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
he suicide rate for Canadians as measured by the !orld "ealth
#rganization $!"#% is appro&imately 1' per 100 000 people per year,
and suicide rates across the country ha(e increased dramatically o(er
the last fi(e decades
Suicide accounts for nearly one in four $)*+% deaths among
Canadians aged 1, to )* and is the second-leading cause of death for
those between the ages of 10 and )*
#ne in four teenagers admits to attempting or seriously contemplating
suicide
Suicide is one of the three leading causes of death worldwide among
people 1, to ** years of age
.ore people die from suicide than from homicide
he impact of suicide on sur(i(ing family members and friends is huge.
hey e&perience guilt/o(er not ha(ing pre(ented the suicide, o(er
things that were said to the person who committed suicide, o(er things
that may ha(e contributed to the suicide.
he !"# says that suicide is a deliberate act of self-harm ta0en with
the e&pectation that it will be fatal.
Suicide-li0e beha(iors fall on a continuum.
ypes of Suicides:
1our types of people who commit suicide:
o 2eath see0ers
Clearly and e&plicitly see0 to end their li(es
heir intentions to commit suicide may be present for a
long time, during which they prepare for their death by
gi(ing away possessions, writing a will, buying a gun
.ost often, their intentions are fleeting
o 2eath initiators
A clear intention to die but belie(e that they are simply
hastening an ine(itable death
.any people with serious illnesses who commit suicide
fall into this category
o 2eath ignorers
3ntend to end their li(es but do not belie(e that this
means the end of their e&istence.
hey see their death as the beginning of a new and
better life.
Suicide bombers who belie(e they will recei(e
tremendous rewards from 4od for their acts are
considered death ignorers.
o 2eath darers
Ambi(alent about dying, and they ta0e 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 0nowing how lethal they are
and then calls a friend is a death darer
2eath darers may want attention or may want to ma0e
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.
.ost researchers and theorists, howe(er, reser(e the label suicide for
deaths that are intentionally caused by the indi(idual
Suicide 5ates:
3t 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 re(ol(er is still in the
(ictim6s hand, with powder stains that could only mean a self-inflicted
wound.
.any deaths are more ambiguous, howe(er, particularly when no
notes are left behind and no clues remain as to the (ictim6s mental
state before the death
Accurate data on non-lethal suicide attempts are e(en more difficult to
obtain, particularly since more than half of all people who attempt, but
do not complete, suicide ne(er see0 professional help and thus may
not be diagnosed
he statistics on the rates of suicide in (arious groups are probably
gross underestimates
3nternationally, an estimated 1 million people die by suicide each year,
or one person e(ery *0 seconds
7arge differences in suicide rates e&ist between men and women,
among age groups, and among cultural groups, but the characteristics
of the indi(iduals who attempt suicide and those who complete it are
similar
Gender Differences
3n Canada, males are more li0ely to commit suicide than are females
!e might ha(e e&pected 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 li0ely
than boys to ha(e considered or planned a suicide attempt
.en and boys are four times as li0ely as women and girls to complete
suicide
his gender difference in suicide completion rate is true in many
nations of the world and across all age ranges
he gender difference in rates of completed suicides may be due in
part to gender differences in the means of attempting suicide.
3n Canada, males are more li0ely to use irre(ersible methods in which
less opportunity to pre(ent death e&ists, such as suicide attempts by
hanging and firearms8 females are more li0ely to use drugs, poison,
and gases, in which a better chance of pre(enting death remains
3n comparing the differences in suicide methods by gender between
the 9nited States and Canada, suicide by gun was found to be the
most common way women in the 9nited States commit suicide, at ':+
of all female suicides
his difference in suicide by firearm between women in Canada and
the 9nited States may point to differences in the a(ailability of guns in
the two countries.
.en tend to be surer in their intent to die when they attempt suicide
than women, and this is why they choose more lethal means
.en may feel that it is not masculine to be ambi(alent about their intent
to die or to communicate this intent to others in hopes that they will be
pre(ented from succeeding
!omen, on the other hand, may be more comfortable in using suicide
attempts as cries for help
Alcohol lowers inhibitions and increases impulsi(e beha(ior, and guns
pro(ide a means for carrying out suicidal thoughts.
