Suicide

SUICIDE
FathimaThabsheera
2nd Sem
MSc. Psychology

Topics in Focus:
■ Suicide
■ Clinical picture and causal Factors
■ Suicidal Ambivalence
■ Suicide Prevention and Intervention

SUICIDE
■ Latin word: Sui : Oneself, Cidium: a killing
■ Suicide: Killing Oneself
■ The Centers for Disease Control and Prevention (CDC), defines
suicide as “death from injury, poisoning, or suffocation where
there is evidence (either explicit or implicit) that the injury was
self-inflicted and that the decedent intended to kill
himself/herself.”

 The risk of suicide—taking one’s own life—is a significant
factor in all types of depression.
 50 - 90% do so during a depressive episode or in the
recovery phase.
 the act often occurs at a point when the person appears to
be emerging from the deepest phase of the depressive
attack.

 1 % during the year in which a depressive episode occurs,
but the lifetime risk for someone who has recurrent
depressive episodes is about 15%.
 90 % of people who either attempted or successfully
committed suicide had some psychiatric disorder at the
time.
 individuals with two or more mental disorders at greater
risk than with only one.

 ranks among the 10 leading causes of death in most
Western countries
 In US, it is the 10th or 11th leading cause of death, with
current estimates of about 35,000 suicides each year .
 approximately half a million attempt suicide each
year and 3% of Americans made a suicide attempt.
 9% experienced suicidal ideation or thoughts.

The Clinical Picture and the Causal
Pattern: Who Attempts and Who Commits Suicide?
 25 and 44 years old , now 18 - 24 years old
 women are about three times as likely to attempt suicide as men.
 three or four times higher in separated or divorced.
 Suicide in Children
 Suicide in children under age 10, extremely rare.
 Increased risk for suicide if lost a parent or have been abused.
 Several forms of psychopathology—depression, antisocial behavior, and
high impulsivity—risk factors

 Suicide in Adolescents andYoung Adults
o For persons 15 and 24, the rate of successful suicides tripled
between the mid-1950s and the mid-1980s.
o Ranks 3rd most common cause of death in US for 15- to 19-year-
olds, i.e., 11 % of total deaths in this age range
o The increases in suicide rates observed in most of the many
countries studied.
o Suicide rates in college students are also high, and it is the 2nd
leading cause of death in this group.

KNOWN RISK FACTORS FOR ADOLESCENT SUICIDE:
 Mood disorders
 conduct disorder
 substance abuse
common in attempters and completers.
 2 or more of above, risk for completion increases.

 Unfortunately, recent evidence suggests that treatment of
adolescent mood disorders with antidepressant
medication also seems to produce a very slightly increased
risk for suicidal ideation (or thoughts) and behavior in
children and adolescents, and so now pharmaceutical
companies must put warnings to this effect on these
medications.

 period during which depression, anxiety, alcohol and drug use, and
conduct disorder problems show increasing prevalence
 Increased availability of firearms
 Exposure to suicides through media because adolescents are highly
susceptible to suggestion and imitative behavior
 One review estimated that between 1 and 13 percent of adolescent
suicides occur as a result of contagion factors
 Finally, the fact that the media rarely discuss the mental disorders
suffered by the suicide victims may further increase the likelihood of
imitation.

 Many college students also seem very vulnerable to the development of
suicidal ideation and plans.
 The combined stressors of academic demands, social interaction
problems, and career choices—perhaps interacting with challenges to
their basic values—evidently make it impossible for some students to
continue making the adjustments their life situations demand.

Other Psychosocial Factors Associated with Suicide
 Personality traits associated with suicide are impulsivity,
aggression, pessimism, and negative affectivity
 Suicide is often associated with negative events such as severe
financial reversals, imprisonment, and interpersonal crises of
various sorts.
 These lead either to the loss of a sense of meaning in life or to
hopelessness about the future ,both of which can produce a
mental state that looks to suicide as a possible way out.

 However, hopelessness about the future may be a better long-
term predictor of suicide (say, 1 or 2 years later) than it is for
the short term (for instance, weeks or months later).
 People who have a strong implicit association between the self
and death or suicide is predictive of future suicide attempts
 Other symptoms: patients with major depression include
severe psychic anxiety, panic attacks, severe anhedonia , global
insomnia, delusions, and alcohol abuse
 study of 76 people who had committed suicide while being
hospitalized, the hospital records revealed that 79% of these
people had been severely anxious and agitated in the week
prior to committing suicide

 Research indicates that suicide is the end product of a long sequence of
events that begins in childhood.
 People who become suicidal often come from backgrounds in which
there was some combination of a good deal of family psychopathology,
child maltreatment
 These early experiences are in turn associated with the child having low
self-esteem, hopelessness, and poor problem-solving skills.
 Such experiences affect the person’s cognitive functioning in a very
negative way, and these cognitive deficits may in turn mediate the link
with suicidal behavior

