Suicide Facts and Definition

Definition and Facts about Suicide

• Suicide is the intentional, direct, and conscious taking of one's own life.
• It has been extensively researched, and risk factors and protective factors have been identified.
• Strategies to successfully intervene have been identified.
• Up to 90% of people who contemplate suicide have a mental illness, often undiagnosed.
• Depression and bipolar disorder are the highest risk factors.
• Suicide is the tenth leading cause of death in the United States.
• Most people who attempt suicide do not want to die, but rather want their pain to end and are unable to see other solutions.

Common Characteristics of Suicide

• The belief that things will never change and that suicide is the only solution.
• Triggering events include intense interpersonal conflict and feelings of depression, hopelessness, guilt, anger, or shame.
• Ambivalence about suicide: there is a strong underlying desire to live.

Occupational Risk Factors

• Jobs with high rates of suicide in men include: farmworkers, fishermen, loggers, carpenters, miners, electricians, and installers.
• A high percentage of workplace injury, possibly leading to loss of employment and stress.
• For women, the highest rates of suicide occur among firefighters, police, and correctional officers.
• It is difficult to discuss mental health (trauma, etc.) because of stigma and fear of discrimination.
• Among medical professionals, psychiatrists have the highest suicide rate and pediatricians have the lowest.

Effects of Suicide on Friends and Family

• Consistent themes among surviving friends include 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.

