Suicide and NSSI

Question 1

Suicide

Answer 1

Death resulting from intentional self-injurious behavior, associated with any intent to die as a result of the behavior.

Question 2

Suicide Attempt

Answer 2

A nonfatal self-directed potentially injurious behavior with any intent to die as a result of the behavior.

Question 3

Interrupted Attempt

Answer 3

A person takes steps toward making a suicide attempt but is stopped by another person prior to any injury or potential injury.

Question 4

Self-interrupted/ Aborted Attempt

Answer 4

A person takes steps to injure self but stops self prior to any injury or potential for injury.

Question 5

Preparatory acts or behavior

Answer 5

Acts or preparation toward making a suicide attempt (e.g. visiting the bridge, stockpile of pills).

Question 6

Suicidal Ideation

Answer 6

Thoughts of suicide. Extremely common.

Question 7

Non-suicidal self-injurious behavior

Answer 7

Behavior that is self-directed and deliberately results in injury or the potential for injury to oneself. LACKS THE INTENT TO DIE.

Question 8

In 2016, _____leading cause of death across all age groups in Canada

Answer 8

9th

Question 9

What constitutes a suicide attempt? (3)

Answer 9

(1) Agency: self-initiated (but doesn’t have to be self-inflicted - can provoke someone)
(2) Intent
(3) Outcome: Has to be either actual and/or perceived potential for death from the behavior. As long as the person thinks there’s a potential to die ⇒ suicidal attempts.

Question 10

Prior to DSM-5, suicide and NSSI were listed as______of MDD and BPD. Now, they’re in DSM-5 but listed under ___________.

Answer 10

symptoms; “conditions for further study”

Question 11

Challenges faced with research on suicide and NSSI (5)

Answer 11

(1) Rare: low base-rate phenomenon (lot of data comes from very small samples)
(2) Etiologically complex: combines a lot of factors
(3) Hard to study longitudinally (cuz you would need a massive sample)
(4) Stigma (culture) /Legal constraints
(5) Replication

Question 12

Common research methods to study Suicide (6)

Answer 12

(1) Archival: pre-existing records, databases (e.g. death records)
(2) Psychological Autopsy: records what a person was like before suicide through interviews
(3) Big Data: Passively collect data from individuals who died (social media, geolocalisation, purchasing history…)
(4) Experimental: Compare individuals’ responses to tasks, manipulations with vs without history of suicide attempts
(5) Treatment studies
(6) Meta-analysis

Question 13

Rank this from more common to rarer: Suicide plan, Suicide ideation, Suicide plan + Attempt (+Ideation), No Suicide plan + Attempt (+Ideation)

Answer 13

Suicide ideation
Suicide plan (inside Suicide ideation)
Suicide plan + Attempt (inside Suicide ideation)
No Suicide plan + Attempt (inside Suicide ideation)

Question 14

Explain gender differences

Answer 14

Women attempt more but men die more. (3.6 : 1)

Question 15

Proposed Explanations for gender differences (7)

Answer 15

(1) Base Rates: Women have higher rates of a lot of diff disorders that are associated with greater risk for suicide attempts (e.g. MDD, BPD).
(2) Lethal means: Men tend to die my more lethal means.
(3) Access: On average, men have greater access to more lethal means (e.g. firearms). Not the same in China.
(4) Greater Intent (meh)
(5) Mental Health Care: Women use mental health services at a much higher rate than men.
(6) Cultural acceptance: People consider non fatal suicide attempts more feminine. -> Prevent some men from actually reporting suicide attempts to the pple around them
(7) Reactions from others: Women will receive more sympathy/empathy for suicidal behaviors than young men will.

Question 16

[Race/Ethnicity]: Higher in . Lower in . But among kids, are at much higher risk.

Answer 16

Natives + Non-Hispanic; Hispanic; black kids (vs white)

Question 17

________ people have among the highest rates of suicide in the world.

Answer 17

Canadian First Nations

Question 18

Theories explaining why Canadian First Nations have those high suicide rates (2)

Answer 18

(1) Anomie theory: Feeling of becoming disconnected from the people around you. As you become more disconnected from the social fabric, rates of suicide attempts increase.
=> Greater knowledge of the native language of the group = significantly lower risk of suicide/attempts.
(2) Lots of demographic factors for suicide/attempts (poverty, AUD, family violence…) are all higher on First Nations reserves in Canada

Question 19

Comparing USA and Canada to other G7 countries

Answer 19

US increase
vs Japan/France decrease; others stable

Question 20

Durkheim: Rates of suicide tend to be lower in traditionally ______ countries than traditionally _____ countries

Answer 20

Catholic; Protestant

Question 21

Most common METHODS use toattemptsuicide (in order) in NA: ____ (3)

Answer 21

(1) Poisoning
(2) Cutting
(3) Stabbing

Question 22

Most common reason for DEATH from suicide (in order) in US/Canada: (4)

Answer 22

US: Firearm, Suffocation, Poisoning, Fall
Canada: Hanging, Suffocation, Poisoning, Firearm

Question 23

Proximal risk factors (proximal to attempt) for suicide (2)

Answer 23

(1) Intoxication (25-50%)
(2) Access to means

Question 24

Protective factors for Suicide (4)

Answer 24

(1) Treatment (psychosocial or pharmaceutical)
(2) Lithium (bipolar) clozapine (psychosis)
(3) Preventative interventions like working to reduce aggressive behaviors in early elementary school (delay, prevent)
(4) Culturally-influenced coping strategies, like values reflecting strong moral objections to suicide, and high family support = lower incidence of ideation and attempts among Latinos

Question 25

[Media Contagion]: Suicide/Suicidal behaviors rates go UP following an increase in the:

Answer 25

(1) Frequency of media reporting–dose dependent.
(2) Content of media reporting–e.g., dramatic headlines, front page, explicit about suicide methods.
(3) Positive/negative reporting biases–e.g., attitudes toward suicide, portrayal of suicide completers, consequences.

