injection, Re-aspiration’ (PAIR) and/or antiparasitic treatment with albendazole (and alternatively mebendazole).

CE is largely a preventable disease. Successful elimination programmes have focused on frequent periodic treatments of dogs with anthelmintics and the control of slaughter of domestic livestock. In many regions elimination or even control remains a problem as the parasite is endemic over vast areas of low income countries where there may be limited resources for control. In some areas, such as former communist administered countries, the parasite is resurgent. New tools are becoming available to control the parasite, including a highly effective vaccine in sheep which prevents the infection in sheep and breaks the transmission cycle. In addition cost effective methods are being developed which may be appropriate in low income countries where financial resources are not available for intensive control programmes that have been successful in high income countries.
Zoonotic infections with dermatophyte fungi
Authors: Mignon B. , Monod M.
Published: January 2012

Dermatophytes are highly specialized pathogenic fungi which are the most common agents of superficial mycoses. These fungi grow exclusively in the stratum corneum, nails or hair utilising them as sole nitrogen and carbon sources. Dermatophyte species are recognized and classified as antropophilic, zoophilic, or geophilic, depending on their major reservoir in nature (humans, animals, and soil, respectively). Zoophilic dermatophytes may result in zoonoses when humans are exposed to these organisms and dermatophytosis is considered to be one of the most common zoonotic diseases. The majority of zoonotic dermatophytoses are caused by four species: Microsporum canis (usually derived from pet animals, particularly cats and dogs), Trichophyton verrucosum (usually derived from cattle), Arthroderma vanbreuseghemii (usually derived from cats and dogs) and Arthroderma benhamiae (usually derived from guinea-pigs). Infection results most often from direct contact with an infected animal, but may be also acquired indirectly through contact with a contaminated environment. While clinical disease is rarely serious, the lesions can result in disfigurement and pain. Diagnosis is based on history, clinical appearance and diagnostic procedures, e.g. direct microscopic examination of scales, hair or nail and fungal culture. Specific treatment is generally required to resolve lesions, and this may be prolonged depending on the fungal species and the host status. Identifying animals as the source of infection for people can help in the prevention of recurrence or new infections, especially in children, by adequately treating affected pets and their environments. Immunoprophylaxis is an attractive means of controlling infection in animals, and the development and widespread use of efficacious T. verrucosum vaccines in certain countries has already proved valuable in the management of cattle ringworm.
Suicide
Authors: Wasserman Camilla
Published: January 2012

The parallels between natural and social sciences are numerous: in each, both field and laboratory studies may include qualitative and quantitative tasks, and in part of the book the researchers combine their expertise in a cross-disciplinary fashion. Studies in suicidology in general aim to prevent suicides. Suicidology is interconnected with social change initiatives, and accordingly, as researchers of applied sciences, suicidologists need pay close attention to the relations between the phenomenon studied and wider arenas of social action. Ahead lies great work, directing attention to ways of experiencing the everyday world that is tied into processes of ruling and rules of thoughts. This includes consideration of the multiplicity of religious expressions and the interplay of religion, history and politics on international as well as local levels. The local is not just a site of meanings and practices, but also a node within an extended set of social relations: as such it can never be studied as separate from larger religious institutional structures.
The role of religion in suicide prevention
Authors: van Praag Herman M
Published: January 2012

In psychiatry, man’s connection with religion and religiosity is underestimated. In the wake of Freud’s The future of an illusion (1975), a wave of atheism inundated psychiatry. Both phenomena were considered to be atavisms: remnants of the past; manifestations of a lack of independence; to be treated, rather than to be cherished. This development disregards the human urge to provide meaning to one’s life through a spiritual dimension, as well as the inclination to search for values that exceed one’s material needs. In this context, religion is central: contrary to Freud, Emile Durkheim states that religion is not only ‘true’, but also ‘real’ (Durkheim 2001). A believer is not stuck in an illusion: their exaltation at the belief of a moral power beyond themselves is quite real to them, these are forces external to the individual and part of society as a whole.

Studies show that if religiosity is experienced as a source of hope and confidence, it reduces the risk of depression in times of mounting stress, facilitates recovery and diminishes suicide risk. Religiosity experienced as a source of guilt and fear probably has the opposite effects. Social bonding and confidence in God are a modus operandi.

