An investigation into the relationship between adolescent parasuicide, depressive illness and associated risk factors
- Authors: Read, Gary Frank Hoyland
- Date: 1996
- Subjects: Youth -- Suicidal behavior , Depression in adolescence
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:3116 , http://hdl.handle.net/10962/d1004615 , Youth -- Suicidal behavior , Depression in adolescence
- Description: This study aimed at investigating the relationship between adolescent parasuicide, depressive illness and associated risk factors. Reports worldwide indicate that suicidal behaviour in this age group has risen 150% over the past 20 years, whilst the rate for suicide in adults and the elderly has remained the same (Deykin et al, 1985; Neiger & Hopkins, 1988; Sudak, Ford & Rushforth, 1984a). In South Africa statistics confirm similar trends with regard to attempted and completed suicide. Statistics reveal that a high local incidence of adolescent suicide attempters are seen at psychiatric units. One pilot study recorded 187 adolescent suicide attempters during a three month period. This study was based on the hypothesis that the incidence of depressive illness in adolescent suicide attempters is higher than is generally accepted and that this condition often goes unrecognised and is misdiagnosed because it manifests differently with acting out behaviour and "masked" symptomatology. A random sample of suicide attempters between the ages of 13 - 25 who presented at C23 (psychiatric emergencies) Groote Schuur Hospital following a suicide attempt were assessed. 100 subjects were seen over a period of three months. The research procedure comprised a comprehensive assessment incorporating a semi-structured interview, self-report and objective rating scales for depression as well as instruments designed to assess the general health of each subject and their level of suicide intent. The depressive inventories used have been validated for use in this age group and were designed to elicit the associated features of adolescent depression. If warranted, a clinical diagnoses was given based on DSM 1V criteria. This diagnosis was substantiated by information from the research instruments which formed part of the assessment process. A high incidence of clinical disorders was diagnosed in the sample (86%). Depressive illness was found to be a significant risk factor for suicidal behaviour with 68% of the subjects suffering from an affective disorder and 21% reporting depressive symptoms. This study shows that the correlation between parasuicide and depressive illness is high enough to suggest that all suicidal behaviour in this age group should be taken seriously as parasuicide in itself is often a reliable indicator of an underlying depressive condition. Additional risk factors for adolescent parasuicide identified in this study correlated well with the findings of similar research studies. Psychiatric co-morbidity, especially substance use (42%) and cluster B personality factors (54%), were high and served to increase an individual's vulnerability to suicide risk. Psychosocial factors such as sexual abuse (28%) and physical abuse (37%) were also identified as high risk factors for adolescent suicidal behaviour. Individuals at risk for depression and suicidal behaviour typically came from broken homes which were disrupted and unsupportive. Family members were frequently abusing alcohol and 67% of the subjects reported the presence of psychiatric illness in the family. The preferred method of suicide attempt was an overdose (90%). These attempts were generally unplanned and impulsive with no disclosure prior to the event. Intent was usually high at the time of the act. It is only through identifying the risk factors specific to the developmental concerns of this age group and acknowledging the role of depressive illness in adolescent suicidal behaviour that effective preventative measures can be devised.
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- Date Issued: 1996
A qualitative study aimed at describing & interpreting the changing symbolic meanings of HIV/AIDS which encountering HIV-positive patients introduces into the personal & professional identities of selected health care professionals
- Authors: Read, Gary Frank Hoyland
- Date: 1993
- Subjects: AIDS (Disease) -- Social aspects -- Africa , Physicians -- South Africa -- Attitudes , Medical personnel -- South Africa -- Attitudes , HIV-positive persons
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:3041 , http://hdl.handle.net/10962/d1002550 , AIDS (Disease) -- Social aspects -- Africa , Physicians -- South Africa -- Attitudes , Medical personnel -- South Africa -- Attitudes , HIV-positive persons
- Description: This study aimed at describing and interpreting the changing symbolic meanings of the Acquired Immunodefiency Syndrome (AIDS) which encountering a Human Immunodefiency Virus (HIV)-positive patient introduced into the personal and professional identities of six health care professionals in a subregion of the Eastern Cape. With the exponential increase of HIV/AIDS in South Africa, medical practitioners have become increasingly exposed to HIV infected patients. This study has considered the psychological structures developed by practitioners in an attempt to control and understand their situation in the context of HIV/AIDS. In order to describe these psychological structures the existential phenomenological approaches of L. Binswanger (in Needleman, 1963), A. Giorgi (1975) and F.J.Wertz (1985) were employed. Through these procedures, the structure of the experience of encountering an HIV infected patient was elucidated. This comprised the first goal of this study. The second goal focused on interpreting these descriptions by way of the symbolic meanings and definitions implicit in the structure of this experience. For this latter purpose the approach of symbo1ic interactionism was used, in particu1ar the understandings outlined by H. Blumer (1969). This theory was seen as appropriate in that the encounter between the practitioner and patient was primarily located in interpersonal parameters. The findings were discussed in terms of the two dominant metaphorical frameworks used by the subjects to comprehend the disease - namely the perspectives of society and the biomedical model. These two frameworks were critically evaluated in the context of HIV/AIDS, the needs of HIV infected individuals as well as the needs of the general practitioner. The process of the encounter was found to be very significant for practitioners in terms of their conceptualisations of HIV/AIDS. Old understandings were reinterpreted within the interpersonal context and replaced with more appropriate symbolic metaphors upon which to base practise. This study has revealed these new understandings were limited and constrained with regard to understanding and treating HIV/AIDS in that the subjects were still influenced by the metaphors of the biomedical model. These constraints were examined in the light of both personal and professional meanings and identities. This study concluded by making suggestions for modification of the medical practitioner's role in the context of HIV/AIDS.
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- Date Issued: 1993