Abnormal Psychology: Suicide And Parasuicide Prof. Craig Jackson Head of Psychology Division BCU

Abnormal Psychology:Abnormal Psychology:SuicideSuicide

AndAndParasuicideParasuicide

Prof. Craig JacksonProf. Craig JacksonHead of Psychology DivisionHead of Psychology Division

BCUBCU

[email protected]@bcu.ac.ukhealth.bcu.ac.uk/craigjacksonhealth.bcu.ac.uk/craigjackson

Research limitationsResearch limitations

• Suicide multi-causalSuicide multi-causal

• End-stage of complex processEnd-stage of complex process

• Attracts emotive reporting in media Attracts emotive reporting in media

• Workplace suicide received little / no academic attentionWorkplace suicide received little / no academic attention

• Occupational attribution straightforward in many casesOccupational attribution straightforward in many cases

• Workplace factors ascertained byWorkplace factors ascertained by• NotesNotes• Recorded trouble at workRecorded trouble at work• Coincidence with unusual workplace situation / landmarksCoincidence with unusual workplace situation / landmarks• Compounded home-life complicationsCompounded home-life complications• Occupational health historyOccupational health history

Suicide Media StoriesSuicide Media Stories

““A teacher who set herself alight had complained about pressure of A teacher who set herself alight had complained about pressure of work, an inquest has been told. Janet Dibb, 28, had complained to her work, an inquest has been told. Janet Dibb, 28, had complained to her father about overwork.”father about overwork.”

20 March 200420 March 2004

““A family doctor hanged herself because of stress at work, an inquest A family doctor hanged herself because of stress at work, an inquest has heard. Bury coroners' court was told Dr Dawn Harris, 38, who has heard. Bury coroners' court was told Dr Dawn Harris, 38, who worked at the Lever Chambers practice in Bolton, became ‘angry, very worked at the Lever Chambers practice in Bolton, became ‘angry, very distressed and quite hurt’ by problems at the busy medical practice.”distressed and quite hurt’ by problems at the busy medical practice.”

22 May 2004

1. Over-emotive2. Blames “extreme stress response”3. Always best when involving females!

Case 1 – “PT” BullyingCase 1 – “PT” Bullying

PT (female armed response officer, 37) suicide in 2004PT (female armed response officer, 37) suicide in 2004hanged at homehanged at home

2003 Dismissed from firearms duties - poor proficiency2003 Dismissed from firearms duties - poor proficiency• One of two female firearms officers in 90-strong unitOne of two female firearms officers in 90-strong unit• One of first female snipers in UKOne of first female snipers in UK

Complained of colleagues viewing pornographic video on a residential courseComplained of colleagues viewing pornographic video on a residential courseFelt victimised in macho culture of firearms unit. Felt victimised in macho culture of firearms unit. Fell out with a number of influential male colleaguesFell out with a number of influential male colleagues

Sefton Coroner Christopher Sumner: Sefton Coroner Christopher Sumner: “Paula Tomlinson killed herself at a time “Paula Tomlinson killed herself at a time that she was suffering from stress, a contributory factor of which was work that she was suffering from stress, a contributory factor of which was work related.”related.”

IPCC found no evidence of bullying or intimidationIPCC found no evidence of bullying or intimidationDid acknowledge management failings and an Did acknowledge management failings and an “in-crowd culture”“in-crowd culture”

France Telecom CasesFrance Telecom Cases

Privatised in 1998Privatised in 1998

40,000 jobs gone since 199840,000 jobs gone since 1998

186,000 employees186,000 employees

45% of those outside France45% of those outside France

Used to be public sector employerUsed to be public sector employernew working conditionsnew working conditionsmodernisationmodernisationcultural & organisational changes neededcultural & organisational changes neededinternal job transfersinternal job transfers

4.3% fall in profits in 1Q of 20094.3% fall in profits in 1Q of 2009

182 million customers in 5 continents182 million customers in 5 continents

France Telecom CasesFrance Telecom Cases

France Telecom CasesFrance Telecom Cases

Between Feb 2008 – Sep 2009Between Feb 2008 – Sep 2009

23 staff committed suicide23 staff committed suicide

• 99thth Sept: 49 yr old male employee stabbed himself in meeting – told he would Sept: 49 yr old male employee stabbed himself in meeting – told he would be undergoing internal job transferbe undergoing internal job transfer

