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Current research is yielding an increasingly heteregeneous picture of suicide seasonalities: They seem to depend on methods and, moreover, they seem to have smoothed in recent decades. This work examines the latter issue by comparing suicide seasonalities in the canton of Zurich, Switzerland, in the 16th-18th centuries, 1901-1920 and 19690-94. The results indicate shifts of peaks and lows on suicide seasonalities over the centuries, with a smoothing of seasonalities toward the 21st century. The recent period does not show any suicide seasonality at all. The canton of Zurich seems to be ahead of the general trend found in other regions of Switzerland.

Trauma survivors with PTSD show social interaction and relationship impairments. It is hypothesized that traumatic experiences lead to known PTSD symptoms, empathic ability impairment, and difficulties in sharing affective, emotional, or cognitive states. A PTSD group (N = 16) and a nontraumatized Control group (N= 16) were compared on empathic abilities, namely the Empathic Resonance Test, Reading the Mind in the Eyes Test, and Faux Pas Test. The Interpersonal Reactivity Index as a self-report measure of empathy and measures of nonsocial cognitive functions, namely the Verbal Fluency Test, the Five-Point Test, and the Stroop Test, were also administered. The PTSD group showed lower empathic resonance. No clear indications of other impairments in social cognitive functions were found. The PTSD group had significantly higher personal distress. Empathic resonance impairments did not correlate with subjective severity of PTSD symptomatology. This article discusses whether impaired empathic resonance in PTSD trauma survivors is a consequence of trauma itself or a protective coping strategy. DOI 10.2466/PR0.106.3.832-844