The psychiatrist cannot and should not ignore or reject religion, irrespective of personal beliefs. In the interest of the evolution of the practice and for the best of their patients, psychiatrists need to reorient towards matters of spirituality, religion and meaning. Taking into account the present state of the discipline, the data on religion and suicide are relatively scarce.
Cultural and religious traditions in China
Authors: Fei Wu
Published: January 2012

In this chapter, we examine ideas about suicide in Confucianism and Taoism in China. In Confucianism, suicide is thought of as an acceptable way to protect one’s dignity and virtue: in late imperial China, suicide was required for intellectuals who had survived their emperor and for women who had been raped. Nevertheless, most Confucian intellectuals do not consider suicide the best way to pursue human virtue. Although Qu Yuan—the great poet and the person responsible for the most famous suicide in Chinese history—is often praised for his loyalty and virtues, he is also criticised for being narrow-minded. According to the Taoist teachings of Zhuangzi, one should not be too concerned about worldly affairs, including life and death. Although the two cultural religious traditions are apparently different, there are similarities in their ideas about a good life and suicide. Examining ideas on life and death found in Confucianism and Taoism will provide a deeper cultural understanding of possible underlying motives for committing suicide. This knowledge can contribute to more effective suicide prevention.
A Buddhist perspective on suicide
Authors: Promta Somparn , Thomyangkoon Prakarn
Published: January 2012

The basic morality of Buddhism is based on the content of the five precepts: killing is an evil; stealing is an evil; sexual misconduct is an evil; lying is an evil; and taking intoxicants is an evil.

Buddhism does not consider killing merely in its form but in its origin, and judges whether or not it is immoral case by case, according to its complicated and contextual factors. Suicide is a type of killing, and the moral rules applying to all types of killing, apply also to suicide. All of the precepts in Buddhism are written in general form, meaning that there is considerable room for interpretation. This chapter discusses interpretations of cases when suicide may be considered as morally wrong and when it can be morally acceptable. Generally speaking, suicide is not necessarily an evil in the Buddhist perspective: some are morally acceptable. All sects of Buddhism agree that death is just a transformation of life, and that we live to die and we die to live again. Therefore, suicide is viewed differently from other religions, which do not believe in life after death or reincarnation.

The chapter concludes with epidemiological data concerning suicide in different Buddhist countries in Asia, which show a range of 6/100,000 in Thailand to 35/100,000 in Sri Lanka. In accordance with the statistics, the Buddhist religion may impact the suicide rate differently depending on the national context.
Suicide in the Jewish scriptures
Authors: Orbach Israel , Rabinowitz Aron
Published: January 2012

The Jewish scriptures and the commentaries of the scriptures throughout history present a very complex approach toward suicide. There is a categorical prohibition against suicide, but also an obligation to submit to death when there is an external coercion to transgress Jewish laws that pertain to the essence of the faith. Talmudic sages have shown a psychological and empathic understanding of the suicidal state of mind, but they have harshly condemned suicide and punished it by omissions of certain religious rituals for the dead. Yet, Jewish law defines suicide in a very minimalistic way, so it is very rare that a death is defined as a suicide. Inherent in this approach is the attempt to avoid further suffering by the family, to show respect for the frailty of the human being, but at the same time, to condemn self-destructive behaviour.
Suicide and Islam
Authors: Okasha Ahmed , Okasha Tarek
Published: January 2012

This chapter will discuss the historical and philosophical aspects of suicide in Islam. Influences of Islamic culture on the phenomena of suicide and attempted suicide will be emphasized, focusing chiefly on attitudes in Egypt. All studies show that suicide is less prevalent in Islamic societies compared to countries associated with other religions. Here, the reasons for suicide in different Islamic and Arabic countries are evaluated in relation to the sociocultural context.