Biological Causal Factors
 There is strong evidence that suicide sometimes runs in families
that genetic factors may play a role in the risk for suicide
 For example, averaging across 22 studies, the concordance rate for
suicide in identical twins is about three times higher than that in
fraternal twins
 Moreover, this genetic vulnerability seems to be at least partly
independent of the genetic vulnerability for major depression

 There is also increasing evidence that genetic vulnerability may be
linked to the neurochemical correlates of suicide.
 Suicide victims often have alterations in serotonin functioning, reduced
serotonergic activity associated with increased suicide risk—especially
for violent suicide.
 studies have been conducted not only in postmortem studies of suicide
victims but also in people who have made suicide attempts.
 This association appears to be independent of psychiatric diagnosis,
including suicide victims with depression, schizophrenia, and
personality disorders

 People hospitalized for a suicide attempt who have low serotonin levels
are also 10 times more likely to kill themselves in the next year than are
those without low serotonin levels.
 Several studies have tried to document an association between suicide
and the short allele serotonin-transporter gene (which controls the
uptake of serotonin from the synapse.
 Although not all studies have found positive results, a quantitative
review of these studies did find that people with one or two copies of
the short allele are at heightened risk for suicide following stressful life
events.

Sociocultural Factors
 Substantial differences in suicide rates occur among
ethnic or racial groups in the United States.
 For example, whites have significantly higher rates of
than African Americans, except among young males, where
rates are similar between white and African American men

 Suicide rates also appear to vary considerably from one society to
another.
 US has a rate of approximately 11 per 100,000.
 Countries with low rates (less than 9 per 100,000) : Greece, Italy, Spain,
and the United Kingdom
 Hungary, more than 40 per 100,000, has the world’s highest rate.
 Western countries with high suicide rates—20 per 100,000 or higher—
Switzerland, Finland, Austria, Sweden, Denmark, and Germany.

 Rates in Japan and China are also high; in China the estimated suicide
rate is three times the global average
 Moreover, almost 30 percent of suicides worldwide are estimated to
occur in China and India.
 Some have estimated the global mortality from suicide at 16 to 18 per
100,000
 These estimates should be considered in the fact that there are wide
differences across countries in the criteria used for determining
whether a death was due to suicide, and such differences may well
contribute to the apparent differences in suicide rates.

 Religious taboos concerning suicide and the attitudes of a
society toward death are also apparently important
determinants of suicide rates.
 Both Catholicism and Islam strongly condemn suicide, and
suicide rates in Catholic and Islamic countries are
correspondingly low.
 In fact, most societies have developed strong sanctions
against suicide, and many still regard it as a crime as well as a
sin.

 Japan is one of the few societies in which suicide has been socially
approved under certain circumstances—such as conditions that bring
disgrace to an individual or group.
 There are also interesting cross-cultural gender differences in whether
men or women are more likely to attempt and complete suicide.
 Although women- more likely to attempt ,men - complete suicide in
the United States, in India, Poland, and Finland men are more likely
than women to engage in nonfatal suicide attempts.
 In China, India, and Papua New Guinea, women are more likely to
complete suicide than men.

 In a pioneering study of sociocultural factors in suicide, the French
sociologist Emile Durkheim (1897/1951) attempted to relate differences
in suicide rates to differences in group cohesiveness.
 Analyzing records of suicides in different countries and during different
historical periods, Durkheim concluded that the greatest deterrent to
committing suicide in times of personal stress is a sense of involvement
and identity with other people.
 More contemporary studies tend to confirm this idea, showing, for
example, that being married and having children tends to protect one
from suicide

Suicidal Ambivalence
 Ambivalence often accompanies thoughts of suicide.
 Some people (most often women) do not really wish to die but instead
want to communicate a dramatic message to others concerning their
distress.
 In stark contrast, a small minority of suicidal people are seemingly intent
on dying.
 A third subset of people are ambivalent about dying and tend to leave the
question of death to fate.The feeling during such attempts can be
summed up as, “If I die, the conflict is settled, but if I am rescued that is
what was meant to be.”

 After an unsuccessful attempt, a marked reduction in emotional turmoil
usually occurs, especially if the attempt was expected to be lethal, such as
jumping in front of a moving train.
 not stable, and subsequent suicidal behavior may follow
 Long-term follow-ups of those who have made a suicide attempt show
that about 7 to 10 percent will eventually die by suicide, a risk about five
times greater than the average risk of 1.4 percent
 Of people who do kill themselves, about 20 to 40 percent have a history of
one or more previous attempts; however, more than half of those who
commit suicide have no previous attempts

Communication of Suicidal Intent
♦ Research has clearly disproved the tragic belief that those who
threaten to take their lives seldom do so.
♦ One review of interviewing friends and relatives of people who had
committed suicide revealed that more than 40 percent had
communicated their suicidal intent in very clear and specific terms
and that another 30 percent had talked about death or dying in the
months preceding their suicide.
♦ These communications were usually made to several people and
occurred a few weeks or months before the suicide

• Nevertheless, most of those interviewed said the suicide came as a
surprise.
• most of these communications of intent were to friends and family
members and not to mental health professionals.
• Nearly 50 % of people who die by suicide have never seen a mental health
professional in their lifetime, and only about 20 percent are under the care
of one at the time of their death
• On the other hand, if a clinician knows that someone has been suicidal he
or she should also not take the patient’s denial of suicidal intent as
necessarily being valid.

