New insights into suicide and associated risk factors by Prof. Ella Arensman

New insights into suicide and associated risk factors by Prof. Ella Arensman

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  New insights intosuicide and associated risk factors Prof. Ella Arensman National Suicide Research Foundation, Department of Epidemiology and Public Health, University College Cork 28th November 2013
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  Background 3 Suicide is adevastating event for individuals, families, and communities. People who experience such a loss, the wider public, and health professionals, often struggle to understand this complex behaviour Limited information on specific risk factors associated with suicide in Ireland Unclear to what extent the increase in suicide in Ireland in recent years is linked to the economic recession
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  Suicide and MedicallyTreated Self Harm: ‘The tip of the iceberg’ Suicide Approx. 550 Deliberate self harm medically treated Approx. 12,000 “Hidden” cases of Deliberate self harm “ Approx. 60,000 New insights through the Suicide Support and Information System
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  Trends in ratesof suicide per 100,000 for men, women and the total population in Ireland, 2001-2011 25 Percentage increase in suicide since 2007: 14.6% Rate per 100,000 20 15 10 5 0 Ireland Female Male
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  Why was theSuicide and Information System (SSIS) developed? Gaps in Knowledge - Challenges Objectives of the SSIS  Need for more timely access to information on suicide deaths (delay CSO data 2-3 years)  Obtain real-time data on suicide cases through accessing Coroner’s records  Need for increased accuracy of suicide mortality figures  In addition to confirmed suicides conduct screening of open verdicts  Need for more information on psychosocial and psychiatric risk factors associated with suicide  Obtain information on a wide range of demographic, psychosocial and psychiatric risk factors accessing multiple sources SSIS objectives in line with Reach Out Action 25.2
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  Innovative aspects ofthe SSIS methodology: Obtaining a complete picture of suicide cases and open verdicts by accessing multiple sources Coroners' verdict records & Post mortem reports (Response Rate: 100%) GP/Psychiatrist/ Psychologist (Response Rate: 77.1%) Close family members/ friends (Response Rate: 66.0%) • Period and area covered: Sept. 2008-June 2012, City and County Cork • Number of consecutive cases: 275 suicide cases + 32 open verdicts meeting screening criteria. Total N=307
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  Key outcomes • Proactivefacilitation: Among those who had no bereavement support, 83.0% took up help following facilitation • Overrepresentation of men (80.1%) • Relatively high proportion were unemployed at time of death (33.1%) • Relatively high proportion had worked in the construction/production sector (40.6%) • Nearly two thirds had a history of self-harm (65.2%); 69.1% were diagnosed with depression, and alcohol/and or drug abuse was present among 60.7%
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  Key outcomes Subgroups amongPeople who died by Suicide: • Men vs. Women • Men aged < 40 years vs. Men aged > 40 years • People who were Unemployed vs. People who were Employed • People with a History of Self-Harm vs. People without a History of Self-Harm • People diagnosed with Depression vs. People without a Depression Diagnosis
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  Men aged <40years versus Men aged > 40 years History of alcohol only abuse Cause of death: Hanging Cause of death: Hanging Marital status: Single Living with family of origin Opiates in toxicology Drugs in toxicology Benzodiazepines in toxicology Marital status: Married/Co-habiting Antidepressants in toxicology Alcohol in toxicology In paid employment History of alcohol and drug abuse Diagnosed with a physical illness Diagnosed with depression Unemployed 0 50 100 Aged < 40 years 0 20 40 60 80 100 Aged > 40 years
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  People who wereunemployed versus those employed Cause of death: Hanging Cause of death: Hanging Construction/Producti on sector Married/Co-habiting Drugs in toxicology Benzodiazepines in toxicology Living with partner/children History of alcohol and/or drug abuse Antidepressants in toxicology Opiates in toxicology Diagnosed with depression History of self-harm 0 20 40 60 Unemployed 80 0 20 40 60 Employed 80
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  People who hadengaged in self-harm versus those who had not Cause of death: Hanging In paid employment Married/Co/habiting Cause of death: Hanging Drugs in toxicology Psychiatric diagnosis History of alcohol and/or drug abuse Unemployed Family or close friend died by suicide History of alcohol and/or drug abuse Treated as psychiatric out-patient Construction/producti on sector Diagnosed with depression 0 20 40 60 80 History of self-harm 0 20 40 60 80 No history of self-harm
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  Required actions arisingfrom the information  Improved access to health care services for people who have engaged in self-harm, people at high risk of suicide and people with multiple mental health problems  The association between the impact of the recession and suicide underlines that suicide prevention programmes should be prioritised during times of economic recession  National strategies to increase awareness of the risks involved in alcohol misuse should be intensified, starting at pre-adolescent age  Pro-active facilitation of bereavement support would be the recommended approach for services working with families bereaved by suicide
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  Impact of SSISinformation on a wide range of agencies Health Services Community Services Government SSIS National Office for Suicide Prevention Academia World Health Organisation General Public
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  “People who attemptsuicide never want to die, what they want is a different life” (R. Wieg, 2003)
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  Thank you! Prof. EllaArensman National Suicide Research Foundation Department of Epidemiology and Public Health University College Cork Ireland T: 00353 214205551 E-mail: [email protected] www.nsrf.ie