.en are more li0ely than women to drin0 alcohol when they are highly
distressed and may ha(e more ready access to guns
3n some countries, women are at least as li0ely as men to commit
suicide. 1or e&ample, in China, women account for ,,+ of all suicide
deaths
4ender roles probably interact with cultural beliefs about suicide to
influence rates in both women and men.
he gender gap is due to selecti(e underreporting of female suicide
mortality
Ethnic and Cross-Cultural Differences
!ithin Canada, substantial differences are seen among ethnic groups
in rates of suicide, with immigrant groups being much less li0ely than
nati(e-born Canadians to commit suicide
3mmigrant rates differ significantly by continent of birth
People born in ;urope and #ceania $e.g., Australia, <ew =ealand%
ha(e relati(ely higher suicide rates than people from Africa and Asia
he presence of ethnic communities in these cities is suggested to
pro(ide a protecti(e effect. 1inally, suicidal ideation, plans, and
attempts do not appear to differ significantly by generation le(el or
degree of acculturation
Cross-national differences e&ist in suicide rates, with higher rates in
much of ;urope, the former So(iet 9nion, and Australia, and lower
rates in 7atin America and South America
hese differences may ha(e to do with cultural and religious norms
against suicide
Suicide among Canada6s Aboriginal peoples $1irst <ations, .>tis, and
3nuit% is a serious problem.
he suicide rate for Aboriginal peoples is three times that of the general
population
he same ris0 factors that are important in non-Aboriginal populations
are e(en more important in Aboriginal populations
Alcohol plays a role in many suicides8 studies on Aboriginal people who
completed suicide found a higher mean blood-alcohol concentration at
death compared with non-Aboriginal indi(iduals who completed suicide
he Cedar Pro?ect
o he study found an association between a pre(ious drug
o(erdose and a future suicide attempt, suggesting a strong lin0
between potentially fatal drug use and Aboriginal suicide
o raumatic e(ents are another 0nown ris0 factor, and research
shows higher rates of traumatic e&posure in Aboriginal
populations compared with non-Aboriginal populations
Specific ris0 factors for Aboriginal suicide may also e&ist, including
en(ironmental factors, such as li(ing in comparati(ely poor, isolated
rural communities
!ithin-group differences may e&ist between different Aboriginal
communities, with community-le(el factors contributing to differences in
rates
Suicide in Children & Adolescent
3n Canada, youth who are older are more li0ely to commit suicide than
are younger adolescents and children, and unfortunately, most adults
do not belie(e children when they (oice their suicidal thoughts
Although suicide is relati(ely rare in young children, it is not
impossible.
4irls are much more li0ely to attempt suicide, but boys are more li0ely
to complete suicide.
he gender ratio for completed suicide is e(en greater among
adolescents and young adults than among older adults: .ales are si&
times as li0ely as females in this age range to commit suicide
3n Canada, suicide is second only to accidents in cause of death for
1,@ to 1:-year-olds
Canada6s suicide rate for children and youth is higher than the !"#6s
estimated global suicide rate for this age group
Suicide may be more common in adolescence than in childhood
because the rate of se(eral types of psychopathology tied to suicide,
including depression, an&iety disorders, and substance abuse,
increase in adolescence
Adolescents may simply ha(e the means to commit suicide $such as
access to drugs and guns% more than do children.
5ates among African-American males, although still lower than among
;uropean Americans, showed no sign of decline until 1::,.
