A Plea For Help- Suicide Prevention

He describes himself as an “inquisitive guy” who’s always thinking about blending research with his clinical work. For psychologist Jim Mendonca, that work involves suicide. Suicide is a public health issue affecting one in 13 Canadians. Each year, 4,000 Canadians take their own lives. Many more try. Canada’s suicide rate has remained relatively high over the years, even though treatments for depression and for other conditions that predispose people to suicide have steadily improved. For Dr. Mendonca, the Director of the Crisis and Relapse Prevention Program at Regional Mental Health Care St. Thomas, understanding the reasons why someone would want to kill himself or herself, has been the cornerstone of much of his research.

Dr. Mendonca explains that “hopelessness” is a factor in many mental disorders and past studies have shown that extreme hopeless expectations about the future are closely related to suicidal intent. “While it is often viewed as a key ingredient in suicidal intent,” he says, “I believe that it is not the only one.” That belief is based on vast discrepancies Dr. Mendonca would receive upon giving a test called the Beck Hopelessness Scale twice in a 24-hour period. The test is widely used by psychologists to measure three aspects of hopelessness: feelings about the future, loss of motivation and expectations. Dr. Mendonca would consistently notice the responses given by the patient in a 24-hour period were different. He wondered whether the reason for this was due to the level of distress upon arrival or their type of personality.

In pursuing this issue further, Dr. Mendonca teamed up with Ron Holden from the Department of Psychology at Queen’s University and launched a study involving 97 patients with suicidal thoughts. The intent was to explore the relationship between the suicidal intent and hopelessness and other prominent symptoms shown by an individual undergoing an acute suicidal crisis. It was determined that when people report suicidal intent there are two components. One is “general suicidal desires” which emphasizes ambivalence about the wish to live or die and the frequency and duration of suicidal wishes. Here, hopelessness is the key ingredient. The second component is called “suicide preparation” which represents an active preoccupation with a method of self-harm and reasons for, deterrents to and expectations of making a suicidal attempt. In this case, it is unusual thinking, not hopelessness which is the strongest predictor of suicidal intent. Unusual thinking involves a person having trouble concentrating, difficulty in making decisions, having thoughts that are not one’s own and a loss of control. Evidence also showed that patients in an acute state are prone to over-report the severity of symptoms as well as to fail to differentiate clearly between different aspects of their distress. “While the Beck test is well established,” Dr. Mendonca explains, “its result depends upon the type of suicidal thinking and the type of diagnosis.”

The results of this research propelled Jim Mendonca to look further into the motivation behind people’s suicidal attempts. In this study, not only was the patient interviewed but so were key family members or close friends with the purpose of comparing the perceptions of both parties in regards to motives for self-poisoning and intent to die. “There were some very interesting responses from both sides,” Dr. Mendonca says, “with turmoil within the family associated with the self-destructive act.” The results strongly confirmed that the suicidal overdose is not an act conceived in isolation. The patient wished to use the overdose often as a means to seek help or call for help or escape from an unbearable situation on account of repressed conflicts and behaviours. “It makes a good case for more education on suicide prevention,” Dr. Mendonca explains, “what to look for and how to help a family member or friend.”

You might think constantly working with clients in crisis and then concentrating your research on the same topic might be depressing in itself. But for Jim Mendonca, talk of death in another way hit home when he underwent heart bypass surgery. Following a successful surgery and resting at home, he experienced a bout of “uncontrollable worrying”. The psychologist-turned-patient discussed his concerns and discovered that depression and anxiety often follows such surgery. A year later, he teamed up with Dr. Richard Novick, Chair/Chief Cardiac Surgery, London Health Sciences Centre to study 128 patients before and after bypass surgery. A core of cognitive symptoms was found to affect the healing process even after the effects of disease and surgical stress were controlled. Obviously, while diet and exercise were being looked after, psychological factors need attention perioperatively to secure smooth functioning later on.

While Jim Mendonca likes to keep his research close to home assisting his own clients, he also reaches out to others in various disciplines. His most recent research focuses on the changes affecting mental health services in Southwestern Ontario-especially when it comes to family physicians and the dilemmas they face in psychiatric crises. It is recommended through this research that collaborative care between family physicians, psychiatrists and a mental health team could improve the standard of care for patients. “And that’s something I fully support in such a changing health-care environment,” says Dr. Mendonca, “especially when it comes to helping people in crisis.”