Listening Part B

Listening Sub-Test: Part B

Secondary Prevention of Suicide written by Debora Ganz, M. Dolores

Braquehais, Leo Sher and accessed from the Public Library of Open Science

In this part of the test, you will a lecture on the topic of Secondary Prevention or Suicide While listening, answer questions in the spaces provided below. There will be a short space between each question You now have one minute to read through the questions and you will hear the talk once only.

Questions
1. Complete the following list. The number of suicide deaths in the US _______________ The number of suicide deaths worldwide almost _______________ The percentage of suicide deaths among all disease related deaths _______________ 2. Complete the following table. Suicidal behaviour Completed suicide Suicide attempt Suicidal ideation Deliberate injury to oneself Unsuccessful attempt Definition

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Listening Part B

3. Complete the following notes. 83% of people who commit suicide or attempt suicide had contact with doctor within _______________________________________________________________________________ 66% of people who commit suicide or attempt suicide had contact with doctor within __________________________________________________________ __________________________________________________________ As a result, these statistics could be lowered with better

4. Complete the following table. Suicidal Prevention Strategy Primary suicide prevention ________________________________ ________________________________ Aim

Secondary suicide prevention ________________________________ ________________________________

Tertiary suicide prevention

reduce suicide in a particular.. ________________________________ ________________________________

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Listening Part B

5. Complete the chart below.

Low blood cholesterol levels

Biological risk factors of suicide

_______________________________________________ _______________________________________________

Childhood history of physical or sexual abuse

Pyschological risk factors of suicide

______________________________________________ Low self esteem ______________________________________________

Relationship problems _______________________________________________

Proximal stressors of suicide

_______________________________________________ Major depression _______________________________________________

6. Answer the following questions. o Why is the clinical evaluation of the medical and psychiatric history of a patient important?
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Listening Part B

o What two mood disorders are associated with over half of suicides? _________________________________________________________________________ _________________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

o What does the percentage 80% represent? o What do physicians need to be taught? o Why should health professionals ask patients about suicidal ideation? o What are 3 reasons why health professionals may not ask such questions? _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

7. Complete the gaps in the summary. Antidepressant medications are the most ____________________________used pharmacological interventions in secondary suicide prevention. However, according to studies, their effectiveness in __________________ suicide attempts have had variable results. For adults under 25 the effect of antidepressants seems to be ___________________on suicidal behavior. However, it does seem to reduce the risk of suicidal behavior in the __________________. Therefore, the relationship between _____________________ and ___________________requires further investigation before this class of medication can be ________________ used for the secondary prevention of suicide.

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Listening Part B

8. Circle the best answer. 1. Suicide rates may decrease due to a) improved physiological treatment of depression and alcoholism b) improved psychological treatment of depression and alcoholism c) improved psychological and pharmacological treatment of depression and alcoholism 2. Which form of follow up care has had no impact on suicide ideation? a) Private psychiatrists b) Telephone follow-up c) Standard after care 3. UK studies on reduced access to legal means of suicide a) Support the findings that it can reduce the number of suicides b) Contradict the findings that it can reduce the number of suicides c) is outdated so therefore not relevant Answer the following questions. o Why have media black outs in reporting suicides led to a reduction in suicide rates? ____________________________________________________________ ____________________________________________________________ 9.Complete the gaps in the paragraph below. In spite of our increasing knowledge regarding suicide prevention, there are still many __________________ in the research and looking to the future, thorough __________________ and appropriate treatments of patients with ____________disorders and other psychiatric _____________ should help to improve the efficacy of secondary prevention of suicide. But, it is also clear that more _________________ into new approaches for the prevention and treatment of suicidal behavior remains _____________.
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o Why might the internet led to an increase in suicide rates?