Objective Accurate information about preferred suicide methods is important for devising strategies and programmes for suicide prevention. Our knowledge of the methods used and their variation across countries and world regions is still limited. The aim of this study was to provide the first comprehensive overview of international patterns of suicide methods. Methods Data encoded according to the International Classification of Diseases (10th revision) were derived from the WHO mortality database. The classification was used to differentiate suicide methods. Correspondence analysis was used to identify typical patterns of suicide methods in different countries by providing a summary of cross-tabulated data. Findings Poisoning by pesticide was common in many Asian countries and in Latin America; poisoning by drugs was common in both Nordic countries and the United Kingdom. Hanging was the preferred method of suicide in eastern Europe, as was firearm suicide in the United States and jumping from a high place in cities and urban societies such as Hong Kong Special Administrative Region, China. Correspondence analysis demonstrated a polarization between pesticide suicide and firearm suicide at the expense of traditional methods, such as hanging and jumping from a high place, which lay in between. Conclusion This analysis showed that pesticide suicide and firearm suicide replaced traditional methods in many countries. The observed suicide pattern depended upon the availability of the methods used, in particular the availability of technical means. The present evidence indicates that restricting access to the means of suicide is more urgent and more technically feasible than ever. Objectif Il importe de disposer d'informations precises sur les methodes de suicide preferentiellement appliquees pour concevoir des strategies et des programmes de prevention du suicide. Nos connaissances sur les methodes utilisees et sur leurs variations d'un pays ou d'une region du monde a l'autre sont encore limitees. Cette etude a pour objectif de fournir un panorama complet des schemas internationaux de methodes de suicide. Methodes Des donnees, encodees selon la Classification internationaie des maladies (10e revision), ont ete tirees de la base de donnees de mortalite de l'OMS. Cette classification a servi a differencier les methodes de suicide. L'analyse de correspondance a ete utilisee pour identifier les schemas typiques de methodes de suicide dans les differents pays, en fournissant un resume des donnees tabulees. Resultats L'empoisonnement par un pesticide est courant dans de nombreux pays d'Asie et en Amerique latine, tandis que l'empoisonnement medicamenteux est frequent dans les pays nordiques et au Royaume-Uni. La methode de suicide privilegiee est la pendaison en Europe de l'Est, le recours a une arme a feu aux Etats-Unis d'Amerique et le saut d'un endroit eleve dans les grandes villes et dans les societes urbaines comme la Region administrative speciale de Hong-Kong, en Chine. L'analyse de correspondance a mis en evidence une polarisation entre le suicide au pesticide et le suicide par arme a feu, aux depens des methodes traditionnelles telles que la pendaison et le saut d'un endroit eleve, qui se situent entre les deux. Conclusion L'analyse montre que le suicide au pesticide et le suicide par arme a leu ont remplace les methodes traditionnelles dans de nombreux pays. Le schema de suicide observe depend de la disponibilite des methodes utilisees et notamment des moyens techniques de suicide. Ces elements montrent que restreindre l'acces aux moyens de suicide est plus urgent et plus faisable techniquement que jamais. Objetivo La disponibilidad de informacion precisa sobre los metodos de suicidio mas frecuentes es importante para idear estrategias y programas de prevencion del mismo. Nuestros conocimientos sobre los metodos empleados y las diferencias entre paises y regiones mundiales siguen siendo limitados. La finalidad de este estudio fue trazar el primer panorama general de los perfiles de metodos de suicidio en el piano internacional. Metodos A partir de la base de datos de mortalidad de la OMS se obtuvieron datos codificados de acuerdo con la Clasificacion Internacional de Enfermedades (10a revision). Dicha clasificacion se utilizo para diferenciar los metodos de suicidio. Se empleo el metodo de analisis de correspondencias-para determinar los perfiles de los metodos de suicidio en los diferentes paises mediante un resumen de los datos de tabulacion cruzada. Resultados Se observo que el envenenamiento por plaguicidas era frecuente en muchos paises asiaticos y en America Latina, mientras que la intoxicacion medicamentosa era frecuente en los paises nordicos y en el Reino Unido. El ahorcamiento era el metodo de suicidio preferido en Europa oriental, al igual que las armas de fuego en los Estados Unidos y el salto al vacio en ciudades y sociedades urbanas como la Region Administrativa Especial de Hong Kong, China. El analisis de correspondencias revelo una polarizacion entre el suicidio con plaguicidas y el suicidio por arma de fuego, situandose entre ambos y en retroceso los metodos tradicionales, como el ahorcamiento y el salto al vacio. Conclusion Este analisis muestra que el suicidio con plaguicidas y el suicidio por arma de fuego tienden a reemplazar a los metodos tradicionales en muchos paises. El perfil de metodos de suicidio depende de la disponibilidad de los metodos empleados, en particular de la disponibilidad de medios tecnicos. La evidencia aqui aportada indica que la restriccion del acceso a los medios de suicidio es mas urgente y tecnicamente viable que nunca., Introduction Restricting access to the means of suicide is an important component of comprehensive strategies for suicide prevention. To improve prevention efforts, better knowledge of national, regional and local suicide [...]

Background: There is a large empirical basis for the importance of social networks and support for people with a mental illness. However, only a few studies have examined the predictors, changes and correlations of these constructs within a longitudinal framework. Aim: To analyze changes in social network diversity as measured by the number of social roles and perceived social support over the course of three years after a psychiatric hospitalization while controlling for sociodemographic and clinical variables. A further aim was to inquire whether some social roles are perceived as being more supportive than others. Method: Random coefficient models were applied to the data of a longitudinal study on the life circumstances of people with affective disorders or schizophrenia (N = 183). Results: The majority of participants had relatives, friends and co-workers, while a markedly smaller proportion had a spouse/partner or children. Social network diversity increased during the time period observed while the perception of social support did not change. Being male, without a job (competitive or sheltered), or having a low income predicted less diverse networks. Partners and friends were perceived as most supportive. Persons without a close friendship perceived less overall support, but only at baseline (hospitalization), while persons with a job on the competitive labor market felt better supported. Conclusions: Social disintegration in the course of mental illness that is found in some studies has no equivalent in our study in what concerns network diversity and perceived support. According to our results, characteristics of vocational and economic integration are of much greater relevance, as they enhance or hinder access to social participation. DOI: 10.1177/0020764007082344

