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What is it? The intentional, direct, and conscious taking of one's life.

Most people who complete suicide do not want to die. Most do have prior attempts. They see no other options, and they feel so much pain and suffering. They just want that to end.

Suicide rates are increasing in the us, 10th leading cause of death in US. They goin up for everyone. Men are 3.6 times more likely to commit suicide than women. Suicide highest among Whites and American Indians and lowest among Blacks, Asians, and Latinos.

Common Characteristics?

• Belief that things will never change, and that suicide is the only solution.
• Desire to escape from psychological pain and distressing thoughts and feelings.
• Triggering events including intense interpersonal conflict and feelings of depression, hopelessness, guilt, anger, or shame.
• Perceived inability to make progress toward goals or to solve problems; related feelings of failure, worthlessness, and hopelessness.
  • Overwhelming fear of failure, dont trust themselves
• Ambivalence about suicide; there is a strong underlying desire to live.
  • They do want to live, some of the sadness is a desire to be happy and fulfilled.
• Suicidal intent is communicated directly or indirectly through verbal or behavioral cues
  • You will know someone is struggling. If they talk about feelings of hopelessness and worthlessness.
  • This could be a sign of Passive Suicidal Ideation

Methods of Suicide

• Firearms
  • 51%
  • Men are more likely
• Drug overdose
  • 13%
  • This is specific intent
  • Women are more likely to use this (including alcohol)
• Hanging/Suffocation
  • 29%
  • Typically by older adolescence. They also try by jumping

Occupational Risk Factors

Jobs with the high rates of suicide in men include:

• Farmworkers, fishermen, lumberjacks, carpenters, miners, electricians, and installers
  For women, the highest rates of suicide occur for those who were:
• Firefighters, police, and correctional officers
  Among medical professionals, psychiatrists have the highest suicide rate and pediatricians the lowest

Effects of Suicide on Friends and Family

Consistent themes among surviving friends

Guilt, and an attempt to understand the tragedy
• Attempts to understand and make meaning of the tragedy
• Development of risky behaviors
• Altered relationships with friends

Surviving family members, especially parents, often feel guilt and responsibility

• Increased rates of depression, anxiety, alcohol abuse, and marital difficulty
• Not many mariages survive the death of a child

Suicide Effects on Children

Suicide of a parent can have lifelong effects

• Child has increased risk of developing mental health problems
• Increased risk of suicide, especially if deceased parent was the other
• Increased likelihood of being hospitalized for depression or anxiety if deceased parent was the father
• Those who experienced parental suicide during adolescence or early adulthood had the highest risk of hospitalization for suicide attempts (first 2 years after the suicide)

Equally traumatic if the los of a spouse or life partner

Possible Reasons for Increase of Suicide in Children and Adolescents

• Suicide rate for young people is at its highest since 2000 and appears to be climbing
  • there is a barrier to identify when someone (young) is struggling
  • You have to go through parents
• Social media use and substance abuse may contribute to the increase
  • There isnt really a beenefit to having it as young kids
• There is an increase in suicidality among African American children and adolescents
• The academic environment can function as a major stressor for children and adolescents
  • Inequity, harsh discipline
  • Private school kids with strict academic environment are more likely to commit suicide
• Bullying
  • happens through social media
  • victims are 2-11 times more likely to consider suicide
  • LGBTQ teens at risk
• Copycat Suicides
  • Exposure of others dying by suicide leads to an increase in others committing suicide
  • Leads to an increase of thoughts and attempts in adolescents
• Antidepressant Medication (SSRIs)
  • 2004 FDA warned that SSRIs increased suicidal thoughts in kids taking anti depressants

Suicide Among the Elderly

• Suicide rates for elderly (white) men are the highest of any age group
• Suicide rates for older Chinese, Japanese, and Filipino Americans were higher than the rate for older European Americans
• You're getting things taken away from you at an older age. You don't know what your doing Etc. This can be hard on people.
• Factors for increased risk:
  • Bereavement
  • Physical ailments
  • Social isolation
  • Financial difficulties

Biological Dimension

• Suicide influenced by low serotonin levels in the brain
• Genetic relationship is unclear
  • We don't know what mechanism is at play here
  • Kids who's parents die by suicide are at a higher likelihood to also commit suicide
• Sleep difficulties (nightmares, trouble falling or staying asleep)
  • Struggling with sucidal ideation, and sleep deprived. Big thing happens in your life and boom. You cant make rational decisions and end up commiting the big S.