Listening Part B

End of Part B You now have 2 minutes to check your answers. Now check your results and add up your score with on the answer sheet. Your Score________ Total Marks 49 To pass the listening test you need to get at least 65%, so for this exam you need to get at least 32/49.
Answer Sheet Total Marks:49 One mark for each correct answer. Underlined words essential. Variations in vocabulary and grammar are acceptable Slash / indicates alternative answers Brackets (_______) indicate optional details which do not need to be included Question 1 30,000 900,000 1.5% Question 2 successful suicide attempt suicidal thoughts self-harm behavior Question 3 contact with doctor within a year (of their death) contact with doctor within a month (of their death) better prevention techniques Question 4 reduce number of new cases in general population decrease the likelihood of a suicide attempt in high-risk patients. geographical area age group Question 5 medical or neurological illnesses cigarette smoking aggressive personality traits poor access to psychiatric treatment financial troubles a family history (of suicide) drug abuse Question 6 it enables the identification of risk factors major depressive disorder bipolar disorder untreated psychiatric disorders (to recognize the) association between mental disorders and suicide. patients will often talk (frankly) about their suicidal thoughts discomfort (with the topic) lack of time lack of skills (in this area) Question 7 widely reducing neutral elderly antidepressants suicide safely Question 8 1. C 2. B

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Listening Part B 3. A Question 9 (media reports) glamorize suicide (for vulnerable individuals) (it provides) accessible instructions Question 10 gaps evaluations depressive illnesses research essential

Transcript
Now read question 1 Pause 10 seconds Suicide poses major threats to public health worldwide. In 2002, suicide ac- counted for about 30,000 deaths in the US alone and almost 900,000 deaths worldwide. This translates to 1.5% of all deaths related to disease . However, I am convinced that suicide can and should be prevented. Pause: 10 seconds Now read question 2 Pause 15 seconds According to recent research, suicidal behavior can be distinguished into 4 distinct categories which are 1. completed suicide where a person has been successful in their attempt to commit suicide 2. suicide attempt where a person has been unsuccessful in their attempt to commit suicide 3. suicidal ideation which is where a person is having suicidal thoughts 4. self-harm behavior: where a person injures themselves deliberately Pause 10 seconds Now read question 3 Pause 15 seconds It is important to realise that 83% of people who commit suicide or attempt suicide have had contact with a doctor within a year of their death and up to 66% of people who commit or attempt suicide have had such contact within a month of their death. Therefore, with better prevention techniques these figures could be reduced. Pause 10 seconds Now read question 4 Pause 15 seconds We can divide suicide prevention into 3 categories which are primary, secondary, or tertiary. Primary suicide prevention aims to reduce the number of new cases of suicide in the general population. Secondary suicide prevention aims to decrease the likelihood of a suicide attempt in high-risk patients. Tertiary suicide prevention occurs in response to completed suicides and attempts to diminish suicide in a particular geographical area or in a particular age group Pause 10 seconds Now read question 5 Pause 15 seconds I would now like to look at Secondary suicide prevention in more detail. Secondary suicide prevention is particularly important but not always given the attention that it deserves, in part because research into secondary prevention is only just starting to be applied to clinical practice. Now, from a clinical perspective, Suicide is often difficult to predict due to its complex nature. The three major risk factors that contribute to suicidal behavior are Biological, Psychological and proximal stressors which are recent events that can lead to increased suicide risk Firstly there are biological risk factors for suicide which include Low blood cholesterol levels Medical or neurological illnesses such as multiple sclerosis, stroke, Huntington disease, and epilepsy Cigarette smoking Secondly there are Psychological risk factors include A Childhood history of physical or sexual abuse Aggressive personality traits Low self-esteem Poor access to psychiatric treatment Thirdly there are the proximal stressors, or the recent events that can lead to increased suicide risk include: Relationship problems with a spouse partner or loved one Financial troubles caused by unemployment or large amounts of debt A family history of suicide Major depression Drug abuse Pause 20 seconds Now read question 6 Pause 15 seconds The suicide assessment The clinical evaluation of the medical and psychiatric history of a patient and of their current state is the crucial and essential element of the suicide assessment process. It is important because it enables the identification of risk factors, in order to determine the patients immediate safety and the best setting for treatment, and also to develop diagnosis and treatment strategies.

