CP Suicide Prevention (lecture 4) Flashcards
Why is it important that we discuss and learn about suicidality?
- Its common in patients with all kinds of mental disorder
- Its a taboo topic
- Awarness helps feeling more confident
- However, it’s not in the DSM-V
Suicidal ideation
Thoughts of killing oneself
Much more common than attempted or completed suicide
Suicide attempts
Involve behaviours that are intended to cause death
- Most suicide attempts don’t result in death
Suicide
Involves behaviours that are intended to cause death and do so
Nonsuicidal self-injury (NSSI)
Involves behaviours that are meant to cause immediate bodily harm but are not intended to cause death
- most common in early adolescence
- those who try NSSI do so less than 10x
- those who persist - risk factor for suicifal ideation and behaviour
- Influences: social factors (social modelling, reinforcement from friends and family but caring all of a sudden), experience of intense emotions, self-critical beliefs (deserve punishment)
What are the four types of suicide according to Emile Durkheim?
- Egoistic
- Altruistic
- Anomic
- Fatalistic
Egoistic suicide
- Stems from absence of social integration
↪ Low level of social integration - Don’t fit in society, feel unloved and alone
- See suicide as a solution to free themselves from the loneliness and excessive individuation
Altruistic suicide
- Social group involvement is too high
↪ High level of social integration - Willing to sacrifice their own life in order to fulfill some obligation for the group (religion or political)
- E.g. Japanese Kamikaze pilots of WWII
Anomic suicide
- Low level of social regulation
- Occurs during high levels of stress and frustration
- Stems from sudden and unexpected changes in situations (e.g. financial loss, uneployement…)
Fatalistic suicide
- High level of social regulation
- Occurs when individuals are kept under tight regulation - extreme rules or high expectations are set upon them (e.g. slavery, persecution)
↪ removed sense of self or individuality
Risk factors for suicide
- Psychological disorders
- Neurobiological
- Social influences
- Psychological influences
Psychological disorders as a risk for suicide
2/3 who attempt suicide have history of psychological disorders but most people with psychological disorders don’t die from suicide
Neurobiological factors
- Twin studes: heritability accounts for 50% of the likelihood of suicide attempts
- Disruptions of the serotonin system - PET
- Overly reactive HPA system (stress system)
Social influences
- a cluster of suicides occurs after media reports of the suicide of a celebrity (but clusters of suicide are still rare)
- lack of social belonging, perceived sense of burden to others, interpersonal conflict (as well as divorce or widowed), peer victimization
- economic recessions
Psychological influences
- feeling of being defeated and inescapability of the problems that lead to defeat
- increased when: problem-solving deficits
- loss of hopefulness
- life satisfaction
Our lecturer contributed in writing a guildline about suicidality. Why did it take so long to have something like this available for clinicians to use in practice?
- Suicidal behaviour is seen as a by-product of mental disorders (e.g. depression)
- Hence, there’s a misconception that when you treat the mental disorder, the suicidal ideation will go away. That is not always the case
What are some common myths about suicidality?
- Talking about suicide will increase the chance someone will act on it
- Most people die by suicide during the Christmas Holidays
- Someone thinking of suicide wants to die
- The media influences the number of suicide
- Artists have an increased risk of suicide
- Women mostly talk about suicide, men die more often
What were the results of a study on the myth Talking about suicide increases the chance someone will act on it?
- One of four GPs and one in five patients supported the notion that screening for suicidal ideation could increase the likelihood of someone thinking about or actually harming themselves
↪ The research found that it’s not true - actually the opposite is true; talking about it helps relieve the sense of isolation - The whole suicidal process is a long process - doesn’t happen just because someone asked about it
- But it depends on how the clinicians ask about it
What is the situation currently like with training professionals about suicidality in their patients?
Most GPs had not received any formal training in how to assess suicide risk
Many professionals ask in a wrong way, are hesitant
↪ results in patients not disclosing and not being honest
What is an estimate of how many people day every year due to suicide?
- estimated 800 000 people: 1 every 40 seconds
- In the Netherlands, around 1850 people: 5 people every day
What are key facts about suicidality that all clinicians should be aware of?