The cognitive schemata of Muslims follow the phrases of the Koran that humans were created for the main reason of worshipping God, and that life and death issues should be controlled by God and not by self-destruction. This faith can be a factor in preventing suicide attempts, especially in those practising their religious rituals. The phenomenology of psychiatric disorders in Islamic culture is characterized and dominated in its content, whether hallucinations or delusions by religious themes.
Suicide prevention and religious traditions on the African continent
Authors: Schlebusch Lourens , Burrows Stephanie , Vawda Naseema
Published: January 2012

Research on suicidal behaviour on the African continent has been limited. A number of sociopolitical and cultural reasons contribute to this situation, among them the political and economic instability that has characterized much of the continent for the last few decades; the lack of available infrastructure, funds and research expertise; and cultural and legal sanctions that contribute to underreporting and misclassification of suicidal behaviour. In addition, the considerable diversity of cultures and religions in Africa make it difficult to give a comprehensive picture of the suicidal problem. Only certain trends are highlighted in this chapter. The African continent is characterized by its unique religious diversity, the mixture of traditional African beliefs with some of the world’s major religions. Generally, suicide tends to be higher in countries in the east and south, compared to those in the north and west, and considerable gender and ethnic differences are apparent. Differing cultural and religious understandings of mental illness and suicidal behaviour contribute to divergent research results across and within various African countries. In the past, suicidal behaviour on the continent was thought to be rare, but more recent figures suggest it is a substantial public health burden. There is a growing need to focus on preventive efforts, with greater collaboration among African researchers and beyond being a key to this process.
The role of religion in suicide prevention work in Uganda
Authors: Ovuga Emilio , Boardman Jed
Published: January 2012

Central themes of traditional religious practice in Uganda have been the role of a creator, an understanding of life in an integral sense and maintenance of contact with the spirit world. Christianity was introduced to Uganda at the end of the nineteenth century and was associated with the colonial powers. Subsequent expressions of religious beliefs juxtaposed traditional and European beliefs. Present expressions of cosmology in everyday life mainly involve a strong sense of the collective and its responsibility, breakdown of which, and the subsequent loss of cohesion, plays a central role in suicide. Suicide has usually been seen as an uncommon occurrence in Uganda, but recent research suggests that this is no longer the case. The rise in suicide may be the result of substantial social changes and long-term strife affecting the population. Associated with this have been examples of mass suicide and internal wars, which have resulted in mass killings which may have their roots in traditional and non-traditional religious beliefs. An understanding and knowledge of the traditional world view of Ugandans may be helpful in developing strategies for the management and prevention of suicide in Uganda.
Maya religion and traditions
Authors: Baquedano Gaspar
Published: January 2012

Although suicide appears to be an individual act, this auto-destructive behaviour occurs in a wider context. Comprehension of this process can be improved through an analysis of its psychological, sociocultural and economic dimensions. Suicide occupies an important place in Maya religion and practices. In fact, it is the only pre- Hispanic culture strongly linked with suicide. For example, the Maya had a suicide goddess. The southeast region of Mexico, which geographically corresponds to the Maya area, where Maya worshippers lived, and still live, has the highest rate of suicide in the country today. What are the other factors behind suicide? There are many ways of exploring this question, and one of them could be a psycho-anthropological approach, elucidating attitudes and perceptions concerning life, death and suicide. In this chapter, an overview of Maya religion and traditions in regards to suicide are given.
Suicidal thoughts, suicide plans and attempts in the general population on different continents
Authors: Bertolote José M , Fleischmann Alexandra , De Leo Diego , Wasserman Danuta
Published: January 2012

The concept of a suicidal process where the suicidal act is preceded by a plan, and that plan is preceded by suicidal thoughts or ideation, does not necessarily imply that every suicidal thought will end in a suicidal act. This chapter explores the relationship between different components of the suicidal spectrum by examining different studies and the World Health Organization (WHO) Multisite Intervention Study on Suicidal Behaviours (SUPRE-MISS) in particular. In the case of suicidal ideation, the outlook with regard to its importance, and its validity as a predictor of other types of suicidal behaviour is uncertain. In addition, the strong cultural underpinning behind the whole spectrum of suicidal behaviours must be emphasized.
Suicide attempts in Africa
Authors: Schlebusch Lourens , Burrows Stephanie
Published: January 2012

An understanding of the full burden of suicidal behaviour in many parts of Africa has been hampered by a lack of systematic data collection. Paucity of research, poor research designs and other influences have contributed to this situation. Given the resultant variability in the reliability of figures across countries, regions and population groups, prudence is needed when interpreting data. The figures discussed in this chapter are not representative of the entire non-fatal suicidal population in Africa and only salient features are highlighted. Figures that are available indicate that, in some areas, the situation is more serious than generally thought. Even more alarming is that known data most likely do not reflect the true extent of the problem. There are substantial variations across gender, age, and ethnic groups. Overdose (especially poisoning) is one of the most common methods of attempted suicide. Psychopathology (especially mood disorders) and substance abuse, HIV/AIDS, and family-related problems are strongly associated with increased risk of suicidal behaviour.
Suicide attempts in Asia
Authors: Jiang Guo-Xin , Cheng Qi
Published: January 2012