Suicide and Specific Populations

• The suicide rate for young people is at its highest since 2000 and appears to be climbing.
• Possible reasons for the increase include social media use and substance abuse.
• There is an increase in suicidality among African American children and adolescents.
• Barriers to identification and treatment of depression.
• The role of school experiences such as racial discrimination, low teacher expectations, or inequitable and harsh discipline practices.
• The academic environment can function as a significant stressor for children and adolescents.
• Bullying is a significant risk factor for suicide.
• LGBTQ+ teens are at exceptionally high risk for both bullying and suicide.
• Cyberbullying seems to be more strongly related to suicide attempts.
• Copycat suicides can occur due to media reports of suicides, and journalists should follow best practice guidelines for reporting.Here are the study notes in detailed bullet points:
• Food and Drug Administration Warning of Increased Suicide Risk for Children Taking SSRIs*
• A warning is required to be distributed with all antidepressant medications (SSRIs) for children
• Recent study confirmed an increase in suicidality in youth taking antidepressants and validated the black box warning
• Medical professionals should monitor suicidal ideation in children taking antidepressants
• The Impact of 13 Reasons Why*
• After the show aired, there was a 20% increase in searches for suicide-related terms
• Significant increase in mental health issues for youth, particularly among males (12% increase) and females (20% increase)
• Suicide Among Those Who Serve in the Military*
• Increasing rate of suicides in the military
• Factors contributing to suicide:
  • Stigma and trauma
  • Many believe the military creates a culture that dismisses and stigmatizes emotional symptoms
  • Barriers to mental health care in the military
  • Financial or personal problems associated with serving in the military
  • Mental health issues such as bipolar disorder, opioid use, depression, and PTSD
  • The rate of suicide in veterans in 2017 was 1.5 times that of nonveterans
• Suicide Among College Students*
• A comprehensive study of suicidal ideation in students at 108 colleges
• 20% of students surveyed had thought about suicide, and 9% had attempted suicide
• Asian American and multiracial students reported the highest rates of suicidal ideation
• Transgender students showed elevated rates of suicidal ideation, suicide attempts, and self-injury
• Stress from various sources was strongly related to suicide attempts and mental health diagnoses
• Campus prevention and intervention efforts are critically important
• Suicide Among the Elderly*
• Suicide rates for elderly men are the highest of any age group
• Factors contributing to suicide:
  • Bereavement
  • Physical ailments
  • Social isolation
  • Financial difficulties
  • Discrimination and prejudice
• 9-4 A Multipath Perspective of Suicide*
• Biological Dimension:
  • Suicide influenced by low serotonin levels in the brain
  • Genetics and specific endophenotypes associated with suicide
  • Sleep difficulties, including nightmares and trouble falling or staying asleep
  • Alcohol use and Chronic Traumatic Encephalopathy (CET) are implicated in suicide
• Psychological Dimension:
  • Psychological pain associated with maltreatment in childhood
  • Rumination, shame, discouragement, and distress over academic or social pressures
  • Many people who commit suicide have a history of mental illness
  • Personal problems that precipitate social withdrawal
• Sociocultural Dimension:
  • Emile Durkheim's sociocultural theory
  • Inability to integrate oneself into society
  • Lack of close ties deprives one of the support systems necessary for adaptive functioning
  • Alienation and isolation experienced by many LGBTQ youth
• 9-5 Preventing Suicide*
• Preventing Suicide:
  • Early detection and successful intervention
  • Understanding risk and protective factors
  • Paths to intervention:
    • Self-referrals or referrals from concerned family or friends
    • Gatekeeper training designed to learn about risk factors and screening methods
  • Three-step process:
    • Know which factors increase the likelihood of suicide
    • Determine the probability that a person will act on suicide wishes
    • Implement appropriate actions
• Lecture 10: Eating Disorders*
• Anorexia Nervosa*
• Typical onset: early adolescence
• Characteristics:
  • Extreme thinness
  • Restricting or binge-eating/purging
  • Loss of weight or failure to gain weight
  • Fear of gaining weight
  • Distorted body image
• Bulimia Nervosa*
• Onset: mid to late adolescence
• Characteristics:
  • Recurrent episodes of binge eating
  • Loss of control over eating
  • Self-evaluation influenced by weight or shape
  • Recurrent attempts to compensate for binge eating (e.g., self-induced vomiting)
• Binge-Eating Disorder (BED)*
• Onset: late adolescence or early adulthood
• Characteristics:
  • Recurrent episodes of binge eating
  • Feeling of loss of control over eating
  • Marked distress over binge eating episodes
  • No compensatory behaviors (e.g., self-induced vomiting)
• Physical Complications and Associated Characteristics of Eating Disorders*
• Anorexia Nervosa:
  • Highest mortality rate out of eating disorders
  • Irregular heart rate, low blood pressure, heart damage, kidney disease, bone loss, and enlarged salivary glands
• Bulimia Nervosa:
  • Dehydration, swelling of the salivary glands, and inflammation of the esophagus, stomach, and rectal area
  • May abuse drugs and engage in risky behaviors
• Binge-Eating Disorder (BED):
  • Often leads to obesity and associated health problems
  • Complications include Type 2 Diabetes, high blood pressure, and high cholesterol levels
• Course and Outcome of Eating Disorders*
• Anorexia Nervosa:
  • Highly variable and unpredictable course
  • Mortality rate is elevated, especially among those who exercise excessively
• Bulimia Nervosa:
  • Begins in late adolescence or early adulthood
  • Mortality rates are elevated, especially among those who exercise excessively
  • Prognosis is more positive than anorexia nervosa
• Binge-Eating Disorder (BED):
  • Remission rates are higher than those of anorexia or bulimia nervosa
  • Most individuals with BED make a full recovery over 5 years
• Other Specified Feeding or Eating Disorders*
• Disturbed eating patterns not meeting criteria for anorexia or bulimia nervosa
• Individuals of normal weight who meet other criteria for anorexia nervosa
• Individuals who meet criteria for bulimia nervosa but binge less than once a week
• Night-eating syndrome
• Many individuals who receive this diagnosis will eventually meet the diagnostic criteria for an eating disorder### Substance Abuse
• 18% of the adult population is affected by substance abuse
• Twice as likely to develop in men, but alcoholism progresses more quickly in women

Opioids

• Pain-killing agents that depress the central nervous system
• Illegal substances: heroin and opium
• Prescription pain relievers: morphine, codeine, and oxycodone
• Highly addictive and can produce euphoria and drowsiness
• Fentanyl is 50-100 times more potent than morphine
• Liberal prescribing has led to widespread misuse and deaths

