Chapter 8 Suicide

mood and thought changes in suicide

-many suicide attempts are preceded by changes in mood and shifts in thinking patterns -hopelessness -sadness, anxiety, tension, frustration, shame -psychache -dichotomous thinking (viewing problems and solutions in rigid either/or terms) - People may become preoccupied with their problems, lose perspective, and see suicide as the only effective solution to their difficulties

Adolescents and suicide

-suicidal actions become much more common after the age of 13 -suicidal attempts by adolescents are usually a relationship failure -2nd leading cause of death in this age group -suicide has become the second leading cause of death in this age group, after accidents -adolescent suicide appears to be on the increase About half of teenage suicides, like those of people in other age groups, have been tied to clinical depression , low self-esteem, and feelings of hopelessness, but many teenagers who try to kill themselves also appear to struggle with anger and impulsiveness or to have serious alcohol or drug problems Some also have deficiencies in their ability to sort out and solve problems. Teenagers who consider or attempt suicide are often under great stress Studies indicate that LGBTQ teenagers are three times more likely than other teenagers to have suicidal thoughts and to attempt suicide

Children and suicide

-suicide is infrequent among children -- has been increasing over the past few decades -suicide by very young is often preceded by behavioral struggles -Studies further have linked child suicides to the recent or anticipated loss of a loved one, family stress and a parent's unemployment, abuse by parents, victimization by peers (for example, bullying), and a clinical level of depression -many child suicides appear to be based on a clear understanding of death and a clear wish to die

Retrospective analysis

A psychological autopsy in which clinicians and researchers piece together information about a person's suicide from the person's past. Relatives, friends, therapists, or physicians may remember past statements, conversations, and behaviors that shed light on a suicide. Retrospective information may also be provided by the suicide notes some victims leave behind. retrospective analyses often turn to the suicide victim's medical records, which can help identify previous mental disorders or prior medications

Suicide by family members and friends

A recent suicide by a family member or friend increases the likelihood that a person will attempt suicide

Crisis intervention

A treatment approach that tries to help people in a psychological crisis to view their situation more accurately, make better decisions, act more constructively, and overcome the crisis

suicide education programs

A type of prevention program that involves mostly teachers and students; the aim is to raise awareness about suicide risks and to promote hope and help-seeking

How is the psychological capability for suicide cultivated?

According to Joiner, we all have a basic motive to live and preserve ourselves — a motive that weakens for certain people as a result of their repeated exposure to painful or frightening life experiences, like abuse, trauma, severe illness, or the like. Given such recurrent experiences, these individuals may develop a heightened tolerance for pain and a fearlessness about death

Suicide therapy goals

Keep the patient alive Reduce psychological pain Help them achieve a nonsuicidal state of mind and a sense of hope restrict their access to lethal suicide means Guide them to develop better ways of handling stress

suicide rates vary from country to country

Lithuania, Russia, Guyana, South Korea, and Ukraine have very high rates — more than 20 suicides annually per 100,000 persons; conversely, Egypt, Indonesia, Lebanon, and Guatemala have relatively low rates, fewer than 5 per 100,000. Falling in between are the United States (14.2), Germany (13.6), Canada (12.5), China (9.7), and England (8.9) Religious affiliation and beliefs may help account for these national differences (Hsieh, 2017). For example, countries that are largely Catholic, Jewish, or Muslim tend to have low suicide rates. Yet there are exceptions to this tentative rule. Poland, a largely Roman Catholic country, has a suicide rate of 16.2 suicides per 100,000 persons, one of the higher suicide rates in the world

Explanations for gender differences in suicide rates

Men tend to use more violent methods, such as shooting, stabbing, or hanging themselves, whereas women use less violent methods, such as drug overdose. Guns are used in 56 percent of the male suicides in the United States, compared with 32 percent of the female suicides (SPRC, 2020a). In addition, transgender individuals have particularly high rates of suicide attempts and fatalities, due in part to the abuse, prejudice, stigmatization, and victimization they experience in their lives adults who have bad memories of transgender identity conversion interventions are two to four times more likely than other transgender persons to attempt suicide

Is suicide a mental disorder in the DSM-5?

