Lecture 10: The psychology of suicidal behaviour Flashcards
myths about 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 influence 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
suicide=
the act of deliberately killing oneself
suicide attempt=
any non-fatal suicidal behaviour, intentional self-inflicted poisoning, injury or self-harm, which may or may-not have a fatal intent or outcome
suicidal behaviour refers to a range of behaviours that include…
thinking about suicide (or ideation), planning for suicide, attempting suicide and suicide itself.
hoeveel mensen overlijden aan suicide elk jaar
more than 700.000 people worldwide, 1850 in NL
suicide is the … leading cause of death
4th
hoeveel .. van de suicides in low en middle income countries
77%
most common methods
ingestion of pesticide, hanging and firearms
language matters:
In Dutch:
* “Suïcide” often used by researchers and policy makers
* “Zelfmoord” in media and debate
* Bereaved give preference to “zelfdoding”
In English
* Instead of commited suicide we use died by suicide
* Instead of suicide attempters we use people that did a suicide attempt
gender paradox in suicide
females more depression, thoughts and attempts, but more deaths in males
- more aggresive
- worse in talking about feelings
- cultural aspect? (in china meer vrouwen die doodgaan door suicide)
wat is lastig aan suicide meten
ze geven per land op hun eigen manier door wat voor doodsoorzaak er was, dus dit kan in sommige landen beter gemeten worden dan in andere landen
vulnerability paradox =
hoe meer geld er in gestopt wordt (meer resources, meer investeringen), hoe meer suicide, depressie en ptsd
- more individualized?
- betere registratie?
- minder dood gaan door andere oorzaken? (infecties, homocide)
wat is de trend in suicides
according to the WHO, suicides are actually decreasing, behalve in americas (however, according to media - they are increasing). het aantal zelfdodingen is sinds 2013 min of meer stabiel
change in suicide rates 2000 - 2009
- Absolute figures: reduction from 883,000 to 703000
- Age standardized suicide rate reduced by 36%
- 17% reduction eastern Mediterranean region
- 47% reduction in EU region
- 49% reduction in Western Pacific
- In the Americas Region, rates increased by 17% in the same time period
suicide attempt kenmerken burden
- Social and economic burden
- Impact on the person and loved one’s
- Utility of health services
- Best predictor of future suicidal behavior
suicide monitoring
- Monitoring helps prevention strategies
- Combined with suicidal deaths helps to estimate the case fatality rate of suicidal behavior
- Two methods of data collection:
1. Self reports in surveys of community residents (In the Netherlands Nemesis)
2. From medical records
methodological challenges of measuring suicide attempts
- Different survey instruments
- Different sample
- Different language
- Literacy of sample
- Time-frame
- Stigma
- Fluctuations of suicidal behavior over time
nemesis II
- Large longitudinal national study on the occurrence of mental health problems in the Netherlands
- First was in 1996, second in 2007. New wave started in 2019.
- In new wave different instrument was used (CIDI 3 versus CIDI 1).
- For first time as a separate topic, not as part of depression section
- CIDI-3 asked in an indirect way about suicidality, via cards
NEMESIS 2 uitslagen prevalentie suicidal thoughts and suicide attempt
- thoughts = 8.3
- attempt = 2.2
wat is de relatie tussen suicidal thoughts and depression
- Of the people with suicidal thoughts, 58% had depression
- THE OTHER WAY AROUND: 26% of people with depression had suicidal thoughts
wat is de relatie tussen suicide attempts en depression
- 70% of people with a history of a suicide attempt also had depression
- THE OTHER WAY AROUND: 8.4% of people with depression also made a suicide attempt
hoe zit het in nl met suicidepreventie
in NL veeeeel investeringen gedaan, maar sinds 2013 is het stabiel -> had het geen nut? of was het anders hoger geweest?
