Lecture 5: Suicide prevention Flashcards
Instead of commited suicide say …
Instead of suicide attempters say …
… died by suicide
… people that did a suicide attempt
Defenition suicide & and suicide attempt & suicidal behavior
Suicide = the act of deliberately killing onself
Suicide attempt = any non-fatal suicidal behavior (intentional self poisoning, injury or self-harm), which may or may-not have a fatal intent or outcome
Suicidal behavior = refers to a range of behaviors that include thinking about suicide (or ideation), planning for suicide, attempting suicide and suicide itself
How to estimate suicide rates and difficulties/ differences HIC and LMIC?
How:
- Counting, cause of death statistics
Difficulties:
- Availability of good quality data
HIC (high prevalence) versus LMIC (low prevalence)
Possible explanation:
- LMIC: greater chance of dying in other ways and suicice is more often illegal
- HIC: better registration
What is meant by the vulnerability paradox?
The less vulnerable a country is, the higher the suicide rates
Possibles explanations:
- in LMIC people are more used to ‘diaster’ and negative life events
- HIC are more individualistic = more social isolation or a lack of feeling part of a community (higher risk for suicidal behavior)
Suicide attempt: what adds to the social and economic burden?
- Impact on individual and associates
- Utility of health services
Suicide attempt is the best…
… predictor of future suicidal behavior (monitoring helps prevention)
Biggest risk is within the first 3 months after attempt
How to estimate the case fatality rate of suicidal behavior? And what methods are there?
Suicide attempt + suicidal death
Methods:
- Self reports in surveys
- Medical records
What are methodological challeges in measuring case fatality rates of suicidal behavior?
7 items
- Different survey instruments
- Different sample
- Different language
- Literacy of sample
- Time-frame
- Stigma
- Fluctuations over time
What is the NEMESIS I, II, and III?
- Large longitudinal study on the occurance of mental health problems in the Netherlands
- Helps determine prevalence and incidence rates
NEMESIS II, Included questions on:
- Thoughts of death (34%)
- Death wish (10%)
- Suicidal thoughts (11%)
- Suicidal attempt (2,7%)
Association suicide and depression?
A large proportion of the people with suicidal thoughts and/or a history of a suicide attempt also had depression
However, the propotion of people with depression that had suicical thoughts and/or a history of a suicide attempt is a lot less.
Association suicide and depression?
A large proportion of the people with suicidal thoughts and/or a history of a suicide attempt also had depression
However, the propotion of people with depression that had suicical thoughts and/or a history of a suicide attempt is a lot less.
What is the Wherther-effect?
“Copycat suicide”
Led to guidelines for the reporting of suicide
Papageno effect = opposite of Wherther-effect
What are the 4 components of the (Public Health) Prevention model?
- Survaillance
- Identify risk and protective factors
- Develop and evaluate interventions
- Implementation
What are risk factors for suicide
Health system (1), Society (3), Community (4),
Health system:
- Barrier to accessing healthcare
Society:
- Acces to means
- Inappropriate media reporting
- Stigma associated with help-seeking behavior
Community:
- Disaster, war, conflict
- Stress due to acculturation, dislocation
- Discrimination
- Trauma/ abuse
The predictive value of these riskfactors is low!
What are risk factors for suicide
Relationships (2), Individual (8)
Relationships:
- Sense of isolation/ lack of social support
- Relationship conflict, loss
Individual:
- Previous suicide attempt
- Mental disorders
- Substance abuse (alcohol)
- Job or financial stress
- Hopelessness
- Chronic pain
- Family history of suicide
- Genetic and biological factors
The predictive value of these riskfactors is low!
Universal prevention of suicide:
7 items
- Mental health policies
- Policies to reduce harmful use of alcohol
- Access to healthcare
- Restriction of acces to means (bridges, railroads, pharmacological agents etc.)
- Responsible media reporting
- Raising awareness (about mental health, substance use disorders and suicide)
- Reducing stigma
Selective prevention of suicide:
2 items
- Gatekeeper training
- Crisis helplines
Indicated prevention of suicide:
3 items
- Follow-up and community support
- Assessment and management of suicidal behaviors
- Assessment and management of mental- and substance use disorders
What are the 3 main phases of the The integrated motivational–volitional model of suicidal behavior?
- Pre-motivational phase
- Motivational phase
- Volitional phase
Explain the pre-motivational phase
= Background factors and triggering events
Diathesis + environment + life events
Explain the motivation phase
= Ideation/ intention formation
Defeat and humiliation leads to entrapment, which leads to suicidal ideation & intent
- Defeat & humiliation leads to entrapment due to: threat to self moderators (social problem solving, coping, memory, biases)
- Entrapment leads to suicidal ideation & intent due to: motivational moderators (attitudes, social support, future thoughts, norms, goals)
Explain the volitional phase
= Behavior enaction
Suicidal ideation & intent leads to suicidal behavior
- Due to volitional moderators (capability, impulsivity, implementation intentions, planning, access to means)
Challenges in the prevention of suicide are…
- Rarity/ uncommon
- Difficulty conducting RCTs (ethical considerations)
- Low predictive value of risk factors (did not improve over 50 years)
Possibilities/ examples to reduce suicide?
5 items
- Educating gatekeepers (e.g. training primary care physicians to recognize depression and treatment)
- Educating youths on depression and suicidal behavior
- Active outreach to psychiatric patients after discharge
- Use of antidepressants
- CBT and dialectal behavior therapy
- Active screening for depression
