Midterm 2 Flashcards
What’s suicide?
- Death resulting from intentional self-injurious behavior, associated with any intent to die as a result of the behavior
- To have something count as a suicide, the outcome has to be death and it is driven by intent or desire to die
What’s a suicide attempt?
- Nonfatal self-directed potentially injurious behaviour with any intent to die as a result of the behaviour
- Intent to die is there but the end result isn’t death
What’s an interrupted attempt?
A person takes steps toward making a suicide attempt but is stopped by another person prior to any injury or potential injury
What’s a self-interrupted/ aborted attempt?
A person takes steps to injure self but stops self prior to any injury or potential for injury
What are preparatory acts or behaviour with regard to suicide?
- Acts or preparation toward making a suicide attempt
- Ex: planning on jumping off a bridge -> preparatory act would be visiting the bridge
What’s suicidal ideation?
- Thoughts of suicide
- Extremely common
- Thinking about suicide, planning suicide or just broad thoughts of death or thinking that the world would be better off without them or wishing they were dead
- Suicidal ideation comes in many different ways of thinking
What’s a common misconception regarding suicide and suicide attempts?
- That you can decide how serious someone’s suicide is based on lethality of method of suicide
- We never infer intent based on lethality of method used
-> can be based on many factors including what resources someone has access to
What’s non-suicidal self-injurious behaviour (NSSI)?
- Behaviour that’s self-directed and deliberately results in injury or the potential for injury to oneself
- Without the intent to die
Describe the prevalence rates of suicide in Canada
- In 2016, 9th leading cause of death across all age groups in Canada
- In terms of fatalities, suicide is a bigger problem than homicide in Canada
- Suicide is a relatively rare event
- Almost 4,000 people
- In Quebec: almost 900 people (slightly higher than average rates of suicide in Canada)
- More deaths in men and boys than in women and girls (more than 3x more)
- Suicidal thoughts: 3.4 million -> 1.1 million between 18-34 (more commonly reported in women and girls than men and boys)
What are the key elements of suicide according to the World Health Organization?
- Agency: something that is self-initiated, but doesn’t necessarily need to be self-inflicted (ex: provoking a cop with intent to die or not taking insulin if diabetic)
- Intent: some desire or intent for death
- This differentiates NSSI from suicide attempts (ex: skydiving and drunk driving are non-intent attempts) - Outcome: actual/perceived potential for death
Identify the appropriate suicide term for this prompt: A 12 yr old girl is grief-stricken after her father died in a car accident. In the months after, she states multiple times that she wants to go to heaven and be with him. One afternoon she watches a Lifetime movie in which a teenager dies from overdosing on sleeping pills. She then takes 20 melatonin tablets that she knows her mother takes to help her sleep.
- Suicide attempt
- Even if you can’t overdose on melatonin, the intent is there so it’s considered a suicide attempt
- She believes the melatonin could have a fatal outcome
- Low lethality event -> still suicidal attempt
Identify the appropriate suicide term for this prompt: a man put a gun to his head because he wanted to kill himself. He pulled the trigger, and the gun failed to fire.
- Suicide Attempt (because he goes through with the behaviour that leads to suicide)
- Interrupted Attempt
Identify the appropriate suicide term for this prompt: A man is drinking near a lake with a group of friends on Victoria Day. On a dare, he and his buddy decide to play Russian Roulette with a loaded gun. He puts the gun to his head, pulls the trigger, and dies instantly from a gunshot wound to the head.
- No suicide term is applicable to this
- We have no evidence that this person’s intent was to injure himself
- Extremely risky behaviour
- Him being intoxicated affects our understanding
Describe Suicide and NSSI in the DSM
- Prior to DSM-5, suicide and NSSI were listed as symptoms of Depression and BPD
- DSM-5 now includes under “conditions for further study”: Suicidal Behavior Disorder and Nonsuicidal self-injury disorder -> these are not diagnoses but behaviours
- We need more info about these before categorizing them
What are the challenges for research in suicidality?