Drugs and Alcohol

• Substance use involving alcohol, cocaine, cannabis, opioids, amphetamines, or sedatives increases the risk of suicide
• Cannabis use during adolescence is associated with depression and suicidality

Alcohol

• As many as 70% of suicide attempts involve alcohol
• Strong correlation to successful attempt

• Lowers inhibitions, cant think through situaiton
  • May lower inhibitions related to fear of death
  • Alcohol-induced myopia
• Alcohol is a depressent and as you keep drinking, it makes the problem worse.

Psychological Dimension

• Psychological pain associated with maltreatment in childhood, particularly sexual abuse and emotional abuse
• Rumination
• Shame, discouragement, distress over academic or social pressures, and other life stressors
• Many people who commit suicide have a history of mental illness
• Personal problems that precipitate social withdrawal

Social Dimension

• Many suicides are interpersonal in nature
  • Some type of conflict leads to struggle
• Disconnection from friends, family, religious institution, or community
• Factors in children who consider suicide
  • Abuse, and unpredictable traumatic events
  • Loss of significant parenting figure before age 12
• Perceived burdensomeness, Thwarted belongingness
  • They think they a burden and they dont want to be that burden
• Acquired capacity for suicide
  • Attempts over time can lead to readiness

Marital Status

• Stable marriage or relationship makes suicide less likely \
  • Protective factor, decreases chances for suicide
• For women, having children decreases suicide risk
• People who are divorced, separated, or widowed have higher suicide rates than the married
• Death of a spouse associated with 50 percent higher suicide rate for men
  • Men do not cope well when widowed
  • within 6 months, they either find someone new or kill themselves

Ethnic and Cultural Variables

• Suicide rates for men of color are from 3 to 4 times higher than their female counterparts

Highest rate of completed suicides
• American Indian/Alaska Native
• European American males
Lower rates
• African American
• Hispanic/Latino
• Asian American/Pacific Islander

Gender

• Death from suicide occurs much more frequently among males
  • around 79% of all suicides
• Females have higher rates of suicidal thoughts and attempts
• Males tend to choose most lethal methods
• Drug overdose/poisoning most common means for women
• Many men who commit suicide have no history of mental illness
  • men dont seek treatment

Socioeconomic Stressors

• Environmental and economic issues can have a significant impact on suicide rates
• Mental health issues often arise during natural disasters
• Puerto Rico: the rate of suicide increased by 29 percent after Hurricane Maria
  • They dont really have a way to rebuild those homes
  • Everything they have is gone
• Suicides increase during economic recessions, particularly among those experiencing poverty and unemployment
  • If you are living poor and cant get a job, its hard to convince you that this will change
• Those who qualify for Medicaid have higher suicide rates compared to those who can afford health insurance

Religious Affiliation

• Suicide rate is lower in countries where the Catholic Church has a strong influence
• Islam also condemns suicide
• Where religious sanctions against suicide are weak or absent, higher suicide rates are observed
  • Prohibition of suicide by religion is a big protective factor
• Children of parents with strong religious beliefs have been found to have an 80 percent lower risk of suicide ideation or attempts

Risk and Protective Factors in Suicide Assessment and Intervention

Risk Factors

• Previous suicide intent or attempt
• Substance abuse, chronic pain or physical illness, insomnia, and certain mental disorders
• Hopelessness, shame, humiliation, despair
• Recent loss or significant traumatic event
• Relationship conflicts, loneliness, and social isolation
• Easy access to lethal methods
• family turmoil; history of physical or sexual abuse
• Family memebers, peers, or favored celebrities have died from suicide

Protective factors

• Good emotional regulation, problem-solving, and conflict resolution skills
• Willingness

to talk about it

• Cultural and religions beliefs that discourage
• Open to seeking treatment for mental, physical, or substance-use disorders
• Family and community
• Connection to or responsibility for children or beloved
• Restricted access to lethal means of suicide

Suicide Crisis Intervention

• Can be highly successful for those who independently seek professional help
• Or are encouraged to seek help
• “No-harm” agreement
  • Written agreement between a suicidal person and therapistor person involved in crisis intervention
  • Lack of research supporting effectiveness
• Now we use a different approach.
• Temporary hospitalization
• Relatives and friends are often enlisted to help monitor their loved one’s safety and well-being

Psychotherapy for Suicidal Individuals

• Treatment often involves both medication and psychotherapy
• CBT and DBT proven to reduce suicide risk by 50 percent compared to other forms of therapy
• CBT focuses on vulnerabilities associated with suicide
  • Come up with more realistic thoughts
  • Solve distorted belies they have
  • Replace those incorrect thoughts
• DBT focuses on helping clients accept current lives and emotional anguish
  • Develop emotional regulation skills