Understanding Suicide: A Behavioral Perspective

Understanding Suicide as a Behavior

• Suicide is defined as taking one’s own life
• It’s from the Latin, “one’s own killing”
• Suicide is a behavior, not a mental health issue
• Cultural, religious and societal norms influence suicide

Cultural and Religious Perspectives

• Many religions consider suicide sinful, affecting belief
• Cultural attitudes greatly impact how communities respond
• Understanding perspectives are key to empathetic care

Risk Factors

Certain populations are at higher risk:

• American Indians
• Alaska Natives
• Military members
• LGBTQ+ individuals
• Mental illness
• Substance abuse
• Social isolation
• Exposure to violence

Legal and Ethical Considerations for Physician-Assisted Suicide in the U.S.

• As of 2022, 10 states and D.C. legalized physician-assisted suicide
• These states include: California, Colorado, Hawaii, Maine, Montana, New Jersey, New Mexico, Oregon, Washington, and Vermont
• The legality of physician-assisted suicide remains a contentious issue
• Differing views exist on whether it is a rational act
• Ethical considerations on individuals making end-of-life decisions versus possible coercion and abuse

Epidemiological and Etiological Perspectives

• Suicide effects people of all ages, ethnicities, and locations
• Statistical data provides insights for prevention
• Understanding the epidemiology aids in identifying at-risk populations and intervention
• Suicide’s etiology is multifaceted
• It involves biological, psychological, and social factors
• Mental illness is commonly associated
• Traumatic experience and chronic health conditions contribute to suicidal ideation

Ancient Greek Perspective on Suicide

• Suicide was an offense against the state
• Severe social consequences were enforced
• Community burial sites were denied
• Societal condemnation was reflected
• Emphasis of civic duty and the collective over the individual was in place

Ancient Rome Perspective on Suicide

• Suicide sometimes was a means to escape personal humiliation or abuse
• Notable figures, such as Cato the Younger, chose personal honor over capture
• Acceptance of suicide in certain contexts depended on the current moral frameworks at the time

Medieval to Renaissance Views

• Suicide was predominantly viewed as selfish or a criminal act
• Individuals faced harsh penalties
• Burial was denied and property confiscated
• Shift occurred disregarding underlying mental health issues

Renaissance Shift

• Philosophical shift allowed for more open discussions among intellectuals
• Exploration of suicide emerged in literature and philosophy
• This period set the scene for future discussions about the complexities surrounding it

Philosophical and Legal Developments in the 17th and 18th Centuries

• Most philosophers deemed suicide a moral failure
• Some writers recognized the connection between suicide and mental disturbance
• Discussions of suicide started including mental health issues

Legal Perspectives

• Suicide remained illegal in England until 1961
• Decriminalization of suicide in Ireland in 1993
• Discussion to use more sensitive terminology has occurred

Religious Perspectives on Suicide

• Most religions, including Judaism, Christianity, Islam, Hinduism, and Buddhism, consider suicide a sin against God
• The Catholic Church opposes suicide because it opposes the proper love of self and has an impact on others through grief
• This condemnation has historically contributed to the stigma, complicating discussions

Modern Religious Views

• Some religious leaders advocate for a more compassionate approach
• Byron (2016) highlights the need for churches to encourage open discussions
• Replacing 'committed suicide' fosters more support

Suicide Statistics Overview

• In 2020, 45,979 people died by suicide in the U.S., marking a decline from the increasing rates observed from 2000 to 2018
• The decline in suicide rates in 2020 indicates a potential shift in public health dynamics
• The Centers for Disease Control and Prevention (CDC) provides annual statistics
• Males have consistently exhibited three to four times higher suicide rates than females
• In 2020, firearms were the most common method at 63%, followed by suffocation at 27%
• In 2020, firearms became the primary means of suicide for females
• Females aged 10 to 24 are seeing an increase in suicide
• Male rates are high among those aged 75+
• Older adults may face challenges that contribute to higher rates
• In 2020, suicide was the 12th leading cause of death across all ages in the U.S.,
• A change from the 10th leading cause in 2019, this is due to the impact of COVID-19
• COVID-19 has influenced mortality statistics
• For every suicide death, approximately 12 individuals attempt suicide
• Suicide attempts are underreported
• Suicide has become a public health issue in the U.S.
• Addressing mental health and preventive work is critical for reducing rates