waarom zit er zo’n verschil tussen de economische recessie en covid
bij covid iedereen in hetzelfde schuitje, toen geen increase in suicides
do’s in suicideprevention
- provide info on where and how to seek help
- recognize that media professions may themselves be affected when covering these stories
- do apply caution when reporting celebrity suicides
- do educate the public wit hthe facts about suicide and suicide prevention based on accurate information
- educate the public with facts about suicide
- report stories of how to cope with stressors/thoughts, and importance of help seeking
- apply caution when interviewing family members
donts about suicide prevention
- dont use sensational language
- dont describe the method used
- dont name or provide details about the site or location
- dont report details about notes
- dont oversimplify the reason for suicide, or reduce it to a single factor
- dont use photographs/videos/audios
- dont use language/content which sensationalizes, romanticises, or normalizes suicide
- dont unduely repeat such stories and dont put it as the top content
wat is nog meer lastig aan het meten van het aantal suicide attempts
mensen veranderen hun mening over of ze ooit een suicide attempt hebben gedaan, wat het dus nog lastiger maakt om dit goed te kunnen meten
wat is een revolutie in suicide research
het wordt nu gezien als een onafhaneklijk proces, niet meer als een onderdeel van depressie (“suicide behaviour”)
goethe of werther effect =
any positive attention to suicide can lead to more suicides (dit was vroeger dus al een bekend fenomeen)
papageno effects =
positieve aandacht naar suicides in media kan ook een positief en beschermend effect hebben
13 reasons why …
heeft zo ongeveer alle regels verbroken van suicide preventie.
in USA zagen ze zogenaamd een increase in suicide hierdoor, maar dat was daarvoor ook al een increase
strategic goals national agenda:
- dare and talk about suicide
- train professionals (vragen op een specifieke manier stellen, en weten hoe je moet reageren op suicide)
- invest in suicide prevention in the neighbourhood
- increase reach specific risk groups
- improve collaborations (government, loved ones)
- limit access to means
- learning data: national learning system
interpersonal theory of suicidal behaviour
thwarthed belonginess (i am alone)
capability for suicide
perceived burdensomness (i am a burden)
tussen tp & pb -> desire for success
tussen alledrie -> lethal part (or near lethal)
wat bedoelen ze met capability for suicide
weten hoe het moet, ook echt doorzetten, tools, etc
wat was er met dit interpersonal theory of suicidal behaviour
de eerste die een verschil aangaf tussen attempts and thoughts
wat zeiden O’connor en Nock
suicide behaviour should be studied as behaviour
moderators =
when you dont know how to cope with the experiences many people have
o connor model
premotivational phase: background factors & triggering events = diathesis + environment + life events
motivational phase: ideation/intention formation = defeat & humiliation + threat to self -> entrapment + motivational moderators -> sucidal ideation & intent + volitional moderators -> suicidal behaviour
entrapment
- 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
welke factoren spelen mee in dat iemand van suicidal ideation and intent naar suicidal behaviour gaat
- access to means
- planning (if-then plans)
- exposure to suicide
- impulsivity
- physical pain toleration/edurance
- fearlessness about death
- mental imagery
- past suicidal behaviour
what two cognitive factors are there
- cognitive rigidity
- problem solving
welke twee factoren passen bij zelfdoding
- rumination
- autobiographical memory bias (suicidal behaviour= less ability to recall specific autobiographical memories)
wat is belangrijk aan het inzetten van interventies
- Recognize that there are no interventions that give great effects. We also don’t know
which treatment works best in which situation - Many interventions give small effects. It is important to offer at-risk patients one or
more of these interventions. - Also look at scalability of an intervention
op welke van de factoren die belangrijk zijn om van ideation naar behaviour te gaan kunnen we de preventiemethoden vooral inzetten
access to means: mensen zullen niet heel snel een andere methode kiezen als je er eentje blokkeert. bv golden gate bridge. misschien komt dit door mental imagery (als je het je zo hebt voorgesteld, dan niet op een andere manier doen?)
hoe genetisch is suicidal behaviour
het heeft wat genetic risk, maar waarschijnlijk vooral leergedrag van ouders overnemen. ook vooral agressie en impulsiviteit is hierbij belangrijk
wat is een treatment voor suicidal behaviour
- It is worth considering offering a problem-solving or cognitive therapy focused on
suicidality in the treatment of patients with suicidal behavior.
=> CBT or IPT
- dialectical behavioural therapy: individual psychotherapy, group skills training, out-of-session coaching, therapist consultation team meeting. lasts one year.
hoe ziet CBT-SP er uit
- 10–12 outpatient sessions
- first phase, suicide risk assessment, treatment plan, collaboratively create a crisis response plan or safety plan, and conduct skills training focused on emotion regulation and crisis management.
- In the second phase, clinicians and patients focus on identifying and challenging the patient’s maladaptive beliefs and self-statements which contribute to suicidal behaviors (e.g., hopelessness, perceived
burdensomeness, entrapment). - In the third phase, clinicians and patients complete a relapse prevention task to facilitate the consolidation of skills and to prepare patients for effectively managing stressful situations in the future.
