Prevalence and individual and work-related factors associated with suicidal thoughts and behaviours among veterinarians in Norway: a cross-sectional, nationwide survey-based study (the NORVET study)

ObjectivesSeveral studies have shown increased suicide rates among veterinarians. We investigated the self-reported prevalence of suicidal thoughts and behaviours and contributing and independent factors associated with suicidal thoughts and behaviours among veterinarians in Norway.DesignCross-sectional, nationwide survey.Participants2596 veterinarians in Norway (response rate: 75%).Main outcome measurePaykel’s five-item questionnaire.ResultsIn total, 27% (n=682/2567) of veterinarians in Norway felt that life was not worth living during the last year, 5% (n=139/2562) had serious suicidal thoughts, and 0.2% (n=6/2537) had attempted suicide. Female veterinarians reported significantly higher prevalence of suicidal feelings and thoughts than males. For serious suicidal thoughts, women had nearly twice the prevalence as their male colleagues (6.2% (n=108/1754) vs 3.6% (n=28/766), χ2: 6.5, p=0.011). Independent factors associated with serious suicidal thoughts were being single (OR 1.76, 95% CI 1.13 to 2.72, p<0.05), negative life events (OR=1.43, 95% CI 1.22 to 1.68, p<0.001) and the presence of mental distress (OR 2.75, 95% CI 2.14 to 3.52, p<0.001). The veterinarians related their serious suicidal thoughts to work and personal problems, and a lesser degree to family, social and other problems. Nearly twice as many women (53%, n=57/108) as men (28%, n=7/25) reported work problems as the most important contributing factor to their serious suicidal thoughts (χ2: 4.99, p=0.03). 4% (n=6/139) reported work problems as the only factor of importance.ConclusionsVeterinarians in Norway have relatively high prevalence of suicidal feelings and thoughts, including serious suicidal thoughts. In multivariable analyses, the individual factors were more important than work-related ones, while work problems were the most reported contributing factor to serious suicidal thoughts by the veterinarians themselves. The role of gender and specific work-related factors should be further investigated to better understand the complexity of suicidal behaviour among veterinarians.

Divergent Views and Experiences Regarding ‘Completed Life’ and Euthanasia in the Netherlands

A small proportion of older people in the Netherlands want to end their lives because they feel their lives to be ‘completed’ and no longer worth living. Currently, there is heated debate over whether or not these people should have the right to euthanasia. Drawing on previous research, we conduct a heuristic analysis of views and experiences of three different ‘parties’ involved in this debate, namely, the older people, their relatives and friends and medical professionals. The views of these three groups tend to be divergent and conflicting, posing a difficult dilemma to decision-makers.

The Infinite Pleasure of Reading

Irene Vallejo11 has perfectly demonstrated the accuracy of Nuccio Ordine’s thesis on the usefulness of the useless. In a screenobsessed world that often destroys our serenity and the pleasure to be found in slowness, this wonderful author has found a direct line to the relevance of the ancient world and, by extension, to the world of books and many of the things they do to make life worth living. Kant distinguished between what has a price – and what has dignity.

Self-Participation Experiences among Well-Adapted Hemodialysis Patients

A successful self-participation experience empowers patients to adapt to living with hemodialysis. However, few studies regarding the subjective experiences of such patient participation have been conducted. This study’s purpose was to describe hemodialysis patients’ perspectives on integrating hemodialysis into a new life regarding self-participation experience. A qualitative study using the grounded theory method was applied. Thirty-two well-adaptive hemodialysis Taiwanese patients attended in-depth interviews. “Integrating hemodialysis into a new life journey” was identified as the core category guiding the entire self-participation experience of hemodialysis patients. The three antecedent themes were “Sense of worthlessness”, “Life is still worth living”, and “Friendly and joyful atmosphere of the hemodialysis room”. Once the patients went through the three antecedent themes, they gradually began making efforts to participate more fully in their hemodialysis. Within this participation experience, the hemodialysis patients exhibited these four interactive themes: “Overcoming one’s predicament”, “Integrating self-care skills into my life”, “Resuming previous roles and tasks”, and “Adapting to independent living”. Finally, most adaptive patients master the hemodialysis life. Encouraging patients to discover that their life is worth living and providing a friendly and joyful atmosphere in hemodialysis units are the keys to facilitating patients’ self-participation more fully.