Military Suicide Rates

• Military personnel have historically had lower rates, indicating unique resilience or support
• The Iraq War onset marked a turning point
• In certain years, more soldiers died by suicide than in combat
• An increase in rates post-2015 suggests a growing mental health crisis
• The suicide rate among military and veterans rose by 16% from 2019 to 2020, reaching 28.7 per 100,000
• In 2015, the suicide rate was lower at 20.3 per 100,000
• Ongoing research and intervention strategies are needed
• Ongoing research aims to identify effective strategies
• It’s crucial to Differentiate between individuals with suicidal ideation
• Evidence-based treatments and interventions are being prioritized
• The federal government supports the "Zero Suicide" movement through the Substance Abuse and Mental Health Services Administration
• This focuses on eliminating suicide in healthcare settings
• This initiative involves collaboration among various national organizations
• The movement emphasizes the importance of systemic changes in mental health treatment

Myths and Misconceptions

• Many assumptions about suicidal thoughts are not supported
• Distinguishing between myths and facts are essential to understand risks more accurately
• Here are some common myths:
• People who talk about suicide do not act on their ideas
  • Fact: Eight of 10 people who kill themselves have given definite clues and warnings about their suicidal intentions
• You cannot stop a suicidal person; they are fully intent on dying
  • Fact: Most suicidal people are ambivalent; they often see their actions as a cry for help
• Once a person is suicidal, they are suicidal forever
  • Fact: Ideation and risk fluctuate over time
• Improvement after severe depression means that a person is no longer at risk of suicide
  • Fact: Suicides often occur 3 months after improvement, due to getting the energy to act on suicidal thoughts
• Suicide is inherited or runs in families
  • Fact: Having a family member increases an individual's risk factor
• All suicidal individuals are mentally ill
  • Fact: Many who attempt suicide are extremely unhappy or clinically depressed but not necessarily psychotic
• All suicidal behavior must be approached with seriousness
• It is crucial to recognize that individuals may be issuing a cry for help rather than seeking attention
• Contrary to belief, gunshot wounds are the leading cause of death, not drug overdoses
• Around half the people who die by it have attempted it at least once
• It is often not impulsive; individuals will contemplate, plan, and even write notes
• An average of 30-35children under the age of 12 end their life each year

Understanding Risk Factors

• Suicide risk factors increase the likelihood of suicide in the future
• Warning signs indicate a person is thinking about acting soon
• Assessing risk includes noting all factors and signs

Differentiating Risk Factors and Warning Signs

• Risk factors are longer term
• Warning signs are indicators of potential suicidal behavior
• Risk factors include mental disorders, substance abuse, life changes
• Warning signs include communication indicating a desire to die, or feelings of hopelessness
• Both categories are essential for assessment

Marital Status and Suicide Risk

• Marital status is a demographic factor that influences suicide risk
• Divorced men are twice as likely to die by suicide
• Single people with low education and lower income face increased rates

Longitudinal Studies for Marital Status

• Kposowa (2000) found no significant effect of being single or widowed
• Naess et al. (2021) emphasized highest risk for never-married individuals correlated with socioeconomic factors
• Roškar et al. (2011) and Yamauchi et al. (2013) supports major life changes elevating the risk, especially in the first year following the change

Transitional Live Events and Social Support

• Transitions, including divorce or death of a spouse, can trigger suicidal thoughts and behaviors
• The first year after a change is critical
• Men are often less likely to ask for help
• Social support networks are vital, yet men may delay seeking help
• Engaging witih social connections can mitigate feelings of loneliness and hopelessness
• Encouraging open communication and support-seeking is crucial

Gender Disparities

• Women attempt more than men
• Men complete suicide more than women
• Men use firearms or hanging most of the time
• Women tend to use less lethal methods

Risk Factors and Gender

• Women have increased risk including mental health disorders, societal pressures, and trauma
• Men face societal disclipline regarding mental health, leading to reporting disparities which can skew statistics
• Men are more likely to engage in substance use disorders, which are closely linked to higher suicide rates

Inpatient Psychiatric Treatment and Suicide Risk

• The risk of suicide is high during impatient treatment
• Acuteness and mental health crises occur
• Post discharge, individuals remain at a high risk
• Females need gender sensitive approaches in treatment