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Listening Part B Psychiatric illness is a major contributing factor to suicide risk, with mood disorders such as major depressive disorder and bipolar disorder being associated with about 60% of suicides. Indeed, psychiatric disorders are diagnosed in more than 90% of completed suicides, and more than 80% of these psychiatric disorders are untreated. Thus, the recognition and treatment of individuals with psychiatric disorders, specifically mood disorders, are essential components of secondary suicide prevention. In addition, the subjective rating of the severity of depression is one of the most powerful predictors of future suicidal acts. Therefore, assessing and managing depression as well as being aware of the suicide risks in psychologically, medically, and neurologically disordered individuals is an important aspect of secondary suicide prevention . Consequently, physicians need to be taught to recognize the association between mental disorders and suicide. Additional information about the individual who may be at risk for suicide, such as medical and psychiatric treatment records, and toxicology screenings, should also be incorporated into the assessment. Equally importantly, clinicians and other professionals in a position to offer help should not hesitate to ask patients about suicidal ideation because, while it may seem surprising, patients will often talk frankly about their suicidal thoughts and tendencies if given the opportunity. Failure to ask about suicidal ideation may be related to the health professionals discomfort with the topic, lack of time, or lack of skills in this area. Clinicians need to overcome these obstacles to provide appropriate care to their patients. Pause 30 seconds Now read question 7 Pause 15 seconds What are the most effective secondary suicide prevention strategies? In a recent systematic review of suicide prevention strategies, Mann along with other researchers found evidence of effectiveness in five secondary suicide prevention methods including : 1. pharmacological interventions, 2. psychological interventions 3. follow-up care 4. reduced access to lethal means 5. responsible media reporting of suicide. Antidepressant medications are the most widely used pharmacological interventions in secondary suicide prevention, but studies of their effectiveness in reducing suicide attempts have had mixed results. Among adults younger than 25 the effect of antidepressants seems to be neutral on suicidal behavior but it seems to reduce the risk of suicidal behavior in the elderly. Thus, the relation between antidepressants and suicide needs further studies before this class of drugs can be safely used for the secondary prevention of suicide. Pause 20 seconds Now read question 8 Pause 15 seconds In terms of psychological interventions, suicidal patients often benefit from therapies that address the repetition of suicidal thoughts and behaviors, and other factors commonly associated with suicide. Better psychological and pharmacological treatment of depression and alcoholism, also appears to decrease suicide rates Social factors that should be addressed in follow-up treatment include availability and willingness of supports within the family. Support individuals who should be contacted about the suicide risk and follow-up arrangements include general practitioners, private psychiatrists, family, and friends. Some interventions, however, such as telephone and psychosocial follow-up, have shown no difference in suicidal ideation when compared with standard after-care. Many studies show that suicides by particular methods for example, firearms, domestic gas, or pesticides decrease after the introduction of legal restrictions that reduce access to such means. This reduction in suicide rates is particularly influential in regions where the specific means of restriction correlates with a common method of suicide. For example, in the UK the reduction of carbon monoxide in domestic gas since 1958 and the reduced availability of analgesics since the mid-1990s have both decreased UK suicide rates . Pause 20 seconds Now read question 9 Pause 15 seconds Finally, many studies have exposed a need for a decrease in reporting of suicide and for responsible reporting. Media black- outs in reporting suicide have coincided with a decrease in suicide rates , because reports of suicide in the media tend to glamorize suicide for vulnerable individuals. The Internet is also of increasing concern, with blogs and chat rooms providing accessible instructions for suicide. For these reasons, guidelines have recently been produced for the responsible reporting of suicide. Pause 20 seconds Now read question 10 Pause 15 seconds Despite our increasing knowledge about secondary suicide prevention, there are still many gaps in the research and looking to the future, thorough evaluations and appropriate treatments of patients with depressive disorders and other psychiatric illnesses should help to improve the efficacy of secondary prevention of suicide. But, it is also clear that more research into new approaches for the prevention and treatment of suicidal behavior remains essential.

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