No

Schizophrenia and suicide

Research indicates, however, that suicides by people with schizophrenia more often reflect feelings of demoralization, a sense of being entrapped by their disorder, and fears of further mental deterioration

Celebrity suicides and suicide risk

Research suggests that suicides by entertainers, political figures, and other well-known people are regularly followed by unusual increases in the number of suicides across the nation Studies on this issue have found, for example, that the national suicide rate rose over 16 percent during the weeks after the 2014 suicide of comedian Robin Williams and the 1963 suicide of actress Marilyn Monroe

Illness and suicide

Severe depression also may play a key role in suicide attempts made by those with serious physical illnesses. A study of 44 patients with terminal illnesses revealed that fewer than one-quarter of them had thoughts of suicide or wished for an early death and that those who did were all suffering from major depressive disorder

Occupational stress and suicide

Some jobs create feelings of tension or dissatisfaction that may help trigger suicide attempts. --Studies have revealed higher suicide rates among people working in unskilled occupations. For persons in skilled occupations, research has found relatively high rates for psychiatrists and psychologists, physicians, nurses, dentists, lawyers, police officers, fire fighters, emergency workers, and farmers These correlations do not necessarily mean that occupational pressures directly cause suicidal actions

Why do adolescents commit suicide?

Some theorists believe that the period of adolescence itself produces a stressful climate in which suicidal actions are more likely. tend to react to events more sensitively, angrily, dramatically, and impulsively than individuals in other age groups; thus the likelihood of their engaging in suicidal acts during times of stress is higher the suggestibility of adolescents and their eagerness to imitate others, including others who attempt suicide, may set the stage for suicidal action

The psychodynamic view of suicide

Suicide results from depression and from anger at others that is redirected toward oneself Suicide is thought to be an extreme expression of this self-hatred and self-punishment Freud proposed that human beings have a basic "death instinct" (Thanatos) that opposes the "life instinct" -According to Freud, while most people learn to redirect their death instinct by aiming it toward others, suicidal people, caught in a web of self-anger, direct it squarely toward themselves

What Are the Underlying Causes of Suicide?

The leading theories come from the psychodynamic, sociocultural, and biological models. Some of these hypotheses have, however, received limited research support and fail to address the full range of suicidal acts. Thus the clinical field currently lacks a satisfactory understanding of suicide.

suicide rates vary according to race and ethnicity

The overall suicide rate of non-Hispanic white Americans is more than twice as high as that of African Americans, Hispanic Americans, and Asian Americans American Indians have a higher rate of suicide than that of non-Hispanic white Americans

Coworkers and colleagues (suicide)

The word-of-mouth publicity that attends suicides in a school, workplace, or small community may trigger suicide attempts

T or F: very religious people seem less likely to die by suicide

True

Suicide rates also differ across gender

Two times as many women attempt suicide as men, yet men die from their attempts at more than three times the rate of women

Abusive/repressive environment and suicide

Victims of an abusive or repressive environment from which they have little or no hope of escape sometimes pursue suicide these people may feel that they can endure no more suffering and believe that there is no hope for improvement in their condition

Combination of factors and suicide

a combination of factors can contribute to suicide Recent studies have found, for example, that individuals experiencing a bipolar episode of depression have an elevated suicide rate, as one might expect, but that bipolar individuals who are also unemployed, divorced, living alone, feeling hopeless, and/or abusing substances have particularly elevated rates of suicide --Moreover, on average, the more such factors, the greater an individual's inclination to pursue a suicidal act

people with perceived burdensomeness believe that their existence places...

a heavy and permanent burden on their family, friends, and even society. This belief — typically inaccurate — may produce the notion that "my death would be worth more than my life to my family and friends."

The TrevorLifeline

a nationwide, around-the-clock hotline available for LGBTQ teenagers who are thinking about suicide. This hotline is one of several services offered by the Trevor Project, a wide-reaching organization dedicated to providing support, guidance, and information to, and promoting acceptance of, LGBTQ teens.

suicide

a self-inflicted death in which one makes an intentional, direct, and conscious effort to end one's life

parasuicides

a suicide attempt that does not result in death

Mental disorders and suicide

as many as 70 percent of all suicide attempters had been experiencing severe depressive or bipolar disorders 20 percent with chronic alcoholism 10 percent with schizophrenia Correspondingly, as many as 20 percent of people with each of these disorders try to kill themselves

Why is the rate of suicide attempts so high among teenagers (as well as among young adults)?

as the number and proportion of teenagers and young adults in the general population have risen, the competition for jobs, college positions, and academic and athletic honors has intensified for them, leading increasingly to shattered dreams and ambitions weakening ties in the family (which may produce feelings of alienation and rejection in many of today's young people) easy availability of alcohol and other drugs and the pressure to use them among teenagers and young adults Modeling of suicides by teenagers and young adults may also contribute to the high rate of suicide attempts among the young

Suicide is also related to social environment and relationship status.