African-American youth typically ha(e 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
;uropean-American youth.
he ris0 factors for suicide in adolescence include current depression,
interpersonal problems, insecure relationships with parents, negati(e
thin0ing and hopelessness, appetite problems, increased substance
abuse, aggression, and a suicide attempt by a friend
3n a ten-year retrospecti(e re(iew of suicide in children and
adolescents referred to the "amilton 5egional 1orensic Pathology 9nit
from 1::' to )00), psychological factors identified in the cases
included depressed mood $AA+%, drug and alcohol problems $1:+%,
and pre(ious suicide attempts $)'+%
A re(iew of self-identified gay, lesbian, and bise&ual youths attending
groups across Canada and the 9nited States suggests that gay and
bise&ual youth are at significantly greater ris0 for suicidal beha(ior,
although the (ast ma?ority report no suicidal thoughts or beha(iors at
all
Almost all ha(e thought about committing suicide for sometime before
actually attempting it.
.any 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 ris0 for future
attempts, which might be successful
University and College Students
3n a sur(ey of 9.S. college students, :+ said they had thought about
committing suicide since entering college, and 1+ said they had
attempted suicide while at college
he students who had contemplated or attempted suicide were more
li0ely to suffer depression and hopelessness, loneliness, and problems
with their parents
#nly )0+ of the students who had contemplated suicide had sought
any type of counseling
Suicide in Older Adults
A ,0+ decline in suicide rates has occurred among older adults o(er
the past few decades, older adults, particularly older men, still remain
at relati(ely high ris0 for suicide.
he highest ris0 is among white men o(er the age of B,
!hen they attempt suicide, older people are much more li0ely than
younger people to be successful
.ost young people who attempt suicide are highly ambi(alent about it.
Some older people who commit suicide do so because they cannot
tolerate the loss of their spouse or other lo(ed ones
Suicide rates are highest in the first year after a loss but remain
relati(ely high for se(eral years after the loss
Some older persons who commit suicide suffer from debilitating
illnesses and want to escape their pain and suffering.
**+ had said they could not bear being placed in a nursing home and
would rather be dead
3ntentional life-threatening beha(ior, such as refusing food or
medication, is a common form of suicidal beha(ior in older people
#lder 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 ris0 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-in?ury,
represents a significant cause of suffering in Canada and places a
substantial burden on the health care system
Understanding Suicide
#ur ability to understand the causes of suicide is hampered by many
factors.
1irstly, family members and friends may selecti(ely remember certain
information about the (ictim $such as e(idence that he or she was
depressed% and forget other information
Second, the ma?ority of people who contemplate suicide ne(er actually
commit suicide, so it is difficult to determine what causes some people
to go through with the act
hird, although suicide is more common than we would li0e, it is still
rare enough that it is difficult to study scientifically
.c4ill 4roup for Suicide Studies $)010%: he group is in(estigating the
ris0 factors associated with suicidal beha(ior and is the only program
of its 0ind in the world
Suicide <otes:
#nly about one in four people lea(es a suicide note, howe(er, and
often these notes pro(ide only a glimpse into their moti(es
Suicide notes are often brief and (ague and may simply say, C3 could
not bear it any longer,D or C3 am tired of li(ing.D
Some suicide notes are (ery concrete, with e&plicit instructions or
reEuests, 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, ha(ing more energy and engagement in life
his energy, howe(er, can simply gi(e them the energy and freedom to
commit suicide
1or people with long-term mental disorders, the prospect of sin0ing
once again into despair leads them to ta0e pre(enti(e action/to 0ill
themsel(es before it happens again
.ost suicide notes are positi(e in their remar0s about remaining family
members, e&pressing lo(e and than0s. Sometimes, the note is meant
to relie(e family members of guilt
Suicide tends to be dri(en by mental anguish and a sense of futility
about going on.
Social Perspecti(es on Suicide:
Econoic !ardshi"
A (ariety of stressful life e(ents appear to contribute to an increased
ris0 for suicide
#ne type of stressful e(ent consistently lin0ed to increased suicide
(ulnerability is economic hardship
he loss of a ?ob can precipitate suicidal thoughts and attempts
o As the farm economy has collapsed in the 9nited States in
recent decades, the rate of suicide among farmers has
increased considerably
o .en and women who ha(e spent their entire li(es trying to ma0e
a li(ing from land that may ha(e been in their families for
generations can find their dreams shattered and their farms lost
fore(er.
