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Chapter 10

Chapter 10- Suicide.doc

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Ayesha Khan

Abnormal Psychology Chapter 10: Suicide • Suicide is both an unusual act and a surprisingly familiar one. • Suicide is a serious health concern in Canada, as it is in many industrialized countries throughout the world • The suicide rate for Canadians as measured by the World Health Organization (WHO) is approximately 13 per 100 000 people per year, and suicide rates across the country have increased dramatically over the last five decades • Suicide accounts for nearly one in four (24%) deaths among Canadians aged 15 to 24 and is the second-leading cause of death for those between the ages of 10 and 24 • One in four teenagers admits to attempting or seriously contemplating suicide • Suicide is one of the three leading causes of death worldwide among people 15 to 44 years of age • More people die from suicide than from homicide • The impact of suicide on surviving family members and friends is huge. They experience guilt—over not having prevented the suicide, over things that were said to the person who committed suicide, over things that may have contributed to the suicide. • The WHO says that suicide is a deliberate act of self-harm taken with the expectation that it will be fatal. • Suicide-like behaviors fall on a continuum. Types of Suicides: • Four types of people who commit suicide: o Death seekers  Clearly and explicitly seek to end their lives  Their intentions to commit suicide may be present for a long time, during which they prepare for their death by giving away possessions, writing a will, buying a gun  Most often, their intentions are fleeting o Death initiators  A clear intention to die but believe that they are simply hastening an inevitable death  Many people with serious illnesses who commit suicide fall into this category o Death ignorers  Intend to end their lives but do not believe that this means the end of their existence.  They see their death as the beginning of a new and better life.  Suicide bombers who believe they will receive tremendous rewards from God for their acts are considered death ignorers. o Death darers  Ambivalent about dying, and they take actions that greatly increase their chances of death but that do not guarantee they will die.  A person who swallows a handful of pills from the medicine cabinet without knowing how lethal they are and then calls a friend is a death darer  Death darers may want attention or may want to make someone else feel guilty more than they want to die • Acts in which people indirectly contribute to their own death, perhaps unconsciously, as subintentional deaths. • Most researchers and theorists, however, reserve the label suicide for deaths that are intentionally caused by the individual Suicide Rates: • It is difficult to obtain accurate suicide rates • Sometimes, it is absolutely clear that a death was a suicide—a note is left, the person had been threatening suicide, or a revolver is still in the victim's hand, with powder stains that could only mean a self-inflicted wound. • Many deaths are more ambiguous, however, particularly when no notes are left behind and no clues remain as to the victim's mental state before the death • Accurate data on non-lethal suicide attempts are even more difficult to obtain, particularly since more than half of all people who attempt, but do not complete, suicide never seek professional help and thus may not be diagnosed • The statistics on the rates of suicide in various groups are probably gross underestimates • Internationally, an estimated 1 million people die by suicide each year, or one person every 40 seconds • Large differences in suicide rates exist between men and women, among age groups, and among cultural groups, but the characteristics of the individuals who attempt suicide and those who complete it are similar Gender Differences • In Canada, males are more likely to commit suicide than are females • We might have expected that rates of suicide in women would be much higher than in men, since women are more prone to depression than men are and depression is often associated with suicide. • A study of high school students found that girls were much more likely than boys to have considered or planned a suicide attempt • Men and boys are four times as likely as women and girls to complete suicide • This gender difference in suicide completion rate is true in many nations of the world and across all age ranges • The gender difference in rates of completed suicides may be due in part to gender differences in the means of attempting suicide. • In Canada, males are more likely to use irreversible methods in which less opportunity to prevent death exists, such as suicide attempts by hanging and firearms; females are more likely to use drugs, poison, and gases, in which a better chance of preventing death remains • In comparing the differences in suicide methods by gender between the United States and Canada, suicide by gun was found to be the most common way women in the United States commit suicide, at 39% of all female suicides • This difference in suicide by firearm between women in Canada and the United States may point to differences in the availability of guns in the two countries. • Men tend to be surer in their intent to die when they attempt suicide than women, and this is why they choose more lethal means • Men may feel that it is not masculine to be ambivalent about their intent to die or to communicate this intent to others in hopes that they will be prevented from succeeding • Women, on the other hand, may be more comfortable in using suicide attempts as cries for help • Alcohol lowers inhibitions and increases impulsive behavior, and guns provide a means for carrying out suicidal thoughts. • Men are more likely than women to drink alcohol when they are highly distressed and may have more ready access to guns • In some countries, women are at least as likely as men to commit suicide. For example, in China, women account for 55% of all suicide deaths • Gender roles probably interact with cultural beliefs about suicide to influence rates in both women and men. • The gender gap is due to selective underreporting of female suicide mortality Ethnic and Cross-Cultural Differences • Within Canada, substantial differences are seen among ethnic groups in rates of suicide, with immigrant groups being much less likely than native-born Canadians to commit suicide • Immigrant rates differ significantly by continent of birth • People born in Europe and Oceania (e.g., Australia, New Zealand) have relatively higher suicide rates than people from Africa and Asia • The presence of ethnic communities in these cities is suggested to provide a protective effect. Finally, suicidal ideation, plans, and attempts do not appear to differ significantly by generation level or degree of acculturation • Cross-national differences exist in suicide rates, with higher rates in much of Europe, the former Soviet Union, and Australia, and lower rates in Latin America and South America • These differences may have to do with cultural and religious norms against suicide • Suicide among Canada's Aboriginal peoples (First Nations, Métis, and Inuit) is a serious problem. • The suicide rate for Aboriginal peoples is three times that of the general population • The same risk factors that are important in non-Aboriginal populations are even more important in Aboriginal populations • Alcohol plays a role in many suicides; studies on Aboriginal people who completed suicide found a higher mean blood-alcohol concentration at death compared with non-Aboriginal individuals who completed suicide • The Cedar Project o The study found an association between a previous drug overdose and a future suicide attempt, suggesting a strong link between potentially fatal drug use and Aboriginal suicide o Traumatic events are another known risk factor, and research shows higher rates of traumatic exposure in Aboriginal populations compared with non-Aboriginal populations • Specific risk factors for Aboriginal suicide may also exist, including environmental factors, such as living in comparatively poor, isolated rural communities • Within-group differences may exist between different Aboriginal communities, with community-level factors contributing to differences in rates Suicide in Children & Adolescent • In Canada, youth who are older are more likely to commit suicide than are younger adolescents and children, and unfortunately, most adults do not believe children when they voice their suicidal thoughts • Although suicide is relatively rare in young children, it is not impossible. • Girls are much more likely to attempt suicide, but boys are more likely to complete suicide. • The gender ratio for completed suicide is even greater among adolescents and young adults than among older adults: Males are six times as likely as females in this age range to commit suicide • In Canada, suicide is second only to accidents in cause of death for 15− to 19-year-olds • Canada's suicide rate for children and youth is higher than the WHO's estimated global suicide rate for this age group • Suicide may be more common in adolescence than in childhood because the rate of several types of psychopathology tied to suicide, including depression, anxiety disorders, and substance abuse, increase in adolescence • Adolescents may simply have the means to commit suicide (such as access to drugs and guns) more than do children. • Rates among African-American males, although still lower than among European Americans, showed no sign of decline until 1995. • African-American youth typically have greater difficulty accessing treatments for mental health problems, and this may account for the fact that their decline in suicide rates came a bit later than that of European-American youth. • The risk factors for suicide in adolescence include current depression, interpersonal problems, insecure relationships with parents, negative thinking and hopelessness, appetite problems, increased substance abuse, aggression, and a suicide attempt by a friend • In a ten-year retrospective review of suicide in children and adolescents referred to the Hamilton Regional Forensic Pathology Unit from 1993 to 2002, psychological factors identified in the cases included depressed mood (77%), drug and alcohol problems (19%), and previous suicide attempts (23%) • A review of self-identified gay, lesbian, and bisexual youths attending groups across Canada and the United States suggests that gay and bisexual youth are at significantly greater risk for suicidal behavior, although the vast majority report no suicidal thoughts or behaviors at all • Almost all have thought about committing suicide for sometime before actually attempting it. • Many more adolescents attempt suicide than die by suicide • Adolescents may be especially prone to using suicide attempts as a way of getting attention and help for problems • A history of a suicide attempt is the single best predictor of future suicide attempts and completions • Adolescents who attempt suicide once are at high risk for future attempts, which might be successful University and College Students • In a survey of U.S. college students, 9% said they had thought about committing suicide since entering college, and 1% said they had attempted suicide while at college • The students who had contemplated or attempted suicide were more likely to suffer depression and hopelessness, loneliness, and problems with their parents • Only 20% of the students who had contemplated suicide had sought any type of counseling Suicide in Older Adults • A 50% decline in suicide rates has occurred among older adults over the past few decades, older adults, particularly older men, still remain at relatively high risk for suicide. • The highest risk is among white men over the age of 85 • When they attempt suicide, older people are much more likely than younger people to be successful • Most young people who attempt suicide are highly ambivalent about it. • Some older people who commit suicide do so because they cannot tolerate the loss of their spouse or other loved ones • Suicide rates are highest in the first year after a loss but remain relatively high for several years after the loss • Some older persons who commit suicide suffer from debilitating illnesses and want to escape their pain and suffering. • 44% had said they could not bear being placed in a nursing home and would rather be dead • Intentional life-threatening behavior, such as refusing food or medication, is a common form of suicidal behavior in older people • Older persons who lose a spouse or become ill do not commit suicide. Again, those who enter older age with a history of depression or other psychological problems are at greatest risk of responding to the challenges of old age with suicide Parasuicide • Parasuicide is a closely related and important problem in Canada. • Parasuicide, defined as an intentional but non-fatal self-injury, represents