Ch. 15 - Suicide.docx

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University of British Columbia
PSYC 208
Paul Wehr

Suicide 12/4/2012 8:53:00 PM Introduction  Suicidal behavior: conscious intentional act(s) that aims at terminating one’s life o Attempted vs. completed suicide o Parasuicide: suicidal attempts or gestures with no intention to die; with practice, individual loses fear and engaged in increasingly dangerous behavior  Difficult to differentiate between suicide and parasuicide o “Hard” vs. “soft” suicide attempts  Men more likely to use “hard” method (gunshot, hanging…)  Women more likely to use “soft” method (overdose…)  Suicidal ideation often triggered by feelings of hopelessness or social isolation o Psychiatric disorders o Health problems  Stages of suicide o Intense suffering leads to thoughts of suicide o Feelings of ambivalence o Narrowing of perceived alternatives o Final decision Epidemiology  One year (2001) prevalence: 850,000 worldwide o Europe: 25 per 100,000 o Canada: 11.5 per 100,000  Males: 17.4 per 100,000  Females: 5.3 per 100,00  Peaks in the 40s o Higher in high social status o Higher after losing status o Rate in 15-19 year olds has more than tripled since 1960  Parasuicidal behavior is 10-20 times higher  More likely to die from suicide than in a car accident Risk Factors  Emotion: aggression, impulsiveness, hopelessness, shame, humiliation, inability to experience pleasure  Trauma: childhood trauma, sexual abuse, recent trauma  Marital: widowhood, divorce, marital discord  Aging: physical illness, chronic insomnia, reduced cognitive functioning  Social: lack of social support, negative family relations  Neglectful parenting for females  Psychiatric disorders o 90% of suicides associated with diagnosable disorder o Affect disorders, substance dependence, schizophrenia, impulsive and dramatic personality disorders o 50% of borderline personalities attempt suicide at least once  Genetic factors are independent of those associated with psychiatric disorders Pathophysiological Mechanisms  Reduced serotonin activity: o Low levels of 5-HIAA (metabolite of serotonin) in the CSF are associated with low levels of serotonin activity and increased aggression and suicide o Two polymorphisms associated with increased risk of suicide code for reduced serotonin activity o Low cholesterol blood levels lead to low serotonin activity, which lead to increased risk-taking and increased risk of suicide  Mixed evidence for hyperactive HPA stress pathway and elevated levels of cortisol Outcome and Treatment  Risk of successful suicide following unsuccessful attempt o First year: 0.5-2% o Nine years: 5% o Lifetime: 30%  Protective factors: social support (including therapy), children in the home, life satisfaction, problem-solving ability  Treatment o Primary and secondary prevention: reduced access to means, increased access to hotlines, public awareness  Primary: prevention of initial suicide attempts  Secondary: prevention of subsequent suicide attempts o Individual assessments of ideation, intent, and planning o Hospitalization of acutely suicidal Evolutionary Synthesis  Suicide and self-injury are complex behaviors involving a broad spectrum of psychological mechanisms and environmental circumstances o Suicide per se is NOT an adaptation o Psychological mechanisms that lead to parasuicide or self-injury might be executing an adaptive strategy (parent-offspring conflict) o Psychological mechanisms that lead to suicide might be executing an adaptive strategy (kin selection or intra-sexual competition) o Suicide might reflect dysregulation of otherwise adaptive psychological mechanisms Parent-Offspring Conflict  Suicidal behavior reflect threats to inclusive fitness of close kin in order to solicit additional investment o Parasuicide o Self-injury o Starvation (anorexia nervosa) o Borderline personality o More likely in females; peak or manifest during adolescence  Sample 1601 adolescents (Andrews) o Suicidal ideation and attempts were both correlated with dissatisfaction with mother th o Dissatisfied (80 percentile) were more likely to be female (61%) o Middleborns who attempted suicide received greater investment from parents compared to firstborns or laterborns  Middleborns receive less investment from parents  First and last born attempt suicide for reasons other than investment? Kin Selection  Suicide might increase fitness of relatives if the individual perceives himself/herself as a burden o Occurs when costs imposed on kin exceed the benefits to kin (e.g. elderly, terminally ill, handicapped) o 58% of variance of suicidal ideation is related to being a burden on family or other similar family issues o Reflect an adaptive strategy, but account for only a small proportion of suicides Intra-sexual Selection  Failures to succeed in intra-sexual competition might lead to progressively greater risk- taking, which sometimes results in suicide o High levels of serotonin associated with higher social status, less aggression and more prosocial behavior
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