Devon Partnership NHS Trust, Salmon Pool Lane, Exeter EX2 4SG, UK.
BMJ. 2011 Oct 18;343:d5801. doi: 10.1136/bmj.d5801.
To shed light on the difficulties faced by relatives, friends, and colleagues in interpreting signs of suicidality and deciding whether and how to intervene.
Qualitative study of completed suicides, based on in-depth interviews with multiple informants.
London, southwest England, and south Wales.
31 lay informants (one to five for each case), including parents, partners, siblings, friends, and colleagues of 14 cases of suicide in which the deceased was aged 18-34 and was not in contact with secondary mental health services.
Informants described both intellectual and emotional barriers to awareness and intervention within the family and social network. They reported that signs and communications of distress were often oblique and difficult to interpret, that they may have disregarded warning signals and focused instead on positive signs, and that, even when they were aware that something was seriously wrong, taking any action at all involved considerable personal risks.
As the suicidal process unfolds, significant others are faced with a highly complex task. Their proximity to the suicidal person and their emotional investment in the relationship make it difficult for them to see what is happening, to say anything to the person or to other members of the network, or to seek help outside the network. Efforts to strengthen the capacity of lay people to play a role in preventing suicide are urgently needed and should be informed by a thorough understanding of these difficulties. They should highlight the ambiguous nature of warning signs and should focus on helping people to acknowledge and overcome their fears about intervening.
阐明亲属、朋友和同事在解读自杀迹象以及决定是否以及如何进行干预方面所面临的困难。
基于对多位知情人进行深入访谈的已完成自杀案例的定性研究。
英格兰西南部的伦敦和南威尔士。
31 名非专业知情人（每个案例有 1 至 5 人），包括父母、伴侣、兄弟姐妹、朋友和同事，他们是 14 例年龄在 18-34 岁且未与二级精神卫生服务机构接触的自杀案例的知情者。
知情人描述了在家庭和社交网络中意识和干预的认知和情感障碍。他们报告说，痛苦的迹象和信息通常是间接和难以理解的，他们可能忽视了警告信号，而专注于积极的信号，即使他们意识到有严重的问题，采取任何行动都会涉及到相当大的个人风险。
随着自杀过程的展开，重要他人面临着一项高度复杂的任务。他们与自杀者的亲近程度以及对关系的情感投入，使得他们难以看到正在发生的事情，难以向当事人或网络中的其他成员表达任何意见，或在网络之外寻求帮助。迫切需要加强非专业人士在预防自杀方面发挥作用的能力，并且应该充分了解这些困难。它们应该强调警告迹象的模糊性质，并应专注于帮助人们承认和克服他们干预的恐惧。
