1. SUICIDE LECTURE OUTLINE
What is suicide?
Prevalence rates
Mental disorder and suicide
Other risk factors
Understanding suicide
Suicide prevention
Treating people who are suicidal

2. SUICIDE What is suicide? difficult to determine suicide
taboo topic – a mortal sin, used to be illegal in Canada
difficult to know person’s intention
large number of equivocal suicides
reporting practices and judgments differ widely making it difficult to get accurate information

3. What is suicide? Key components
act of deliberate self-injury – degree of self-destructiveness
appeal to other people – suicidal gesture, “cry for help” (Farberow & Schneidman, 1961)
intention – varies from clear intention to unconscious wish to reckless/impulsive behaviour to suicidal ideation, with many people being ambivalent about suicide

4. SUICIDE Prevalence rates
Average rate of 12 per 100,000 population in Canada
varies by gender with men having higher rates (20 per 100,000) than women (5 per 100,000)
but, women are almost twice as likely to attempt suicide
men tend to use more lethal means than women

5. SUICIDE Attempters and Completers
Characteristic
Attempters
Completers
Sex
More often female
More often male
Age
Younger
Older
Means
Low lethality
High lethality
Setting
High chance of rescue
Low chance of rescue
Diagnoses
Dysthymia, Borderline Personality
Mood disorder, Schizophrenia, Substance Abuse

6. Prevalence rates - Canada
SUICIDE
Prevalence rates - Canada
attempted suicide is much more common than completed suicide
suicide rates are lowest in the Maritimes, highest in NWT and Yukon
suicide rate has steadily risen since 1920 when it was 6 per 100,000
increasing rates for young men in Canada from , plateau since 1980

7. Prevalence rates - Canada
SUICIDE
Prevalence rates - Canada
very high rates young aboriginal men (ages 15-24) – nearly 120 per 100,000
second leading cause of death for those between ages 15 – 30
3 times as many suicides as homicides

8. Prevalence rates - International
SUICIDE
Prevalence rates - International
internationally highest suicide rates are in eastern and northern European countries (e.g., Hungary – rate of 45 per 100,000; Denmark – rate of 32 per 100,000)
low rates in Mediterranean countries (e.g., Greece – rate of 3 per 100,000; Spain – rate of 4 per 100,000)

9. Mental disorder and suicide
Retrospective studies suggest that up to 90% of those who complete suicide had a mental disorder at the time of their death
Several mental disorders have high rates of suicide – mood disorder, schizophrenia, substance abuse/alcoholism

10. Mental disorder and suicide
Iowa 500 study followed people who had been hospitalized for depression and schizophrenia with a control group of people without a mental disorder
Suicide as a % of all deaths was 10% for depression group, 10% for schizophrenia group, and 0% for control group

11. SUICIDE Other risk factors
Age – in general, older men have higher rates of completed suicide (although the increase in suicide in young men has narrowed this gap); younger people higher rates of suicide attempts
Marital status – high rates of suicide attempts for single people; high rates of completed suicide for people who are widowed, separated, or divorced; risk also diminishes if person has children
Race – high among Caucasians and aboriginal people

12. SUICIDE Other risk factors
Physical illness
Life stress – especially loss experiences
Loneliness, isolation
Previous attempts
Suicide plan
Family history
Suicide sometimes occurs after improvement in mental health

13. Understanding suicide
Biological – suicide is related to mental disorder, genetic link
Psychological – Freud, anger turned inward; Cognitive-behavioural – modelling and social learning; Existential-humanistic – hopelessness and despair, lack of meaning
Sociocultural – Durkheim, suicide is related to social norms and culture; 3 types of suicide: egoistic, altruistic, anomic

14. SUICIDE Suicide prevention
No formal recognition of the problem in Canada; no official government or professional organization; “suicide – the deserted field”
England – Anti-suicide prevention bureau, 1906; New York, Save a life league
England – Samaritans, 1953
Los Angeles Suicide Prevention Center (Farberow & Shneidman, 1961), 1960, AAS, Center for Suicide Studies in Washington DC

15. Suicide prevention, crisis intervention, and distress lines
use of telephone
24-hour service
use of trained volunteers
emotional support
connection to other services

16. Suicide education programs
provides information to students in high school, builds awareness
Little research showing the effectiveness of suicide prevention, crisis intervention, distress lines, or suicide education programs in reducing suicide rates
many suicidal people do not come into contact with these services
suicide education and awareness can actually increase suicidal ideation (Shaffer et al., 1988)

17. Effective suicide prevention
General approaches to primary prevention and health promotion – building competence, coping, and problem-solving skills
Reduction of access to lethal means – CO gas in UK, firearms

18. Treating suicidal individuals
SUICIDE
Treating suicidal individuals
Need to assess suicidal risk and ensure adequate supervision of attempter
Deal with life crisis swiftly
Therapy focused on building protective factors and reducing risk factors, through a variety of different approaches
Encourage open talk about suicidal ideation

19. SUICIDE
SUMMARY
Suicide is strongly related to serious mental health problems and other risk factors
Suicide rates vary widely by different aspects of social context
Reducing availability of lethal means of suicide is important for effective prevention
Need for a more focused, coordinated national strategy to deal with this problem