SUICIDE
Definition- death resulting directly or
indirectly from a positive or a negative act
of the victim himself which he knows will
produce this result (Durkheim, French
Sociologist)
Suicide is an intentional act resulting in
one’s own death
Para suicide – non-suicidal
behaviors(deliberate self harm)
Suicide and Para suicide differ in terms of
demographic, psychological and
psychiatric aspects.
The intention in Para suicide is to evoke a
response from the human surroundings,
reorder the life circumstances.(a cry for
help).
It may lead to suicide in 10%.
Among Para suicides personality disorders
and mild depression are common
Durkheim’s typology –
Anomic suicide(individual is no longer
guided by the society due to its weakness,
like the suicide of an unemployed )
Egoistic(individualistic decision of a person
no longer dependent on others' control or
opinion)
Altruistic (society which can exert a strong
influence on an individual's decision to
sacrifice his or her life)
Fatalistic(as a result of strict rules in a
society which have proved decisive for the
destiny of an individual)
In most cases life events are not
accidental, but are usually also dependent
on the individual's own behavior
Patients who have seriously attempted
suicide by violent means have low levels
of the serotonin metabolite 5-
hydroxyindole acetic acid in their
cerebrospinal fluid(marker)
Suicide is usually preceded by years of
suicidal behavior or feelings, and plans
and warnings
Availability is a major factor affecting this
choice.
Hanging is universally available and it is
the most common suicide method globally
Imitation means learning the use of a
specific suicide method from a model
which is overtly available in a culture,
community, institution, or mass media.
Suicide always has a major impact on the
survivors.
Suicide is a threatening event not only
among close family members, but also in
the surrounding population, including
treating personnel and the people at the
victim's workplace.
The major challenges after a suicide, in
addition to a normal mourning process,
are dealing with shame and guilt feelings,
and the crisis of survivors
Assessment of the suicidal intent-
Act alone
Precautionary measures taken to avoid
discovery
Acts in anticipation of death(insurance,
will)
Timing of the act
Preparations for the act
Not crying for help after the act,
Communication of the intent,
Extensive premeditation
Leaving a note.
Assessment of lethality-
The lethality of the suicide act is related to the
severity of the intent to die and the degree of
mutilation caused by the act, and how quickly a
method can cause death. Firearms, carbon
monoxide, and hanging are active suicide
methods with the highest potential to cause
death. Poisoning, drowning, or wrist cutting are
typically methods which leave more time for
help seeking and intervention
Epidemiology
8thleading cause of death in US
Suicide rate is 12/100,000
Scandinavia, Japan, Switzerland,
Germany, Austria have higher rates
Spain, Italy, Ireland, Egypt, Netherlands
have lower rates
Factors
Age
Rare in children
Adolescents more attempts
Teens …. Occur in clusters
Risk increases substantially with age
Sex and ethnicity
Women attempt 4 times men
Completed suicides 3 times more in men
Immigrants higher rates
White Americans higher compared to African
Americans
Marital status and religion
Provide social support
Separated, divorced and widowed more likley
Catholic and Muslims prohibit suicide
Occupation
Professionals at higher risk than non
professionals
Access to means of suicide
Physicians, police officers
Other factors
Alcohol use decreases inhibitions
Aggressive, impulsive and violent people
Suicide gene – serotonin transporter ?
Family history increases risk
Risk factors for suicide
serious previous suicide attempt
older adults
substance dependence or abuse
history of rage and violent behavior
male
socially isolated
suicide in close relatives
Jewish or protestant
psychotic symptoms
chronic illness
professional
poor economic conditions
Causes of suicide –
Psychiatric disorders
Physical illness
Psychosocial problems
Psychiatric disorders
Depression (15%),schizophrenia(10%),bipolar
disorders(20%).
Hopelessness, substance use, ideas of guilt,
past attempt carry high risk in depression.
Risk is highest during the period of recovery.
Command hallucinations, delusions, regaining
of insight increases risk in schizophrenia.
Physical illness-
Patients with terminal illness, disability carry
high risk.
Personality disorders and psychosocial
factors –
Borderline personality disorders ,stressful
family situation, economic factors, love
affairs, sudden fall in self esteem.
Death of parent by suicide, death of parent in
child younger than 11yrs, loss of parent by
divorce in adolescence increases risk of
depression and suicide
SUICIDE: A MULTI-FACTORIAL EVENT
Psychiatric Illness
Co-morbidity
Personality Neurobiology
Disorder/Traits
Impulsiveness
Substance
Use/Abuse
Hopelessness
Severe Medical Suicide
Illness Family History
Access To Weapons Psychodynamics/
Psychological Vulnerability
Life Stressors Suicidal
Behavior
Preventive Measures
treatment of psychiatric disorders
prophylaxis with long term lithium, TCAs,
or SSRIs
ECT in acutely depressed with suicidality
improve support system
psychotherapy in borderline personality
marital counseling
legal restrictions
public education about the concept of
mental health
centers for crisis management
Attending the families of suiciders
Hospitalizing a suicidal patient
Hospitalization is indicated for high risk
patients.
Patient can be detained against his will for
1-2 days depending on state law.
Physician is held responsible legally if they
fail to identify or detain a suicidal patient
Indications for hospitalisation
Possession of a means of suicide
Presence of a plan for suicide
Acute intoxication
Expresses feeling out of control
Psychotic symptoms
Lack of social support
History of repeated suicide attempts
Patient is unreliable
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