Abnormal Ch.7

Prevalence of Suicidal Behavior

1,000,000 adults per year attempt suicide - 1 completed suicide for every 25 attempts (38,000) - Ratio of attempts to suicides much greater for the young • Suicidal behavior and ideation begin with individual's initial thoughts about their life circumstances and desirability of death - Most just think about death abstractly ("what if..." ) - Much smaller number actually attempt suicide - Even fewer are successful (but even just one is tragic)

Suicidal actions become much more common after the age of 14

1,400 teenagers (age 13 to 18), or 7 of every 100,000, commit suicide in the US each year • At least 12% of teenagers have persistent suicidal thoughts and 4% make suicide attempts • Around 10% of all adolescent deaths are the result of suicide • Teenagers who consider or attempt suicide are often under great stress

Assessment of Suicide Risk

1. History of prior suicide attempts (#1 risk predictor) 2. Depression or other major mental illness 3. Having a specific suicide plan 4. Race/Gender/Age but see emerging new categories 5. Substance use/abuse; impulsivity 6. Few sources of support 7. Recent loss (death of a loved one; loss of a job) 8. Physical illness; Physical isolation 9. Dramatic changes in mood/behavior; impulsivity 10. Taking final steps/saying goodbye/making will 11. Giving away prized possessions

subintentional death

A death in which the victim plays an indirect, hidden, partial, or unconscious role.

hopelessness

A pessimistic belief that one's present circumstances, problems, or mood will not change.

suicide prevention program

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

retrospective analysis

A psychological autopsy in which clinicians and researchers piece together information about a person's suicide from the person's past.

suicide

A self-inflicted death in which the person acts intentionally, directly, and consciously.

parasuicide

A suicide attempt that does not result in death.

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 Among College Students

Comprehensive study of students at over 70 colleges - More than 50% reported suicidal thoughts - 18% seriously considered attempting suicide • Among these, 90-92% had a specific plan • Between 8-14% had made a suicide attempt • Approximately 80% did not seek professional help • 45% percent never told anyone • Some signs of suicidal risk • Verbalizing intentions • Withdrawal and depression • Giving away prized possessions

Suicide Among Military Veterans

Concern about rate of military suicides (VA, 2014) - Veteran suicide rate higher than deaths in combat • 20/day (7,400/yr) 18% of all suicides (vets only 9% of pop) • Factors contributing to increased risk • Barriers/stigma • PTSD + TBI + Depression + Substance abuse • Frequent separation from family; divorce; conflict • Loss of comrades; war-related trauma • Financial concerns/worries • Administrative actions (getting in trouble)