Follow-up Care

• Following up post discharge after treatment can reduce risk
• Structure and aftercare plan are essential

Support Systems

• Support system, including family involvement and community resouces, make up a big part in assistance for recovery
• Mental health professionals should be trained to increased risk particullarly in women right after post discharge

Overview of Suicide Risk and Age Correlation

• Suicide risk can generally increase by age, specifically for males
• In 2020 CDC has reported female suicide rates from age 10 to 20 were high

Adolescent Suicide Risk Factors

• Suicide remain third leading death among adolescents
• In 2013 rate ranked second leading
• Factors to sucide including impulsive behaviors or disorders

Suicide in Younger Children

• Historically children younger than 10 show low suicide rates with some not having capacity to intend to end their lives
• Emerging research reveals there are risks among younger kids, so mental health providers need to implement care

Statistical Insights and Findings

• The rates among 5 to 11 nearly doubled from 1993 to 2012 for black children
• 11% of children has exhibit suicidal ideation
• The average is abou 33 each year with the range from ages 5 to 11 die from suicide
• there is an increase in self inflicted injuries for 10 to 14 year old girls

Implications for Healthcare and Screening

• Duran and Mcguiness emphasize the duty to screen for the thoughts to help the younger population
• Integrated mental health to help with early prevention, early healthcare practices, screening

General Recommendations as a Provider

• Train to have an aware mind
• Get good screening tools
• Collaborate with the health specialists

Complexity of Religion and Suicide Risk

• Religion and suicide goes hand in hand and it depends on varying factors
• Studies differ between protective elements and increase in risk
• Dynamics depend on beliefs
• Affects of religion can fluctuate with cultures

Religious Factors of Protection:

• systematic review of Lawrence in 2016
• regular services

Empirical Studies of Lawrence

• reduced suicidal thoughts with affiliation is not significant
• community as well as support in setting can be seen a factor

Rasic findings:

• religious affiliation and attempt

Financials and Unemployment

Financial strain leads to people’s feeling Losses create critical risk factors for the need of intervention Financial strain and suicide can be seen as complex and can have different interactions Nuances to how the financial strain can affect demographics essential for strong prevention Geogrpahic has many inbalancces to the rate and what factors play for rural spots high with suicide It is hard to reach the help needed a as well and attitude Rural has fireearm usage 2x as raising concerns with access/ safety safety measures Stephen has the emphasized on the needs and tailoring and geographic and cultural context needs

Prevention and Risk

The Zero Suicide Movement  Ongoing research aims to identify effective strategies for suicide prevention and risk assessment among military personnel.  Differentiating between individuals with suicidal ideation and those who attempt suicide is crucial for tailoring interventions and support.  Evidence-based treatments and interventions are being prioritized to ensure that military personnel receive the most effective care. The Zero Suicide Movement  The federal government, through the Substance Abuse and Mental Health Services Administration, supports the "Zero Suicide" movement, which focuses on eliminating suicide in healthcare settings.  This initiative involves collaboration among various national organizations to develop and implement evidence-based strategies for suicide prevention.  The movement emphasizes the importance of systemic changes in how mental health care is delivered to military personnel and veterans.

Protective factors of religion

Community and belonging: regular services Moral and ethics: deter from ending ones life Promote coping as well and help challenge mental health Negative Feeling guilt Pressure to conform as well as isolate In certain cases mental health can make things so that it becomes a risk factor

Transition Attempt

Low end education Unemployment of adults Intervention and socioeconomic can have groups at a high affect Previous issues can indicate more assessments Outreach, education can help with little and high education to help outreach

Ethnicity

Highest rate of adjustment includes indians and alaskans whites are less with the rate Rates between blacks and pacifics are highlighted Need targered invervensiton in community Within the american indians it is an extreme group A reason it was 2.5 higher is because some have history with it with problems Adress these and do solutions that have community intervention

Understanding Suicide Risk

• Mental health: most are able to be diagnosed or even have a past illness There's a need for earlier and in order to reduce risk

Socioeocnomic facotrs:

• financial stability
• relatinoshio
• violence
• External forces are the reason for an increase is a reason for risk
• Assess life for accurate suicide