Due to high unemployment rates, people with mental illness are at risk of poverty and are deprived of the social and psychological functions of work, such as the provision of social support, structuring of time, and self-esteem, with a negative effect on their perceived quality of life (QoL). Two distinct processes are held responsible for the low work force participation of people with mental illness: 'Social underachievement' and 'social decline'. Social underachievement signifies that, due to early illness onset, the educational attainment of people with mental illness is low and entry to the labor market fails. Social decline, on the other hand, describes the loss of competitive employment after illness onset, followed by prolonged periods of unemployment and difficulties to re-enter the labor market. This study examines how social underachievement and decline are reflected in the course of vocational status, income, and QoL of people with severe mental illness in the years after a psychiatric admission in a naturalistic longitudinal design. A total of 176 participants diagnosed with schizophrenia or affective disorders were interviewed during an index hospitalization in two large psychiatric hospitals in Zurich. Follow-up interviews were conducted 12 and 30 months after. Random coefficient models (multilevel models) were used to examine simultaneously the predictors and course of the variables of interest. A low number of psychiatric hospitalizations, a higher educational degree, a diagnosis of schizophrenia, and years of work experience predicted a higher vocational status. Vocational status decreased in first-admission participants with prolonged hospitalizations during the follow-up period. Income did not change over time and was positively influenced by a higher age of illness onset, competitive employment, higher education, and not having had a longer hospitalization recently. Subjective QoL significantly improved and was rated higher by people with any kind of employment than by participants without a job. Participants with an affective disorder, those with few hospitalizations but a recent inpatient stay of longer duration, showed lower QoL. Including employment issues early in treatment is especially important for people with an early illness onset and those with more severe forms of psychiatric disorder. A life course perspective enhances the understanding of patients' vocational potential and needs for support. Keywords: Switzerland; Mental illness; Employment; Income; Quality of life; Longitudinal studies

We investigated changes in the proportion of firearm suicides in Western countries since the 1980s and the relation of these changes to the change in the proportion of households owning firearms. Several countries had an obvious decline in firearm suicides: Norway, United Kingdom, Canada, Australia, and New Zealand. Multilevel modeling of longitudinal data confirmed the effect of the proportion of households owning firearms. Legislation and regulatory measures reducing the availability of firearms in private households can distinctly strengthen the prevention of firearm suicides.

Background: Mental health authorities must know the public's attitude to community psychiatry when planning community mental health services. However, previous studies have only investigated the impact of demographic variables on the attitude to community psychiatry. Aim: To assess the influence of psychological and sociological parameters on the public opinion of community psychiatry in Switzerland. Method: Linear regression analyses of the results of a public opinion survey on a representative population sample in Switzerland (n = 1737). Results: Most respondents have positive attitudes to community psychiatry. In the regression analysis ([R.sup.2] adjusted = 21.2%), negative emotions towards mentally ill people as depicted in the vignette, great social distance, a positive attitude to restrictions, negative stereotypes, high rigidity and no participation in community activities significantly influenced negative attitudes to community psychiatry. Additionally, other parameters, e.g. contact with mentally ill people and the nationality of the interviewee, have a significant influence. Conclusions: In planning psychiatric community services, general individual traits and emotive issues should be considered because they influence the response towards community psychiatry facilities in the host community.

Background/aims: Family members of people with schizophrenia are heavily burdened. Thus, we aimed at quantifying the amount of additional efforts during the two weeks before hospitalisation of acute exacerbating psychosis compared to the time before. Methods: By means of the semi-structured 'Interview for Measuring the Burden on the Family' we interviewed relatives of people with schizophrenia. To quantify additional burden we asked how much time a person who would take over the additional burden has to afford. Subscales of different sources of burden and total scales were correlated. Results: An additional 8.9 hours per day would have to be spent in favour of the patient, which results in additional costs of 3,115 [euro]-4,984 [euro] (ca. 2,100 [pounds sterling]-3,400) for two weeks. The main sources of additional burden are quantity, quality and nature of contacts to the affected. This includes the frequency of contact to the affected, the whereabouts and symptoms of the affected, as well as the social contacts of the relatives. Conclusions: Our results clarify the quantitative aspect of care provided by relatives of people with schizophrenia. Apart from the practical and emotional help to relatives the development of a diversified network of community psychiatry services, e.g. day and night hospitals, as well as crisis accommodations should be established.