Chronic economic hardship also contributes to suicidality.
o #ne 9.S. study found that B.,+ of people li(ing below the
po(erty le(el had thought about committing suicide in the
pre(ious year, compared with ,.*+ of people li(ing abo(e the
po(erty le(el
Suicide rates among African-American males in the 9nited States were
highest in communities where the occupational and income ineEualities
between African Americans and ;uropean Americans were the greatest
Serious #llness
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 ha(e been at increased ris0 for
suicide
Physical illness is a ris0 factor for suicidal thoughts and attempts in
adolescents as well as in older adults
he pain and burden of chronic physical illness may not be well
managed by the medical professions, lea(ing some people feeling
incapable of bearing them on their own.
$oss and Abuse
7oss of a lo(ed one through death, di(orce, 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 ha(e e&perienced certain traumas in childhood, especially
se&ual abuse or the loss of a parent, also appear at increased ris0 for
suicide
A history of childhood se&ual abuse increases the odds of a suicide
attempt by ) to * times for women and * to 11 times for men
Physical abuse by a partner is a potent predictor of suicide attempts
he loss of a parent during childhood may create a lifetime of instability
and feelings of abandonment, which can contribute to suicidal
intentions
Se&ual abuse during childhood may shatter people6s trust in others and
pre(ent the de(elopment of a strong self-concept, which can protect
against suicide.
Dur%hei&s 'heory
Sociologist Fmile 2ur0heim $1B:A% focused not on specific e(ents that
precipitate suicide but, rather, on the mindsets that certain societal
conditions can create that increase the ris0 for suicide
here 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
unsupporti(e world
o Anoic suicide is committed by people who e&perience se(ere
disorientation because of a ma?or change in their relationships to
society.
o Altruistic suicide is committed by people who belie(e that
ta0ing their own li(es will benefit society in some way
2ur0heim6s theory suggests that social ties and integration into a
society help pre(ent suicide if the society discourages suicide and
supports indi(iduals in o(ercoming negati(e situations
3f 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-0nown member of a society commits suicide, people who closely
identify with that person may see suicide as more acceptable
!hen 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 li0ely to occur among people who 0new
the person who committed suicide.
.any of those who attempted suicide or had acti(e suicidal thoughts
were friends and friends of the two students who had completed
suicide.
#ther suicide clusters occur not among close friends but among people
who are lin0ed only by media e&posure to the suicide of a stranger,
often a celebrity
Some studies ha(e suggested that suicide rates, at least among
adolescents, increase after a publicized suicide
Some theorists ha(e argued these clusters are due to suicide
contagion( meaning that people somehow CcatchD suicidal intentions
and beha(iors from those who commit suicide
Sur(i(ors who become suicidal may be modelling the beha(ior of the
friend or admired celebrity who committed suicide
he suicide may also ma0e the idea of suicide more acceptable and
thus lower inhibitions for suicidal beha(ior in sur(i(ors
.edia attention gi(en to a suicide can be attracti(e to some people
who are feeling alienated and abandoned.
Suicide clusters are best understood as the result of se(eral sets of
factors coming together in the same time and place.
o 1irst, people form relationships with others who possess similar
Eualities or problems/0nown as assortative relationships.
People who are at ris0 for suicide, because of
psychopathology, life problems, or lac0 of social support
from families, may be more li0ely to gra(itate together
o Second, se(ere negati(e e(ents can be triggers for suicide, and
these negati(e e(ents often happen to groups of people as well
as to indi(iduals.
he suicide of a close friend Eualifies as a se(ere
negati(e e(ent and, thus, may increase the ris0 for
suicide among others, as would any other se(ere
negati(e e(ent
Psychological heories of Suicide:
Psychodynaic 'heories
1reud $1:1A% argued that depression is anger turned inward on the
self.
3nstead of e&pressing anger at people they feel ha(e betrayed or
abandoned them, depressed people e&press that anger at themsel(es,
specifically at the part of their ego that represents the lost person
Sometimes, that anger is so great that the depressed person wants to
annihilate that image of the lost person
Annihilating the self/suicide.
