Suicide
psychological therapies
* Dialectical behavior therapy (DBT)* developed to treat people with borderline personality disorder who frequently attempt suicide focuses on managing negative emotions and controlling impulsive behaviors aims to increase problem solving skills, interpersonal skills, and skills at managing negative emotions DBT and *cognitive behavioral therapy* can reduce suicidal thoughts and behaviors
*Defining suicide*
*CDC* - death from injury, poisoning, of suffocation where there is evidence (either explicit or implicit) that the injury was self-inflicted and that the decedent intended to kill himself/herself great variability in the form that suicide takes, and whether to call a certain death suicide is open to debate there is a distinguishment between completed suicides, suicide attempts, and suicidal ideation, or thought
intervention programs and suicide
*intervention programs* - target people immediately at risk of suicide. Include: - crisis intervention services (hotlines) - dialectical behavior therapy
prevention programs and suicide
*prevention programs* - target general public or people with risk factors, but not immediately in crisis focus on: - educating people about suicide risk and steps to take if they are suicidal - removing access to guns
CLASS - risk factors and warning signs
*risk factors* - variables that increase the likelihood that someone might consider or attempt suicide * warning sign* - a signal that suicide attempt might occur
Medications
Medication most consistently shown to reduce risks is *lithium* those not treated with lithium (high risk people) are 13 times more likely to commit or attempt suicide *selective serotonin re uptake inhibitors* also may reduce the risk because they reduce depressive symptoms and they regulate levels of serotonin - they may also increase the risks in certain situations
*Gender differences in suicide*
Two to three times more women than men attempt suicide Men are four times more likely to complete suicide These gender differences are true across all age groups many people assume that suicide rates are highest among adolescents, but they are not (even though the rates are increasing over time) Most typical suicide in the US involves a middle aged Caucasian man
Hospitalization and Suicide
a person who is gravely suicidal needs immediate care needed to prevent an imminent suicide attempt can be hospitalized both voluntarily and involuntarily (only for short period of 3 days)
suicide in children and adolescents
although relatively rare in young children, it is not unheard of. Each year 17% of teenagers in the US consider suicide. 15% devise a plan, 8% attempt, 2% make a serious attempt (life threatening).
hopelessness and suicide
cognitive variable that has most consistently predicted suicide - feeling that the future is bleak and there is no way to make it more positive - being a burden on others - feeling of not belonging this theory is named: *interpersonal theory of suicide* - merges cognitive and social factors hopelessness may be a big reason why suffering people do not seek treatment
psychological disorders and suicide
more than 90% of people who commit suicide have been suffering from a diagnosable mental disorder *depression* increases the odds of a suicide attempt by approximately 6 times. *bi polar disorder*: increases suicide rate by 7 times. - 1 in 4 people with bipolar I disorder - 1 in 5 people with bipolar II disorder *mood disorders* most closely associated with suicide. additional disorders that can be predictors: - *borderline personality* - *substance abuse* - *anxiety* (lesser extent)
Understanding Suicide
our ability to understand the causes of suicide are hampered by many factors: 1. Still too rare to make studying it simple 2. In the wake of a suicide, family members and friends selectively remember certain information about the victim (evidence that he/she was depressed) and tend to forget other information 3. most people who kill themselves do not leave a note. The notes that are left often do not provide much understanding of what led the people to take their lives.
Fears of asking teens about suicide
parents and school officials worry that asking teens about thoughts of suicide may "put the idea in their head" but studies show that there is no evidence that proves or makes these fears relevant at all.
best predictors of future suicidal thoughts
past suicidal thoughts and behaviors among adolescents: a history of previous suicide attempt increases the odds of suicide by 30 times (boys) and (3) among girls. suicidal thoughts should be seriously assessed in addition to any other mental disorders the person has.
physical illness and suicide
physical illness occurring in early life is a risk factor for suicidal ideation, plans, and attempts. even among people without a mental disorder illness mots strongly related to suicidal thoughts and behaviors is epilepsy.
controversy with broad based prevention/education programs
possible problems: 1. often simultaneously target both the general population of students and those students that are higher risk. 2. programs attempt to destigmatize suicide by making it appear common and not mentioning the association it has to mental health disorders These messages can backfire with students who are not suicidal, making suicide seem like an understandable response to stress. 3. studies found that students who had made prior suicidal attempts, reacted negatively to the programs. Said they were less inclined to seek help after programs than before.
