Chapter Eight Suicide Suicide Suicide The intentional direct

Chapter Eight Suicide

Suicide • Suicide: – The intentional, direct, and conscious taking of one’s own life – Not classified as a mental disorder, although the suicidal person usually has psychiatric symptoms, such as: • Depression, alcohol dependence, and schizophrenia – Suicide and suicidal ideation (thoughts about suicide) may represent a separate clinical entity

Correlates of Suicide • Psychological autopsy: – Systematic examination of existing information to understand explain a person’s behavior before death – Suicide survivors are different from those who succeed: • Typical attempter: White female housewife in 20 s-30 s with marital difficulties; uses barbiturates • Typical succeeder: Male in 40 s or older with poor health or depression; uses gun or hangs himself

Facts About Suicide • Frequency: – Approximately 34, 000 people commit suicide each year – Among top 11 causes of death in industrialized parts of the world – Number of actual suicides is probably 25 -30% higher than what is recorded

Facts About Suicide (cont’d. ) • Suicide publicity/identification with victims: – Media reports of suicide, especially celebrity suicide, spark increase in suicide – Suicides by young people in small communities evoke copycat suicides • Gender: – Men are about four times as likely to be successful (they use more lethal means) – Women are more likely to attempt suicide

Facts About Suicide (cont’d. ) • Marital status: – Married people are less vulnerable – Divorced and widowed individuals are more vulnerable • Occupation: – Higher risk for physicians, lawyers, law enforcement personnel, and dentists – Burnout, stress, and guilt over medical errors may increase risk for surgeons

Facts About Suicide (cont’d. ) • Socioeconomic level is not a factor • Choice of method: – Over 50% of suicides are committed using firearms – 70% of attempts are from drug overdose – Most common means for children under 15 is jumping from buildings and running into traffic – Most common means for adolescents over 15 is drug overdose or hanging themselves

Facts About Suicide (cont’d. ) • Religious affiliation: – Correlated with suicide rates – Suicide rates are lower in Catholic and Muslim countries where there is strong condemnation of suicide – Where religious sanctions are weaker—e. g. , Scandinavian countries, former Czechoslovakia, Hungary—suicide rate is higher

Facts About Suicide (cont’d. ) • Ethnic and cultural variables: – Highest rates in U. S. are for American Indian; lowest for Asian Americans – High rates of alcoholism, low standard of living, and invalidation of cultural lifestyles also contributing factors

Facts About Suicide (cont’d. ) • Historical period: – Tends to decline during times of war and natural disasters – Increase during periods of shifting norms and values or social unrest • Communication of intent: – More than two-thirds of those who commit suicide communicate their intent to do so within three months of the act

Facts About Suicide (cont’d. ) • Reinforcing protective factors: – Reawakening and reinforcing desire to live – Expanding perceptual outlook by reducing suicide myopia – Enhancing social connectedness – Increasing repertoire of coping skills

A Multipath Perspective of Suicide • Most viable explanation of mental disorders must come from an integrated and multidimensional analysis • Many different factors involved in suicide – Biological – Psychological – Sociocultural

Biological Dimension • Suicide influenced by low serotonin levels in the brain – 5 -hydroxyindoleacetic acid (5 HIAA): • Produced when serotonin is broken down in the body • Low amounts of 5 -HIAA in suicidal patients • Genetics: – High rate of suicide and suicide attempts among parents and close relatives of individuals who attempt or complete suicide – Unclear relationship

Psychological Dimension • Depression and hopelessness: – Depression plays important role; relationship is complex – Increase in sadness is a frequent mood indicator of suicide – Heightened feelings of anxiety, anger, and shame also associated – Hopelessness, or negative expectations about future, may be even stronger factor

Psychological Dimension (cont’d. ) • Alcohol consumption: – One of most consistent correlates • As many as 70% of suicide attempts involve alcohol – Also strong correlation to successful attempt – May lower inhibitions related to fear of death – Alcohol-induced myopia: a constriction of cognitive and perceptual processes – May increase distress by focusing thoughts on the negative aspects of their personal situations

Social Dimension • Many suicides are interpersonal in nature and are influenced by relationships involving a significant other • Individuals who are incapacitated or have a terminal illness are often at higher risk • Family instability, stress, and chaotic family atmosphere related to attempts by younger children

Social Dimension (cont’d. ) • Interpersonal-psychological theory of suicide (Joiner): – Perceived burdensomeness – Thwarted belongingness – Acquired capacity for suicide • Social factors that separate people or make them less connected to other things they care about (e. g. , family religious affiliation, etc. )

Sociocultural Dimension • Emile Durkheim: – Inability to integrate oneself into society; lack of close ties deprives one of support systems necessary for adaptive functioning • Other factors: – Modern mobile society that de-emphasizes importance of family and sense of community – Further group goals or achieve greater good – Social change and disorganization within one’s community

Suicide and Specific Populations • Three groups of people affected by suicide: – Children and adolescents – College students – Elderly people

Suicide Among Children and Adolescents • Suicide rate for children under 14 is increasing at alarming rate • Suicide is third leading cause of death among teenagers • Teen suicide increased by 18% in 2004 and by 17% in 2005 • High school study: 13. 8% considered suicide, 6. 3% attempted, and 1. 9% required medical attention