Suicidal people tend to be filled with rage against others
Anger and rage are not the most common emotions that suicidal
people e&press, instead, guilt and emotional despair are more common
A psychodynamic theorist might argue that suicidal people don6t
e&press anger in suicide notes or in other ways precisely because they
cannot e&press these emotions and are turning the feelings in on
themsel(es
1reud was ultimately dissatisfied with his own theory of suicide and
belie(ed it a more comple& phenomenon than anger turned inward
)ental Disorders
.ore than :0+ of people who commit suicide ha(e probably been
suffering from a diagnosable mental disorder
he most common disorder among people who commit suicide is a
mood disorder
Suicide is associated with se(eral other disorders as well, including
borderline personality disorder, disrupti(e beha(ior disorders $such as
conduct disorder%, alcohol and other drug use disorders, an&iety
disorders, anore&ia ner(osa, and schizophrenia
5esearchers conduct a psychological autopsy/an analysis of the
person6s moods, thoughts, and beha(iors based on the reports of
family and friends and the indi(idual6s writings/after the suicide has
occurred.
A prospecti(e study of suicide attempts in adolescents found that ma?or
depression greatly increases the ris0 for suicide
3t might seem strange that a manic person would attempt suicide,
because the symptoms of mania include elation and heightened self-
esteem
"owe(er, often the predominant feelings of mania are agitation and
irritation mi&ed with despair o(er ha(ing the illness or in contemplating
falling into a debilitating depression
Another psychological disorder that greatly increases the ris0 for
suicide attempts is substance abuse
''.0+ of the indi(iduals who attempted suicide were identified as
hea(y drin0ers, compared with ).,+ of those who did not ma0e an
attempt.
he lifetime ris0 for suicide among people who are dependent on
alcohol is se(en times as great as the lifetime ris0 among people who
are not alcohol dependent
!hen alcoholism co-occurs with depression, as in Styron6s case, the
ris0 for suicide is especially high
Alcohol lowers people6s inhibitions to engage in impulsi(e acts, e(en
self-destructi(e ones, such as suicide attempts
Alcohol abuse has been identified as a ma?or ris0 factor accounting for
the higher suicide rates among Canada6s Aboriginal peoples
Getween 10+ and 1,+ of people with schizophrenia commit suicide, a
rate )0 times as high as in the general population
.ost suicide attempts among people with schizophrenia happen not
when the people are psychotic but when they are lucid but depressed
Aside from se(erity of psychotic symptoms, the presence of a mood
disorder was the most significant predictor of death by suicide in this
population
hose who are most li0ely to commit suicide are young males who had
freEuent relapses into psychosis but who had a good education and
high e&pectations for themsel(es before they de(eloped schizophrenia
!hate(er mental disorder a suicidal indi(idual has, the most common
reason e&pressed for attempting suicide is to escape intolerable
distress
People say they want to relie(e their lo(ed ones of the burdens of their
e&istence and of caring for them.
#"ulsivity
he beha(ioural characteristic that seems to predict suicide best is
i"ulsivity( the general tendency to act on impulses rather than to
inhibit them appropriately
!hen impulsi(ity is o(erlaid on other psychological problems/such as
depression, substance abuse, or life in a chronically stressful
en(ironment/it can be a potent contributor to suicide.
3mpulsi(e suicide cases tended to be characterized by the presence of
these personality disorders
#ne family history study showed that the children of parents with a
mood disorder who also scored high on measures of impulsi(ity were
at a much greater ris0 of attempting suicide
Cognitive 'heories
he cogniti(e (ariable that has most consistently predicted suicide
is ho"elessness/the sense that the future is blea0 and there is no
way of ma0ing it more positi(e
"opeless feelings about being a burden on others and about ne(er
belonging with others are especially lin0ed to suicidality
Canadian researchers ha(e labelled this type of hopelessness
as social hopelessness and ha(e shown its association with suicidal
ideation among uni(ersity students
"opelessness may also be one reason people who are suicidal often
do not see0 treatment
People who attempt or commit suicide tend to be rigid in their thin0ing
hey engage in dichotoous thin%ing( seeing e(erything in eitherHor
terms
his infle&ibility ma0es it more difficult for them to consider alternati(e
solutions to their situations or simply to hold out until the suicidal
feelings pass.
