5- Suicide & NSSI Flashcards
Definitions (7)
- Suicide: Death resulting from intentional self-injurious beh, associated with any intent to die as a result of the beh
- Suicide Attempt: A nonfatal self-directed potentially injurious beh with any intent to die as a result of the beh
- Interrupted Attempt: A person takes steps toward making a suicide attempt but is stopped by another person prior to any injury or potential injury
- Self-interrupted/ Aborted Attempt: A person takes steps to injure self but stops self prior to any injury or potential for injury
- Preparatory acts or beh: Acts or preparation toward making a suicide attempt
- Suicidal Ideation: Thoughts of suicide * Passive vs. Active ideation (doesn’t = want to die)
- Non-suicidal self-injurious behavior: Behavior that is self-directed and deliberately results in injury or the potential for injury to oneself
Suicide Elements
15th leading cause of death around the world (1.4% of all deaths)
In Canada: Approx. 4,500 deaths by suicide each year
Lifetime prevalence rates in Canada (stigma so probs underrep):
- Thoughts: 12%
- Plans: 4.2%
- Attempts: 3.1%
*All mental dx increase risk of suicidality (Especially depression) => Most people who die by suicide have at least one previous psychological dx and comorbidity increases risk
Key elements:
- Agency => Self-initiated, not necessarily self-inflicted (ex: picking a fight in a bar)
- Intent => Non-zero intent to die
- Outcome => Actual or perceived potential for death (person themselves)
Suicidal Beh Dx - DSM-5
Prior to DSM-5, suicide and NSSI were listed as sx of depression and BPD => Recognition that suicide and NSSI occur across dx categories
DSM-5 now includes under “conditions for further study”:
- Suicidal Behavior Disorder
- Non-Suicidal Self-Injury Disorder
Dx Criterias:
- Individual has made suicide attempt in last 24 months => Rule out NSSI AND Not applicable to just SI
Research Methods
Archival:
- Data is obtained from pre-existing records, databases => Look at how variables relate to each other at any given moment
Psychological Autopsy:
- Reconstruct what a person was like before the suicide through interviews with family, friends, co-workers, etc.
Surveys/Interviews:
- Ask participants questions related to their internal processes, emotions, thoughts, beh, etc. *Neg bias
Prospective/Longitudinal:
- Screen, identify, follow individuals over time to examine beh, attempts, or suicide deaths *Bad at predicting attempts, no single risk factor, would need big sample
Big Data:
- Passively collect data from individuals (e.g., geolocation, social media, activity trackers, phone calls, purchasing history, etc.)
Challenges to Research
- Correlational
- Rare => Need 100 so get 20 000 ppl
- Etiologically complex
- Difficult to study longitudinally
- Stigma/legal constraints
- Replication
Gender and Ethnicity
Gender Diff:
Women are more likely to think about suicide + attempt suicide vs men BUT Men are 4x more likely to die by suicide vs women
Changes over time? =>Increases especially for women (50%) vs. men (21%) from 1950 to 2015
Reasons for Diff?
- Rates of psychopathology
- Lethal means*
- Greater intent? x
- Access to means
- Mental health care => Women + in therapy
- Cultural acceptance
Race/Ethnicity:
Death by suicide/higher risk: Kids = Black* vs White and Adults = White* vs Black
=> Canadian First Nations people have among the highest rates of suicide in the world *Not equally distributed across First Nation pop
- Durkheim: Suicide caused by lack of social anomie => Evidence from studies using language as a proxy for community cohesion
*Higher community rates of a number of risk factors (ex: subs use, violence, poverty)
Age and Youth Suicidality
In Canada, suicide is 2nd leading cause of deaths among youth and young adults =>Youth suicidality specifically is drastically increasing
Why?
- Increased academic pressure?
- Changes in family structure?
- Increases in substance use?
Study: Jean Twenge proposes this might be associated with increased use of social media among youth => Reduced social connection?