Current research is yielding an increasingly heteregeneous picture of suicide seasonalities: They seem to depend on methods and, moreover, they seem to have smoothed in recent decades. This work examines the latter issue by comparing suicide seasonalities in the canton of Zurich, Switzerland, in the 16th-18th centuries, 1901-1920 and 1969-94. The results indicate shifts of peaks and lows on suicide seasonalities over the centuries, with a smoothing of seasonalities toward the 21th century. The recent period does not show any suicide seasonality, at all. The canton of Zurich seems to be ahead of the general trend found in other regions of Switzerland.

Background: When identifying ways to reduce stigmatization because of mental illness it is crucial to understand contributing factors. Social distance--the willingness to engage in relationships of varying intimacy with a person--is an indicator of public attitudes toward persons with mental illness. Methods: Multiple linear regression analysis of the results of a vignette-based opinion survey conducted on a representative population sample in Switzerland (n = 594). Results: The level of social distance increases if situations imply 'social closeness.' The vignette describing a person with schizophrenia, attitudes to general aspects of mental health (lay helping, community psychiatry), emotions toward those affected, and the attitude toward consequences of mental illness (medical treatment, medication side effects, negative sanctions, e.g. withdrawal of the driver license) were found to predict social distance. Demographic factors such as age, gender, and the cultural background influence social distance. The explained variance ([R.sup.2]) is 44.8%. Conclusions: Social distance is a multifaceted concept influenced by, e.g., socio-economic and cultural factors, but also by the respondent's general attitude toward (mental) health issues. These results suggest that more knowledge about mental illnesses, especially schizophrenia, may increase social distance. The findings presented here may help to focus anti-stigma campaigns not only on transmission of knowledge, but on integrating different approaches. KEY WORDS: mental illness; attitude; public opinion survey; social distance; stigmatization.

In general, suicide frequencies peak in spring and early summer and depict a low in autumn and winter months. Suicide seasonality is a ubiquitous phenomenon; however, recent studies have indicated that it is related particularly to violent suicide methods. We investigated differences in suicide seasonalities by suicide methods using Swiss mortality data. The suicide data were extracted from the Swiss cause of death statistics and cover the period 1969-1994. In this period 37,518 suicides (ICD-8 codes 950-959) were registered in the mortality statistics. The data were analysed by the Edwards' method, which examines unimodal sinusoidal patterns in aggregated monthly data, and by spectral analysis with disaggregated monthly data. Overall, Swiss suicide data in 1969-1994 depict the expected pattern with a peak in May and June and a low in December. However, analyses by suicide methods show that there is no common pattern. Suicide seasonalities are absent or weak in some violent as well as non-violent methods (firearms, cutting, crashing, poisoning). Even if clearly present (hanging, drowning, jumping from high places, unspecified/other), the seasonalities show distinct patterns and cycles. Apart from sinusoidal patterns, there are also outliers: in overall data as well as in most method-specific data, the December frequencies fall more than 10% below the neighbouring months. The decrease of the frequencies culminates at Christmas/New Year and then returns to average levels. Hence, the seasonality of the overall Swiss suicide frequencies is but a compound seasonality. It largely depends on specific suicide methods and different cyclical dynamics. Keywords: Suicide: Season; Switzerland; Hanging; Poisoning

Background: The United Nations proclaimed 2001 the 'International Year of Volunteers'. Little is known about factors influencing the attitude to volunteering in psychiatry. However, knowledge about these factors is important as target groups to be addressed by an awareness and promotion campaign could be identified. Aims: To determine the influence of demographic, psychological and sociological factors on the attitude to volunteering in psychiatry. Methods: Multiple logistic regression analysis of the results of an opinion survey conducted on a representative population sample in Switzerland (n = 1737). Results: Public attitude is mostly positive. It depends, however, on the form of volunteering. Two explanatory models for volunteering in psychiatry were found: first, the 'antipathetic person' having social distance to and negative stereotypes towards the mentally ill, Second, the 'people with social responsibility and commitment' who have former experience in volunteering, a positive attitude to community psychiatry, interest in mass media, a social profession and perceive discrimination of mentally ill persons. Age and gender are significant predictors. Conclusions: An awareness and promotion campaign to use the vast potential of people willing to volunteer in psychiatry can be primarily focused on those with a basic interest in social issues. Volunteering must be limited in time and responsibility. Contacting people with a positive attitude by mass media is a promising way.

