Suicide and NSSI Flashcards
What are the difference between suicide attempts, interrupted attempt, self-interrupted attempt, preparatory acts and suicidal ideation?
Suicide Attempt→ A nonfatal self-directed potentially injurious behavior with any intent to die as a result of the behavior
- should not infer attention form methods used
Interrupted Attempt→ 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
- ex: takes drugs but then call 911
Preparatory acts or behavior: Acts or preparation toward making a suicide
attempt
- step towards suicide attempt
- “rehearsal of the act”
Suicidal Ideation→ Thoughts of suicide
- very common phenomenon
- but take different forms
Define Non suicidal self injury (NSSI)
Non-Suicidal self-injurious behavior (NSSI)→ Behavior that is self-directed and deliberately results in injury or the potential for injury to oneself
- no attempt to die
What is the epidemiology of suicide?
Prevalence→ 9th leading cause of death across all age groups in Canada in 2016
- 4000 people each year
9.8 million people think seriously about suicide
- 2.8 million→ make suicidal plan
- 1.3 million→ attempted suicide
- 0.3 million made no plans and attempted suicide
Age of onset→ 16yo
Gender->
- Women more likely to attempt suicide but less likely to die by suicide
- 77% of deaths are male
- gender difference in all country except for China
Race/Ethnicity
- highest rate for White people and even more for Indigenous people
- in children→ black children more likely to die by suicide
What are the three key element to infer a suicidal attempt?
Agency→ self-initiated but not necessarily self-inflicted
- ex: provoking cop in order to get killed
Intent→ death as an intent
- NSSI does not have death as an intent
Outcome→ reel or perceived death as an outcome
- person have to think that this is life-threatening even if it is not
What are some challenges for research on suicide?
- Rare (less than 1% of adults will die by suicide each year)→ very small sample
- Etiologically complex→ result of lot of different factors
- Difficult to study longitudinally
- Stigma→ laws in some countries about what can be called a suicide, can have consequences on family’s reputation
- Replication missing
What are some common research methods of suicide?
Archival → Data is obtained from pre-existing records, databases.
- Look at how variables relate to each other at any given moment
- ex: rates of suicide in a state and correlates with it
- bias because what is called a suicide depends on the place
Psychological Autopsy→ Reconstruct what a person was like before the
suicide through interviews with family, friends, co-workers, etc.
- hard to have a picture of the person because can have social isolation
Big Data → passively collect data from individuals (e.g., geolocation, social
media, activity trackers, phone calls, purchasing history, etc.)
What are some possible explanations to the gender difference observed in rates of suicide?
Proposed explanations
- Base rates→ women more vulnerable for disorders associated with increased risk for suicide
- Lethal means→ males more likely to use more lethal means (guns) than women (toxins)
- Access→ males have more access guns
- Greater Intent→ BUT cannot evaluate intent by the lethally of the means employed so no real evidence
- Mental Health Care→ women more likely to report low lethally attempt suicide and get help after than men
- Cultural acceptance→ non fatal suicide attempt are more likely to be consider cry for help and are better accepted for women
- Reactions from others→ women receive more empathetic reaction after suicidal attempt
What are the most common methods use to attempt suicide?
Most common methods use to attempt suicide:
- Poisoning
- Cutting
- Stabbing
What are proximal risk factors for suicide?
- Intoxication→ 25-50% of people committing suicide are intoxicated
- Rates higher in younger people
- Access to means
- Mental disorders→ 90% of person dying by suicide have metal disorders
–>BUT 98% of people with mental disorders do not commit suicide
What is the suidice contagion and by which factors is it influenced by?
Suicide Contagion→ exposure to suicide influence others to engage in these behaviours
- suicide cluster
Influenced by
- frequency of media reporting→ dose dependent
- content of media reporting→ ex: explicit about suicide methods
- Positive/negative reporting biases→ ex: good portrayal of suicide completers
What are the media guidelines concerning suicide report?
Media guidelines
- Full picture of the person
- Don’t sensationalize the event
- don’t share the means
What are some protective factors against suicide?
- treatment (lithium and clozapine for BPD and psychosis)
- Preventative interventions to reduce aggressive behaviors in elementary schools seems to delay onset of suicidal behaviors
- culturally-influenced coping strategies→ ex: strong moral objections, high family support
What is impulsivity and how is it related to suicide?
Many dimensions of impulsivity→ Poor premeditation (bad at thinking about consequences), sensation-seeking, lack of perseverance, negative urgency
- Negative urgency→ higher in both ideators and attempters
—>but not different so cannot help us to determine who could attempt suicide
- Poor premeditation higher in SA
- Neither SI nor SA higher in sensation seeking or lack of perseverance
What is the interpersonal psychological theory of suicide?
Interpersonal Psychological Theory
- Exposure to painful and fearsome stimuli reduces innate fears of pain and death
- Making it easier to approach the task of attempting suicide
What is the 3 steps theory of suicide?
3-Step theory→ Road towards suicide
- pain and hopelessness
- pain exceed connectedness (purpose, relationships…)
- suicide capacity
What are the 3 elements to acquire suicide capacity accoridng to the 3 steps theory?
elements to acquiring capabilities for suicide
- practical→ have access to means
- dispositional→ traits disposition
- acquired→ through experience, getting closer to the act (ex: NSSI for some people)
—>Reduced fear of pain and death
What could the explanation behind the fact that physicians who have greater exposure to provocative work experiences, are associated with increased capacity for suicide?
active gene-environment interaction→ people that are lower on fearlessness could lead people to vet or medicine
What can distinguish between a suicidal ideators and non suicidal individuals?
- Depression severity
- PTSD
- Depressive Disorders
- BD
- Hopelessness, Impulsivity and Depression
What can distinguish between suidical ideators and attempters?
No clinical variables was relevant
What is the epidemiology of NSSI?
Age of onset→ during adolescence/ young adulthood
- 13 yo
Lifetime prevalence→ 13-28% worldwide
- clinical sample→ 80%
Fairly stable in regions of the world that have been studied
No gender differences but higher in LGBTQ+ community
- especially present during coming out process
What are the functions of NSSI?
Interpersonal functions
- Autonomy
- Interpersonal boundaries (where do I start)
- Interpersonal influence
- Peer Bonding
- Revenge
- Sensation seeking
- Toughness
Intrapersonal function
- Affect Regulation
- Anti-dissociation
- Anti-suicide
- Marking distress
- Self-punishment
—>most commun function is affect regulation
What is the relationship between suicide and NSSI?
85% of people attempting suicide have a history of NSSI
- 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
- BUT many people with a history of NSSI do not go on to attempt suicide (more than 60%)
