337 suicide and NSSI

Question 1

suicide attempt

Answer 1

nonfatal self-directed potentially injurious behaviour with an intent to die

Question 2

suicidal ideation

Answer 2

• thinking about, considering, planning suicide
• can be defined very broadly or specifically, not always conceptualized the same way which makes it hard to study

Question 3

NSSI vs. suicide attempts

Answer 3

• both highly correlated, also with depression and suicidal ideation
• NSSI more prevalent and frequent, different methods, less severe, performs different functions

Question 4

NSSI functions

Answer 4

• to relieve negative emotions/regulate affect
• not with intent to die
• interpersonal: autonomy (sense of independence), interpersonal boundaries (who I am vs. others) or influence (trend), peer bonding, revenge (rarely endorsed), sensation seeking, toughness
• intrapersonal (frequently endorsed): affect regulation, anti-dissociation, anti-suicide, marking distress, self-punishment

Question 5

why is suicide difficult to study

Answer 5

• stigma
• low base-rate phenomenon
• cannot be studied retrospectively, so must be studied longitudinally which requires very large samples
• studying proxies for suicide because we can’t study suicide as an outcome which may not be representative
• ethically researchers must intervene if an attempt is imminent
• etiologically complex (difficult to get a good holistic picture)
• not much replication work

Question 6

epidemiology of suicidal behaviour

Answer 6

• high-income countries have higher rates of suicide
• men are 3x more likely to die from suicide (disparity even larger in high-income countries)
• women make more attempts than men, deaths by suicide are increasing for women
• sex and age patterns differ according to economic status of country and time
• death by suicide is more common in kids and younger adults
• sexual and gender minorities have higher rates
• white and First Nations have highest rates
• young children have much lower rates of suicide, except Black youth who have higher rates of death by suicide

Question 7

which disorders are more associated with suicidal behaviour in types of countried

Answer 7

• developed: PTSD, bipolar, MDD
• developing: PTSD, conduct, SUDs

Question 8

psychosocial predictors of suicidal ideation and attempts

Answer 8

• depression, hopelessness, impulsivity
• impulsivity hastens transition from through to action

Question 9

Edwin & Shneidman’s theory of suicide

Answer 9

• psychache (emotional pain) is the primary motivator (threshold has been surpassed)

Question 10

Roy Baumeister’s theory of suicide

Answer 10

• motivated by a need to reduce aversive self-awareness

Question 11

Thomas Joiner interpersonal theory of suicide

Answer 11

• perceived burdensomeness and low belongingness as motivators & hopelessness about both these things create desire for suicide
• capability to act on suicide desire requires overcoming fears of death and pain

Question 12

superordinate dimensions of suicide motivators

Answer 12

• internal self-oriented: hopelessness, psychache, need to escape, etc. (associated with greater intent to die and more preparation)
• communication other-oriented: desire to seek help, communicate, etc. (associated with lower suicidal intent because they represent a continued connection to people and desire to maintain connection)

Question 13

therapies and prevention for suicide

Answer 13

• dialectical behaviour therapy (for BPD)
• cognitive therapy for suicide prevention (CT-SP) based on Beck’s theory
• collaborative assessment and management of suicide risk (CAMS)
• prevention: reduce access to means, school-based interventions,

Question 14

ideation-to-action framework

Answer 14

• risk factors can predict ideation, but not attempts (difficult to study how one progresses from thought to action)
• Joiner’s interpersonal theory
• integrated motivational-volitional theory (O’Connor)
• mental disorders (depression), impulsivity, hopelessness are predictors of ideation
• specific disorders (PTSD), poor premeditation, access to lethal means are predictors of attempts

Question 15

integrated motivational-volitional theory of suicide (O’Connor)

Answer 15

• defeat and entrapment are predictors of suicide desire
• acquired capability, access to lethal means, planning, impulsivity explain the progression to action

Question 16

3-step theory of suicide

Answer 16

• first step: psychological pain (one’s existence is being punished with pain) and hopelessness about the future
• pain can be isolation, high burdensomeness and low belonging, defeat and entrapment, etc.
• second step: pain exceeds connectedness (to other people, a sense of purpose, an interest, etc.) and then ideation will escalate
• third step: ideation progresses to attempt through capacity (fear of death is difficult to overcome)
• capacity can be dispositional (lower pain sensitivity) or acquired (habituation to pain, injury, death), or practical (knowledge or and access to lethal means

Question 17

suicide

Answer 17

death resulting from intentional self-injurious behaviour, associated with an intent to die as a result of the behaviour

Question 18

interrupted attempt

Answer 18

takes steps toward making a suicide attempt but is stopped by another person prior to any injury or potential injury

Question 19

self-interrupted/aborted attempt

Answer 19

takes steps to injure self, but stops self prior to any injury or potential for injury

Question 20

preparatory acts or behaviour

Answer 20

acts or preparation toward making a suicide attempt

Question 21

non-suicidal self-injury

Answer 21

• behaviour that self-directed and deliberately results in injury or the potential for injury to oneself WITHOUT the intent to die (destruction of tissue not for socially sanctioned purposes)
• low-lethality methods, people often use more than one
• people who endorse suicide attempts report using the same method but with higher lethality
• may have addictive properties (increasing severity or frequency to achieve the same effect)

Question 22

key elements of suicide

Answer 22

• agency: self-initiated behaviour (not necessarily self-directed)
• intent: some desire for death
• outcome: actual/perceived potential for death