Data on the prevalence of attempted suicide are sparse in Asian countries, particularly data gathered from large, general population- based surveys. Rates of attempted suicide reported results in various target groups and different areas, sometimes with large variations. For example, the prevalence of suicide attempts could be as low as 0.4 per cent of a sample aged over years in Hanoi, Vietnam; and 7.0 per cent among adolescent students aged 12–18 years in a rural prefecture of China. However, the age and gender distribution of suicide attempts are similar in Asia to Western countries, with the highest being among females and young people. Self-poisoning by ingestion of various medications or pesticides is a common method in Asian countries, predominantly in the rural areas. In general, fewer suicide attempters in Asia have had a diagnosis of psychiatric illness before the attempt compared to Western countries. Large representative, population-based investigations on suicide behaviour with a well-designed epidemiological method are urgently needed in Asia.
Suicide attempts in Europe
Authors: Rutz Ellenor Mittendorfer , Schmidtke Armin
Published: January 2012

The comparison of international statistics on suicide attempt across European countries is challenged by differences in definitions and the lack of compulsory registration of suicide attempts. The WHO/EURO multi-centre study on parasuicide has overcome these obstacles, and has provided comprehensive data on both the occurrence and background factors of suicide attempt in different European countries. This article summarizes findings from the WHO/EURO study as well as from various other clinical and community surveys carried out in the region. Peculiarities of the inter-European variation in patterns and trends of the phenomenon and various social and psychiatric determinants are described in detail. The WHO/EURO study is continued as the MONSUE (Monitoring suicidal behaviour in Europe) study, which will supply even more detailed data on specific risk groups. These can then be supported by tailor-made suicide prevention strategies.
Interaction of hereditary and environmental factors in the psychiatric disorders associated with suicidal behaviour
Authors: Roy Alec , Sarchiapone Marco
Published: January 2012

Data from clinical, twin and adoption studies suggest that genetic factors may play a role as a distal risk factor in suicidal behaviour. The serotonin transporter gene, as a model for studies examining interaction between genes and environment, is discussed. Studies that report interaction between the serotonin transporter and stressful life events, in relation to the development of depression in both adults and adolescents and in relationship to suicidal behaviour, are reviewed. Relevant interaction studies in primates are also discussed.
Suicide during transition in the former Soviet Republics
Authors: Värnik Airi , Mokhovikov Alexander
Published: January 2012

Significant social, political, and economic changes in the countries of the former Soviet Union present a good model for investigation of the impact of environment on suicide mortality during times of transition. During the period of perestroika (1985–1990), when promising social changes were rapid, a significant decrease of suicide mortality was observed for both genders in all fifteen republics of the USSR. One of the factors which contributed to the decrease was the strict anti-alcohol policy implemented in 1985 and suspended by 1989. However, times of spiritual liberation, the aspiration of democracy, social optimism and hopes for higher living standards could also have attributed to the causality of suicide decrease. In the years 1990–1994, after the disintegration of the Soviet Union, the suicide rates in post-Soviet countries increased, with the exception of prevailingly Muslim central Asiatic, and the Caucasus countries which have a traditionally low level of suicides. The transitional period called for high adaptation capacity and the necessity of developing suicide-prevention programmes to increase social support and re-education measures.
Suicide among migrants
Authors: Sharma Menakshi , Bhugra Dinesh
Published: January 2012

Migration or mobility of individuals from one location to another is a frequent phenomenon and has been the case for millennia, although reasons for such movement of people have varied. Reasons for migration and the experiences an individual has when arriving at the new place are important, especially in terms of understanding the experiences and problems they may encounter. How well an individual adapts to the new country can be explained by factors of acculturation and how well this occurs may in turn affect the mental health of the person. Studies have shown that migration across the world is on the increase, as are the mental health problems amongst the migrant population; especially self-harm and suicide. Investigating the factors for this is important in order to develop strategies of prevention from a public health point of view. In this chapter we examine differences in the rates of suicide amongst the migrant groups across different countries and explore preventative methods from a public health perspective.
Suicide and attempted suicide among indigenous people
Authors: Wasserman Danuta , Durkee Tony , Hadlaczky Gergö
Published: January 2012