Chapter 7 Suicide: Quick Quiz

Define suicide and subintentional death. Describe four different kinds of people who attempt suicide. What is nonsuicidal self-injury? pp. 222-225 Suicide: a self-inflicted death in which the person acts directly, intentionally, and consciously. Subintentional death: a death in which the victim plays an indirect, hidden, partial, or unconscious role. Four kinds of people who attempt suicide are: death seeker, death initiator, death ignorer, and death darer. Non-suicidal self-injury: injury to one's body without the intent of killing oneself; cutting, burning, or banging one's head. What techniques do researchers use to study suicide? P. 226 Retrospective analysis: a psychological autopsy in which clinicians piece together information about a person's suicide from the person's past. Studying people who survived suicide attempts. How do statistics on suicide vary according to country, religion, gender, marital status, and race? Pp. 226-227 Suicide ranks among the top 10 causes of death in western societies. Rates vary from country to country One reason seems to be cultural differences in religious affiliation, beliefs, and degree of devoutness. Suicide rates also vary according to gender, race, and marital status. What kinds of immediate and long-term stressors have been linked to suicide? pp. 227-228 (immediate) The loss of a loved one through death, divorce, or rejection; loss of a job; significant financial loss; and stress caused by hurricanes or other natural disasters, even among very young children. (long-term) stressors: social isolation, serious illness, abusive or repressive environment, occupational stress. What other conditions or events may help trigger suicidal acts? Pp. 228-231 Changes in mood or thought, particularly increases in one's sense of hopelessness. The use of alcohol or other kinds of substances, mental disorders, or news or another's suicide may precede suicide attempts. How do psychodynamic, sociocultural, and biological theorist explain suicide, and how well supported are their theories? Pp. 232-235 Psychodynamic theorists believe that suicide usually results from depression and self-directed anger. Emile Durkheim's sociocultural theory defines three categories of suicide, based on the person's relationship with society: egoistic, altruistic, and anomic suicides. Biological theorists suggest that the activity of the neurotransmitter serotonin is particularly low in people who commit suicide. Each has received only limited support. Compare the risk, rate, and causes of suicide among children, adolescents, and elderly persons. Pp. 235-241 Suicide is uncommon among children, although it has been increasing in that group during the past several decades. More than 6 percent of all deaths among children between the ages of 10 and 14 yrs are caused by suicide. Adolescent suicide has been linked to clinical depression, anger, impulsiveness, major stress, and adolescent life itself. Numbers have been decreasing over the past decade. In western societies, the elderly are more likely to commit suicide than people in most other age groups. The loss of health, friends, control, and status may produce feelings of hopelessness, loneliness, depression, or inevitability in this age group. How do theorists explain the high rate of attempts by adolescents and young adults? Pp. 236-239 There is a high attempt rate among young adults and adolescents may be related to the growing number and proportion of young people in the general population, the weakening of family ties, the increased availability of drugs among young people, and the broad media coverage of suicide attempts by the young. Describe the nature and goals of treatment given to people after they have attempted suicide. Do such people often receive this treatment? P. 242 Unfortunately, even after trying to kill themselves, many suicidal people fail to receive systematic follow-up care. The goals of therapy for those who have attempted suicide are to keep the individuals alive, reduce their psychological pain, help them achieve a nonsuicidal state of mind, provide them with hope, and guide them to develop better ways of handling stress. Describe the principles of suicide prevention programs. What procedures are used by counselors in these programs? How effective are the programs? Pp. 242-246 Suicide prevention programs include 24-hour-a-day hotlines and walk-in centers staffed largely by paraprofessionals. During their initial contact with a suicidal person, counselors try to establish a positive relationship, understand and clarify the problem, assesses the potential for suicide, assess and mobilize the caller's resources, and formulate a plan for overcoming the crisis. It is difficult for researchers to measure the effectiveness of suicide prevention programs.

Alcohol Consumption

One of most consistent correlates of suicide - As many as 70% of suicide attempts involve alcohol (and/or other substances) - Strong correlation to successful suicide • May lower inhibitions related to fear of death • Alcohol-induced 'myopia' - Focusing thoughts on the negative aspects of personal situations - Impulsivity - Failing to see the 'big picture' or the 'long game

Modeling: The Contagion of Suicide

One suicidal act apparently serves as a model for another • Triggers • Suicides by family members and friends, celebrities, other highly publicized suicides, and ones by coworkers • Bizarre or unusual suicides • Media coverage and programs

The Biological View

Pedigree and twin studies support the position that biological factors contribute to suicidal behavior - There are higher rates of suicide among the parents and close relatives of those who commit suicide than among those with non-suicidal relations • SEROTONIN levels have been found to be low in people who commit suicide (even those with no hx of depression)

4 Step Suicide Risk Assessment: P. L. A. N.

Plan: has the person made a plan? Lethality: is the method likely to result in death? Availability: are the means at hand? Nearby help: how close at hand is help? Listen Carefully. Assess. Take action. Help save a life.

Suicide

SUICIDE: The intentional, direct, and conscious taking of one's own life • Has been extensively researched - Risk factors and protective factors identified - Strategies to successfully intervene identified - Most often, there has been a plan of some sort • Up to 90% of completers may have MI (often undiagnosed); rates may be underestimates - 10th leading cause of death in the U.S. - 2nd leading cause of death amongst college students

Religious Affiliation/Devoutness

Suicide rate is lower in countries where the religion has a strong influence (Christianity; Islam) • Islam also condemns suicide - Medical students in the United Arab Emirates reported low lifetime prevalence of suicidal thoughts and attempts • Where religious sanctions against suicide are weak or absent, higher suicide rates are observed

