L10: Psychology of Suicidal Behaviour Flashcards
What is the prevalence of suicidal behaviour?
- more than 700.000 ppl die to suicide per year
- in nl, around 1850, 5 every day
- 4th leading cause of death among 15-29y olds
- 77% of global suicides occur in low- and middle income countries
- ingestion of pesticides, hanging & firearms are most common methods
- more men than women die by suicide
How can we identify specific groups at risk for suicide using methodology?
use disaggregated rates at least by sex, age, and method
-> provides info necessary for understanding the issue & allows us to tailor prevention strategies
What are some trends in suicide prevalence?
- higher rates in men than women (male female paradox)
- more in low income countries, but percentage wise more in high income (vulnerability paradox)
- more in under age of 50y
- decrease in last 20years, everywhere but in americas
What could explain the male female paradox in suicide?
- men are more aggressive so use more deadly methods of suicide
- worse at talking about feelings
- cultural aspect (that there is an image that men dont do attempts they do suicides)
What are the myths on suicide?
- Asking about suicide puts an idea into someone’s head
- Most people die by suicide during the Christmas holidays
- Someone thinking of suicide wants to die
- The media influences the number of suicides
- Antidepressants increase the risk of suicide
- Artists have an increased risk of suicide
- Suicide runs in the family
- Women mostly talk about suicide, men die more often
- Suicide rate rises during an economic recession
What do we mean by suicidal behaviour?
Suicide, suicide attempt
suicide: the act of deliberately killing oneself
suicide attempt: any non-fatal suicidal beahviour, intentional self inflicted poisoning, injury, or self harm, which may or may not have a fatal intent or outcome
suicidal behaviour: range of behaviours that include thoughts about suicide (or ideation), suicide plans, attempting suicide, and suicide itself
What are the risk factors for non-fatal suicidal behaviours?
- being a woman
- being young
- being unmarried
- being socially disadvantaged (low income & education, or unemployed)
- presence of a previous psychiatric disorder (tho most psychiatric patients never become suicidal)
- not feeling like part of a group
What, according to the Oconnor paper, are the main groups of factors associated with suicide risk?
- personality & individual differences
- cognitive factors
- social factors
- negative life events
What personality & individual differences factors play a role in suicidal behaviour risk/protection?
higher risk if
- hopelessness
- impulsivity
- perfectionism
- neuroticism
- low extraversion
- optimism
- resilience
What cognitive factors play a role in suicidal behaviour risk/protection?
higher risk if
- cognitive rigidity/inflexibility (so think suicide is only option)
- rumination
- thought suppression
- autobio memory biases (cant remember autobio memories well)
- lack of perceived belongingness
- perceived burdensomeness
- fearlessness about injury/death
- pain insensitivity
- difficulties problem solving & coping
- agitation
- implicit associations with death & self
- attentional biases towards suicide & death
- impaired positive future thinking on future & goal adjustment
- little desire to live
- defeat & entrapment
What social factors play a role in suicidal behaviour risk/protection?
increased risk if
- social transmission (history of suicide/suicidal behaviour around you)
- modelling (ex in media)
- social isolation
What negative life events play a role in suicidal behaviour risk/protection?
increased risk if
- childhood adversities
- traumatic life events in adulthood
- physical illness
- other interpersonal stressors
- psychophysiological stress response
What are the difficulties associated with research on suicidal beahviour?
- a lot of suicidal behaviour is invisible (happens at home)
challenges with registration - suicide rates vary between countries from 0-44 per 100k
- of the whos 170countries, 80 provide good quality data
- lots of differences between these countries!!
- suicide often miscoded due to stigma
What is the vulnerability paradox?
the countries that at a national level have the best protective factors against suicide (like health system, good education, safety)
tend to have higher suicide rates per 100k
What could explain the vulnerability paradox?
in more developed countries theres:
- more individualized societies
- more good counting & stats on the figures
- we die less by other things
What has been the change in suicide rates 2000-2019?
- absolute figures: red from 883k to 703k
- age standardized suicide rate reduced by 36%
- 17% reduction eastern mediterranean region
- 47% reduction in EU region
- 49% reduction in western pacific
- in americas, increase by 17%
in netherlands suicide rates have been stable since in 2013
What are some suicide prevention strategies on the societal & community levels?