• 1111thth Sep: 32 yr old female employee leapt to death from office window Sep: 32 yr old female employee leapt to death from office window

•1414thth Sep 53 yr old senior manager overdosed Sep 53 yr old senior manager overdosed

• 11stst Oct: 51yr old male employee jumped from road bridge – note blamed work Oct: 51yr old male employee jumped from road bridge – note blamed work “atmosphere”“atmosphere”

French suicide rate:French suicide rate: 26.4 per 100,000 male deaths26.4 per 100,000 male deaths 9.2 per 100,000 female deaths9.2 per 100,000 female deaths17.8 per 100,000 all deaths17.8 per 100,000 all deaths

France Telecom’s DefenceFrance Telecom’s Defence

France Telecom’s two-point defence: France Telecom’s two-point defence:

1)1) ““There were 28 suicides in the company in 2000, so 23 suicides over There were 28 suicides in the company in 2000, so 23 suicides over 17 months is actually an improvement and not evidence of an 17 months is actually an improvement and not evidence of an epidemic”epidemic”

2) 2) ““Most suicides caused by personal problems not Most suicides caused by personal problems not professional onesprofessional ones””

France Telecom CaseFrance Telecom Case

Oct 2009Oct 2009

Deputy CEO Louis-Pierre Wenes (second in command) resignsDeputy CEO Louis-Pierre Wenes (second in command) resigns

CEO Didier Lombard – vowed to end the “Spiral of death”CEO Didier Lombard – vowed to end the “Spiral of death”Phone helplinePhone helplineCounsellingCounsellingSuspending job transfersSuspending job transfers

French Labour Minister, Xavier Darcos wants:French Labour Minister, Xavier Darcos wants:2,500 biggest companies to plan “anti-stress” strategies2,500 biggest companies to plan “anti-stress” strategiesPlan it with UnionsPlan it with Unions

Govt has 27% stake in FTGovt has 27% stake in FT

Health & Happiness now on “National Agenda” in FranceHealth & Happiness now on “National Agenda” in France

Foxconn and the iPadFoxconn and the iPad

Manufacturing giant in ChinaManufacturing giant in China

Renowned for efficiency – 300,000 employeesRenowned for efficiency – 300,000 employees

Laptops, mobiles - Nokia, Apple, Dell HPLaptops, mobiles - Nokia, Apple, Dell HP

13 suicide attempts since Jan 2010 – 10 deaths13 suicide attempts since Jan 2010 – 10 deaths

Foxconn and the iPadFoxconn and the iPad

Foxconn and the iPadFoxconn and the iPad

Compensation for families in povertyCompensation for families in poverty

Working conditions – long shifts, rigid,Working conditions – long shifts, rigid,Oppressive, poor payOppressive, poor pay

Company asked workers to sign a letter promising not to kill themselves Company asked workers to sign a letter promising not to kill themselves (now withdrawn)(now withdrawn)

Building giant safety net to prevent jumpers from Dorms and WorkshopsBuilding giant safety net to prevent jumpers from Dorms and Workshops

Hiring counsellors and Buddhist monks Hiring counsellors and Buddhist monks

Case – “TB” Overwork / DepressionCase – “TB” Overwork / Depression

TB (male engineer, 28) suicide in 2002 – hanged at homeTB (male engineer, 28) suicide in 2002 – hanged at home

Been working for 1 year in SingaporeBeen working for 1 year in Singapore

Had party celebrating end of contractHad party celebrating end of contract

2 suicide notes:2 suicide notes:First addressed work colleagues First addressed work colleagues “unfortunately the game has got the “unfortunately the game has got the better of me – give my apologies to all the lads”better of me – give my apologies to all the lads”

Second addressed his parents Second addressed his parents “I have been depressed for a while “I have been depressed for a while now now – pressure of work has turned my mind into a ticking time – pressure of work has turned my mind into a ticking time bomb”bomb”

Cardiff Coroner – Mary Hassell: Cardiff Coroner – Mary Hassell: “It is hard to understand why someone “It is hard to understand why someone described as happy-go-lucky should choose to end their own life over pressure described as happy-go-lucky should choose to end their own life over pressure in work.”in work.”