There are hundreds of indigenous groups and peoples around the world. Examples are the Australian Aborigines, the North American Indians (Native Americans) of the US and Canada, and the Maori of New Zealand. Such groups and peoples often have elevated suicide rates compared with the general population in their countries, and divergent epidemiological characteristics. Adoption of culture-specific prevention strategies in countries where indigenous peoples live is proposed and discussed.
Labour market, work environment and suicide
Authors: Mäkinen Ilkka Henrik
Published: January 2012

Work is an important sphere of human life. Besides economic subsistence, it also furnishes workers with social status and influences their life conditions in a profound manner. Social class at large seems to be connected with suicidality, but studies on the effects of specific occupations have produced few lasting results, perhaps due to the different societies investigated. In addition, lack of adequate data and problems with the methods chosen cause problems in the estimates of suicide mortality by class or occupation. However, it seems that the most vulnerable position is that of those who do not work at all. There is abundant empirical evidence of a surplus risk for suicide among the unemployed, but the causal nature of this relationship still needs clarification. Globally, the labour markets differ greatly, and so does their connection with suicide. Labour-market oriented suicide prevention issues concern unemployment policies, reduction of work-related access to means of suicide, and the use of the workplace as a base for suicide prevention.
Measurement of suicidal behaviour with psychometric scales
Authors: Bech Per , Awata Suichi
Published: January 2012

Among the many psychometric scales for assessing suicidal risk and behaviour, only short scales with high clinical validity have been selected. According to clinical focus, the scales have been classified into those including ‘fixed’ items outside the suicidal process (predictive factors) and ‘flexible’ items measuring the severity of the current suicidal state.

The SAD PERSONS scale supplemented by the NO HOPE scale are among the valid predictive scales, and the item of suicide severity in the Hamilton Depression Scale or the Paykel Suicidal Ladder are among the valid measurements of current suicidal severity.

The subjective dimension of suicidal thoughts has been especially contrasted against the dimensions of positive psychological well-being as measured by WHO-5. Such short questionnaires have been found important in modern Internet communication, especially with young people. The individual, idiographic approach has also been discussed by selecting individual items from the Reasons for Living Inventory.
Instruments used in SUPRE-MISS
Authors: Fleischmann Alexandra , Bertolote José M , De Leo Diego , Wasserman Danuta
Published: January 2012

The WHO Multisite Intervention Study on Suicidal Behaviours (SUPRE-MISS) was launched on the five continents to increase knowledge about suicidal behaviours and effective interventions for suicide attempters in culturally diverse places around the globe, with the ultimate goal of reducing mortality and morbidity associated with suicidal behaviours.

The three components of SUPRE-MISS are a community description to grasp basic sociocultural characteristics, a community survey to identify suicidal behaviours, and a randomized controlled trial to evaluate treatment strategies for suicide attempters treated in emergency care settings of the same catchment area. Three specific instruments were used for the three components of the study and commonly applied in all participating sites. These assessment instruments were designed for SUPRE-MISS in particular, partly based on existing instruments and measurements and compiling them. They succeeded in fulfilling the requirements of being applicable across different cultures, manageable in low- and middle-income countries, assessing suicidal behaviours, and comprising well-established and widely recognized predictors of suicidal behaviours.
Neuroimaging of suicidal behaviour
Authors: Oquendo Maria A , Gibbs Tresha , Parsey Ramin
Published: January 2012

Consistent evidence implicates serotonin system dysfunction in the neurobiology of suicidal behaviour. Neuroimaging studies link brain structure and function in vivo and contribute to our understanding of neural pathways. Areas of the prefrontal cortex and limbic structures are targeted in neuroimaging studies of suicidal behaviour, which have focused on structural, haemodynamic, metabolic, and neuroreceptor changes in the brains of suicide attempters. Neuroimaging studies have revealed that signal hyperintensities, perfusion and metabolic abnormalities, processing of affect and serotonin receptor and transporter changes, may each play a role. Knowledge regarding the neurobiology of suicidal behaviour must rely on study designs utilizing robust methodologies, including improved patient and control group selection, improved neuroimaging techniques, and adequate statistical analysis to enhance the validity, consistency, and conclusiveness of the data. Ongoing development of new radioligands and imaging methodologies promise to enhance our ability to delineate the neurobiology of suicidal acts.
Electrodermal hyporeactivity and suicide risk
Authors: Thorell Lars-Håkan
Published: January 2012

