Prepared by : Mr. Ahmad Abu-Rahma Mr. Ayman El-Ghouty

Supervised by : Dr. Ashraf El Jedi

SUICIDE AND ATTEMPTED SUICIDE AND ATTEMPTED SUICIDESUICIDE

What is the suicideWhat is the suicide

Definition :

Suicide is the process of purposely ending one's own life.

The way societies view suicide varies widely according to culture and religion. For example, many Western cultures, as well as mainstream Judaism, Islam, and Christianity tend to view killing oneself as quite negative. One myth about suicide that may be the result of this view is considering suicide to always be the result of a mental illness. Some societies also treat a suicide attempt as if it were a crime.

From most religious viewpoint suicide is generally seen as a sin .

Other see it as a right if the condition of life become intolerable .

The national institute for mental health (NIMH) list of reasons that would be suiciders give for attempting the act :

To escape from feeling of hopelessnessTo escape from an intolerable situationTo change other peoples behaviourTo avoid punishment

To avoid becoming a burdenTo escape from the effects of a dreaded diseaseTo seek martyrdom .

There are fairly distinct characteristics that tend to discriminate between those who are likely to complete the suicide act and those who attempt it in order to seek help, change other peoples attitudes or behaviour and so on .

Completed suicides may be seen as being at one end of the continuum with parasuicides at the other , in the middle one can place those persons attempting suicide with highly lethal methods.

A number of those attempting suicide in the middle range on the continuum do finally complete the suicidal act at a later stage .

There are demographic and clinical differences between the completed suicide and parasuicides groups

Completed group:

Older

Male

Use more lethal techniques

Suffer from a more sever type of psychatric disorder .

Parasuicides group:

Younger

Female

use less lethal methods

Suffer from less severe types of psychiatric disorders

Risk factors for the completed Risk factors for the completed suicide groupsuicide group

Sainsbury provides a most useful table(12.1) summarising the main characteristics of this group .

Klerman summary :male more than femalesDepression and affective disordersSubstance abuseFamily history of suicide Influence of others who have completed suicide

(contagion effect).

Allebeck has reviewed the risk factors in young men and has presented the finding that the suicides in his group represented indications of an antisocial personality. Additionally interesting characteristics were:

Poor emotional controlContact with the child welfare authoritiesContact with police Father who used alcohol frequentlyFrequent misconduct in schoolExcessive use of alcohol and narcotics

Holden identifies pure depression as a reason in young females and a hard driving perfectionism .

Litman and Diller list three main variables as being the chief risk factors :

(1) absent relationships of significant others {history of social isolation and being shy}

(2) negative relationships {violent interaction}

(3) lack of resilience with normal relationships until the experience of a sudden loss

There has been evidence in recent years of the presence of a biochemical marker in the form of serotonin abnormalities .

Risk factors for the attempted Risk factors for the attempted and parasuicide groupsand parasuicide groups

People may attempt to take their lives for quite a number of reasons.

Often these are a cry for help , an indication of an extreme sense of frustration.

Recent researcher {klerman & davis} have summarised some of the main demographic and clinical features that identify this group :

Female more than maleRecent stressful life event {ending of a relationship,

money and family problem }ImpulsivityFeeling of being a bad personRecent thoughts of ending lifeLow lethality of method {Ex. Pills, wrist-cutting

characteristics}Previous suicide attempts Repetition of suicide attempt

One study (Hawton & Catalan):

Shows that 6-15% make a further attempt within one year, with repeats being most frequent during three months after an attempt.

In this study :

Show that 1-2% of attempters kill themselves in the year following and a third to a half of those who eventually complete suicide have a history of previous attempt.

What are the signs and What are the signs and symptoms for suicide?symptoms for suicide?

Warning signs that an individual is imminently planning to kill themselves may include the person making a will, getting his or her affairs in order, suddenly visiting friends or family members (one last time), buying instruments of suicide like a gun, hose, rope or medications, a sudden and significant decline or improvement in mood, or writing a suicide note.