PHILOSOPHICAL FOUNDATIONS OF THE DIGITAL HYGIENE OF LIFE

Автор статьи утверждает, что вопрос А. Камю о том, стоит ли человеческая жизнь того, чтобы её прожить, потому до сих пор не нашел убедительного ответа, что на него нельзя ответить сугубо теоретически. По мнению автора статьи, надо не только обосновать необходимость любви к жизни, но и научиться её практиковать. Он полагает, что практика любви к жизни предполагает следование гигиене жизни. Пребывание в цифровой реальности сильно влияет на жизнь человека. Поэтому современный человек должен следовать цифровой гигиене жизни. Цифровая гигиена жизни не может быть сведена к набору ряда рекомендаций, поскольку их выполнение должно стимулироваться убедительными мотивами. Эти мотивы, согласно автору статьи, являются философскими основами цифровой гигиены жизни и представляют собой приятие трех взаимосвязанных утверждений: мир природы ценнее цифровой реальности, должно воспитывать в себе все большую любовь к живым существам, противодействие механизации человеческого мышления. The author of the article claims that the question of A. Camus whether a human life is worth living, has not yet found a convincing answer, because it cannot be answered purely theoretically. According to the author of the article, it is necessary not only to justify the need for love of life, but also to learn how to practice it. He believes that the practice of loving life involves following the hygiene of life. Being in a digital reality greatly affects a person's life. Therefore, a person, who is often present in a digital reality, should follow the digital hygiene of life. Digital hygiene of life cannot be reduced to the implementation of a number of recommendations, because their application must be stimulated by convincing motives. These motives, according to the author of the article, are the philosophical foundations of digital hygiene of life. They represent the acceptance of three interrelated statements: the natural world is more valuable than digital reality, it should cultivate an increasing love for living beings, and it should resist the mechanization of human thinking.

The QALY is ableist: on the unethical implications of health states worse than dead

Introduction A long-standing criticism of the QALY has been that it would discriminate against people in poor health: extending the lives of individuals with underlying health conditions gains fewer QALYs than extending the lives of ‘more healthy’ individuals. Proponents of the QALY counter that this only reflects the general public’s preferences and constitutes an efficient allocation of resources. A pivotal issue that has thus far been overlooked is that there can also be negative QALYs. Methods and results Negative QALYs are assigned to the times spent in any health state that is considered to be worse than dead. In a health economic evaluation, extending the lives of people who live in such states reduces the overall population health; it counts as a loss. The problem with this assessment is that the QALY is not based on the perspectives of individual patients—who usually consider their lives to be well worth living—but it reflects the preferences of the general public. While it may be generally legitimate to use those preferences to inform decisions about the allocation of health care resources, when it comes to states worse than dead, the implications are deeply problematic. In this paper, I discuss the (un)ethical aspects of states worse than dead and demonstrate how their use in economic evaluation leads to a systematic underestimation of the value of life-extending treatments. Conclusion States worse than dead should thus no longer be used, and a non-negative value should be placed on all human lives.

He Waka Eke Noa at Korowai Manaaki: A Process Evaluation of a Dialectical Behaviour Therapy-informed skills programme for young people in a secure youth justice residence

<p>Dialectical Behaviour Therapy (DBT) aims to help people live a life worth living. It has increasingly been developed and adapted to address a range of mental health symptoms across different ages, cognitive abilities and environmental contexts; however, its popularity in implementation has outpaced empirical research. The current study was a Process Evaluation which assessed professionals’ perspectives about a DBT-informed skills group called He Waka Eke Noa operating at Korowai Manaaki – a youth justice secure residence in New Zealand (NZ). The study involved 11 interviews with professionals across two organisations involved in facilitating He Waka Eke Noa and/or supporting the young people who participated. Thematic analysis was used to analyse the interviews and three overarching themes were identified. The first theme, ‘Factors influencing practical effectiveness’, explored areas which professionals highlighted as having a significant impact on how He Waka Eke Noa worked and had three subthemes: ‘Generalisability’, ‘Cultural Responsivity’, and ‘Criminal Justice Environment’. The second theme, ‘Theoretical application of DBT to young people in NZ’ investigated the compatibility of DBT with young people in secure youth justice residences in NZ. The final theme, ‘Motivation’, considered the role that motivation played in engagement and continuation of treatment for people involved in He Waka Eke Noa. The findings from this study shed light on how the group was operating and highlighted the importance of the relationship between facilitators and young people. It identified the challenges He Waka Eke Noa faced including the difficulty of balancing a risk-reduction approach with creating a therapeutic environment. Further developments are considered that would assist He Waka Eke Noa in maximising its effectiveness through increasing resources and ensuring diversity amongst the clinicians (e.g., increasing cultural diversity). The thesis concludes with recommendations for the future direction of operation, for example, rolling out DBT-informed skills groups in other residences and the community; and potential research avenues.</p>

