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Powerlessness, battling with mental illness and self-blame are common themes found in suicide notes, according to a study from Canadian researchers that recommends health-care professionals target those issues in treatment and prevention programs.

The research, published this week in the Canadian Journal of Psychiatry, aimed to find patterns of thinking that contribute to suicide and make recommendations to target those patterns in treatment.

“We know a lot about peoples’ experiences with suicide, but it’s very rare to be able to get into a unique window into the mindset of people who die by suicide,” said Dr. Juveria Zaheer, who co-authored the study and is a clinician scientist at the Centre for Addiction and Mental Health.

The study, conducted by researchers at CAMH and the Sunnybrook Health Sciences Centre, examined 290 suicide notes that were then narrowed down to 36 notes that explicitly referenced mental illness and mental health care.

The notes were from suicide cases that occurred between 2003 and 2009 and were reported to the Office of the Chief Coroner for Ontario, the study said.

About 90 per cent of people who die by suicide have been diagnosed with a mental illness, Zaheer said.

Dr. Zainab Furqan, who also co-authored the study, said the research aimed to explore how mental illness and mental health care was described by those who died by suicide.

While the study acknowledged that people describe their mental illness differently, it found that feelings of powerlessness were commonly expressed in the notes. In terms of treatment, others wrote that they were angry that they couldn’t make any progress in treating their illness.

Describing a battle with mental illness was also a recurring theme in the notes, the study found.

“Mental illness was often portrayed as an opponent or a foe that you’re battling,” said Furqan. “We found that this really uses up a lot of mental energy and they used words like ‘exhaustion’ and ’tiredness’ to describe this battle.”

The study also said that in more than half of the suicide notes examined, hopelessness was mentioned in reference to previous mental illness treatment. People also often blamed themselves for not responding positively to treatments, the study found.

Zaheer said the themes found in the notes can help form recommendations for treatments, such as cognitive behavioural therapy which addresses negative thinking and negative views of the future.

Furqan said clinicians should also work toward helping a patient balance how they view themselves and their mental illness.

“So not completely separating themselves from their mental illness but also not taking on the mental illness as their full identity,” she said.

Furqan and Zaheer said they want the study to be “hopeful” but they acknowledge that it’s hard for people who are experiencing depression to feel that way.

“If we could say anything to people who are suffering, is to hold on to that thread of hope because there are treatments that can be effective and can work,” said Zaheer. “You are not your illness.”

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