What is Suicide?

 Suicide

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

 Parasuicide

A suicide attempt that does not result in death (= “suicidal attempt, suicidal gesture”)

 Suicidal Ideation

Seriously thinking about suicide

Edwin Shneidman

 Thanatologist

 LA Suicide Prevention

Clinic (1952) - First

 Notion of “psychache”

Shneidman’s Classification

 Death Seekers

Clearly intend to end their lives

 Death Ignorers

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

 Death Darers

Mixed feelings or ambivalence

 Death Initiators

Intend to hasten a process which is already underway

 Subintentional Death

Intention is indirect, covert, partial, or unconscious

Statistics & Patterns • 1

 Nationality

– Low: Egypt, Mexico, Greece, Spain (< 5/100K)

– High: Russia, Germany, Scandinavia, China, Japan

– Medium: USA (10.8/100K), Canada (12 /100K) England (8 /100K)

 Age

– Young < Middle Age < Elderly

– 3rd leading cause of death: 10-24 yo (2001)

– 2nd leading cause of death: 25-34 yo Males (2001)

 Gender

– Attempts: 3x F > M

– Actual: 3-4x M > F

Statistics & Patterns • 2

 Marital Status

– Divorced > Widowed >Single > Married

– Divorced Males 2-3x > Married Males

– Young widowed males (20-34 yo) 9-17x > Married males

 Methods

– Men use more violent methods, e.g., guns are used by 67% of men but only 40% of women

Race & Suicide

 White > Latino Americans/African American

 Whites commit 90% of all suicides

 White males commit 73% of all suicides

 White-Black differences appear to be diminishing in recent years

 * Young American Indian males are at high risk for suicide & during 1979-1992, Native Americans were greater than the national average for suicide

Suicide: Vulnerability & Triggers

Stressful Events & Situations

 Immediate Stress

– shame or humiliation (school failure, arrest, rejection by loved one)

– natural disasters

 Long-Term Stress

– Abuse

– Occupational Stress

Mood & Thought Changes

 Psychic pain (sadness, anxiety) increases

 Hopelessness

Pessimistic belief that one’s present circumstances, problems, or mood will not change.

 Dichotomous Thinking

Viewing a problem and solutions in rigid “either/or” terms.

Alcohol and Other Drug Use

 60% of suicide attempts are preceded by drinking

 25-50% of actual suicides are intoxicated (33% of adolescent suicides)

 Disinhibiting effects of ETOH on judgment

 Depressive effects of ETOH on CNS

Mental Disorders

 > 50% of suicide attempters & 90% of completed suicides have at least one diagnosable DSM-IV disorder

 Mood Disorders (hopelessness)

 Substance-related Disorders (especially chronic alcoholism)

 Schizophrenia (demoralization)

Modeling: Contagion of Suicide

 When suicide is reported in the news media, rates tend to go up by 10-20% over the next 6 months

 Celebrities

 Popular TV characters

 Local, but highly-publicized suicides

– School responses must be carefully planned

Explanations for Suicide • 1

 Psychodynamic

– Early loss and development of depression

– Anger turned against the self

 Sociocultural (Emile Durkheim)

– Egoistic Suicide

– Altruistic Suicide

– Anomic Suicide: loss of a sense of belonging to society

Explanations for Suicide • 2

 Biological

– Individuals related to suicide victims are at higher risk for suicide

– Serotonin (5-HT) Levels

 Depressed individuals - low 5-HT

 5-HT may moderate aggression & low

levels may increase aggressive acts

Treatment

 Post-suicide attempt: medical à psychotherapy &/or drug treatment

 Suicide prevention: crisis intervention programs (hotlines)

– Positive relationship

– Understand problem

– Suicide potential

– Caller’s resources

– Form plan

 No suicide contract