Suicide and NSSI Flashcards
Suicide
Death resulting from intentional self-injurious behavior, associated with any intent to die as a result of the behavior.
Suicide Attempt
A nonfatal self-directed potentially injurious behavior with any intent to die as a result of the behavior.
Interrupted Attempt
A person takes steps toward making a suicide attempt but is stopped by another person prior to any injury or potential injury.
Self-interrupted/ Aborted Attempt
A person takes steps to injure self but stops self prior to any injury or potential for injury.
Preparatory acts or behavior
Acts or preparation toward making a suicide attempt (e.g. visiting the bridge, stockpile of pills).
Suicidal Ideation
Thoughts of suicide. Extremely common.
Non-suicidal self-injurious behavior
Behavior that is self-directed and deliberately results in injury or the potential for injury to oneself. LACKS THE INTENT TO DIE.
In 2016, _____leading cause of death across all age groups in Canada
9th
What constitutes a suicide attempt? (3)
(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.
Prior to DSM-5, suicide and NSSI were listed as______of MDD and BPD. Now, they’re in DSM-5 but listed under ___________.
symptoms; “conditions for further study”
Challenges faced with research on suicide and NSSI (5)
(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
Common research methods to study Suicide (6)
(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
Rank this from more common to rarer: Suicide plan, Suicide ideation, Suicide plan + Attempt (+Ideation), No Suicide plan + Attempt (+Ideation)
Suicide ideation
Suicide plan (inside Suicide ideation)
Suicide plan + Attempt (inside Suicide ideation)
No Suicide plan + Attempt (inside Suicide ideation)
Explain gender differences
Women attempt more but men die more. (3.6 : 1)
Proposed Explanations for gender differences (7)
(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.
[Race/Ethnicity]: Higher in . Lower in . But among kids, are at much higher risk.
Natives + Non-Hispanic; Hispanic; black kids (vs white)
________ people have among the highest rates of suicide in the world.
Canadian First Nations
Theories explaining why Canadian First Nations have those high suicide rates (2)
(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
Comparing USA and Canada to other G7 countries
US increase
vs Japan/France decrease; others stable
Durkheim: Rates of suicide tend to be lower in traditionally ______ countries than traditionally _____ countries
Catholic; Protestant
Most common METHODS use toattemptsuicide (in order) in NA: ____ (3)
(1) Poisoning
(2) Cutting
(3) Stabbing
Most common reason for DEATH from suicide (in order) in US/Canada: (4)
US: Firearm, Suffocation, Poisoning, Fall
Canada: Hanging, Suffocation, Poisoning, Firearm
Proximal risk factors (proximal to attempt) for suicide (2)
(1) Intoxication (25-50%)
(2) Access to means
Protective factors for Suicide (4)
(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
[Media Contagion]: Suicide/Suicidal behaviors rates go UP following an increase in the:
(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.
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 ________________.
some risk for the disorders that are associated with suicide. E.g. alcohol use disorder, BPD…
2 phenotypes intermediate between genes & suicide attempts:
Impulsivity & Fearlessness
Dimensions of Impulsivity (4)
(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)
[Impulsivity dimensions] When we compare pple w suicidal ideation vs attempters, we see that BOTH ideators and attempters show high ____________.
negative urgency
(not higher in one of the other)
___________ (3) higher in attempters (vs ideators).
(1) Poor premeditation
(2) Fearlessness
(3) Reduced pain sensitivity
Interpersonal Psychological Theory
Exposure to painful and fear stimuli reduces innate fears of pain and death.
-> Making it easier to approach the task of attempting suicide
3-Step Theory (Klonsky & May)
Practical: Having access to means, familiarity w lethal medications…
Dispositional: Fearlessness…
Acquired: Engaging in NSSI, combat training…
In both Interpersonal Psychological Theory & 3-Step Theory, reduced ___________ is critical in moving pple from ideation to action.
fear of pain/death
Capacity can arise through _____, ______, ______ with threatening, dangerous or provocative situations:
practice, habituation, experience
(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?
(1) Depression severity, PTSD, MDD
(2) NONE
Like suicide attempts, NSSI onset tends to peak during _______________.
adolescence/young adulthood
-> NSSI has slightly earlier age of onset (around 13) compared to suicide attempts (around 16)
Rates of NSSI may decrease with _______.
middle age
-> Pple kind of age out of NSSI
[Number of methods].
Most people who endorse repeated NSSI use _______ methods.
People endorsing Suicide Attempts often use _____________.
more than one method (average of 4);
same method, but increase the lethality
Rates of NSSI higher in ____ individuals than heterosexual
LGBTQ
2 big Functions of NSSI
Interpersonal & Intrapersonal
Interpersonal function of NSSI (7)
(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
Intrapersonal function of NSSI (5)
(1) Affect Regulation (reduce distress) => MOST COMMON REASON
(2) Anti-dissociation
(3) Anti-suicide
(4) Marking distress
(5) Self-punishment
Ecological Momentary Assessment (EMA) def
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
Findings: NSSI in real time. When were they more likely to do it? (2)
(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.
Findings: NSSI in real time. When were they more likely to think about it?
Thoughts about NSSI were more likely to occur when participants were feelingoverwhelmedorscared/anxious.
=> BUT didn’t predict engaging in the behaviors.
Context of NSSI
NSSI usually socializing (not alone in their room) - usually a social context.
Up to ____ of people attempting suicide have a history of NSSI
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.
