Bivalence and in some cases anger and hostility even

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bivalence and, in some cases, anger and hostility – even ex- plicit death wishes – towards a suicidal person (22-25). This absence of good communication and dialogue seems not to be characteristic of the young rural Vietnamese families studied here alone. In a Chinese study (6) the association between impulsive, low-planned suicidal actions and acute life events was de- scribed. Our study results confirm the important role played by these acute and prolonged psychosocial stressors in the suicidal process. Given the high proportion of low-planned suicides that involve pesticides stored in the home, Phillips et al (26) rec- ommend restricting the accessibility of these drugs as an ef- fective suicide-preventive strategy. This is important, but re- IMP. 47-53 23-01-2008 17:11 Pagina 51
52 World Psychiatry 7:1 - February 2008 stricting the means of committing suicide may only post- pone suicidal acts. On the basis of the interviews in the present study, teaching young people and their parents to use communication skills and coping abilities, instead of re- sorting to violence and punishment when problems arise in everyday life, appears to be an equally important strategy. The low educational level of the suicide attempters’ par- ents may be a limitation on their ability to understand these young people’s communication of distress. However, the same problems may exist in suicidal families where the par- ents’ educational level is high (20, 21). The barriers charac- teristic of Vietnamese culture, in which disclosure of emo- tional problems is unusual, are of limited explanatory value, since lack of communication between parents and suicidal young people is also observed in Western studies (13,20,21). Perception of support from the family The young persons in the present study felt, deeply and bitterly, that they did not receive practical, financial and psy- chological support when they felt distressed. Moreover, 15 of the 19 young people were primary or secondary school dropouts. Reactions from the school, society and the family were lacking. The Programme on Global Child Mental Health (www . globalchildmentalhealth.com ) recently launched by the WPA, in cooperation with the World Health Organization and the International Association for Child and Adoles- cent Psychiatry and Allied Professions (IACAPAP), makes school dropouts the focus of interventions aimed at pre- venting mental problems and suicide. Dropping out of school is one of the most significant indicators of mental distress and mental problems, of which suicide attempts and suicide are the ultimate consequence. Suicide prevention Is suicide prevention through detection of suicidal com- munication and distress possible? It is difficult to judge how much this kind of intervention could prevent suicide attempts among Vietnamese youngsters. However, it seems meaning- ful to supplement restriction of highly toxic and lethal means of suicide with some kind of psychosocial strategy. Psy- chosocial strategies that focus on young people at risk, such as school dropouts, and on teaching families how to commu- nicate about problems and distress, can be tested. Teaching

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