Assessment

Thorough assessment when seeing someone with need Many disorders are known to be recognized and in relation to suicide you need to be aware Important high risk is needed for assessing Hospitalization of the increased risk to be aware of during those months. Suicide more likely occurs A good system is needed and is a must have support

Mental Health Disorder

Suicide is linked to depression but is seen thru variety Mental illness

• schizophrenia
• bi polar
• personality with borderline
• eating disorders a such as nerves

Assessments

Assessments needs to assess what's going on current and past Inquire on lifestyle Structured tool

The columbia suicde rating is good Conversations and feelings of self harm

Physical Conditions

Conditions are linked Ahmedani Sleep HIV And brain injuries can lead to suicide if not handled

Substance Abuse

Withdrawal can be bad due so and is important to catch Commands: Can push you to harm

Commuincation and Hallucinations

Can give an urgency Approached are needed for psychosis

Commuicnation and Hallucinations

Can give an urgency Approached are needed for psychosis

LGBTQ suicide

Higher amount CDc recognizes as bisexual and lesbian attempt twice as much Transgender have 41 percents attempt suicide

Factors and Risk

Distress Family past Discrimination Loss life changes

Bullying

Bullying causes it Is emotional and very present Common with appearance Also targets gender and LGBTQ

Cyber bullying

Is with use of platforms against you especially youth Harass or humiliate Forms are: social media and texting

Suicide Stats

15/20 have issues Anonymity is a perpetration Is constant and around

Prevention

Parents can educate the students Be there and trained to help and recognize

Theorries

Psychoglical factors are looked at related to suicide Depression as well Factors can prevent as well as intervene

Theories of suicide

There are many points of view and different theories to help explain suicide better.

• anger turned inward
• Hopeleseness and depression
• history of aggression and voilence
• shame and humiliation

Overview and factors

1951 emile wrote To see individuals in society which related societal coves can play in relation The study is ground breaking 3 categories Egoistic: those to society and integration Altrusitic: excessive integration for perceived greaer anomic: lack of norms or signfiicant triggers

Steps after these

A connection or realitabilty helps for a big protective factor community and connectedness helps

Interpersonal theory

• Durkheim's said social is the reason why it occurs and what influences behavior
• Lacking is where suicide is going to occur
• Joiner introduces some more and how to handle as well and look at how it impacts

Concepts of thought as well

• ideations
• Interpersonal needs: is to look at how connected, and high burdens are effecting.
• capability: being able to be repeatedly being able to hurt

key interaction

• connections as well as psychological are there are condusive
• increased as well as capable
• Multiple risk factors are linked to suicide

Mechanism

• desensitization of feat to pain for many, to attempt from ideation
• case studies have high histories to trauma for violence Steps towards to lethal have patterns

Three Step theory

kLOSNKY AS WELL FOR 2015 AIMS IS the actual attempts Pain is the source of illness High with sadness is high to be likely for suicide Not good if there is no connection

Assessment

Factors of understanding for suicide A process as good to keep improving the patient

• The Safe-T model provide s a structured approach to suicide assessment
• It includes five key step identifying risk factors , assessing risk deeding a saffetty play and determining the need ofr hisptializatli

Safe-T Safety Plan

Protective Factors

Understanding underlying feelings and how it works are important for prevention and intervention

• Focus on interpersonal needs like social connectedness
• Family engagement
• Addressing capability
• Education
• Addressing violence in individuals

Biological Facts

Elcidate genetics as well and biological Recognised nature to involve relationships and environment Complex and is hard to account for History if psychological Genetics neurology shifting underinnigns for behavior

Suicide Risk

Higher rates of twins more likely Hereditary is high Research on enzyme crucial suicides related Diminished means is increase this Genetical for prefrontal cortex Dna overlap genetics for this disorder

Genetic research

Complexity of mental and what must be measured

altered euro chemical

Serotonin, glutamate These levels if different can trigger cortisol release Studies we've found only week Fatty acids are potential to inflitrate Holistic to support as a whole and target everything Important to be on top

Nursing Inpliacation

Focus and see that everyone is different Risk is good for decreasing the chance Hospitals is top importance is key to see what characteristics To check with what they are feeling also essential with their skills Good is to use a number for the suicide Easy access on a way to be better

All good is to stay trained at all Essential is a lot is needed Essential To communicate is a great way