Transcript Suicide: Risk Factors

Dr. Saman Yousuf
15 June 2011
SOCIETY
COMMUNITY
FAMILY
INDIVIDUAL
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SOCIO-DEMOGRAPHIC FACTORS
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Male
Being over 60
Separated, widowed or divorced
Living alone
Being unemployed or retired
Indebted
Occupation
SMOKING
DRUG/ALCOHOL MISUSE
HISTORY OF TRAUMA / ABUSE / BULLYING
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PAST SUICIDE ATTEMPT / DELIBERATE SELF HARM
After a suicide attempt that is seen in the Emergency Room, about 1%
per year take their own life, up to approximately 10% within 10 years
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PSYCHIATRIC DISORDERS
Most common psychiatric risk factor resulting in suicide
- Depression*
- Major Depression
- Bipolar Depression
- Alcohol abuse and dependence
- Drug abuse and dependence
- Schizophrenia
*Especially when combined with alcohol and drug abuse
Other psychiatric risk factors account for significantly fewer suicides
- Post Traumatic Stress Disorder (PTSD)
- Eating disorders
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Prior suicide attempt
Eating disorders
Bipolar disorder
Major depression
Mixed drug abuse
Dysthymia
Obsessive-compulsive
Panic disorder
Schizophrenia
Personality disorders
Alcohol abuse
Cancer
38.4
23.1
21.7
20.4
19.2
12.1
11.5
10.0
8.45
7.08
5.86
1.80
 General population
1.00
Adapted from A.P.A. Guidelines, part A, p. 16
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MAJOR LIFE EVENTS
- Chronic physical pain
- Major physical illness (especially if recent)
- Impending legal prosecution
- Family/relationship breakdown
- Impulsivity
- Unwillingness to seek help
- Difficulty accessing services
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HOPELESSNESS
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COGNITIVE THINKING DIMENSIONS
- Thought constriction
- Polarized thinking
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FAMILY HISTORY OF SUICIDE
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FAMILY DISCORD / SEPARATION OR DIVORCE
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POOR FAMILY SUPPORT
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JOB OR FINANCIAL LOSS
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EASY ACCESS TO LETHAL MEANS
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RELATIONAL LOSS WITHIN COMMUNITY
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LOCAL CLUSTERS OF SUICIDE / EXPOSURE TO SUICIDE
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MEDIA EXPOSURE TO SUICIDE
Lee Eun-ju (1980-2005)
Min-Jan
Nee(1946-2005)
Leslie Cheung (1956-2003)
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CULTURAL AND RELIGIOUS BELIEFS THAT GLORIFY SUICIDE
- Seppuku/Hara-Kiri ("stomach-cutting") is a form of Japanese ritual suicide by
disembowelment -- originally reserved only for samurai -- Part of the samurai
“bushido” honor code, used voluntarily by samurai to die with honor rather than
fall into the hands of their enemies, as a form of capital punishment for samurai
who had committed serious offenses, or performed for other reasons that had
brought shame to them.
The ceremonial disembowelment, which is usually part of a more elaborate ritual
and performed in front of spectators, consists of plunging a short blade,
traditionally a “tanto”, into the abdomen and moving the blade from left to right in
a slicing motion
- Sati/Devanagari is a religious funeral practice among some indian communities
which the recently widowed lady voluntarily or by coercion immolates herself –
rare and outlawed practice in India since 1829
Demographic
male; widowed, divorced, single; increases with age; white
Psychosocial
lack of social support; unemployment; drop in socio-economic status;
access to means, media regulation on reporting suicides
Psychiatric
psychiatric diagnosis; comorbidity
Physical Illness
malignant neoplasms; HIV/AIDS; peptic ulcer disease; hemodialysis;
systemic lupus erthematosis; pain syndromes; functional impairment;
diseases of nervous system
Psychological
Dimensions
hopelessness; psychic pain/anxiety; psychological turmoil; decreased
self-esteem; fragile narcissism & perfectionism
Behavioral
Dimensions
impulsivity; aggression; severe anxiety; panic attacks; agitation;
intoxication; prior suicide attempt
Cognitive Dimensions
thought constriction; polarized thinking (part of depression or
otherwise)
Childhood Trauma
sexual/physical abuse; neglect; parental loss
Genetic & Familial
family history of suicide, mental illness, or abuse
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Effective clinical care for mental, physical and substance disorders
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Easy access to clinical interventions and support for help-seeking
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Restricted access to highly lethal means of suicide
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Strong connections to family and community support
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Support through ongoing medical/mental health care relationships
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Skills in problem solving, conflict resolution and handling disputes
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Cultural/religious beliefs discouraging suicide & supporting selfpreservation
- Christianity : Forbids the act “Thou shalt not kill”
- Islam : Forbids the act
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Having children at home (other than those of postpartum
depression)
Pregnancy / Life Satisfaction
SOME LOCAL RESEARCH …
RISK FACTORS
PROTECTIVE
FACTORS
What are the risk factors?
What are the protective factors?