Giological heories of Suicide:
Genetic 'heory
Suicide runs in families
#ne study found that the children of parents who had attempted
suicide were si& times as li0ely to attempt suicide as were the children
of parents who had a mood disorder but had not attempted suicide
Almost three-Euarters of the suicides occurring in this culture come
from ?ust four large families, all of which ha(e high rates of mood
disorders
Although some of this clustering of suicide within families may be due
to en(ironmental factors, such as family members6 modelling each
other or ha(ing common stressors, twin and adoption studies suggest
that genetics are in(ol(ed as well
win studies estimate that the ris0 for suicide attempts increases by ,.I
times if a person6s monozygotic twin has attempted suicide, and by *.0
times if a person6s dizygotic twin has attempted suicide
Part of the predisposition to suicide may be transmitted (ia the genes
that code the pathway of the neurotransmitter serotonin and the in
e&pression of impulsi(ity
*eurotransitter 'heory
.any studies ha(e found a lin0 between suicide and low le(els of the
neurotransmitter serotonin in the brain
1or e&ample, postmortem studies of the brains of people who
committed suicide find lower than a(erage le(els of serotonin
People with a family history of suicide or who ha(e attempted suicide
are more li0ely to ha(e abnormalities on genes that regulate serotonin
People who attempt suicide who ha(e low serotonin le(els are ten
times as li0ely to ma0e another suicide attempt as those with higher
serotonin le(els
7ow serotonin le(els are lin0ed with suicidality e(en among people who
are not depressed, suggesting that the connection between serotonin
and suicidality is not due entirely to a common connection to
depression.
7ow serotonin le(els are most strongly associated with impulsi(e and
(iolent suicides.
Although these pieces of e(idence do not pro(e that low serotonin
le(els cause suicidal beha(ior, they suggest that people with low
serotonin le(els may be at high ris0 for impulsi(e and (iolent beha(ior
that sometimes results in suicide.
'reating and Preventing Suicidal 'endencies
A person who is suicidal needs immediate care
Sometimes, people reEuire hospitalization to pre(ent an imminent
suicide attempt
Community-based crisis intervention programs are a(ailable to help
people who are highly suicidal deal in the short term with their feelings
and then refer them for longer care to mental health specialists
Some crisis inter(ention is done o(er the phone, on suicide hotlines.
Some communities ha(e suicide pre(ention centres, which may be part
of a larger mental health system, or stand-alone clinics, where suicidal
people can wal0 in and recei(e immediate care.
Crisis inter(ention aims to reduce the ris0 for an imminent suicide
attempt by gi(ing suicidal persons someone to tal0 with, someone who
understands their feelings and problems
he crisis inter(ention counsellor may ma0e a contract with the suicidal
person that he or she will not attempt suicide, or at least will contact the
counsellor as soon as the suicidal feelings return
he counsellor will help the person identify other people he or she can
turn to when panic0ed or o(erwhelmed.
And the counsellor will ma0e follow-up appointments with the suicidal
person or refer the person to another counsellor for long-term
treatment.
People who recei(e longer-term treatment for suicidality typically
recei(e psychotherapies and medications similar to those used to treat
mood disorders.
Pre(enti(e measures are ta0en with high-ris0 people who ha(e
.ost people who are suicidal ne(er see0 treatment
;(en when their families 0now they are suicidal, they may not be ta0en
for treatment because of denial and a fear of the stigma of suicide
he people who do recei(e treatment typically recei(e inadeEuate care.
7ess than a third of those with a history of suicide attempts were being
adeEuately treated
2rug reatments:
he medication most consistently shown to reduce the ris0 for suicide
is lithium
People with ma?or depression or bipolar disorder and found that
those not treated with lithium were 1' times as li0ely to commit or
attempt suicide as those who had been treated with lithium.