Suicide and Teenagers

Teenagers: Race/Ethnicity, Sexual orientation: - 15.8% of high school students seriously consider suicide - 7.8% had made a reported attempt in previous 12 months - Hispanic/Latino and American Indian/Alaska Native female adolescents have highest rate of attempted suicides; - Black and Hispanic/Latino students more than 2x as likely to attempt suicide compared to white students (CDC, 2011) • VICTIMS of BULLYING: - 1/3 of all youth report experiencing bullying; - Victims of bullying are 2-9x times more likely to consider suicide - GLBTQ youth are 4-6x more likely than straight kids to attempt suicide and report much higher rates of bullying/violence towards them (CDC, 2011)

Sigmund Freud believed that human beings have an unconscious "death instinct." He called this:

Thanatos.

Treatment for Suicidal Individuals

Treatment often involves both medication and psychotherapy • Crisis hotlines; some specialized (Vets); can only refer • Commonly used "No-harm" agreement (crisis situation) - But lack of research supporting effectiveness • Temporary hospitalization (voluntary/involuntary) - Extreme measure; must be discussed Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) reduce suicide risk by 50% compared to other forms of therapy - CBT focuses on vulnerabilities; modifying thought patterns - DBT focuses on helping clients accept current lives and emotional anguish; accepting the 'yin' and 'yang' of life

dichotomous thinking

Viewing problems and solutions in rigid "either/or" terms.

No one kills himself who has not wanted to kill another or at least wished the death of another." This quotation suggests that suicide is an internalization of anger that is truly directed at others. It was MOST likely made by physician and psychologist:

Wilhelm Stekel.

A major controversy in the clinical field pertains to whether _____ is/are highly dangerous for depressed children and teenagers.

antidepressants

After a suicide attempt, the MOST pressing need for most victims is

medical care

According to the text, treatment of suicidal people falls into two categories: suicide prevention and:

treatment after suicide has been attempted.

Suicide Among Baby Boomers

• Baby boom generation - Born between 1946 and 1964 - Consistently higher suicide rates than previous or subsequent generations • 50% increase between 1999 and 2010 for people in their 50s • Suicide prevention programs typically focus on youths and elderly adults (not boomers)

Sex/Gender

• Females have higher rates of suicidal thoughts and attempts (3x) • Males are more likely to complete (4x) • Death from suicide occurs much more frequently among males • 8/10 of all U.S. suicides • Males tend to choose most lethal methods • Women often choose drug overdose/poisoning

Choice of Method

• Firearms - used in 50% of completers • Drugs/alcohol - 70% in attempters • Hanging/suffocation - Increased in recent years for all age groups • Especially among ages 45-59 • Older adolescents most frequently try hanging, jumping, and using firearms • Elderly most likely to use most lethal means

Occupational Prevalence

• Higher than average suicide rates: - Physicians • Highest among psychiatrists; lowest among pediatricians • Risk factors may include burnout, stress, drug availability, hopelessness, sense of ineffectivenes s • Suicide rate is 4X higher in female doctors than women in general population - Lawyers - Law enforcement - Dentists

Depression and Hopelessness

• Mood states most strongly associated with suicide - Not so much simply having "depression" as it is the specific feature of hopelessness (often found in depression) that increases risk - Limited energy associated with severe depression makes suicide less likely - Highest risk period for suicide is actually after beginning treatment! (1-3mos)

The Biological View

• Pedigree and twin studies support the position that biological factors contribute to suicidal behavior - There are higher rates of suicide among the parents and close relatives of those who commit suicide than among those with non-suicidal relations • SEROTONIN levels have been found to be low in people who commit suicide (even those with no hx of depression)

Marital Status

• Stable marriage or relationship makes suicide less likely • For women, having children decreases suicide risk • People who are divorced, separated, or widowed have higher suicide rates than the married, or never married • Death of a spouse associated with 50% higher suicide rate for men

Suicide Among the Elderly

• Suicide rates for (white) elderly men are the highest of any age group (except...) • Suicide may accompany depression but hopelessness is the critical factor • Factors for increased risk in elderly • Significant health issues • Loss of independence • Bereavement; death of spouse • Serious financial and relationship problems