Epidemiology of World SuicideEpidemiology of World Suicide

• 1 million suicide deaths per year worldwide1 million suicide deaths per year worldwide

• 10 – 20 million attempts (huge variation)10 – 20 million attempts (huge variation)

• Suicide ideation / rumination even higherSuicide ideation / rumination even higher

• WS comprises 3.5% of workplace fatalities worldwide (Pegula 2004)WS comprises 3.5% of workplace fatalities worldwide (Pegula 2004)

• Nearly 50% of first-time attempts failNearly 50% of first-time attempts fail

• Those with history of repeated attempts X 23 likely to die by suicideThose with history of repeated attempts X 23 likely to die by suicide

World Wide AttitudesWorld Wide Attitudes

Epidemiology of SuicideEpidemiology of Suicide

Epidemiology of Suicide in the UKEpidemiology of Suicide in the UK

Males Males FemalesFemales

30 suicides per 30 suicides per 10 suicides per 10 suicides per 100,000 deaths in Scotland100,000 deaths in Scotland

22 suicides per 22 suicides per 6 suicides per 6 suicides per 100,000 deaths in Wales100,000 deaths in Wales

18 suicides per 18 suicides per 5.6 suicides per 5.6 suicides per 100,000 deaths in Northern Ireland100,000 deaths in Northern Ireland

16 suicides per 16 suicides per 5.4 suicides per 5.4 suicides per 100,000 deaths in England100,000 deaths in England

Ages 15-44 have highest suicide rate in malesAges 15-44 have highest suicide rate in males

Ages 75+ have highest suicide rate in femalesAges 75+ have highest suicide rate in females

Epidemiology of Suicide in the UKEpidemiology of Suicide in the UK

Slow decrease in UK suicide rates since 1990sSlow decrease in UK suicide rates since 1990s

75% of suicidal deaths are Male75% of suicidal deaths are Male

Sex split been same since 1991 – but may just reflect methods usedSex split been same since 1991 – but may just reflect methods used

2006 2006 5554 suicides in adults (15 or over)5554 suicides in adults (15 or over)

2007 2007 5377 suicides in adults (15 or over) 5377 suicides in adults (15 or over)

2008 2008 5706 suicides in adults (15 or over) 5706 suicides in adults (15 or over)

Epidemiology of Suicide in the UKEpidemiology of Suicide in the UK

Epidemiology of Suicide in the MidlandsEpidemiology of Suicide in the Midlands1998-20041998-2004

WolvesWolves 22.1 per 100,000 deaths22.1 per 100,000 deaths 146 cases146 cases #101#101

BirminghamBirmingham 19.3 per 100,000 deaths19.3 per 100,000 deaths 541 cases541 cases #172#172

DudleyDudley 18.0 per 100,000 deaths18.0 per 100,000 deaths 147 cases147 cases #215#215

CoventryCoventry 17.3 per 100,000 deaths17.3 per 100,000 deaths 146 cases146 cases #245#245

SandwellSandwell 16.6 per 100,000 deaths16.6 per 100,000 deaths 125 cases125 cases #268#268

WalsallWalsall 15.9 per 100,000 deaths15.9 per 100,000 deaths 105 cases105 cases #294#294

SolihullSolihull 13.8 per 100,000 deaths 74 cases13.8 per 100,000 deaths 74 cases #363#363

Can we pin any of this to industry, ethnicity, decline, deprivation ????Can we pin any of this to industry, ethnicity, decline, deprivation ????

Demographics of SuicideDemographics of Suicide

Case – “TC” Chronic Ill-health / DepressionCase – “TC” Chronic Ill-health / Depression

TC (male mechanic, 37) suicide in 2002TC (male mechanic, 37) suicide in 2002

1996 right ear severed in accident at work IBC Vehicles Luton1996 right ear severed in accident at work IBC Vehicles LutonProlonged tinnitus, headache, severe depressionProlonged tinnitus, headache, severe depression

2005 TCs widow at High Court for 2005 TCs widow at High Court for ££750,000750,000

IBC accepts liability for accident – not suicide. Awarded £IBC accepts liability for accident – not suicide. Awarded £82,52082,520

Court of Appeal overturned award – Lord Justice Sedley claimed there to be Court of Appeal overturned award – Lord Justice Sedley claimed there to be no other cause. TC had previously been ano other cause. TC had previously been a

““rational man. . . The suicide was proved to have been a function of the rational man. . . The suicide was proved to have been a function of the depression and so formed part of the damage for which IBC were liable. . . To depression and so formed part of the damage for which IBC were liable. . . To treat TC as responsible for his own death was an unjustified exception to treat TC as responsible for his own death was an unjustified exception to modern views on the links between accidents and their causes”.modern views on the links between accidents and their causes”.

