Dr. Saman Yousuf 15 June 2011
SOCIETY COMMUNITY FAMILY INDIVIDUAL
SOCIO-DEMOGRAPHIC FACTORS 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
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 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
Prior suicide attempt 38.4 Eating disorders23.1 Bipolar disorder 21.7 Major depression 20.4 Mixed drug abuse 19.2 Dysthymia12.1 Obsessive-compulsive11.5 Panic disorder10.0 Schizophrenia8.45 Personality disorders 7.08 Alcohol abuse 5.86 Cancer 1.80 General population 1.00 Adapted from A.P.A. Guidelines, part A, p. 16
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 HOPELESSNESS COGNITIVE THINKING DIMENSIONS - Thought constriction - Polarized thinking
FAMILY HISTORY OF SUICIDE FAMILY DISCORD / SEPARATION OR DIVORCE POOR FAMILY SUPPORT
JOB OR FINANCIAL LOSS EASY ACCESS TO LETHAL MEANS RELATIONAL LOSS WITHIN COMMUNITY LOCAL CLUSTERS OF SUICIDE / EXPOSURE TO SUICIDE
MEDIA EXPOSURE TO SUICIDE Lee Eun-ju ( ) Min-Jan Nee( ) Leslie Cheung ( )
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
Demographicmale; widowed, divorced, single; increases with age; white Psychosociallack of social support; unemployment; drop in socio-economic status; access to means, media regulation on reporting suicides Psychiatricpsychiatric diagnosis; comorbidity Physical Illnessmalignant 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 Dimensionsthought constriction; polarized thinking (part of depression or otherwise) Childhood Traumasexual/physical abuse; neglect; parental loss Genetic & Familialfamily history of suicide, mental illness, or abuse
Effective clinical care for mental, physical and substance disorders Easy access to clinical interventions and support for help-seeking Restricted access to highly lethal means of suicide Strong connections to family and community support Support through ongoing medical/mental health care relationships Skills in problem solving, conflict resolution and handling disputes
Cultural/religious beliefs discouraging suicide & supporting self- preservation - Christianity : Forbids the act “Thou shalt not kill” - Islam : Forbids the act 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?