a significant cause of suffering in Canada and places a substantial burden on the health care system Understanding Suicide • Our ability to understand the causes of suicide is hampered by many factors. • Firstly, family members and friends may selectively remember certain information about the victim (such as evidence that he or she was depressed) and forget other information • Second, the majority of people who contemplate suicide never actually commit suicide, so it is difficult to determine what causes some people to go through with the act • Third, although suicide is more common than we would like, it is still rare enough that it is difficult to study scientifically • McGill Group for Suicide Studies (2010): The group is investigating the risk factors associated with suicidal behavior and is the only program of its kind in the world Suicide Notes: • Only about one in four people leaves a suicide note, however, and often these notes provide only a glimpse into their motives • Suicide notes are often brief and vague and may simply say, “I could not bear it any longer,” or “I am tired of living.” • Some suicide notes are very concrete, with explicit instructions or requests, such as how to handle the body, what to tell others about the suicide, and how to distribute assets • Suicides often happen when people are not in the deepest depths of depression and despair but, rather, when they seem to be getting better, having more energy and engagement in life • This energy, however, can simply give them the energy and freedom to commit suicide • For people with long-term mental disorders, the prospect of sinking once again into despair leads them to take preventive action—to kill themselves before it happens again • Most suicide notes are positive in their remarks about remaining family members, expressing love and thanks. Sometimes, the note is meant to relieve family members of guilt • Suicide tends to be driven by mental anguish and a sense of futility about going on. Social Perspectives on Suicide: Economic Hardship • A variety of stressful life events appear to contribute to an increased risk for suicide • One type of stressful event consistently linked to increased suicide vulnerability is economic hardship • The loss of a job can precipitate suicidal thoughts and attempts o As the farm economy has collapsed in the United States in recent decades, the rate of suicide among farmers has increased considerably o Men and women who have spent their entire lives trying to make a living from land that may have been in their families for generations can find their dreams shattered and their farms lost forever. • Chronic economic hardship also contributes to suicidality. o One U.S. study found that 8.5% of people living below the poverty level had thought about committing suicide in the previous year, compared with 5.4% of people living above the poverty level • Suicide rates among African-American males in the United States were highest in communities where the occupational and income inequalities between African Americans and European Americans were the greatest Serious Illness • Some people who commit suicide, especially older people, suffer from serious illnesses that bring them constant pain and debilitation • People who are seriously ill may always have been at increased risk for suicide • Physical illness is a risk factor for suicidal thoughts and attempts in adolescents as well as in older adults • The pain and burden of chronic physical illness may not be well managed by the medical professions, leaving some people feeling incapable of bearing them on their own. Loss and Abuse • Loss of a loved one through death, divorce, or separation often immediately precedes suicide attempts or completions • People feel they cannot go on without the lost relationship and want to end their pain • People who have experienced certain traumas in childhood, especially sexual abuse or the loss of a parent, also appear at increased risk for suicide • A history of childhood sexual abuse increases the odds of a suicide attempt by 2 to 4 times for women and 4 to 11 times for men • Physical abuse by a partner is a potent predictor of suicide attempts • The loss of a parent during childhood may create a lifetime of instability and feelings of abandonment, which can contribute to suicidal intentions • Sexual abuse during childhood may shatter people's trust in others and prevent the development of a strong self-concept, which can protect against suicide. Durkheim’s Theory • Sociologist Émile Durkheim (1897) focused not on specific events that precipitate suicide but, rather, on the mindsets that certain societal conditions can create that increase the risk for suicide • There are three types of suicide: o Egoistic suicide is committed by people who feel alienated from others, empty of social contacts, and alone in an unsupportive world o Anomic suicide is committed by people who experience severe disorientation because of a major change in their relationships to society. o Altruistic suicide is committed by people who believe that taking their own lives will benefit society in some way • Durkheim's theory suggests that social ties and integration into a society help prevent suicide if the society discourages suicide and supports individuals in overcoming negative situations • If a society supports suicide as an act that benefits the society in some situations, then ties with such a society may actually promote suicide Suicide Contagion • A well-known member of a society commits suicide, people who closely identify with that person may see suicide as more acceptable • When two or more suicides or attempted suicides are non-randomly bunched in space or time, such as a series of suicide attempts in the same high school or a series of completed suicides in response to the suicide of a celebrity, scientists refer to this as a suicide cluster • Suicide clusters appear most likely to occur among people who knew the person who committed suicide. • Many of those who attempted suicide or had active suicidal thoughts were friends and friends of the two students who had completed suicide. • Other suicide clusters occur not among close friends but among people who are linked only by media exposure to the suicide of a stranger, often a celebrity • Some studies have suggested that suicide rates, at least among adolescents, increase after a publicized suicide • Some theorists have argued these clusters are due to suicide contagi
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