Preventing Suicide among Psychiatric Inpatients with Psychotic Depression

Abstract

To investigate which factors individuals with a psychotic depression experience as preventive of suicide while beeing hospitalized. Semi-structured qualitative interviews with nine inpatients, all hospitalized for a unipolar or bipolar depressive episode with psychosis, were conducted at time of discharge. For analysis we used systematic text condensation. Main outcomes were accounts of participants’ experiences of suicide prevention measures and treatment, and how these affected suicidal ideation, plans, and attempts. Participants experienced (1) suicide attempts being physically interrupted or prevented; (2) receiving medical treatment to alleviate unbearable suffering; (3) finding refuge behind locked doors; (4) receiving guidance to redefine their identity and situation. They reported being protected from suicidal impulses and imagined persecutors in a secure environment with staff present. They described their autonomy as compromised by intense suffering and chaos. They retrospectively appreciated staff interventions, if these were performed compassionately and with empathy. Participants described that suicidal thoughts and actions were triggered by terrifying psychotic experiences, anxiety and sleeplessness, and felt that medication – and in one instance electroconvulsive therapy– alleviated suffering. At time of discharge, participants reported no psychotically motivated suicidal thoughts. They described a new, insightful self-view and acknowledged having been severely mentally ill. To prevent impulsive suicidal behavior, findings highlight the need for both security measures and a treatment approach focusing on modifying psychotic experiences and intense anxiety. Gaining anxious and paranoid patients’ trust is essential to build motivation for medical treatment. Patients emphasize that having time to talk is crucial to this process.

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Acknowledgments

Funding organization: Stavanger University Hospital.

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Authors

Contributions

Kristin J. Fredriksen, Margrethe A. Schaufel, Jan O. Johannessen, Fredrik A. Walby and Helle K. Schoeyen contributed to the study conception and design. Material preparation, data collection and initial coding was performed by Kristin Joerstad Fredriksen, Helle Kristine Schoeyen and Margrethe Aase Schaufel. Data analysis was a collaboration within the group and all authors took part. The first draft of the manuscript was written by Kristin Joerstad Fredriksen and all authors commented on previous versions of the manuscript. All authors critically reviewed the paper and approved the final manuscript.

Corresponding author

Correspondence to Kristin J. Fredriksen.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Regional Committee for Medical Research Ethics, West Norway (approval no 2012/740) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Written informed consent was obtained from all participants, who were informed that they could withdraw from the study at any point without consequence.

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Fredriksen, K.J., Schaufel, M.A., Johannessen, J.O. et al. Preventing Suicide among Psychiatric Inpatients with Psychotic Depression. Psychiatr Q 91, 223–236 (2020). https://doi.org/10.1007/s11126-019-09677-6

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Keywords

  • Psychotic depression
  • Suicide prevention strategies
  • Inpatient treatment
  • Patient experiences
  • Qualitative research