• One fascinating study of clinical correlates of inpatients who had
committed suicide revealed some sobering statistics: Among patients
who were being hospitalized for having had either suicidal ideation or
intent, nearly 80 percent denied suicidal ideation the last time they spoke
with a clinician before actually committing suicide; moreover, over 50
percent of those who committed suicide did so while on a 15-minute
suicide watch or under 1-on-1 observation.

Suicide Notes
 analyzed suicide notes in an effort to understand the motives and
feelings of people who take their own lives.
 only about 15 to 25 % left notes, usually addresses to relatives or
friends.
 Usually coherent and legible, either had been mailed or were found
on the person’s body or near the suicide scene.
 Some notes included statements of love and concern, which may
have been motivated by the desire to be remembered positively
and to reassure the survivor of the worth of the relationship.
 Occasionally, notes contained very hostile content
 Many notes are often quite short and straightforward: “I am tired of
living” or “I could not bear it any longer” or “No one is to blame for
this. It’s just that I could never be reconciled with life itself. God
have mercy on my soul”

Suicide Prevention and Intervention
 Preventing suicide is extremely difficult.
 Most people who are depressed and contemplating
suicide do not realize that their thinking is restricted and
irrational and that they are in need of assistance.
 Rather than seeking psychological help, they are more
likely to visit a doctor’s office with multiple vague
complaints of physical symptoms that the doctor often
does not detect as symptoms of depression or alcoholism.
 Others are brought to the attention of mental health
personnel by family members or friends who are
concerned because the person appears depressed or has
made suicide threats.

• The vast majority, however, do not receive the help they
desperately need, which is unfortunate because if a
person’s cry for help can be heard in time it is often
possible to intervene successfully.
• Currently, there are three main thrusts of preventive
efforts:
 treatment of the person’s current mental disorder(s),
 crisis intervention, and
 working with high-risk groups.

Treatment of Mental Disorders
In depression, treatment : antidepressant medications or lithium
Benzodiazepines : treating the severe anxiety and panic that so
often precede suicide attempts.
Although there is not a great deal of work using cognitive-
behavioral treatments for suicide, one important study examined
adults who had already made at least one attempt and gave
10 sessions of cognitive therapy focused on suicide prevention.
 This treatment was quite beneficial in reducing further attempts.

Crisis Intervention
• The primary objective : help a person cope with an immediate life
• first step involves emergency medical treatment, followed by referral
inpatient or outpatient mental health facilities in order to reduce the
for future attempts
• When people contemplating suicide are willing to discuss their
with someone at a suicide prevention center, it is often possible to
an actual suicide attempt. Here the primary objective is to help these
people regain their ability to cope with their immediate problems as
quickly as possible.

Emphasis is usually placed on
(1) maintaining supportive and often highly directive contact with
the person over a short period of time—usually one to six
contacts;
(2) helping the person to realize that acute distress is impairing his
or her ability to assess the situation accurately and to see that
there are better ways of dealing with the problem; and
(3) helping the person to see that the present distress and
emotional turmoil will not be endless

 Since the 1960s, the establishment of suicide hotlines for suicide prevention centers.
 but questions have been raised about the quality of care offered by them
 24-hour-a-day availability of telephone contact.
 staffed primarily by nonprofessionals who are supervised by psychologists and
psychiatrists.
 The worker attempts to establish the seriousness of the caller’s intent and
simultaneously tries to show empathy and to convince the person not to attempt
suicide.
 Efforts are also made to mobilize support from family or friends.
 Unfortunately, good information on the assessment of the effects of these hotlines
and suicide prevention centers has not revealed much impact on suicide rates.

Focus on High-Risk Groups and Other Measures
 Many investigators have emphasized the need for broad-based
prevention programs aimed at alleviating the life problems of people
are in groups at high risk for suicide
 Few such programs have actually been initiated, but one approach has
been to involve older men—a high-risk group— in social and
activities that help others. Playing such roles may lessen these men’s
sense of isolation and meaninglessness, which often stems from
retirement, financial problems, the deaths of loved ones, impaired
physical health, and feeling unwanted.
 Other programs have been targeted at young adolescents who are at
higher risk because of previous suicidal ideation and behavior or mood
substance use disorders.

Suicide

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Suicide