Job Specific FactorsJob Specific Factors

Vets and FarmersVets and Farmers

• Functional use of euthanasia Functional use of euthanasia • Facilitate a “Good death”Facilitate a “Good death”• Long working hoursLong working hours• Rural isolationRural isolation• Client dependenceClient dependence• Social isolationSocial isolation• Not adapting to change / fluxNot adapting to change / flux

Attitudes to suicide and (non) help-seeing behaviourAttitudes to suicide and (non) help-seeing behaviour

This may serve to make suicide seem like a plausible solution to problemsThis may serve to make suicide seem like a plausible solution to problems

Jobs with “Gallows Humour” Police, Nursing, Military, Fire, Ambulance ?Jobs with “Gallows Humour” Police, Nursing, Military, Fire, Ambulance ?

ComplexityComplexity

• Emotive reporting of WRS suicidesEmotive reporting of WRS suicides

• Coroner’s & Inquests often too narrow in scopeCoroner’s & Inquests often too narrow in scope

• Wrongly suggests WRS is “final remedy” for workplace problems e.g. stressWrongly suggests WRS is “final remedy” for workplace problems e.g. stress

• Suicide is complex final stage behaviour with many antecedentsSuicide is complex final stage behaviour with many antecedents

Socio-demographicsSocio-demographics

Childhood experiencesChildhood experiences

Psychiatric morbidity / historyPsychiatric morbidity / history

Recent stressful life eventsRecent stressful life events

Social interactions / supportsSocial interactions / supports

Complexity of BackgroundComplexity of Background

Beautrais (2001) Beautrais (2001)

Following are all common to suicide & attempts: Following are all common to suicide & attempts:

1.1. current mood disordercurrent mood disorder2.2. previous suicide attemptsprevious suicide attempts3.3. prior outpatient psychiatric treatmentprior outpatient psychiatric treatment4.4. admission to psychiatric hospital within the previous yearadmission to psychiatric hospital within the previous year5.5. low incomelow income6.6. absence of educational qualificationsabsence of educational qualifications7.7. recent stressful interpersonal, legal & work-related life events.recent stressful interpersonal, legal & work-related life events.

Many suicidents do not fit this profile

Suicides and Recession – Japanese DataSuicides and Recession – Japanese Data

Suicides risen since 1989 and financial declineSuicides risen since 1989 and financial declineClimbed higher in 1997 recessionClimbed higher in 1997 recessionSeems a natural end-point considering over-work and working hoursSeems a natural end-point considering over-work and working hours

Joins UN RecessionFinancial boom

Suicides and RecessionSuicides and Recession

Prof Natalie Jeremiienko – Bureau of Inverse Technology Engineering Prof Natalie Jeremiienko – Bureau of Inverse Technology Engineering

Created "Despondency Index" - correlating the Dow Jones Industrial Created "Despondency Index" - correlating the Dow Jones Industrial Average with number of jumpersAverage with number of jumpers

Detected by "Suicide Boxes" containing motion-detecting cameras, Detected by "Suicide Boxes" containing motion-detecting cameras, under the bridge.under the bridge.

Boxes recorded 17 jumps in three monthsBoxes recorded 17 jumps in three months

High Risk OccupationsHigh Risk Occupations

US Data from 10,000 suicides and 135,000 deaths US Data from 10,000 suicides and 135,000 deaths

15 occupations with higher / lower risk than the general pop.15 occupations with higher / lower risk than the general pop.

Reduced to 8 after adjustment for socio-demographicsReduced to 8 after adjustment for socio-demographics

Dentists (X 5.4)Dentists (X 5.4) Doctors (X 2.3)Doctors (X 2.3) Scientists (X 1.5)Scientists (X 1.5)Nurses (X 1.5)Nurses (X 1.5) Social workers (X 1.5)Social workers (X 1.5) Artists (X 1.2)Artists (X 1.2)

Farm workers (X 0.69)Farm workers (X 0.69) Admin staff (X 0.85)Admin staff (X 0.85)

UK picture different – suggests Farm workers & Veterinary have one of highest UK picture different – suggests Farm workers & Veterinary have one of highest rates (Mellanby, 2005) rates (Mellanby, 2005)

