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Correlates of Suicide
Chapter Nine
Suicide
Correlates of Suicide (cont’d.)
• Psychological autopsy:
– Systematic examination of existing information to
understand and explain a person’s behavior before
his/her death
– Suicide survivors are different from those who
succeed:
• Attempter: White female housewife in 20s-30s, who
has marital difficulties; uses barbiturates
• Succeeder: Male in 40s or older, with poor health or
depression; use guns or hangs himself
• Suicide:
– The intentional, direct, and conscious taking of
one’s own life
– Not classified as a mental disorder, although the
suicidal person usually has psychiatric symptoms,
such as:
• Depression, alcohol dependence, and schizophrenia
– Suicide and suicidal ideation (thoughts about
suicide) may represent a separate clinical entity
Facts About Suicide
• Frequency:
– Approximately 34,000 people commit suicide each
year
– Among top 11 causes of death in industrialized
world
– Number of actual suicides is probably 25-30%
higher than what is recorded
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Facts About Suicide (cont’d.)
• Children and young people as victims:
– In 2007, suicide was the third leading cause of
death for children ages 10-14, adolescents ages
15-19, and young adults ages 20-24
– Suicide among 15-24 year olds has increased more
than 40% in last decade
• Suicide publicity/identification with victims:
– Media reports of suicide, especially celebrity
suicide, spark increase in suicide
Facts About Suicide (cont’d.)
• Occupation:
– Risk higher for physicians, lawyers, law
enforcement personnel, and dentists
• Socioeconomic level is not a factor
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Facts About Suicide (cont’d.)
• Gender:
– Men are about four times as likely to be successful
(they use more lethal means)
– Women are more likely to attempt suicide
• Marital status:
– Married people are less vulnerable
– Divorced and widowed individuals are more
vulnerable
Facts About Suicide (cont’d.)
• Choice of weapons:
– Over 50% of suicides are committed using
firearms
– 70% of attempts are from drug overdose
– Most common means for children under 15 is
jumping from buildings and running into traffic
– Most common means for adolescents over 15 is
drugs or hanging themselves
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Facts About Suicide (cont’d.) Facts About Suicide (cont’d.)

• Religious affiliation: • Ethnic and cultural variables:

– Suicide rates are lower in Catholic and Muslim – Highest rates in U.S. are for American Indian,
countries where there is strong condemnation of lowest for Asian Americans
suicide – High rates of alcoholism, low standard of living,
– Where religious sanctions are weaker—e.g., and invalidation of cultural lifestyles also
Scandinavian countries, former Czechoslovakia, contributing factors
Hungary—suicide rate is higher

Facts About Suicide (cont’d.) Facts About Suicide (cont’d.)

• Historical period:
– Tends to decline during times of war and natural
disasters
– Increase during periods of shifting norms and
values or social unrest
• Communication of intent:
– More than two-thirds of those who commit
suicide communicate their intent to do so
beforehand
Figure 9-2 Rates of Suicide by Race/Ethnicity Of all the groups, white men have the highest rates of
suicide when men are separated from women. However, as a group (men and women combined),
Native Americans have the highest overall group rates, with Asian Americans lowest.
Source: Adapted from American Society of Suicidology (2008).

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Multipath Perspective of Suicide:
Biological
• Suicide influenced by low serotonin levels in
the brain
– 5-hydroxyindoleacetic acid (5HIAA):
• Produced when serotonin is broken down in the body
and serotonin receptors may be impaired
• Low amounts of 5HIAA in suicidal patients
• Genetics:
– High rate of suicide and suicide attempts among
parents and close relatives of individuals who
attempt or complete suicide
Multipath Perspective of Suicide:
Psychological (cont’d.)
• Alcohol consumption:
– One of most consistent correlates; as many as 70%
of suicide attempts involve alcohol
– Also strong correlation to successful attempt
– May lower inhibitions related to fear of death
– May increase distress by focusing thoughts on the
negative; alcohol-induced myopia, a constriction
of cognitive and perceptual processes
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Multipath Perspective of Suicide:
Psychological
• Depression and hopelessness:
– Depression plays important role; relationship is
complex
– Increase in sadness is a frequent mood indicator
of suicide
– Heightened feelings of anxiety, anger, and shame
also associated
– Hopelessness, or negative expectations about
future, may be even stronger indicator
Multipath Perspective of Suicide: Social
• Many suicides are interpersonal in nature and
are influenced by relationships involving a
significant other
• Family instability, stress, and chaotic family
atmosphere related to attempts by younger
children
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Multipath Perspective of Suicide: Social
(cont’d.)
• Interpersonal-psychological theory of suicide
(Joiner):
– Perceived burdensomeness
– Thwarted belongingness
– Acquired capacity for suicide
• Social factors that operate to separate people
or make them less connected to other things
they care about (e.g., family religious
affiliation, etc.)
Victims of Suicide
• Two groups of people especially victimized by
suicide
– Children and adolescents
– Elderly people
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Multipath Perspective of Suicide:
Sociocultural
• Emile Durkheim:
– Inability to integrate oneself into society; lack of
close ties deprives one of support systems
necessary for adaptive functioning
• Other factors:
– Modern mobile society that deemphasizes
importance of family and sense of community
– Further group goals or achieve greater good
– Social change and disorganization within one’s
community
Children and Adolescents
• Suicide rate for children under 14 is increasing
at alarming rate
• Suicide is third leading cause of death among
teenagers
• Teen suicide increased by 18% in 2004 and by
17% in 2005
• High school study: 13.8% considered suicide,
6.3% attempted, and 1.9% required medical
attention
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Children and Adolescents (cont’d.)
• The role of bullying:
– “Bullycide:” bullying leading to suicide
– Bully victims 2-9 times more likely to consider
suicide than non victims
– Nearly 50% of young people who commit suicide
experienced bullying
• Copycat suicides:
– Youngsters mimic a previous suicide
– Highly publicized suicides increase the number of
attempts
Elderly People
• Unwelcome physical changes, including
wrinkling, graying hair, and diminished
physical strength
• Life events connected with “feeling old” lead
to depression (one of the most common
psychiatric complaints of the elderly)
• Suicide rates for elderly white men are the
highest for any age group
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Children and Adolescents (cont’d.)
• Decrease in antidepressant medication:
– 2004 FDA warning of an increased suicide risk for
children taking SSRI antidepressants
– Recent research suggests SSRIs may increase
suicidal thoughts or behaviors for very select few
– Increase in youth suicide rates since FDA warning
because antidepressants are less likely to be
prescribed
Elderly People (cont’d.)
• Firearms are most common method for
people over 65 years old
• Elderly make fewer attempts per completed
suicide
• For Asian Americans, the highest risk is for
first-generation immigrants
• Lowest rates among American Indians and
African Americans
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Preventing Suicide Preventing Suicide (cont’d.)