Electrodermal hyporeactivity is related to the incidence of suicide and violent attempted suicide in depressed patients. The electrodermal reactivity test is a non-invasive examination of habituation to a standardized tone stimulus. Further testing of electrodermal hyporeactivity in clinical conditions is needed.
An economic perspective on suicide across the five continents
Authors: McDaid David , Kennelly Brendan
Published: January 2012

In considering suicide prevention measures it is important to consider potential economic risk factors, as well as the costs and consequences of suicide. We provide a brief overview of some areas where economics has played a role in the analysis of suicide and suicide prevention strategies. Evidence on the wide-ranging socioeconomic costs and consequences of suicide is provided, as well as a reflection on the development of economic theories on individual motivations for suicide. The evidence from econometric models at both cross-country and single country levels on the links between suicide and socio-economic risk factors such as poverty and unemployment are reviewed. Cost-effectiveness is increasingly used as part of decision-making processes in health and other sectors. In respect of suicide prevention, such evidence remains limited. The present review, nonetheless, suggests that suicide prevention measures may be highly cost-effective. Incorporating economic analyses into future effectiveness studies is likely to help strengthen the case for investment in suicide prevention. There is also scope to look at the economic implications of interventions already shown to be effective.
World Health Organization and European Union policy actions, responsibilities and solutions in preventing suicide
Authors: Wasserman Danuta , Mårtensson Elizabeth , Wasserman Camilla
Published: January 2012

Mental health policies in Europe have been driven, in recent years, by two key documents: The Mental Health Declaration (WHO 2005) and the European Commission Green Paper (2005). As such, these important papers have paved the way towards the development of a European Mental Health Pact (European Commission 2008) in which policy-makers and stakeholders are urged to act upon European, national and local policies and implement key measures to enable the prevention of suicide and depression, improvement of mental health in youth, older people and in working places.
Countertransference in the treatment of suicidal patients
Authors: Goldblatt Mark J , Maltsberger John T
Published: January 2012

Countertransference is an inescapable component of all psychotherapy. Intense countertransference reactions often occur during the treatment of suicidal patients. Lack of awareness of countertransference reactions of malice and aversion may be suicide-inviting. On the other hand, awareness of these reactions may enhance the treatment by alerting therapists that the suicidal patient is fomenting issues he is unable or unwilling to articulate. Problems that arise in the course of psychotherapy of suicidal patients may be understood in relation to the therapist’s countertransference reactions. In this chapter, we review case examples of countertransference manifestations and their effects on the treatment of the suicidal patient.
Pharmacological and other biological treatments of suicidal individuals
Authors: Möller Hans-Jurgen
Published: January 2012

Due to the role of depressive disorders, as the most frequent cause of suicidal behaviour, antidepressants have the most prominent place in psychopharmacological prevention of suicidal behaviour. Based on clinical experience, antidepressants reduce suicidality in association with the reduction of depressive symptoms, and it is assumed that suicidal behaviour is also reduced as a consequence. However, based on the results of empirical studies, the evidence is not as clear as clinicians like to believe, which might, in part, be due to methodological problems. Other pharmacological and biological treatment methods with lithium, neuroleptics, benzodiazepines, anti-epileptics and ECT are described as well.
Severe anxiety and agitation as treatment modifiable risk factors for suicide
Authors: Fawcett Jan
Published: January 2012

This chapter focuses on the presence of symptoms of severe anxiety and agitation in depressed patients, as an indicator of heightened suicide risk and a target for treatment to reduce suicide risk. Published evidence demonstrates that from 33–70 per cent of suicides occur in individuals in active treatment by mental health professionals. Clinicians who treat depressed patients who are at high chronic risk for suicide based on prior ideation or attempts, or patients with severe depressive illness who have not admitted suicidal ideation, or given history of prior attempts face a dilemma, since roughly half of patients who complete a suicide have not made previous attempts. Severe anxiety and agitation, often comorbid with depression, are modifiable suicide risk factors if recognized and treated.
Treatment of attempted suicide and suicidal patients in primary care
Authors: Rihmer Zoltán , Rutz Wolfgang
Published: January 2012