- Rare: worldwide, fewer than 1% of adults make a suicide attempt each year
- Etiologically complex: a lot of our data on suicide comes from small samples, clinical samples and western samples
- Difficult to study longitudinally: need massive samples to study longitudinally
- Stigma/legal constraints: different laws on what’s considered suicide and what’s not, different places defining suicide in different ways
- Replication: not much replication for research on this
- Also, most studies will look at suicidal ideation and suicidal attempts, but won’t look at transition from ideation to attempt
What are the common research methods used to study suicide?
- Archival → data is obtained from pre-existing records and databases. Look at how variables relate to each other at any given moment
- Ex: looking at death records and trying to identify which deaths were by suicide
- Psychological Autopsy → reconstruct what a person was like before the suicide through interviews with family, friends, co-workers, etc.
- Big Data → passively collect data from individuals (ex: geolocation, social media, activity trackers, phone calls, purchasing history, etc.)
- Ex: social media has data from users and maps patterns to identify suicide attempts -> looking at correlates that may or may not be meaningful
- Experimental → compare individuals’ responses to tasks, manipulations, etc.
- Treatment Studies → randomly assign people to different conditions (or treatments) and compare outcomes -> Waitlist Control, Placebo, Alternative Treatment
- Meta-analysis → pools results from separate but similar studies to get a more accurate estimate of the effect
Describe gender differences in suicide and suicide attempts
- Women attempt suicide at significantly higher rates than men in North America
- 77% of deaths by suicide are male in North America
What are the proposed explanations for gender differences in suicide and suicide attempts
- Base Rates
- Lethal means: men tend to use more lethal means (most common means = hanging and firearms), while most common suicide means of women = toxic substances and drowning
- Access
- Greater Intent: idea that men have greater intent
- Mental Health Care: women use mental health services at a higher rate than men
- Cultural acceptance: seeking help is attributed to more feminine qualities -> barrier for men seeking help for suicidality (seen as weak)
- Reactions from others: if a woman commits suicide and doesn’t die, she will receive more support than men who attempt and don’t die
Describe race/ethnicity differences in suicide
- Suicide rates are highest in North America in White people and First Nations (highest in First Nations)
- Exception: among young children (5-12), Black children are at much higher risk of dying by suicide
Describe suicide within Canadian First Nations Populations
- Canadian First Nations people have among the highest rates of suicide in the world
- Not equally distributed across first nation populations
- Durkheim’s theory of “anomie” -> feeling of being disconnected from the community, lack of belonging
- Anomie can account for population-wide attempts to suicide
- Among youth living in First Nations with close proximity to community and greater knowledge of language -> have significantly lower risks of suicide (language and community cohesion)
- Higher community rates of a number of risk factors (ex: poverty, substances)
What are country differences in rates of suicide (highest to lowest rates)?
- Japan (highest)
- France
- United States
- Germany
- UK
- Italy (lowest)
- Rates for Japan and France have been decreasing overtime
- Rates for US started increasing in early 2000s (surpassing France)
What are the most common methods used in North America to attempt suicide (in order)?
- Poisoning
- Cutting
- Stabbing
What are the most common reasons for death from suicide (in order) in the US?
- Firearm suicides
- Suffocation
- Poisoning
- Fall
What are the most common reasons for death from suicide (in order) in Canada?
- Hanging
- Suffocation
- Poisoning
- Firearm
Describe risk factors for suicide
- Risk factors are things that indicate a group or community at higher risk of developing a disorder
- Risk factors are not warning signs
- Some are modifiable (ex: depression, access to lethal means), and some are not (ex: race, genetic predisposition, family history of suicide)
- There are many risk factors for suicide -> even with identifying all of the risks we can’t predict accurately who will commit suicide
- The risks don’t tell us how much each of them are linked to suicidal ideation and for moving from ideation to attempt
- Belief that reducing risk factors and increasing protective factors can help prevent suicide
What are proximal risk factors to a suicide attempt?
- Intoxication -> ~ 25-50% of adults who die by suicide are intoxicated at the time of death. Usually alcohol, but sometimes other substances
- When people are taking these substances, they’re at greater risk
- Rates are higher in younger people
- Access to means -> people who have greater access to lethal means are more likely to die by suicide (treatment = means restriction)