Personality and Cognitive Factors in Suicide
two personality characteristics that seems to predict suicide are *impulsivity* *hopelessness* other cognitive factors: - cognitive rigidity - rumination - perfectionism - poor problem solving
warning sign vs. risk factors
warning sign: 1. threatening to hurt or kill self 2. looking for ways to kill oneself 3. talking or writing about death risk factors: 1. previous attempts 2. impulsivity 3. family history of suicide 4. recent discharge from hospitalization 5. transgender, same sex orientation
suicide cluster
when two or more attempts non randomly bunched together in space or time (series of suicide attempts in the same high school) that is called *suicide cluster* suicide clusters occur mostly in adolescent groups suicide clusters can take on many forms: - close groups of friends - same schools - linkage through media exposure to suicide of strangers (celebrity)
*ethnic and cross cultural differences*
within the US, there are substantial differences in suicide rates among ethnic/racial groups. European Americans have higher suicide rates than all other groups (15/100,000). Native Americans follow closely behind (13/100,000) Suicide among native Americans is tied to poverty, lack of education, discrimination, substance abuse, limited access to care, and easy availability of firearms African American generally commit suicide at lower rates than other groups. (6/100,000) (higher levels of family support and religious background). Rates among AA males has increased over time.
*suicidal ideation*
thinking about suicide, usually with some serious emotional and intellectual or cognitive overtones many people with mental disorders think about committing suicide, but never attempt to kill themselves.
Treatment of Suicidal Persons
- Hospitalization - Community-based crisis intervention programs - Drug therapy - Psychological therapies most people who are suicidal never seek treatment because of denial and fear of stigmas suicide attempts increase in lethality each time they happen
impulsivity and suicide
- general tendency to act on on'es impulses rather than to inhibit them when it is appropriate to do so. - risk factor trait for suicide - big contributor on top of other mental illnesses
What to do if a friend is suicidal
1. *take the person seriously* - most people who commit suicide have communicated their suicidal intentions to friends or family members beforehand 2. *Get Help* - call a therapist, hotline, 911, professional mental health care 3. *express concern* - tell the person who you think they are suicidal 4. *pay attention* - listen closely, eye contact, use body language 5. *ask direct questions about suicidal plans and what it is* 6. *acknowledgement of person's feelings* 7. *reassurance* - that things can get better 8. *confidentiality* - DO NOT promise confidentiality 9. *means of self harm* - remove guns, medications, ect. 10. *alone* - do not leave the person alone until they are in the hands of a professional.
CLASS - CDC stats
1. 45,000 lives lost to suicide in 2016 2. 30% increase in suicide rates since 1999 3. 54% of people that die from suicide do not have known mental health condition 4. percentage of highschoolers considering suicide has increased 25% since 2009
why is suicide more common in adolescents than children?
1. more common adolescence than childhood because the rates of several types of psychopathology tied to suicide - including depression, anxiety disorders, and substance abuse - all increase in adolescents 2. May also rise during teen years because adolescents are more sophisticated than children in their thinking and can contemplate suicide more clearly 3. Adolescents have more/readier access to the means to commit suicide (drugs, weapons), than children do .
CLASS - Statistics
13.4 per 100,000 each year = 45,000 117 per day 1 every 15 minutes each year: worldwide - 1 million worldwide - 1 every 40 seconds - 15th leading cause of death worldwide
*college students*
9% think about committing suicide, 1% attempt suicide while at college. students who had contemplated, where more likely to execute than those who haven't, and were just experiencing situational depression, loneliness, and hopelessness. only 20% of students who had contemplated, received counseling rates of suicidal thinking among college students are the same as non college students, rates of attempts are somewhat lower.
college students
9% think about suicide 1% attempt suicide students who contemplate or attempt suicide are more likely than those who had not experiences depression and hopelessness. 20% of students who thought about suicide received counseling.
Prevelance
Among the three leading causes of death worldwide among people from ages 15 - 44 More than 40,000 people kill themselves each year in the US. 113 people per day (average) 3% of the population make a suicide attempt (with intent to die) at some point in their lives Around the world, more people die from suicide than from homicide
*Why are there gender differences in suicide rates?*
Gender differences in suicide rates may be due in part to gender differences in the means of attempting suicide Men tend to choose more lethal methods of suicide than do women, with more than half of men who kill themselves use a firearm for women, most common method is poisoning Men who attempt suicide are more sure in their intent to die than women are.