Although suicidal behaviour is a rare event in society in general, it is very common among psychiatric patients who contact their general practioner (GP) before the suicide event. The most common current psychiatric diagnosis among suicide victims and attempters is major depressive episode (56–87 per cent). The current prevalence of major depressive episodes in GP practice is around 10 per cent, but at least half of these cases are not recognized and treated adequately by GPs. Successful acute and long-term treatment of depression significantly reduces the risk of suicidal behaviour. Given that more than half of all suicide victims contact their GPs within four weeks before their death, GPs play an important role in suicide prevention. Several large-scale community studies demonstrate that education of GPs on the diagnosis and appropriate pharmacotherapy of depression, particularly in combination with psychological interventions and public education, improve the identification and treatment of depression and reduces the frequency of suicidal behaviour in the areas served by trained GPs.
A specialized inpatient unit for suicidal patients
Authors: Träskman-Bendz Lil , Sunnqvist Charlotta
Published: January 2012

In 1986, the Suicide Research Unit (SRU) in Lund, Sweden was established. The unit included a psychiatric inpatient facility specializing in suicidal behaviour until it closed down in 2001. Structured management based on research, scientific evidence and confidence-building measures was offered. The SRU also had a consultation liaison with somatic clinics, an outpatient facility, as well as a unit for the aftermaths of suicide. At SRU, a structured psychiatric diagnostics as well as an organized nursing concept with different levels of supervision and treatment planning were in use. Care included contacts with families and significant others. SRU also collaborated with child and adolescent psychiatry staff. In order to prevent further suicidal acts, a confidence-inspiring relationship with the patients was created at SRU. Strong empathy for suicidal patients, non-judgemental attitudes as well as acceptance of the various feelings of the patients were cornerstones of the care. Warning signs of suicidal behaviour were discovered and discerned.
The role of schools, colleges and universities in suicide prevention
Authors: Gould Madelyn S , Klomek Anat Brunstein , Batejan Kristen
Published: January 2012

The present chapter reviews school-based suicide prevention strategies. School-based suicide prevention efforts have usually been designed separately for high school and college/university students, but the underlying strategies are similar, having two general goals: case finding with accompanying referral and treatment or risk factor reduction. Promising empirically based prevention strategies include screening for at-risk youth, gatekeeper training programmes, and skills training for students. Positive results from new ‘hybrid’ curriculum programmes may lead to overcoming the long-standing reluctance to implement curriculum-based strategies due to deleterious effects formerly reported for suicide ‘awareness’ curriculum programmes. Continuing evaluation studies of all the specific programmes reviewed in this chapter are needed, particularly as they are adapted to the cultural context in which a programme is to be implemented. A remaining challenge is to overcome the obstacles that have impeded the development and implementation of suicide prevention programmes in developing countries in Asia, Africa and South America. Today there is a marked disparity in the prevalence of school-based programmes between developing and developed countries.
Restriction of access to drugs and medications in suicide prevention
Authors: Leenaars Antoon , Lester David , Baquedano Gaspar , Cantor Chris , Connolly John F , Ovuga Emilio , Remigio Silvia Pelaez , Vijayakumar Lakshmi
Published: January 2012

Suicide by prescription drugs and medications is a very common method of suicide in many countries. In 1972, Oliver and Hetzel first called attention to the adverse effects of easy availability of medications in Australia; they also reported that restriction of drugs and medications decreased the rate of suicides. Results for different countries support these observations; yet there is a lack of impact on clinical practice. Experiences from some countries are presented, which suggests, despite great variation around the world, that the way physicians and other mental health professionals act needs to be more congruent with existing evidence-based knowledge. Of course, even if medication is associated to risk, it can be asked if restriction makes a difference. The sparse research suggests that restriction of access to drugs and medications reduces the suicide rate. Governments and the WHO could be involved more; for example, to promote educational programmes, and to define standards and agreements among pharmaceutical companies, national health services, medical associations, and the population in general. Much more research and clinical action are needed.