• Assumption that potential victims are • Three-step process for working with a
ambivalent: they have a strong wish to die, potentially suicidal person:
but also a wish to live – Knowing which factors are highly correlated with
• Part of success in prevention is ability to suicide
assess lethality: – Determining probability that person will act on
suicide wish (high, moderate, or low)
– The probability that a person will choose to end
his or her life – Implementing appropriate actions
• Attempt to quantify the “seriousness” of each
factor

Preventing Suicide (cont’d.) Clues to Suicidal Intent

• Demographic:
– Male, increased age, history of suicide threat
• Specific:
– Amount of detail in the threat
– Direct access to means of suicide
– Precipitating events
– Verbal communication of intent (often this is
subtle)
Figure 9-3 The Process of Preventing Suicide Suicide prevention involves the careful assessment of risk factors to determine – “Practice run” at an actual attempt
lethality- the probability that a person will choose to end his or her life. Working with a potentially suicidal individual is a three-
step process that involves (1) knowing what factors are highly correlated with suicide; (2) determining whether there is high,
moderate, or low probability that the person will act on the with; and (3) implementing appropriate actions.

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Clues to Suicidal Intent (cont’d.)
• Indirect behavioral cues:
– Put affairs in order, take a long trip, give away
prized possessions, etc.
• Early signs:
– Depression, guilt feelings, insomnia, tension, loss
of weight, impulsiveness, etc.
• Critical signs:
– Sudden changes in behavior, giving away
possessions, threats, actual attempts
Crisis Intervention (cont’d.)
• Active in working with patient while also
taking charge of person’s personal, social, and
professional life outside facility
• After crisis passes, traditional forms of
treatment, inpatient or outpatient, are used.
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Crisis Intervention
• Clinical level:
– Educate staff at mental health institutions and
schools to recognize signs of potential suicide
• Crisis intervention aimed at providing
intensive short-term help to resolve
immediate life crisis
– Patient may be immediately hospitalized, given
medical treatment, seen by psychiatric team for
two-four hours per day until stabilized
Crisis Intervention (cont’d.)
• Suicide prevention centers:
– Many in acute distress are not being treated and
may be unaware of available services
• Telephone crisis intervention:
– Maintain contact/establish relationship
– Obtain necessary information
– Evaluate suicidal potential
– Clarify nature of stress and focal point
– Assess strengths and resources
– Recommend and initiate action plan
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Crisis Intervention (cont’d.)
• Today, there are about 200 suicide prevention
centers in U.S., along with many “suicide hot
lines”
• Little research has been done on effectiveness
(anonymity)
Moral, Ethical, and Legal Implications
• Recent legislation/literature has debated
whether it is morally, ethically, and legally
permissible to aid in suicide
– Derek Humphrey’s Final Exit (1991):
• Hemlock Society’s manual on suicide
– Jack Kevorkian:
• “Dr. Death” and his “suicide machine”
• Ironically, by prolonging life, medical science
has also prolonged the process of dying
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The Right to Suicide
• A majority of Americans believe terminally ill
individuals should be allowed to take their
own lives.
• Suicide is both a sin and an illegal act in most
countries
• Oregon (1998):
– Physician-assisted suicide act
– U.S. Attorney General Ashcroft attempted to
overturn (U.S. Court of Appeals upheld Oregon’s
law)
Moral, Ethical, and Legal Implications
(cont’d.)
• Pro:
– Suicide can be a rational act; mental health and
medical professionals should be allowed to help
without fear or legal issues
• Con:
– Suicide is not rational; dangerous to say it is
• Criteria to decide between life and death:
– “Quality of life” and “quality of humanness” are
subjective and difficult to define