Suicide & NSSI

Question 1

What is being defined: death resulting from intentional self-injurious behaviours, associated with any intent to die as a result of the behaviour

Answer 1

Suicide

Question 2

Define a suicide attempt

Answer 2

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

Question 3

True or false: low lethality equals low intent

Answer 3

False

Question 4

What is the difference between an interrupted attempt and a self-interrupted/aborted attempt

Answer 4

Interrupted attempt: a person takes steps toward making a suicide attempt but is stopped by another person to any injury or potential injury
Self-interrupted/aborted attempt: a person takes steps to injure themself but stops prior to any injury or potential injury

Question 5

What is being described: acts or preparation toward making a suicide attempt

Answer 5

Preparatory acts of behaviour

Question 6

True or false: there is much heterogeneity in measuring suicidal ideation

Answer 6

True

Question 7

What is being described: behaviour that is self-directed and deliberately results in injury or the potential for injury to oneself

Answer 7

non-suicidal self-injurious behaviour

Question 8

In 2016, suicide was the ____ leading cause of death across all age groups in Canada

Answer 8

9th

Question 9

How many people die by suicide each year in Quebec and in Canada

Answer 9

Canada: almost 4000 people
Quebec: almost 900 people

Question 10

What is the rate of deaths by suicide per 100 000 for men and women

Answer 10

Men: 16.3
Women: 5.7

Question 11

What is the total number of suicidal thoughts?

Answer 11

3.4 million

Question 12

What is the number of suicidal thoughts among 18-34 year olds and how does this divide between males and females in that age range

Answer 12

Total: 1.1 million
Males: about 480 000
Females: about 650 000

Question 13

What are the key elements to suicide

Answer 13

Agency, intent, and outcome

Question 14

Identify this scenario: a 12 year 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 move where a teenager dies from overdosing on sleeping pills. She then takes 20 melatonin tablets that she knows her mother taker to help her sleep

Answer 14

Suicide Attempt

Question 15

Identify the scenario: A man is drinking near a lack 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

Answer 15

Nothing related to suicide because there was no intent and we cannot infer intent

Question 16

Identify the scenario: Tina was a 15-year-old girl whose girlfriend recently broke up with her. On the way home from school, she saw her kissing another girl. When Tina arrived home, she immediately went upstairs and cut her arm several times with scissors. Although she wore long sleeves to dinner that evening her mother spotted the wounds and brought her daughter to the emergency room, saying her daughter tried to kill herself. Tina, stated empathetically that she did not want to die. “I cut myself because it made me feel better” she said. Tina explained to the psychiatrist that she cute herself because it was calming

Answer 16

NSSI

Question 17

How were suicide and NSSI listed prior to the DSM-5

Answer 17

Listed as symptoms of Depression and BPD

Question 18

How is suicide and NSSI now categorized in the DSM 5

Answer 18

It is included under conditions for further study

Question 19

What are the challenges with conducting research on suicidality

Answer 19

It is rare - there is a low base rate
Etiologically complex
Difficult to study longitudinally
Stigma/level of constraints
Replication

Question 20

What are common research methods used to study suicidality

Answer 20

Archival: using pre-existing records and databases, look at how variables relate to each other at any given moment
Psychological Autopsy: reconstruct what a person was like before the suicide through interviews with family, friends, co-workers
Big data

Question 21

What are the differences between the rates of suicide ideation, plans, and attempts

Answer 21

9.8 million people will have severe ideation (very common)
2.8 million will make a plan
1.3 million attempted
1 million made plans & attempted
0.3 million made no plans but attempted

General idea: having ideation doesn’t mean people will attempt, most people do not

Question 22

What can we say about gender and suicide

Answer 22

Women will make more attempts than men but less likely to die by suicide and it is the opposite pattern for men
77% of deaths by suicide are male

Question 23

What are some proposed explanations for the gender differences in suicide

Answer 23

Base rates of disorders more common in women
Lethal means - mean choose more lethal means
Access to lethal means is higher among men
Greater intent in men
Women are more likely to use mental health services than men
Cultural acceptance - non fatale suicide attempts are seen as feminine
Reactions from others - women tend to get more support

Question 24

What is the main race/ethnicity difference in suicide

Answer 24

White non-Hispanics have higher deaths by suicide along with American Indians which is substantially higher than Asians, Blacks, Hispanics

Question 25

Which group of people has the highest rates of suicide in the world

Answer 25

Canadian indigenous people

Question 26

Seeing that the distribution of suicides among Canadian indigenous people is not evenly distributed, what groups are the highest to the lowest in terms of risk.

Answer 26

1. Inuit 2. First Nations 3. Métis

Question 27

What did Durkheim say about suicide

Answer 27

Language and community cohesion

Question 28

From 2000 to 2021, which country has had increasing rates of death by suicide

Answer 28

United States

Question 29

What are the most common methods used to attempt suicide in order

Answer 29

Poisoning Cutting Stabbing

Question 30

What are the most common reasons for death by suicide in order in the US

Answer 30

Firearms Suffocation Poisoning Falling

Question 31

What are the most common reasons for death by suicide in order in Canada

Answer 31

Hanging Suffocation Poisoning Firearms

Question 32

True or false: risk factors are equivalent to warning signs

Answer 32

False

Question 33

Which risk factors would be considered modifiable and which would not?