- societal level: awareness campaings
- community level: focus on discriminated groups
How do we measure how many suicide attempts are happening?
- from medical records
- self reports in surveys of community residents (NEMESIS)
What are the methodological challenges w registring suicide attempts?
- changing survey instruments
- changing samples
- time-frame might change ppls attempts
- literacy of sample
- different languages
- stigma
- fluctuation of suicidal behaviour over time
What is NEMESIS II?
- large longitudinal national study on occurence of mental health problem in NL
- different instrument used in most recent wave: for the first time suicidal behaviour was measured as separate topic, not as part of depression section
- asks in an indirect way about suicdality
What were the nemesis II findings?
- suicidal thoughts: 8.3
- suicide attempt: 2.2
- of the ppl w suicidal thoughts, 58% had depression
- the other way around: 26% of ppl w depression had suicidal thoughts
- 70% of ppl w histroy of suicide attempt also had depression
- other way around: 8.4% of ppl w depression also had suicide attempt
What is the goethe or werchter effect? and papageno effect?
that media can affect suicidality: like any positive attention to suicide (idealization)
(13 reasons why, when celebrity dies, when method is mentioned)
papageno: some media can also have positive effect if character overcomes it
What are some important strategic goals in the national agenda for suicide prevention?
- dare & learn to talk about suicide
- train professionals
- invest in suicide prevention in the neighbourhood
- increase reach of specific risk groups (like middle aged men)
- improve care by collaboration between professionals, loved ones & ppl w lived experiences
- limiting access to means (like fences around railways)
- develop national learning system (learn from data)
What are the different theoretical models of suicidal behaviour?
- Durkheim wrote on societal role of suicide
- Baumeister: suicide as escape from self
- interpersonal theory of suicidal behaviour
- integrated motivational volitional model of suicidal behaviour
How does Joiner’s interpersonal theory of suicidal behaviour explain suicidal behaviour?
thwarted belongingness (i am alone) & perceived burdensomeness(i am a burden) -> suicidal desire, ideation, thoughts
if this suicidal desire + capability for suicide -> high risk of serious suicide attempt
How does the integrated motivational-volitional model of suicidal behaviour conceptualize suicidal behaviour?
as a behaviour (rather than a byproduct of mental disorders) that develops through motivational & volitional phases
- motivational phase describes factors that rule the dev of suicidal ideation intent (here feelings of defeat & entrapment are central)
- volitional phase describes the factors that determines whether someone attempts suicide
Define entrapment (from the integrated suicide model) & its 2 sub-types
- the experience of “defeat” and “humiliation” from which there is no escape
- internal entrapment: i want to escape from myself/my own thoughts
- external entrapment: i want to escape from my situation
- some debate about whether defeat = entrapment (“i feel i have not made it in life, i feel powerless”)
What are the volitional moderators from the integrated suicide model?
aka the factors that make u go from suicidal ideation to behaviour
- access to means
- planning
- exposure to suicide or suicidal behaviour
- impulsivity
- physical pain sensitivity/endurance
- fearlessness about death
- mental imagery
- past suicidal behaviour
Is it possible to treat suicidal behaviour?
- there are no interventions that give great effects
- we dont know which treatment works best in which situation
What are the different treatments of suicidal behaviour?
- recognise these issues
- ++ interventions give small effects so offer min 1 of these to at risk patients
- look at how far some interventions, like online ones, can reach!
- safety planning!
- CBT/IPT: problem solving or cognitive therapy focused on suicidality
- Dialectical behavioural therapy
- Collaborative Assesment and Management of Suicidality (CAMS Framework)
How does CBT focused on suicide prevention work?
10-12 outpatient sessions
1st phase: suicide risk assessment, treatment plan, safety plan, & skills training on emotion regulation and crisis management
2nd phase: identify & challenge patients maladaptive beliefs & self statements that contribute to suicidality (like hopeless)
3rd phase: relapse prevention task
how can we improve the monitoring of suicide?
- improve death registration
- improve cause-of-death collection
- improve regular household health surveys
- improve complete facility recording