.any people ha(e difficulty ta0ing lithium, because of its side effects
and to&icity
.ost recently, studies ha(e focused on the selecti(e serotonin
reupta0e inhibitors $SS53s%, such as Cele&a, Prozac, 7u(o&, =oloft, and
Pa&il, in the treatment of suicide ris0
hese drugs can reduce impulsi(e and (iolent beha(iors in general and
suicidal beha(iors specifically
Some studies suggest that the SS53s can increase the ris0 for suicide
in some people.
his ris0 is ?ust one of many reasons it is crucial for people ta0ing
psychotherapeutic drugs to be closely monitored by physicians with
e&pertise in these drugs
#lder adults may be especially (ulnerable to suicide when they are
ta0ing SS53 medications
Although the absolute ris0 for suicide caused by an SS53 medication is
low, some older adult patients may be (ulnerable to suicide when
treatment is started
Antipsychotic medications can be used to treat psychotic symptoms in
people with psychotic mood disorders or schizophrenia
5educing psychotic symptoms may also reduce the ris0 for suicidality
Psychological reatments:
Psychodynamic therapists focus more on e&ploring une&pressed anger
at others, whereas cogniti(e therapists focus more on the client6s
hopelessness and dichotomous thin0ing, as well as on the
en(ironmental triggers for suicidal beha(ior
Psychologist .arcia 7inehan $1:::% has de(eloped a cogniti(e-
beha(ioural inter(ention designed specifically to address suicidal
beha(iors and thoughts, which she calls dialectical behavior thera"y.
his therapy was originally de(eloped to treat people with borderline
personality disorder, whose moods and self-images ha(e a tendency to
swing between e&tremes
2ialectical beha(ior therapy is somewhat li0e cogniti(e-beha(ioural
therapy, but it focuses on difficulties in managing negati(e emotions
and in controlling impulsi(e beha(iors
3n(ol(es a number of techniEues aimed at increasing problem-sol(ing
s0ills, interpersonal s0ills, and s0ills in managing negati(e emotions
Studies comparing this therapy with control conditions suggest that it
can reduce suicidal thoughts and beha(iors, as well as impro(e
interpersonal s0ills
herapists often include spouses, partners, and family members in the
treatment of people who are suicidal.
1amily members can play a role in pre(enting future attempts by
helping suicidal members recognize when they are (ulnerable and
acti(ely see0 professional help.
Suicidality in one member can de(astate a family, and often the entire
family is in need of psychological help.
Social Approaches and Pre(ention:
Suicide hotlines and crisis inter(ention centres are forms of suicide
pre(ention programs
hey pro(ide help to suicidal people in times of greatest need, hoping
to pre(ent a suicidal act until suicidal feelings ha(e passed.
.any pre(ention programs aim to educate entire communities about
suicide
Students are gi(en information about the suicide rates in their age
group, the ris0 factors for suicide, and what to do if they or a friend is
suicidal.
Suicide awareness curricula can also include formal screening of
students for mental health problems and referrals to mental health
professionals
Studies of the effects of broadly based pre(ention and education
programs ha(e suggested that they are not (ery helpful and, indeed,
might cause harm
#ne ma?or problem with these programs is that they often
simultaneously target both the general population of students and
students who are at high ris0 for suicide.
he programs may attempt to destigmatize suicide by ma0ing it appear
Euite common and by not mentioning that most suicidal people are
suffering from a psychological disorder, in hopes that suicidal students
will feel more free to see0 help
Such messages can bac0fire among students who are not suicidal,
ma0ing suicide seem to be an understandable response to stress.