Groups within adolescents
Girls are more likely to attempt suicide Boys are more likely to succeed at suicide. 6 times more than girls. gay, lesbian, and bisexual adolescents have rates of suicide 2 to 6 times higher than heterosexual adolescents
interpersonal violence and suicide
Interpersonal violence (especially sexual abuse) is the traumatic event most strongly linked to suicidal thoughts and attempts such experiences can be immediate triggers of suicidal thoughts and behaviors. Also associated with increased risk over victim's life span. physical abuse by a partner is also an indicator
Treatment and Prevention of Suicide
Intervention and Prevention programs reduce the risk of suicide
nonsuicidal self-injury
direct, deliberate destruction of body tissue in the absence of any intent to die cut, burn, puncture NSSI relatively common with lifetime prevalence up to 18% internationally prevalent among adolescents (17%) compared to young adults and adults.
suicide contagion
exposure to suicide or suicidal behaviors within one's family, one's peer group, or media reports of suicide when a well known member of society commits suicide, people who closely identify with that person may see suicide as more acceptable
difficulty of defining suicide
given this difficulty, it is not surprising that accurate suicide rates are difficult to obtain. many deaths are ambiguous, particularly when no notes are left behind and no clues exist as to the victim's mental state before the death.
CLASS - guns
guns are the most lethal form of fatality in suicide attempts 82.5%
*cultural relativism in adolescents*
hispanic females have very high rates of suicidal thoughts/plans/ attempts compared to hispanic males. girls who come from traditional homes that value "familiasm" but have become americanized. Girls want to branch out, but family rejects this choice of independence.
guns and suicide
in US 50% of suicides involve guns purchase of a gun can indicate suicidal intent majority of people who commit suicide by gun, use a gun that has been in their household for some time. explanation for higher suicides in men
biological factors and suicide
include genetic predispositions and neurotransmitter dysfunction
adolescents and substance abuse
increase in suicidal rates due to increase in substance abuse and availability of firearms increase in the use of antidepressants (SSRIs)
neurotransmitter dysfunction and suicide
link between suicide levels and low levels of neurotransmitter serotonin abnormalities in the genes that regulate levels of serotonin people with low serotonin levels are more likely to make multiple suicide attempts, than people who have normal levels This low levels of serotonin can be linked to suicidal tendencies even among individuals who are not depressed. connection between serotonin and suicide is not due entirely to a common connection to depression
economic hardship and suicide
loss of a job can precipitate suicidal thoughts and attempts. increased suicide rate among AA males tied to perceptions of their economic failures and comparison of such to that of the majority culture higher rates of suicide in communities where occupational and income inequalities are greatest
loss of a loved one and suicide
loss of a loved one through death, divorce, or separation is also consistently related to suicide attempts or completions people feel they cannot go on without the lost relationship and wish to end their pain.
*suicide attempt*
self-inflicted injury from which a person has at least some intention of dying attempts are more common than completed suicides
genetic predispositions of suicide
some of this clustering of suicide within families may be due to environmental factors (family members modeling each other or sharing common stressors) twin studies suggest genetics is also involved.
stressful life events and suicide
studies across cultures have shown that the risk of suicide is increased by a variety of stressful life events related to: - abuse - interpersonal loss - perceived failure - economic hardship - physical illness
*completed suicides*
suicide attempts that result in death
suicide prevention
suicide hotlines/intervention centers: help suicidal people in times of greatest need prevention programs: educate communities (schools, colleges)
reason for suicide clustering
the role of media in suicide contagion contagion may occur when survivors who become suicidal are modeling the behavior of the friend or admired celebrity who committed suicide that suicide may make the idea of suicide more acceptable, thus lower inhibitions for suicidal behavior in survivors.
CLASS - ideation vs. plan/attempt
there's a big increase in the ideation of suicide between ages 12 - 17 the increase is much less steep for planning and attempt. planning and attempt are much closer together than ideation
Community Based crisis intervention programs
these programs are available to help suicidal people deal in the *short term* with their feelings and the refer them to mental health specialists for longer term care some is done over the phone, on suicide hotlines some communities have walk in clinics or suicide prevention centers part of a non comprehensive mental health system crisis intervention aims to reduce the risk of an imminent suicide attempt by providing suicidal persons someone to talk with who understands their feelings/problems or give them the support they need to seek strength from family/friends.