at least half of individuals who carry out suicide have few or no close personal friends never-married and divorced persons have a higher suicide rate than married or cohabitating individuals individuals in violent, high-conflict, or otherwise distressing relationships have a higher suicide rate than those in more harmonious relationships

psychiatrist Karl Menninger

called suicide "murder in the 180th degree"

suicidal behavior disorder

category of DSM-5 which contains people who have tried to kill themselves within the last two years

Death seekers

clearly intend to end their lives at the time they attempt suicide

Death initiators

clearly intend to end their lives, but they act out of a belief that the process of death is already under way and that they are simply hastening the process

Crisis Text Line

nonprofit service has been offering text counseling since 2013, in partnership with a number of hotlines across the United States In the first half year of operation, it exchanged nearly a million texts with 19,000 teenagers, with only minimal advertising, and since then it has processed a total of 129 million texts

subintentional deaths

occurs when people play indirect, covert, partial, or unconscious roles in their own deaths Traditionally, clinicians have cited drug, alcohol, or tobacco use, recurrent physical fighting, and medication mismanagement as behaviors that may contribute to subintentional deaths. In recent years, another behavioral pattern, self-injury or self-mutilation, has been added to this list — for example, cutting or burning oneself.

Do suicidal people contact prevention centers?

only a small percentage do On the other hand, prevention programs do seem to reduce the number of suicides among those high-risk people who do call.

Depression and suicide

people with major depressive disorder often have suicidal thoughts. Even when depressed people are showing improvements in mood, they may remain at high risk for suicide. In fact, among those who are severely depressed, the risk of suicide may actually increase as their mood improves and they have more energy to act on their suicidal wishes

Social isolation and suicide

people without social support are particularly vulnerable to suicidal thinking and actions Researchers have found a heightened risk for suicidal behavior among those who feel little sense of "belongingness," believe that they have limited or no social support, live alone, and have ongoing conflicts with other people

Durkheim's sociocultural view of suicide

probability of suicide is determined by how attached a person is to such social groups as the family, religious institutions, and community The more thoroughly a person belongs, the lower the risk of suicide. Conversely, people who have poor relationships with their society are at higher risk of killing themselves. He defined several categories of suicide, including egoistic, altruistic, and anomic suicide.

Altruistic Suicide (Durkheim)

undertaken by people who are so well integrated into the social structure that they intentionally sacrifice their lives for its well-being

dichotomous thinking

viewing problems and solutions in rigid either/or terms

hopelessness

A pessimistic belief that one's present circumstances, problems, or mood will not change Some clinicians believe that a feeling of hopelessness is the single most likely indicator of suicidal intent, and they take special care to look for signs of hopelessness when they assess the risk of suicide.

suicide prevention program

A program that tries to identify people who are at risk of killing themselves and to offer them crisis intervention

studying people who survive their suicide attempts

It is estimated that there are 28 nonfatal suicide attempts for every fatal suicide However, it may be that people who survive suicide attempts differ in important ways from those who do not. Many of them may not really have wanted to die, for example

The biological view of suicide

-Genetics •Early twin studies point to genetic links to suicide -Brain development •Low serotonin activity and abnormalities in depression-related brain circuits contribute to suicide •Both aid in the production of aggressive feelings and impulsive behavior

Suicide hotlines

24-hour-a-day telephone services, in the United States. Callers reach a counselor, typically a paraprofessional — a person trained in counseling but without a formal degree — who provides services under the supervision of a mental health professional. offers crisis intervention

Substance use and suicide

A number of the people who drink alcohol or use drugs just before a suicide attempt actually have a long history of abusing such substances The basis for the link between substance use disorders and suicide is not clear - tragic lifestyles, hopelessness, and psychological pain may cause substance use and psychological pain

What Treatments Are Used After Suicide Attempts?

After a suicide attempt, most victims need medical care Psychotherapy or drug therapy may begin once a person is medically stable. Many suicidal people fail to receive psychotherapy after a suicide attempt. Various therapies and techniques have been employed Cognitive and cognitive-behavioral therapies may be particularly helpful.