Suicide SpaceSuicide Space

• Access to lethal meansAccess to lethal means

• Opportunity for solitudeOpportunity for solitude

• Freedom of movement Freedom of movement

• Location away from assistanceLocation away from assistance

Behavioural Yellow FlagsBehavioural Yellow Flags

Observable in 75% of decedents in few weeks before deathObservable in 75% of decedents in few weeks before death

• Previous suicide attemptsPrevious suicide attempts

• History of suicide in familyHistory of suicide in family

• Begin “tidying up” affairsBegin “tidying up” affairs

• Person acting completely out of characterPerson acting completely out of character

• Symptoms of depressionSymptoms of depression

• Hopelessness about the futureHopelessness about the future

• Periods of difficulty and change – holiday periods, prior to disciplinary Periods of difficulty and change – holiday periods, prior to disciplinary hearingshearings

More Behavioural Yellow FlagsMore Behavioural Yellow Flags

• recent bereavement or other life-altering loss recent bereavement or other life-altering loss • recent break-up of a close relationship recent break-up of a close relationship • major disappointment (failed exams or missed job promotion) major disappointment (failed exams or missed job promotion) • major change in circumstance (retirement, redundancy, children leaving) major change in circumstance (retirement, redundancy, children leaving) • physical illnessphysical illness• mental illness mental illness • substance misuse / addictionsubstance misuse / addiction• deliberate self-harm, (particularly in women)deliberate self-harm, (particularly in women)• previous suicide attempts previous suicide attempts • loss of close friend / relative by suicidal meansloss of close friend / relative by suicidal means• loss of statusloss of status• feelings of hopelessness, powerlessness and worthlessnessfeelings of hopelessness, powerlessness and worthlessness• declining performance in work and other (sometimes this can be reversed)declining performance in work and other (sometimes this can be reversed)• declining interest in friends, sex, or previous activitiesdeclining interest in friends, sex, or previous activities• Neglect of personal welfare and hygieneNeglect of personal welfare and hygiene• Alterations in sleeping habits (either direction) or eating habitsAlterations in sleeping habits (either direction) or eating habits

ReferencesReferences

Etzersdorfer, E., L. Vijayakumar, W. Schöny, A. Grausgruber and G.Sonneck (1998). Attitudes towards suicide among medical students:comparison between Madras (India) and Vienna (Austria). Social Psychiatryand Psychiatric Epidemiology. 33. 3. 104-110.

Gibb, B. E., M. S. Andover and S. R. Beach (2006). Suicidal ideation andattitudes toward suicide. Suicide & Life-Threatening Behavior. 36. 1. 12-8.

Hawton, K and van Heeringen, K (eds). (2000). The International Handbookof Suicide and Attempted Suicide. Chichester, Wiley.

Jackson CA. (2008) Work-Related Suicide. Management of Health Risks.126: 2-8.

Karasek, R. and T. Theorell (1990). Healthy work: stress, productivity, andthe reconstruction of working life. New York, Basic Books.

ReferencesReferences

Karasek, R. A. (1979). Job demands, job decision latitude and mental strain:implications for job design. Administrative Science Quarterley. 24. 285-308.

Mellanby, R. J. (2005). Incidence of suicide in the veterinary profession inEngland and Wales. Veterinary Record. 157. 14. 415-7.

Sawyer, D. and J. Sobal (1987). Public Attitudes Toward Suicide Demographicand Ideological Correlates. The Public Opinion Quarterly. 51. 1. 92-101.

Siegrist, J. (1996). Adverse health effects of high-effort/low-reward conditions.Journal of Occupational Health Psychology. 1. 27-41.

Stack, S. (2001). Occupation and Suicide. Social Science Quarterly (BlackwellPublishing Limited) 82. 2. 384.

ReferencesReferences

Stansfeld, S., R. Fuhrer, M. Shipley and M. Marmot (2002). Psychologicaldistress as a risk factor for coronary heart disease in the Whitehall II Study.International Journal of Epidemiology 31. 248-255.

Stansfeld, S. A., R. Fuhrer, J. Head, J. Ferrie and M. Shipley (1997). Workand psychiatric disorder in the Whitehall II Study. Journal of PsychosomaticResearch. 43. 1. 73-81.

Vilhjalmsson, R., E. Sveinbjarnardottir and G. Kristjansdottir (1998). Factorsassociated with suicide ideation in adults. Social Psychiatry and PsychiatricEpidemiology. 33. 3. 97-103.