Assessed: Depressive dx and suicidality + Social media use
Results:
From 2010 to 2015, saw increases in:
- Depressive symptoms (33% more)
- Suicide-related outcomes (12%)
- Suicides (31%)
- Increases in social media use (decrease in non-screen time act)
=> Positive correlation between screen time and depressive symptoms and suicide-related outcomes
Exposure-response relationship
Limitation: Correlational, Third variable, Reverse causation?
Risk Factors
Risk factors are NOT warning signs (immediately in crisis) => Some are modifiable (ex: depression, access to lethal means), and some are not (ex: race, genetic predisposition, family history of suicide)
Reducing risk factors and increasing protective factors can help prevent suicide (we think…)
*Biggest thing that predict another suicide attempt = past attempt
Biological Factors
Evidence from twin studies that suicidal beh are genetically- influenced
Adoption studies: Rates of suicide in biological relatives of adoptees who died by suicide higher vs rates in adopted families
=> Result of more general familial transmission of psychopathology? Or specific to suicide?
What is inherited (diathesis)?
- Impulsivity
- Fearlessness
Impulsivity has many dimensions:
- Negative Urgency higher in SI and SA (compared to controls) => Tendency to act impulsively in face of negative emotions
- Poor Premeditation higher in SA => Diminished ability to think through consequences of one’s actions
Fearlessness, reduced pain sensitivity among SA (but not SI)
Cog Models
Joiner’s Interpersonal-Psychological Model
Ideation-to-action?
Two proximal and sufficient causes of suicidal ideation:
- Perceived burdensomeness
- Thwarted belongingness
Need presence of learned factor:
- Acquired capability => Has 2 components: Reduced fear of death and Increased pain tolerance
=> Acquired through repeated practice, habituation or exposure ex: violent video games, vet students, combat exposure
Three-Step Theory (3ST)
Ideation-to-action model
- Step 1: SI develops from pain & hopelessness
- Step 2: Connectedness is protective factor
- Step 3: Three components to suicidal capacity: Acquired (learned in env), Dispositional, Practical (do you have what means you intend to use)
Distinguishing SA from SI
All 3 SI vs controls see a diff:
- Depression/anxiety
- PTSD
- Depressive dx
SA and SI can’t tell diff
Suicide Contagion
Identified suicides on front page of The New York Times and tracked monthly suicide rates => Found “copycat suicide” effect
Suicide rates influenced by:
- Similarity to person
- Frequency of reporting
- Content of media reporting
Unclear mechanisms of how suicide contagion occurs => Social norms? (“glamourizing”) Learning/modeling?
Ex: 13 Reasons Why => Goal to “raise suicide awareness” => Suicide-Related + Prevention/Hotline = + in Google searches
Rates among youth: Tested whether increase in suicide rates in 3 months following release
- 13.3% increase in suicides among 10-19 year-olds => Above and beyond the generally increase trend over time (correlational) => Issue: can’t tell who actually watched the show
Brief Intervention
No Suicide” Contract => Suicidal patient commits (verbal or written agreement) to not engaging in suicidal beh *No evidence for effectiveness
Safety Planning Intervention “ride the wave” => Help patient develop tools and coping skills to manage SI and SA *Meta-analysis shows its effectiveness and feasibility
NSSI Course
Like suicide attempts, NSSI onset tends to peak during adolescence/ young adulthood =>NSSI has slightly earlier age of onset (~13) vs SA (~16)
Rates of NSSI may decrease with middle age
Lifetime prevalence of NSSI: 13-28% worldwide and in clinical samples as high as 80% => Prevalence fairly stable in world
NSSI Gender, Ethnicity and Sexual Orientation
Gender differences are inconclusive => Some studies suggest females engage in NSSI at a higher rate than males, other studies find no difference
=> But, might be differences in terms of method used:
- Women engage in more cutting
- Men engage in more hitting, burning, and head banging
Rates of NSSI higher in LGBTQ individuals vs heterosexual => Higher risk during coming-out process
No definitive studies on race/ethnic differences