Suicide rates differ within racial groups

Among Hispanic Americans, for example, Puerto Ricans are more likely to attempt suicide than any other Hispanic American group

Teen Suicides: Multicultural Issues

Around 9 of every 100,000 non-Hispanic white American teenagers die by suicide each year, compared with 5 of every 100,000 African American teens and 5 of every 100,000 Hispanic American teens 19 of every 100,000 American Indian teenagers die by suicide each year, double the rate of non-Hispanic white American teenagers and triple that of other minority teenagers the rates of the three groups are in fact becoming closer - closing trend may reflect increasingly similar pressures on young African, Hispanic, and non-Hispanic white Americans The growing suicide rates for young African and Hispanic Americans may also be linked to their rising unemployment, the many pressures of inner-city life, and the indignation many feel over racial inequities and discrimination in our society

factors that contribute to suicide in elderly populations

As people grow older, all too often they become ill, lose close friends and relatives, lose control over their lives, and lose status in our society - leads to feelings of hopelessness, loneliness, depression, "burdensomeness," or inevitability Elderly people are typically more determined than younger people in their decision to die and give fewer warnings, so their suicide completion rate is much higher clinical depression appears to play an important role in as many as 60 percent of suicides by the elderly, suggesting that more elderly people who are suicidal should be receiving treatment for their depressive disorders

Modeling: The Contagion of Suicide

It is not unusual for people, particularly teenagers, to try to commit suicide after observing or reading about someone who has done so One suicidal act appears to serve as a model for another Suicides by family members and friends, celebrities, other highly publicized suicides, and ones by co-workers are particularly common triggers

Alcohol and other drug use in suicide

Autopsies reveal that about one-quarter of people who attempt suicide are legally intoxicated at the time of their act --Moreover, the more intoxicated they are, the more lethal their chosen suicide method the use of alcohol lowers a person's inhibitions, reduces fears of suicide, releases underlying aggressive feelings, or impairs judgment and problem-solving ability The likelihood of completing suicide is seven times greater among those who engage in extended drug use

What Is Suicide Prevention?

Both suicide prevention programs and suicide hot lines provide crisis intervention The general approach includes: Establishing a positive relationship Understanding and clarifying the problem Assessing suicide potential Assessing and mobilizing the caller's resources Formulating a plan

Do suicide prevention centers reduce the number of suicides in a community?

Clinical researchers do not know

Stressful Events and Situations that can lead to suicide

Combat stress - Research indicates that combat veterans from various wars are more than twice as likely to die by suicide as nonveterans Immediate stressors -Loss of loved one through death, divorce, or rejection -Loss of job or significant financial loss -Natural disasters Long-term stressors -Social isolation -Serious illness -Abusive or repressive environment -Occupational stress

Self-Injury Implicit Association Test

Developed by Matthew Nock A cognitive test used to help assess suicidal risk. Rather than asking people if they plan to attempt suicide, this test instructs them to pair various suicide-related words (for example, "dead," "lifeless," "suicide") with words that are personally relevant ("I," "myself," "mine") and with words that are not personally relevant ("they," "them," "other").

Interpersonal theory of suicide (a.k.a interpersonal-psychological theory)

Developed by Thomas Joiner and colleagues asserts that people will be inclined to pursue suicide if they hold two key interpersonal beliefs — perceived burdensomeness and thwarted belongingness — and, at the same time, have a psychological capability to carry out suicide, a capability that they have acquired from life experiences

nonsuicidal self-injury (NSSI)

Direct and deliberate destruction of one's own body tissue that is not accompanied by an intent to die Although DSM-5-TR does not officially classify NSSI as a mental disorder, it acknowledges the powerful role this pattern can play in various disorders.

The elderly and suicide

Elderly people account for over 20 percent of all suicides in the United States, yet they comprise only 16 percent of the total population

Teen Suicides: Attempts Versus Completions

Far more teenagers attempt suicide than actually kill themselves — most experts believe that the ratio is at least 100 to 1, with estimates ranging as high as 200 to 1 The particularly large number of nonfatal teenage suicide attempts may mean that adolescents are less certain than middle-aged and elderly people who make such attempts. While some do indeed wish to die, many may simply want to make others understand how desperate they are, or they may want to get help or teach others a lesson

serious illness or injury and suicide

People whose illnesses cause them great pain or severe disability may attempt suicide, believing that death is unavoidable and imminent. They may also believe that the suffering and problems caused by their illnesses are more than they can endure. -- Studies suggest that as many as one-third of those who die by suicide have been in poor physical health during the months prior to their suicidal acts -Suffering a traumatic brain injury more than doubles a person's likelihood of suicide and this risk quadruples when the injury is particularly severe and in need of extensive medical care

Edwin Shneidman's four kinds of people who commit suicide

death seeker death initiator death ignorer death darer

A key difficulty for suicide prevention programs is that they...

depend on accurate assessments of suicide risk, and accurate assessments are elusive People who are suicidal do not necessarily admit to or talk about their true feelings in discussions with professionals.