- For every suicide there are many more people who attempt suicide
↪ Females have more attempts but men actually die more often because they use more lethal methods - Population based studies found that each year, 3% (350 000) of the Dutch adult population have serious suicidal thoughts
- 77% of global suicide low- and middle- income countries (BUT! see next flashcard)
- Ingestion of pesticide, hanging and firearms are among the most common methods of suicide globally
Vulnerability paradox
Most suicides come from low- and middle- classes because they are the majority in the world. But there is a higher suicide rate among high-income countries compared to low- or middle- classes.
How does people’s thinking about suicide changed over the years?
Ancient Greek - suicidal behaviour saves your soul, you have control over your life
Middle ages, western countries - suicide became illegal
After the Enlightenment - became more liberal, people should be able to decide what they want to do with their lives
Why is suicidality a taboo topic?
Because it reminds us of our vulnerability which we are often afraid of and don’t want to face it.
Also, it’s very much against the social norms
↪ if people are reminded of their vulnerability they conform to norms more
What is the most common thing that clinicians do when they are confronted with suicidal thoughts in their patients?
They try to provide solutions because it’s difficult to endure the suicidal ideation (face their vulnerability)
What should we/clinicians do when we are confronted with suicidality?
The basic model has 4 steps:
1. Ask questions if you have at least some rapport with the person, not straight after someone discloses their sadness
2. Tune in to the distress (don’t just say that they should have happy thoughts)
3. Tap into the hope
4. Safety and referral
Most importantly, be empathetic, do not try to solve
Interpersonal theory of suicidal behaviour
Very infuential theory - closed the gap between thoughts and actions
Three conditions need to be met for a person to decide that they are gonna commit a suicide
First suicidal thoughts must be there! Desire for suicide:
1. Thwarted belongingness (I am alone)
2. Perceived burdensomness (I am a burdem)
↪ Suicidal thoughts are much more common than the attempts
3. Capability for suicide (no fear of death - self-harming, less pain sensitivity)
↪ After this third one is met > lethal (or near-lethal) suicide attempts
What is the important model to understand suicidal behaviour?
Three phases
1. Pre-Motivational Phase
2. Motivational Phase
3. Volitional Phase
Model of suicidal behaviour
Pre-Motivational Phase
Background Factors & Triggering Events
- Diathesis + environment + life events
Model of suicidal behaviour
Motivational Phase
Ideation/Intention Formation
Steps: Defeat & humiliation > Entrapement > Suicidal ideation & intent
Motivational phase
Moderators between each step
Defeat & humiliation
↪ Threat to Self moderators, e.g. social problem-solving, coping, memory biases, ruminative processes
Entrapement
↪ Motivational moderators, e.g. Thwarted belongingness, burdensomeness, future thoughts, goals, norms, social support, attitudes
Suicidal ideation & intent
↪ Volitional moderators, e.g. capability, impulsivity, implementation intentions (planning), access to means, imitation
↪ These are already in the volitional phase - if they have these, they’re attempting at suicide
model of suicidal behaviour
Volitional phase
Behavioural enaction = suicidal behaviour
Depending on the volitional moderators
What are the two psychological ways to prevent suicides?
- Treating the associated psychological disorder (meds and ECT for mood disorders, antipsychotics for schizophrenia)
- Treating suicidality directly
- Programs to study suicidality and prevent it at the same time (within military - higher rates of suicide than general public)
- Means restriction (making highly lethal methods less available)
Treating suicidality directly - three strategies
- CBT - challenge negative thoughts, tolerate emotions of distress, develop safety plan of coping startegies in case of suicidal crisis
- DBT - CBT specifically for self-harming patients
↪ safety plan, mindfulness, acceptance, emotion regulation through individual and group therapies - CAMS - identify possible drivers of suicidal thoughts and then develop techniques to target those concerns
Important things to remember
- You can ask people about suicidal thoughts
- Most people with suicidal thoughts do not want to die
- Even experienced professionals find it difficult to dicuss suicidal behaviour