Contrary to popular belief, many people who Contrary to popular belief, many people who complete suicide do not tell any mental-complete suicide do not tell any mental-health professional they plan to kill health professional they plan to kill themselves in the months before they do so. themselves in the months before they do so. If they communicate their plan to anyone, it If they communicate their plan to anyone, it is more likely to be someone with whom they is more likely to be someone with whom they are personally close, like a friend or family are personally close, like a friend or family member.member.

SUICIDE: A MULTI-FACTORIAL EVENT

Neurobiology

Severe MedicalIllness

Impulsiveness

Access To Weapons

Hopelessness

Life Stressors

Family History

SuicidalBehavior

Personality Disorder/Traits

Psychiatric IllnessCo-morbidity

Psychodynamics/Psychological Vulnerability

Substance Use/Abuse

Suicide

Social interventionSocial intervention * It will be clear that the foregoing demographic and clinical characteristics are too indefinite to pinpoint precisely those who are either going to complete suicide or to attempt it .

* The possibilities of effective intervention in this area must depend on such factors as positive social policy to prevent suicide, adequate mental health professionals to undertake the work, public education and so on..

The NIMH has outlined a sequence of steps that could be the basis of successful intervention :

{1} all suicide attempt need adequate follow up to try to eliminate the condition that may give rise to further attempt .

{2} close attention must be given to verbal warnings, which may be direct or indirect .

{3} pay attention to those who are making various changes without apparent reason, for Ex. Changing the condition of a will.

{4} personality and behavioural changes should be noted.

{5} identify the features of clinical depression and take appropriate steps to deal with it.

Useful forms of social Useful forms of social interventionintervention

The NIMH continues to outline a framework for effective social intervention :

(1) listen to the person carefully . (2) make an estimate of the extent to which the individual

has planned and prepared for the suicide event . (3) it is vital for the listener to be really emotionally

supportive . (4) the subject may be too confused to be able to make

sensible decisions at this time . (5) a priority must be given to making the enviroment safe . (6) sometimes the subject may appear to have made a quick

recovery from the trauma and even seem quite elated .

Treatment once an attempt Treatment once an attempt has taken placehas taken place

Unfortunately, all too often the mental health professional will only hear of the situation once an attempt has been made .

Where clients are allowed to take an active role in defining their problems.

Quite often subjects will have problems with their spouse or de facto or with their children or other close relatives.

It is important to test the reality of what clients are claiming by checking things out with close relatives and other important figures in clients lives.

It is of vital importance to establish the extent to which the client intended to complete the suicidal act and the Beck Intent Scale is a useful instrument for this purpose .

• Hawton and Catalan outline a treatment program for the parasuicide group, focusing upon the following factors :• Communication :many client lack the capacity to discuss their needs and feeling with their partners.• Attitude change : the clients prevailing attitudes may be against her/his own best interests. The therapist needs to bring out the connections between the clients failures and these attitudes.• Referral to special agencies for particular needs .• Improving coping mechanisms : it is important for the client to appreciate why he/she made this attempt.• Provide an open access facility .

Prevention of suicidePrevention of suicide• It is doubtful whether it is feasible to take steps to prevent suicide.• However, a number of researchers have proposed a range of measures, all of which would be worthwhile and might, if fully implemented, save lives.• For example, the studies of the NIMH, Allebeck and McCulloch can be used to make suggestions for preventive intervention at a micro and macro level.

• Changes at the micro level•1). Increase the number of mental health professionals in the community.•2). Make better use of telephone hotline services, for example lifeline.•3). Educate general practitioners and other medical personnel about the recognition of depression as a means of reducing suicide risk.•4). Provide increased social services at points where suicide risks are high, for example for those clients seen in social service departments, those clients being interviewed by the police for offences

• Changes at the macro level•1). Teach coping skills at school.•2). Make retirement age more flexible.•3). Provide preretirement counselling services.•4). Ensure every elderly person has a phone and a range of contact.•5). Build physical barriers at places that people may use to attempt suicide, for example tall building and bridges.•6). Limit the number of pills on prescription.•7). Implement tougher and more restrictive gun laws.•8). Foster community pride and neighbourliness.•9). Develop a better understanding of the contagion effect in adolescent suicide.