Question 23

common research methods in suicide

Answer 23

• archival: looking at existing death records and how variables relate to each other
• psychological autopsy: reconstruct what a person was like before suicide through interviews with friends, family, etc. (gets individual-level predictors, but not from the person themselves)
• big data: passively collect data from individuals and mapping it onto known suicide attempts to reconstruct psychological variables
• experimental: comparing performance on tasks for people with attempts or without attempts
• treatment studies: randomly assign to treatments or controls and compare outcomes
• meta-analysis: looking at real effect sizes and associations

Question 24

explanations for gender differences in suicidal behaviour

Answer 24

• women have higher rates of disorders associated with suicide attempts
• men tend to die by more lethal means (firearm), likely because they have more access to more lethal means
• greater intent? access to means influences the results of studies about this
• women seek treatment and receive services for suicidal ideation
• cultural acceptance: suicide attempts are seen as a cry for help (‘feminine’), so men not seeking help or reporting attempts
• women receiving more support from family and friends, men unlikely to seek support

Question 25

suicide and First Nations populations

Answer 25

• highest rates of suicide in the world
• not equally distributed in different communities
• youth living in communities with greater knowledge of their language (proxy for connectedness) have lower rates of suicide
• Durkheim’s theory
• in Indigenous reserves, higher rates of risk factors for suicide (poverty, alcohol use, family violence, access to lethal means)

Question 26

Durkheim’s theory

Answer 26

• feeling of becoming disconnected from people around you (lack of belonging in the world)
• this sense accounts for population-wide rates of attempts and deaths

Question 27

most common methods to attempt suicide

Answer 27

1. Poisoning
2. Cutting
3. Stabbing

Question 28

most common reasons for death by suicide in US

Answer 28

1. firearm
2. suffocation
3. poisoning
4. fall

Question 29

most common reasons for death by suicide in Canada

Answer 29

1. hanging
2. suffocation
3. poisoning
4. firearm

Question 30

risk factors for suicide

Answer 30

• not warning signs
• can be modifiable or not
• include many disorders, alcohol/drug abuse, impulsivity, aggressivity, perfectionism, abuse, chronic and physical illness, family/friend history of suicide, stressful events, NSSI, past attempts, etc.

Question 31

proximal risk factors for suicide

Answer 31

• intoxication (usually alcohol)
• younger age
• access to means

Question 32

protective factors for suicide

Answer 32

• psychosocial/pharmaceutical treatment
• lithium for BP, clozapine for psychosis
• reducing aggressive behaviours in younger people can delay or prevent onset in adulthood
• culturally-influenced coping strategies (moral objections to suicide, high family support in Latinx communities = lower rates of suicide)

Question 33

suicide contagion in the media

Answer 33

• rates of suicide influenced by frequency of media reporting, content of media reporting (explicit about methods), positive/negative reporting biases (attitude toward suicide, portrayal of attempters)
• more likely to experience contagion if the person is characteristically or demographically similar
• glamorizing the victim and attempt could increase risk (13 Reasons)

Question 34

biological factors in suicide behaviour

Answer 34

• genetically influenced
• what is inherited is likely a predisposition toward impulsivity, fearlessness, disorders associated with suicide

Question 35

impulsivity and fearlessness in suicide

Answer 35

• specific subdimensions of impulsivity (poor premeditation, sensation-seeking, poor perseverance, negative urgency) are more related to suicidal behaviour
• poor premeditation more related to attempters, while more negative urgency is high in both ideators and attempters
• sensation-seeking and perseverance not related to ideation or attempts
• fearlessness and lower pain sensitivity

Question 36

environmental influences on capability

Answer 36

• capacity can arise through practice, habituation, experience (playing violent video games, exposure to euthanasia, treating injuries, surgery)
• research is cross-sectional/correlational (could be an active GxE)

Question 37

study looking to distinguish suicide attempters vs. ideators

Answer 37

1. depression severity (suicide ideators vs. no ideation)
2. PTSD (suicide ideators vs. no ideation)
3. depressive disorder (suicide ideators vs. no ideation)
4. hopelessness
5. anxiety disorder
6. drug use disorder
7. alcohol use disorder
8. sexual abuse
9. marital status
10. race
11. gender
12. education
    - these are correlated with general suicidality, but none of these factors distinguished ideators vs. attempters

Question 38

NSSI course and prevalence

Answer 38

• peaks during adolescence/young adulthood
• earlier age of onset (13) than attempts (16)
• rates decrease in middle age
• lifetime prevalence 13-28% (much higher in clinical samples)
• prevalence is stable worldwide

Question 39

common methods of NSSI

Answer 39

• cutting
• skin abrading
• interfering with wound healing
• banging/self-hitting
• burning

Question 40

sexual orientation and gender NSSI

Answer 40

• male-female rates are inconclusive (despite the conception that it’s more common in females)
• higher rates in LGBTQ+ and may peak during the coming out process
• risk somewhat more pronounced for males than females

Question 41

NSSI in real-time study

Answer 41

• ecological momentary assessment to see what variables in the real world predict NSSI
• assessing frequency, duration, intensity of NSSI thoughts, the context of the impulse before, during, after
• intense but brief thoughts about NSSI = more likely to engage (negative urgency)
• thoughts about NSSI likely to arise when feeling overwhelmed or scared/anxious
• engaging in NSSI likely to occur when feeling rejected, self-hatred, numbness
• function was to decrease or distract from negative thoughts (regulating affect)
• negative reinforcement because NSSI does reduce negative affect
• hourse preceding, slow increase in NA and decrease in PA, peak during NSSI, then NA decreases and PA increases

Question 42

NSSI relationship to suicide

Answer 42

• attempters likely to have a history of NSSI, but many people engaging in NSSI do not attempt suicide
• repetitive/severe NSSI is a strong predictor of attempts
• likelihood of ideation in people engaging in NSSI
• NSSI as a means of increasing capacity (practice/experience)
• but temporal ordering still unclear