Suicide

SUICIDE

Presented ByKF Khan

Clinical Psychologist

SUICIDE

• The word “suicide” comes from two Latin roots, sui (“of oneself”) and cidium (“killing” or “slaying”).

• Suicide is a deliberately initiated act with the knowledge of its fatal outcome.

METHODS OF SUICIDE

People may take their lives in one of the following ways:• Hanging• Self-poison• Drug Overdose• Drowning • Jumping• Gunshot• Other violent methods

MOST COMPLETED SUICIDES HAVE BEEN PLANNED.

ICONIC SITES FOR SUICIDE Particular sites acquire iconic status as places for suicide. • Such places are usually public, attractive, have aesthetically pleasing structure. • The nature and persistence of media reporting of suicides from such sites

makes local history, tradition and myth. All these features likely combine to render a place as “an iconic site” for suicide.

People tend to make their choice of method of suicide based upon their

perceptions of what they understand to be certain to achieve death, • to be quick, • to be readily available, • and to avoid risk of disfigurement.For example, By jumping off bridges (Golden Gate Bridge) or minarets (Minar.e.Pakistan).

EPIDEMIOLOGY OF SUICIDE

• Suicide is the 10th leading cause of death in US.

• Suicide is 3 times more common in men than in women.

• Suicide rate is higher in elderly.• Suicide is lower in married people as

compared to the ones never married.• Highest in health care professionals.

CAUSES OF SUICIDE

MEDICAL FACTORS• Depressive Disorders………………….36-90%• Alcohol Dependence…………………..43-54%• Drug Dependence……………………….04-45%• Schizophrenic……………………………..03-10%• Personality Disorders……………….....05-44%• Past History of DSH• Poor Physical health• Chronic pain

CAUSES OF SUICIDE

SOCIAL FACTORS• High unemployment• Poverty• Social fragmentation• Media Coverage of suicide

CAUSES OF SUICIDE

BIOLOGICAL FACTORS• Family history• Decreased activity of serotonin

PSYCHOLOGICAL FACTORS• Hopelessness• Impulsivity• Aggression• Dichotomous Thinking• Cognitive Constriction• Problem Solving Deficits

Problems that can potentially trigger suicidal thoughts in a young person

• Death of a parent. • Divorce of parents. • Joining a new family with a step-parent and step-

siblings. • Breaking up with a boyfriend / girlfriend. • Moving to a new community. • Not feeling accepted by peers. • Being ridiculed by classmates. • Feeling misunderstood. • Any experience perceived to be "humiliating.” • Alcohol abuse. • Drug abuse.

Durkheim’s 4 TYPES OF SUICIDE

• ANOMICFeel morally lost and have no sense of direction in their lives.

Example: Sexually abused teenagers.

• EGOISTICLow social integrity. Doesn’t have anyone to talk to. Example: The elderly people.

• ALTRUISTICDie for a higher causeExample: suicide bombers. Kamikaze.

• FATALISTICGet tired of extreme rules & expectations. Feel oppressed of society. Example: Prisoners

RATIONAL SUICIDE & SUICIDE PACTSRATIONAL SUICIDEThe act of suicide based on reasoned decision by mentally healthy people.Example,Usually happens due to a charismatic leader who has strong convictions and is deluded.

SUICIDE PACTSTwo or more people agree that at the same time each will take his or her own life. Example,Usually lovers aged less than 30 years

SUICIDE AMONG THOSE TAKING PSYCHIATRIC TREATMENT

• Support patients intensively during the first few weeks after discharge from hospital.

• Plan in advance the steps that should be taken if the patient ceases to comply with the treatment.

• Monitor side-effects of drugs

• Ward Designs must be safe

• Risk of suicide increases in depressive disorder patients following initial treatment as psychomotor retardation decreases.

SUICIDE IN DOCTORS

• It has been found that doctors commit more suicide than any other profession. This is because:

• They are more exposed to people’s problems.• Know the exact dose of medication for committing suicide• Greater access to lethal drugs• Such professionals are expected to be physically and mentally

healthy and hence they are reluctant to seek treatment for suicidal ideation.

• Do not get quality treatment as it is assumed that such professionals know how to care for themselves.

• Greater risk of burnout.

SUICIDAL RISK

• There are two requirements for doctors to assess suicidal risk:

1. Willingness to make direct but tactful inquiries about a patient’s intentions.

2. Be alert to factors that predict suicide.

RISK FACTORS• Direct statement of intent• About two-thirds of those who die by suicide have told

someone of their intention.• Just before the act their maybe a subtle change in their way

of talking about dying.• Marked hopelessness• 40-60% patients with previous suicidal attempts• Social isolation• Older age• Chronic painful diseases• Depressive disorder• Borderline Personality disorder• Schizophrenia

ASSESSING SUICIDE usingSAD PERSONS SCALE

• Sex• Age• Depression• Past history of illness/Previous attempt• Ethanol or other substance abuse• Rational thinking loss (Psychosis, Cognitive Errors)• Separated/Single/Divorce/Widow• Organized Plan (high risk)• No social support• Stated intent (any future suicide plans)

Protective Factors from Suicide

• Researches have proven, religion and marriage to be two strong protective factors from suicide.

RELIGION AND SUICIDE

MANAGEMENT OF SUICIDAL PATIENTS

• Decide whether to admit patient In Ward or treat as Outdoor patient.

• Safe ward environment• Adequate number of well-trained nursing staff• Good working relationship between the staff and

between staff and patient• Assess risk• Agree the level of observation required• Remove objects that can be used for suicide • Discuss and agree on treatment plan with the patient

• Agree a policy of visitors• Clear communication between staff about

observations especially when the shift changes• Agree action to be taken if the patient leaves the ward

without permission• Agree date and plan for aftercare (follow-up)• Discuss the follow up and continued treatment plan

with those who’ll care for the patient• Medicine prescribed should be in adequate but non-

dangerous amounts• Arrange follow-ups and agree action to be taken if the

patient doesn’t attend

SUICIDE PREVENTION

• Better and more available psychiatric services• Restricting the means of suicide

(detoxifying gas, car exhaust fumes, drug overdose, points at prison or wards from where hanging might be possible)

• Encouraging responsible media reporting• Educational programs

(campaigns about mental illnesses)• Improved care for high risk groups• Crisis centers or hot line services