Answer 33

Modifiable: depression and access to lethal means Non modifiable: race, genetic predisposition, family history of suicide

Question 34

______ risk factors and ______ protective factors can help prevent suicide

Answer 34

Reducing, increasing

Question 35

What can we say about proximal risk factors - risk factors proximal to the attempt

Answer 35

Intoxication - about 25-50% of adults who die by suicide are intoxicated at the time of death either by alcohol or other substances 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)

Question 36

What can we say about suicide contagion in the media

Answer 36

Exposure to the suicidal behaviour of one or more persons influences others to engage in these behaviours Exposure can occur through different mediums It is unclear how suicide contagion works

Question 37

According to suicide contagion in the media, what do the rates of suicide and suicidal behaviour appear to be influenced by

Answer 37

The frequency of media reporting - dose dependent (more reporting = more contagion) Content of media reporting - ex: dramatic headlines Positive/negative reporting biases - ex: attitudes toward suicide

Question 38

There are higher rates of suicide among countries that interpret suicide more _________

Answer 38

Openly/positively

Question 39

When reporting on suicide, what should and should not be done

Answer 39

Should: talk about how it impacts others and what the person was feeling Should not: talk about methods

Question 40

What were 2 arguments made about the 13 reasons why release

Answer 40

Some argued that it may be glamorizing suicide and others argued that it would help raise awareness

Question 41

What are some protective factors of suicide

Answer 41

Treatment - psychosocial or pharmaceutical Lithium for bipolar and clozapine for psychosis Preventative interventions - ex: working to reduce aggressive behaviours in early elementary school Culturally influenced coping strategies - ex: values reflecting strong moral objections to suicide and high family support

Question 42

What can we say about biological factors as an etiological explanation of suicide

Answer 42

Evidence from twin studies that suicidal behaviours are genetically-influenced — additive genetic effect in suicidal behaviour rather than ideation Adoption studies: rates of suicide in biological relatives of adoptees who died by suicide is higher than rates in the adopted families Inherited tendencies like impulsivity and fearlessness which could also be reflecting general psychopathology inheritance

Question 43

What are the dimensions of impulsivity? Mention if the dimension is higher in attempters or in ideators

Answer 43

Poor premeditation - higher in attempters Sensation seeking - neither Lack of perseverance - neither Negative urgency - both

Question 44

What did Thomas Joiner contribute to “ideation-to-action”

Answer 44

Interpersonal Psychological Theory: - exposure to painful and fearsome stimuli reduces innate fears of pain and death (habituation not sensitization) making it easier to approach the task of suicide

Question 45

What is the 3-step theory suggested by Klonsky & May

Answer 45

Practical - having access to means Dispositional - trait propensity Acquired - though lived experiences, building up to an attempt

Question 46

What is one thought that needs to be overcome within the person in order for that person to decide to make an attempt

Answer 46

Reduced fear of pain and death

Question 47

How can the environment influence capability

Answer 47

Capacity can arise through practice habituation and experience

Question 48

What are some examples of how the environment can influence capability

Answer 48

Playing more violent video games correlated with greater capacity, even when controlling for previous painful life events Among vet students, greater exposure to euthanasia associated with increased fearlessness Among physicians, greater exposure to provocative work experience is associated with increased capacity

Question 49

What is the category of rGE that would explain people self-selecting into fields that have a higher risk of death

Answer 49

Active rGE

Question 50

True or false: A meta-analysis by May & Klonsky looking at 27 studies and comparing 12 sociodemographic and clinical variable between suicide attempters and ideators were able to differentiate these 2 groups

Answer 50

False, the two groups were do distinguishable

Question 51

When does onset of NSSI tend to peak

Answer 51

Adolescence/young adulthood

Question 52

What is the age of onset of NSSI

Answer 52

13

Question 53

True or false: Rates of NSSI may decrease with middle age

Answer 53

True

Question 54

What is the lifetime prevalence of NSSI worldwide and in clinical samples? Is the prevalence stable in regions of the world that have been studied

Answer 54

Worldwide prevalence: 13-28% Clinical samples prevalence: 80% Prevalence is stable in regions of the world that have been studies

Question 55

True or false: people who engage in NSSI tend to use lower lethality means that those engaging in a suicide attempt

Answer 55

True

Question 56

What are some NSSI behaviours

Answer 56

Cutting Skin abrading (scratching) Interfering with wound healing Banging/self-hitting Burning

Question 57

Most people who endorse repeated NSSI use on average ____ methods

Answer 57

4

Question 58

People endorsing suicide attempts often use the ______ methods but _______ the lethality

Answer 58

Same, increase

Question 59

What can we say about the gender differences in NSSI

Answer 59

They are inconclusive but men are somewhat more at risk

Question 60

Seeing that rates of NSSI are higher in LGBTQ+ when would we expect them to peak

Answer 60

During the coming out-process

Question 61

What are the interpersonal functions for NSSI

Answer 61

Autonomy Interpersonal boundaries Interpersonal influence Peer bonding Revenge Sensation seeking Toughness

Question 62

What are some of the intrapersonal functions of NSSI

Answer 62

Affect regulation Anti-dissociation Anti-suicide Marking/objectifying distress Self-punishment

Question 63

What did the study by Muehlenkamp and colleagues (2009) find when the looked at females with bulimia nervosa who engaged in NSSI and those who did not engage in NSSI

Answer 63

Negative affect group: negative affect increased until onset of NSSI and then slightly decreased Positive affect group: positive affect decreased until the onset of NSSI and then increased

Question 64

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

Answer 64

85%

Question 65

College students with a history of NSSI are _____ more likely to have suicidal ideation, and _____ more likely to have attempted suicide than students with no NSSI

Answer 65

8X, 25X

Question 66

True or false: many people (about 60%) with a history of NSSI go one to attempt suicide

Answer 66

False, they do not

Question 67

Repetitive and/or severe NSSI seems to be a particularly strong ______

Answer 67

Predictor