Suicide Flashcards
Suicide
Suicidal Ideation: refers to serious thoughts about suicide or a desire to kill oneself.
Suicidal plan: serious consideration of how one would kill oneself.
Suicidal gestures/intent: actions people take to make others believe that they want to kill themselves when in fact they have no intention of doing so. Also called a suicidal threat.
Suicidal attempt: engagement in self-injurious behavior with at least some intent to die.
Suicidal death: (aka suicide) fatality that directly results from a suicidal attempt
DSM-V: Suicidal Behavior Disorder
Within the last 24 months, the individual has made a suicide attempt.
The act does not meet criteria for NSSI
The diagnosis is not applied to suicidal ideation or to preparatory acts.
The act was not initiated during a state of delirium or confusion.
The act was not undertaken solely for political or religion objection.
Specifiers: current if less than 12 months since last attempt or in Early Remission if 12-24 months since last attempt
Epidemiology
Prevalence/Incidence: one community-based study found 42% of high school students experience NSSI ideation and 9% severe preoccupation
Rates are higher in teens than young adults.
Lifetime rates for NSSI range from 15-20%
Consistent rates in many countries
Clinical ratings are higher (40-82%)
Suicidal thoughts reported in in 12.1% of adolescents in one community-based study but rates range from 19.8-37.9% lifetime
In the US, data from the CDC (2013) show average of 3.9-4.5 suicide deaths per 100,000 children and adolescents occur each year. Higher rates among older adolescents
Epidemiology (con’t.)
Gender Differences
- Girls at least twice as likely to engage in NSSI as boys
- Adolescent girls report suicidal ideation twice as often as boys, and attempt suicide three times as often.
- Boys have a higher incidence of suicide death (2-3 times more than girls).
Culture and SES
- Generally, European American youth more likely to engage in NSSI than African Americans or Asian Americans
- Native American youth highest rates of suicide
- Inconsistent results on SES, some studies report no differences, others report high rates of suicide among youth from high SES households
Course and Prognosis
NSSI and suicidal SITBs typically begin in adolescence
Risk factors include parental absence and childhood maltreatment
NSSI behavior typically persists for 10-15 years
Prognosis concerning because NSSI increases risk of suicidal SITBs.
Longer NSSI behavior leads to increased likelihood of suicide attempt.
Earlier onset of suicidal ideation is associated with poorer prognosis and increased risk of later psychopathology.
Comorbidity
r/o Borderline Personality Disorder
Substance Use Disorder (59.6%)
Conduct Disorder (49.4%)
Oppositional Defiant Disorder (44.9%)
Major Depressive Disorder (41.6%)
Posttraumatic Stress Disorder (23.6%)
Impulse-Control Disorders
*Rates are for Nonsuicidal SITBs. All rates higher in Suicidal SITBs.
Theories on NSSI Behavior
Integrative Model by Nock (2010)
Biosocial Theory by Linehan (1993)
Pragmatic Hypothesis
Implicit Identification Hypothesis
Self-Punishment Hypothesis
Social Signaling Hypothesis
Social Learning Hypothesis
Four-Function Model
Theories on Suicidal Behavior
Sociological Theory by Durkheim (1951)
Cognitive Theory by Beck (1967)
Escape Theory by Baumeister (1990)
Cry of Pain Model by Williams (1997)
Interpersonal-Psychological Theory by Joiner (2005)
Etiology
Biological Factors
-Dysregulation of the neurobiological systems and/or neurotransmitters, brain structure abnormalities, genetic risk factors
Psychological Factors
-Negative cognitions, perfectionism, emotional dysregulation
Environmental Factors
-Child abuse, family functioning, peer victimization
Assessment and Treatment
Assessment
- Assess for suicide risk
- Refer to outside mental health agency or hospital if needed
Empirically Supported Treatments
- Problem-Solving Therapy
- Cognitive Behavioral Therapy
- Dialectical Behavior Therapy- works on relationships and improve interpersonal skills with others
Implications for School Psychologists
Most students turn to friends and family first, not school staff
Impulsive nature of NSSI means there is often very little time for intervention prior to the action
Raise awareness about the sources of help available in school
Support peers who may be the first person a friend turns to
Inform others of current and accurate information on NSSI
Ensure guidelines or procedures are in place to address suicidal behavior
Refer as needed