Suicide Among Children and Adolescents (cont’d. ) • The role of bullying: – “Bullycide”: bullying leading to suicide – Bullying victims are 2 -9 times more likely to consider suicide than non victims – Nearly 50% of young people who commit suicide experienced bullying • Copycat suicides: – Youngsters mimic a previous suicide – Highly publicized suicides increase the number of attempts

Suicide Among Children and Adolescents (cont’d. ) • Decrease in antidepressant medication: – 2004 FDA warning of an increased suicide risk for children taking SSRI antidepressants – Recent research suggests SSRIs may increase suicidal thoughts or behaviors for very select few – Increase in youth suicide rates since FDA warning because antidepressants are less likely to be prescribed

Suicide Among College Students • According to study, suicide rates among college students are no higher than noncollege group but: – Limited access to lethal means – Decreasing proportion of males attending college – Nearly 1, 000 students commit suicide per year – 44% increase in students with psychiatric disorders – Between 2009 and 2010 serious thoughts of suicide among college students rose significantly

Suicide Among College Students (cont’d. ) • College study: – More than 50% reported suicidal thoughts – 14% of undergraduates and 8% of graduates had made a suicide attempt • Development of programs and resources to: – Identify warning signs – Have well-established suicide prevention procedures – Clearly identify resources for a suicidal crisis

Suicide Among the Elderly • Unwelcome physical changes, including wrinkling, graying hair, and diminished physical strength • Life events connected with “feeling old” lead to depression (one of the most common psychiatric complaints of the elderly) • Suicide rates for elderly white men are the highest for any age group

Suicide Among the Elderly (cont’d. ) • Firearms are most common method for people over 65 years old • Elderly make fewer attempts per completed suicide • For Asian Americans, the highest risk is for first -generation immigrants • Lowest rates among American Indians and African Americans

Preventing Suicide • Assumption that potential victims are ambivalent: they have a strong wish to die, but also a wish to live • Part of success in prevention is ability to assess lethality: – The probability that a person will choose to end his or her life

Preventing Suicide (cont’d. ) • Three-step process for working with a potentially suicidal person: – Knowing which factors are highly correlated with suicide – Determining probability that person will act on suicide wish (high, moderate, or low) – Implementing appropriate actions • Attempt to quantify the seriousness of each factor

Clues to Suicidal Intent • Demographic: – Male, increased age, and history of suicide threat • Specific: – Amount of detail in the threat – Direct access to means of suicide – Precipitating events – Verbal communication of intent (often this is subtle) – “Practice run” at an actual attempt

Clues to Suicidal Intent (cont’d. ) • Indirect behavioral cues: – Puts affairs in order; takes a long trip; gives away prized possessions; etc. • Early signs: – Depression, guilt feelings, insomnia, tension, nervousness, loss of weight, and impulsiveness • Critical signs: – Sudden changes in behavior; gives away possessions; threats or actual attempts

Clues to Suicidal Intent (cont’d. ) • Crisis intervention: – Clinical level: • Educate staff at mental health institutions and schools to recognize signs of potential suicide – Crisis intervention aimed at providing intensive short-term help to resolve immediate life crisis • Patient may be immediately hospitalized, given medical treatment, seen by psychiatric team for two-four hours per day until stabilized • Working with patient and taking charge of person’s personal, social, and professional life outside facility

Clues to Suicidal Intent (cont’d. ) Figure 8 -2 The Process of Preventing Suicide prevention involves the careful assessment of risk factors to determine lethality- the probability that a person will choose to end his or her life. Working with an individual who is potentially is a three-step process that involves (1) knowing what factors are highly correlated with suicide; (2) determining whethere is high, moderate, or low probability that the person will act on the with; and (3) implementing appropriate actions.

Clues to Suicidal Intent (cont’d. ) • After clients return to more stable emotional state and immediate risk has passed: – Traditional forms of treatment, inpatient or outpatient, are used – Relatives and friends may be enlisted to help monitor individual

Suicide Prevention Centers • Many in acute distress are not being treated and may be unaware of available services • Telephone crisis intervention: – Maintain contact and establish relationship – Obtain necessary information – Evaluate suicidal potential – Clarify nature of stress and focal problem – Assess strengths and resources – Recommend and initiate action plan

Suicide Prevention Centers (cont’d. ) • Today, there about 200 suicide prevention centers in U. S. , along with many suicide hotlines • Little research has been done on effectiveness (anonymity)

The Right to Suicide • A majority of Americans believe terminally ill individuals should be allowed to take their own lives • Suicide is both a sin and an illegal act in most countries • Oregon (1998): – Physician-assisted suicide act – U. S. Attorney General Ashcroft attempted to overturn (U. S. Court of Appeals upheld Oregon’s law)

Moral, Ethical, and Legal Implications • Recent legislation and literature has debated whether it is morally, ethically, and legally permissible to aid in suicide – Derek Humphrey’s Final Exit (1991): • Hemlock Society’s manual on suicide – Doctor Jack Kevorkian: • “Dr. Death” and his “suicide machine” • Ironically, by prolonging life, medical science has also prolonged the process of dying

Moral, Ethical, and Legal Implications (cont’d. ) • Pro: – Suicide can be a rational act; mental health and medical professionals should be allowed to help without fear or legal or professional repercussions • Con: – Suicide is not rational, and it is dangerous to say that it is • Criteria to decide between life and death: – “Quality of life” and “quality of humanness” are subjective and difficult to define