Research indicates that people who experience both perceived burdensomeness and thwarted belongingness are inclined to...

develop a desire for suicide studies also indicate that such individuals are unlikely to attempt suicide unless they further possess the third variable cited by the theory — the psychological capability to inflict lethal harm on themselves

Do Suicide Prevention Programs Work?

difficult to measure -many kinds of programs- each have their own procedure and serving populations that vary in number, age, etc. -generally researchers have found they can be effective and should be widely implemented

Death ignorers

do not believe that their self-inflicted death will mean the end of their existence

Death darers

experience mixed feelings, or ambivalence, about their intent to die, even at the moment of their attempt, and they show this ambivalence in the act itself

TREATMENT OF SUICIDAL people falls into two major categories:

treatment after suicide has been attempted and suicide prevention

Social contagion effect

increases in the risk of suicide among the relatives and friends of people who recently committed suicide

People with thwarted belongingness feel...

isolated and alienated from others — not an integral part of a family or social network. Their sense of social disconnect may be overstated or it may be accurate, but, either way, it feels enduring, unchangeable, and confining.

Problems with Durkheim's theory

it cannot by itself explain why some people who face particular societal pressures attempt suicide while the majority do not. Durkheim himself concluded that the final explanation probably lies in the interaction between societal and individual factors

anomie

lack of the usual social or ethical standards in an individual or group

Yet another promising approach to suicide assessment makes use of...

mobile devices, including sensor-carrying wearable devices, to monitor suicidal individuals as they go about their daily lives Because inclinations for self-harm can fluctuate greatly from day to day or even hour to hour, technology-based strategies that detect shifting risk indicators within suicidal individuals (for example, tone of voice, sleep changes, and physical activity levels) are able to provide important data for suicide assessment

Things about self-injurious behavior

more common than previously recognized, particularly among teenagers and young adults, and it may be on the increase Studies suggest that 13 percent of all adolescents try to injure themselves at least once --It appears that the behavior becomes somewhat addictive in nature. The pain brought on by self-injury seems to offer some relief from tension or other kinds of emotional suffering, the behavior serves as a temporary distraction from problems, and the scars that result may document the person's distress self-injury may help a person deal with chronic feelings of emptiness, boredom, negativity, isolation, and identity confusion Although self-injury and the other risky behaviors mentioned earlier may indeed represent an indirect attempt at suicide, the true intent behind them is unclear

Anomic Suicide (Durkheim)

pursued by people whose social environment fails to provide stable structures, such as family and religion, to support and give meaning to life the act of a person who has been let down by a disorganized, inadequate, often decaying society Durkheim argued that when societies go through periods of anomie, their suicide rates increase. Historical trends support this claim. Periods of economic depression may bring about some degree of anomie in a country, and national suicide rates tend to rise during such times A major change in a person's immediate surroundings, rather than general societal problems, can also lead to anomic suicide. Durkheim predicted that societies with more opportunities for changes in individual wealth or status would have higher suicide rates; this prediction has also been supported by research over the years

How Is Suicide Studied?

retrospective analysis and studying people who survive their suicide attempts

What Triggers a Suicide?

stressful events mood and thought changes alcohol and other drug use mental disorders modeling

Suicide stats

suicide is one of the leading causes of death in the world It has been estimated that 1 million people die by suicide each year, more than 48,000 in the United States alone Around 25 million other people throughout the world —1.4 million in the United States — make nonfatal attempts or gestures to kill themselves (parasuicides)

Egoistic Suicide (Durkheim)

suicide that occurs when one is not well integrated into a social group carried out by people over whom society has little or no control. These people are not concerned with the norms or rules of society, nor are they integrated into the social fabric. this kind of suicide is more likely in people who are isolated, alienated, and nonreligious. The larger the number of such people living in a society, the higher that society's suicide rate.

Edwin Shneidman

suicidologist defined suicide

Cognitive-behavioral therapy for suicidal people

the approach focuses largely on identifying and changing the painful thoughts, sense of hopelessness, dichotomous thinking, poor coping skills, weak problem-solving abilities, and other cognitive and behavioral features that characterize suicidal people Applying the principles of mindfulness-based cognitive-behavioral therapy, the therapists may also guide the clients to accept many of the painful thoughts and feelings that keep streaming through their minds rather than try to eliminate them

Is Suicide Linked to Age?

the likelihood of dying by suicide steadily increases with age up through middle age, then decreases during the early stages of old age, and then increases again beginning at age 75 The exceptional rate of suicide among those who are middle-aged is a relatively recent phenomenon and is not fully understood