Question 26

There is some genetic contribution to suicide (higher in biological parents). BUT: a lot of what’s inherited is not necessarily the behaviors themselves, but ________________.

Answer 26

some risk for the disorders that are associated with suicide. E.g. alcohol use disorder, BPD…

Question 27

2 phenotypes intermediate between genes & suicide attempts:

Answer 27

Impulsivity & Fearlessness

Question 28

Dimensions of Impulsivity (4)

Answer 28

(1) Poor premeditation (i.e. think though the consequences of one’s actions)
(2) Sensation-seeking (engaging in risky behaviors in order to feel something)
(3) Lack of perseverance
(4) Negative urgency (i.e. tendency to act without a lot of forethought in the face of negative emotions)

Question 29

[Impulsivity dimensions] When we compare pple w suicidal ideation vs attempters, we see that BOTH ideators and attempters show high ____________.

Answer 29

negative urgency
(not higher in one of the other)

Question 30

___________ (3) higher in attempters (vs ideators).

Answer 30

(1) Poor premeditation
(2) Fearlessness
(3) Reduced pain sensitivity

Question 31

Interpersonal Psychological Theory

Answer 31

Exposure to painful and fear stimuli reduces innate fears of pain and death.
-> Making it easier to approach the task of attempting suicide

Question 32

3-Step Theory (Klonsky & May)

Answer 32

Practical: Having access to means, familiarity w lethal medications…
Dispositional: Fearlessness…
Acquired: Engaging in NSSI, combat training…

Question 33

In both Interpersonal Psychological Theory & 3-Step Theory, reduced ___________ is critical in moving pple from ideation to action.

Answer 33

fear of pain/death

Question 34

Capacity can arise through _____, ______, ______ with threatening, dangerous or provocative situations:

Answer 34

practice, habituation, experience

Question 35

(1) Which correlates of suicide were more common in suicide ideators vs non suicidal pple? (2) Which one were more common in ideators vs Attemptors?

Answer 35

(1) Depression severity, PTSD, MDD
(2) NONE

Question 36

Like suicide attempts, NSSI onset tends to peak during _______________.

Answer 36

adolescence/young adulthood
-> NSSI has slightly earlier age of onset (around 13) compared to suicide attempts (around 16)

Question 37

Rates of NSSI may decrease with _______.

Answer 37

middle age
-> Pple kind of age out of NSSI

Question 38

[Number of methods].
Most people who endorse repeated NSSI use _______ methods.
People endorsing Suicide Attempts often use _____________.

Answer 38

more than one method (average of 4);
same method, but increase the lethality

Question 39

Rates of NSSI higher in ____ individuals than heterosexual

Answer 39

LGBTQ

Question 40

2 big Functions of NSSI

Answer 40

Interpersonal & Intrapersonal

Question 41

Interpersonal function of NSSI (7)

Answer 41

(1) Autonomy
(2) Interpersonal boundaries: demarcation about who i am vs other pple
(3) Interpersonal influence: evidence that there’s some contagion
(4) Peer bonding
(5) Revenge (rarely)
(6) Sensation seeking (more common)
(7) Toughness

Question 42

Intrapersonal function of NSSI (5)

Answer 42

(1) Affect Regulation (reduce distress) => MOST COMMON REASON
(2) Anti-dissociation
(3) Anti-suicide
(4) Marking distress
(5) Self-punishment

Question 43

Ecological Momentary Assessment (EMA) def

Answer 43

Repeatedly assessing the same variables across the day & across many diff days.
-> You can text the person repeatedly throughout the day fir a pre specified period - “how are you doing right now?”
-> Then you can look at variables in real time in the real world that predict probability of engaging in NSSI

Question 44

Findings: NSSI in real time. When were they more likely to do it? (2)

Answer 44

(1) If participants had intense but brief thoughts about self-harming, they were more likely to do it. (“negative urgency style” of thinking) => If they spent more time thinking about it - less likely to engage in NSSI
(2) What predicted engaging in the behaviors was: Feeling rejected, holding anger towards oneself or others, self-hatred, feeling numb/nothing predicted NSSI.

Question 45

Findings: NSSI in real time. When were they more likely to think about it?

Answer 45

Thoughts about NSSI were more likely to occur when participants were feelingoverwhelmedorscared/anxious.
=> BUT didn’t predict engaging in the behaviors.

Question 46

Context of NSSI

Answer 46

NSSI usually socializing (not alone in their room) - usually a social context.

Question 47

Up to ____ of people attempting suicide have a history of NSSI

Answer 47

85%
=> NSSI viewed as a means through which people increase their capacity to attempt suicide → they’re becoming accustomed to damaging their own tissue
=> College students with a history of NSSI 8 x more likely to have suicidal ideation, 25 x more likely to have attempted suicide than students with no NSSI.