He Waka Eke Noa at Korowai Manaaki: A Process Evaluation of a Dialectical Behaviour Therapy-informed skills programme for young people in a secure youth justice residence

<p>Dialectical Behaviour Therapy (DBT) aims to help people live a life worth living. It has increasingly been developed and adapted to address a range of mental health symptoms across different ages, cognitive abilities and environmental contexts; however, its popularity in implementation has outpaced empirical research. The current study was a Process Evaluation which assessed professionals’ perspectives about a DBT-informed skills group called He Waka Eke Noa operating at Korowai Manaaki – a youth justice secure residence in New Zealand (NZ). The study involved 11 interviews with professionals across two organisations involved in facilitating He Waka Eke Noa and/or supporting the young people who participated. Thematic analysis was used to analyse the interviews and three overarching themes were identified. The first theme, ‘Factors influencing practical effectiveness’, explored areas which professionals highlighted as having a significant impact on how He Waka Eke Noa worked and had three subthemes: ‘Generalisability’, ‘Cultural Responsivity’, and ‘Criminal Justice Environment’. The second theme, ‘Theoretical application of DBT to young people in NZ’ investigated the compatibility of DBT with young people in secure youth justice residences in NZ. The final theme, ‘Motivation’, considered the role that motivation played in engagement and continuation of treatment for people involved in He Waka Eke Noa. The findings from this study shed light on how the group was operating and highlighted the importance of the relationship between facilitators and young people. It identified the challenges He Waka Eke Noa faced including the difficulty of balancing a risk-reduction approach with creating a therapeutic environment. Further developments are considered that would assist He Waka Eke Noa in maximising its effectiveness through increasing resources and ensuring diversity amongst the clinicians (e.g., increasing cultural diversity). The thesis concludes with recommendations for the future direction of operation, for example, rolling out DBT-informed skills groups in other residences and the community; and potential research avenues.</p>

Critical Events as Factors Shaping Life Experiences

The article presents the life story of an elderly woman, the sense of the quality of her life, the critical events that shaped her life, and the lessons learned from her experiences. The study adopted a biographical paradigm, which explains the importance of individual biographies in the education process and indicates the need to study the history of life as a source of knowledge about man and his learning. The main aim of the undertaken research was to recognise the meanings that the respondent gives to critical events in shaping the quality of her life. The biographical method was used, and, within it, an autobiographical narrative interview. The most significant events assessed as positive were the births of her children. The negative events were in particular: the deaths of close ones, a failed marriage and an accident. In coping with suffering, the woman was helped by: help from others, faith, strength, optimism, activity, activities for the benefit of others, and her value system. Lessons emerged from the subject’s history, helpful in her life, which can also inspire others. The narrator tried to live in harmony with her conscience and the accepted principles, which gave her satisfaction. Biographical research has an educational function. Life stories can teach what is important in life, what is worth living for, and they can lead to reflections.

The (Un)Willingness to Keep Living at Very Advanced Ages

A long life is a general desire that will be reached by more and more people, particularly in developed countries. But the delay of mortality raises important questions about quality of life in the later years. Centenarians have received attention from different disciplines, particularly from demography and genetics, but a psychological approach on whether life at age 100 is perceived as worth living is still very limited. This study explores centenarians’ will to live and associated factors in a sample of 121 centenarians (mean age 101 years; SD 1.63 years; 84.3% female), who answered to a questionnaire comprising sociodemographic characteristics, health status, social functioning, and well-being as well as open questions on their will to live and end-of-life issues. Of the total sample, 31.4% expressed willingness to live longer, 30.6% did not, and 38% presented no clear positioning. From the qualitative thematic analysis, annoyance, uselessness, loss of meaning, disconnection, and loneliness were the most common justifications for being reluctant to live longer. Positive valuation of life and good self-rated health, followed by having a confidant and reduced pain frequency, were the reasons for being willing to live longer. From the quantitative analysis, associated factors of will to live include pain frequency, self-rated health, having a friend confidant and valuation of life. This study provides researchers suggestions for further investigation and highlight the importance of inquiring and understanding very old people’s values and views on their will to live, future wishes, and meaning in life.