Abstract Background In the aftermath of the Tsunami disaster in 2004, an online psychological self-assessment (ONSET) was developed and made available by the University of Zurich in order to provide an online screening instrument for Tsunami victims to test if they were traumatized and in need of mental health care. The objective of the study was to report the lessons learnt that were made using an Internet-based, self-screening instrument after a large-scale disaster and to discuss its outreach and usefulness. Methods Users of the online self-assessment decided after finishing the procedure whether their dataset could be used for quality control and scientific evaluation Their answers were stored anonymously only if they consented (which was the case in 88% of the sample), stratified analyses according to level of exposure were conducted. Results A total of 2,914 adult users gave their consent for analysis of the screenings. Almost three quarter of the sample filled out the ONSET questionnaire within the first four weeks. Forty-one percent of the users reported direct exposure to the Tsunami disaster. Users who were injured by the Tsunami and users who reported dead or injured family members showed the highest degree of PTSD symptoms. Conclusion ONSET was used by a large number of subjects who thought to be affected by the catastrophe in order to help them decide if they needed to see a mental health professional. Furthermore, men more frequently accessed the instrument than women, indicating that Internet-based testing facilitates reaching out to a different group of people than "ordinary" public mental health strategies.

Abstract Background After the tsunami disaster in the Indian Ocean basin an Internet based self-screening test was made available in order to facilitate contact with mental health services. Although primarily designed for surviving Swiss tourists as well as relatives and acquaintances of the victims, the screening instrument was open to anyone who felt psychologically affected by this disaster. The aim of this study was to evaluate the influences between self-declared increased substance use in the aftermath of the tsunami disaster, trauma exposure and current PTSD symptoms. Methods One section of the screening covered addiction related behavior. We analyzed the relationship between increased substance use, the level of PTSD symptoms and trauma exposure using multivariable logistic regression with substance use as the dependent variable. Included in the study were only subjects who reported being residents of Switzerland and the analyses were stratified by gender in order to control for possible socio-cultural or gender differences in the use of psychotropic substances. Results In women PTSD symptoms and degree of exposure enlarged the odds of increased alcohol, pharmaceuticals and cannabis use significantly. In men the relationship was more specific: PTSD symptoms and degree of exposure only enlarged the odds of increased pharmaceutical consumption significantly. Increases in alcohol, cannabis and tobacco use were only significantly associated with the degree of PTSD symptoms. Conclusion The tsunami was associated with increased substance use. This study not only replicates earlier findings but also suggests for a gender specificity of post-traumatic substance use increase.

Abstract Background The association between poverty and mental health has been widely investigated. There is, however, limited evidence of mental health implications of working poverty, despite its representing a rapidly expanding segment of impoverished populations in many developed nations. In this study, we examined whether working poverty in Switzerland, a country with substantial recent growth among the working poor, was correlated with two dependent variables of interest: psychological health and unmet mental health need. Methods This cross-sectional study used data drawn from the first 3 waves (1999–2001) of the Swiss Household Panel, a nationally representative sample of the permanent resident population of Switzerland. The study sample comprised 5453 subjects aged 20–59 years. We used Generalized Estimating Equation models to investigate the association between working poverty and psychological well-being; we applied logistic regression models to analyze the link between working poverty and unmet mental health need. Working poverty was represented by dummy variables indicating financial deficiency, restricted standard of living, or both conditions. Results After controlling other factors, restricted standard of living was significantly (p < .001) negatively correlated with psychological well-being; it was also associated with approximately 50% increased risk of unmet mental health need (OR = 1.55; 95% CI 1.17 – 2.06). Conclusion The findings of this study contribute to our understanding of the potential psychological impact of material deprivation on working Swiss citizens. Such knowledge may aid in the design of community intervention programs to help reduce the individual and societal burdens of poverty in Switzerland.