1. Dr. Saman Yousuf 15 June 2011

2. SOCIETY COMMUNITY FAMILY INDIVIDUAL

3.  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

4.  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

5.  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

6.  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

7.  FAMILY HISTORY OF SUICIDE  FAMILY DISCORD / SEPARATION OR DIVORCE  POOR FAMILY SUPPORT

8.  JOB OR FINANCIAL LOSS  EASY ACCESS TO LETHAL MEANS  RELATIONAL LOSS WITHIN COMMUNITY  LOCAL CLUSTERS OF SUICIDE / EXPOSURE TO SUICIDE

9.  MEDIA EXPOSURE TO SUICIDE Lee Eun-ju (1980-2005) Min-Jan Nee(1946-2005) Leslie Cheung (1956-2003)

10.  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

11. 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

12.  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

13.  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

14. SOME LOCAL RESEARCH …

22. RISK FACTORS PROTECTIVE FACTORS

23. What are the risk factors? What are the protective factors?