Studies of school-based suicide pre(ention programs ha(e found that
adolescents who had made prior suicide attempts generally reacted
negati(ely to the programs, saying they were less inclined to see0 help
after seeing the program than before they had seen the program
5esearchers ha(e begun tailoring suicide pre(ention messages to
specific populations, particularly high-ris0 populations, in hopes that the
right 0ind of help will get to the most needy people
A program that in(ol(es screening adolescents for suicidality, doing a
diagnostic inter(iew with the adolescents with the help of a laptop
computer, and then inter(iewing the adolescents to determine the most
appropriate referral to a mental health specialist
his program has shown success in identifying high-ris0 youth and
getting them into effecti(e treatment
Suicide specialists ha(e created a C2-5#. for teaching s0ills in crisis
inter(ention and suicide assessment in culturally distinct groups
A C2-5#. pac0age aiming to promote mental health and s0ills in
detecting the first signs of depression, an&iety, and suicidality led to
significant learning and retention of information that could reduce
suicidal beha(ior in these Canadian communities
#ne promising approach to suicide pre(ention using the health care
system is the training of family doctors and general practitioners
$sometimes called primary care physicians% to recognize, acti(ely treat,
and, where necessary, refer patients with depression and other mental
health problems to specialists
he treatment of depression has been associated with decreased
suicide rates and suicide attempts among youth
Guns and Suicide
Canada represents an international test case for the e&amination of the
relationship between gun control legislation and suicide
his change in legislation allowed for a direct test of the impact of gun
control laws on their use in suicide
his reduction in firearm suicides was not offset by an increase in
substitute non-firearm suicides, as the o(erall suicide rate declined
o(er this period
7ac0 of a(ailability of guns allows the time for suicidal impulses to
wane
.ost people who commit suicide by gun do not buy guns e&pressly to
commit suicide.
#ften, suicide with guns is an impulsi(e act committed by people under
the influence of alcohol: hey may be depressed, get drun0, retrie(e
the family handgun, and shoot themsel(es
A gunshot to the head is highly li0ely to end in death, whether or not
the person truly intended to commit suicide.
#pponents of gun control argue that restricting access to guns only
ma0es people more (ulnerable to intruders in their homes or to others
wanting to harm them
he mere presence of a firearm in the home appears to be a ris0 factor
for suicide when other ris0 factors are ta0en into account, especially
when handguns are improperly secured or are 0ept loaded
hese data strongly suggest that remo(ing guns from the home is an
important pre(enti(e measure against suicide.
'he +ight to Coit Suicide
.any societies, including Canada and the 9nited States, are currently
debating whether people ha(e a right to commit suicide
Some people, such as psychiatrist homas Szasz and physician Jac0
Ke(or0ian, argue that the right to die as one chooses and when one
chooses is a fundamental human right that cannot be regulated by the
state
.ost people who attempt suicide but do not complete it do not later
commit suicide, suggesting that they do not truly want to die
.ost people who contemplate suicide, particularly if they are
depressed and not suffering from terminal medical illness are
ambi(alent about it, and their suicidal wishes pass after relati(ely short
periods.
Pre(enting suicide is appropriate, at least for people who ha(e serious
mental disorders, because many people who attempt suicide are not
ma0ing rational or permanent choices.
'he Controversy of Assisted Suicide
3n most cases of suicide by the seriously ill, ill people 0ill themsel(es,
but, in a substantial number of cases, they are 0illed by a medical
professional or a family member or friend, an act sometimes referred to
as Cmercy 0illing.D
.ercy 0illing, or euthanasia( is illegal in Canada.
Assisted suicide has been prohibited by Parliament since the adoption
of Canada6s first criminal code
he effect of this distinction is to deny to some people the choice of
ending their li(es solely because they are physically unable to do so,
pre(enting them from e&ercising the autonomy o(er their bodies
a(ailable to other people
A study conducted in Alberta found that the ma?ority of patients with
terminal cancer, as well as the population more broadly, fa(oured the
legalization of euthanasia and assisted suicide, although the ma?ority of
physicians opposed it
Patients nearing death from ad(anced cancer found that A'+ fa(oured
policies that would allow them to ha(e access to euthanasia and
physician-assisted suicide.
2esire for death in terminally ill patients is highly correlated with clinical
depression, a treatable condition, with the li0elihood of changes
occurring o(er time
2ebates regarding euthanasia and physician-assisted suicide should
include consideration of transient psychological factors.