SUICIDE

LECTURE OUTLINE

• What is suicide?

• Prevalence rates

• Mental disorder and suicide

• Other risk factors

• Understanding suicide

• Suicide prevention

• Treating people who are suicidal

SUICIDE

What is suicide?

• difficult to determine suicide

• taboo topic – a mortal sin, used to be illegal in Canada

• difficult to know person’s intention

• large number of equivocal suicides

• reporting practices and judgments differ widely making it difficult to get accurate information

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What is suicide? Key components

• act of deliberate self-injury – degree of self-destructiveness

• appeal to other people – suicidal gesture, “cry for help” (Farberow & Schneidman, 1961)

• intention – varies from clear intention to unconscious wish to reckless/impulsive behaviour to suicidal ideation, with many people being ambivalent about suicide

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Prevalence rates

• Average rate of 12 per 100,000 population in Canada

• varies by gender with men having higher rates (20 per 100,000) than women (5 per 100,000)

• but, women are almost twice as likely to attempt suicide

• men tend to use more lethal means than women

SUICIDEAttempters and Completers

CharacteristicCharacteristic AttemptersAttempters CompletersCompleters

SexSex More often More often femalefemale

More often maleMore often male

AgeAge YoungerYounger OlderOlder

MeansMeans Low lethalityLow lethality High lethalityHigh lethality

SettingSetting High chance of High chance of rescuerescue

Low chance of Low chance of rescuerescue

DiagnosesDiagnoses Dysthymia, Dysthymia, Borderline Borderline PersonalityPersonality

Mood disorder, Mood disorder, Schizophrenia, Schizophrenia, Substance AbuseSubstance Abuse

SUICIDE

Prevalence rates - Canada

• attempted suicide is much more common than completed suicide

• suicide rates are lowest in the Maritimes, highest in NWT and Yukon

• suicide rate has steadily risen since 1920 when it was 6 per 100,000

• increasing rates for young men in Canada from 1950-1980, plateau since 1980

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Prevalence rates - Canada

• very high rates young aboriginal men (ages 15-24) – nearly 120 per 100,000

• second leading cause of death for those between ages 15 – 30

• 3 times as many suicides as homicides

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Prevalence rates - International

• internationally highest suicide rates are in eastern and northern European countries (e.g., Hungary – rate of 45 per 100,000; Denmark – rate of 32 per 100,000)

• low rates in Mediterranean countries (e.g., Greece – rate of 3 per 100,000; Spain – rate of 4 per 100,000)

SUICIDE

Mental disorder and suicide

• Retrospective studies suggest that up to 90% of those who complete suicide had a mental disorder at the time of their death

• Several mental disorders have high rates of suicide – mood disorder, schizophrenia, substance abuse/alcoholism

SUICIDE

Mental disorder and suicide

• Iowa 500 study followed people who had been hospitalized for depression and schizophrenia with a control group of people without a mental disorder

• Suicide as a % of all deaths was 10% for depression group, 10% for schizophrenia group, and 0% for control group

SUICIDE

Other risk factors

• Age – in general, older men have higher rates of completed suicide (although the increase in suicide in young men has narrowed this gap); younger people higher rates of suicide attempts

• Marital status – high rates of suicide attempts for single people; high rates of completed suicide for people who are widowed, separated, or divorced; risk also diminishes if person has children

• Race – high among Caucasians and aboriginal people

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Other risk factors

• Physical illness

• Life stress – especially loss experiences

• Loneliness, isolation

• Previous attempts

• Suicide plan

• Family history

• Suicide sometimes occurs after improvement in mental health

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Understanding suicide

• Biological – suicide is related to mental disorder, genetic link

• Psychological – Freud, anger turned inward; Cognitive-behavioural – modelling and social learning; Existential-humanistic – hopelessness and despair, lack of meaning

• Sociocultural – Durkheim, suicide is related to social norms and culture; 3 types of suicide: egoistic, altruistic, anomic

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Suicide prevention

• No formal recognition of the problem in Canada; no official government or professional organization; “suicide – the deserted field”

• England – Anti-suicide prevention bureau, 1906; New York, Save a life league

• England – Samaritans, 1953

• Los Angeles Suicide Prevention Center (Farberow & Shneidman, 1961), 1960, AAS, Center for Suicide Studies in Washington DC

SUICIDE

Suicide prevention, crisis intervention, and distress lines

• use of telephone

• 24-hour service

• use of trained volunteers

• emotional support

• connection to other services

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Suicide education programs

• provides information to students in high school, builds awareness

• Little research showing the effectiveness of suicide prevention, crisis intervention, distress lines, or suicide education programs in reducing suicide rates

• many suicidal people do not come into contact with these services

• suicide education and awareness can actually increase suicidal ideation (Shaffer et al., 1988)

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Effective suicide prevention

• General approaches to primary prevention and health promotion – building competence, coping, and problem-solving skills

• Reduction of access to lethal means – CO gas in UK, firearms

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Treating suicidal individuals

• Need to assess suicidal risk and ensure adequate supervision of attempter

• Deal with life crisis swiftly

• Therapy focused on building protective factors and reducing risk factors, through a variety of different approaches

• Encourage open talk about suicidal ideation

SUICIDE

SUMMARY

• Suicide is strongly related to serious mental health problems and other risk factors

• Suicide rates vary widely by different aspects of social context

• Reducing availability of lethal means of suicide is important for effective prevention

• Need for a more focused, coordinated national strategy to deal with this problem