Sedatives, Hypnotics, and Anxiolytics

• Have calming effects and are used to treat agitation, muscle tension, insomnia, and anxiety
• Hypnotics induce sleep, while anxiolytics reduce anxiety
• Examples include barbiturates and benzodiazepines
• Rapid anxiolytic effects in moderate doses, and hypnotic effects in higher doses

Stimulants

• Speed up central nervous system activity and produce feelings of euphoria and well-being
• Improve mental and physical performance, reduce appetite, and prevent sleep
• Unwanted effects include anxiety, restlessness, agitation, and paranoia
• Tolerance develops rapidly, and they are often illegal (e.g., cocaine, meth) or legal (e.g., caffeine, Adderall)

Caffeine

• Stimulant found in coffee, chocolate, tea, and soft drinks
• Most widely consumed psychoactive substance in the world (90% of adults use daily in North America)
• Withdrawal symptoms include headache, fatigue, irritability, and difficulty concentrating
• Caffeine intake has increased due to the widespread marketing and consumption of energy drinks

Amphetamines

• Stimulants that speed up central nervous system activity
• Prescribed for attention and sleep disorders, but increasingly used illicitly
• Can cause psychosis and brain damage
• Methamphetamine is highly addictive and can cause permanent heart damage

Cocaine

• Highly addictive and can cause acute psychiatric symptoms and shortened lifespan
• Crack is a potent form of cocaine that produces immediate but short-lived effects
• Withdrawal symptoms include lethargy and depression

Hallucinogens

• Produce vivid sensory awareness and hallucinations
• Effects can vary significantly, and users may experience "bad trips" or "good trips"
• Hallucinogen persisting perception disorder can occur weeks or even years after drug intake

Substances with Mixed Chemical Properties

• Substances that have varied effects on the brain and CNS
• Examples include nicotine, cannabis, and inhalants
• Nicotine releases both adrenaline and dopamine
• Cannabis is the most commonly used illicit drug worldwide
• Inhalants can cause strokes even in first-time users

Etiology of Substance-Use Disorders

• Typical progression from substance use to abuse
• Individual decides to experiment with drugs, then consumption continues to serve essential purposes
• Brain chemistry becomes altered from chronic use, resulting in physiological dependence, withdrawal symptoms, and cravings
• Lifestyle changes occur due to chronic abuse

Psychological Factors

• Huge impact on substance use and abuse
• Coping with psychological stress and emotional symptoms is a primary motive for substance use
• Stress plays a role in the development of alcoholism and relapse
• Almost half of abusers have a concurrent psychiatric disorder
• Four categories of life stressors influence substance use

Social Factors

• Influence varies across the lifespan
• Childhood: victimization and stressful events (neglect)
• Adolescence: parental attitudes and behaviors, lack of parental monitoring, peer pressure, and desire to fit in socially
• College: transition to independence, easy access to alcohol, and exposure to peers who drink heavily

Sociocultural Factors

• Use and abuse of alcohol and other substances pervade all social classes
• Cultural trends and social norms influence substance use and abuse

Biological Factors

• Genetic factors account for 56% of alcohol dependence risk
• Genetic factors influence individual responses to specific drugs and can decrease substance abuse risk
• Sex differences in the physiological effects of substances are significant
• Some genes have a preventative factor, such as the Asian flush

Treatment for Substance-Use Disorders

• Disparity between the millions affected and the small percentage receiving intervention
• Treatment and supportive intervention settings include self-help groups, mental health clinics, and inpatient and outpatient treatment centers
• Treatment is most effective when incorporating best practices based on high-quality addiction research
• Inclusion of integrated care that addresses underlying emotional difficulties enhances treatment outcomes
• Goals of treatment include achieving sustained abstinence, maintaining a drug-free lifestyle, and functioning productively

Relapse Prevention

• Relapse prevention considers the physiological and psychological effects of substance use
• Neuroplasticity: the brain's ability to change its structure and function in response to experience
• Abstinence can help recondition the brain
• Contingency management procedures can significantly reduce relapse
• Motivational enhancement therapy addresses ambivalence about giving up substance use

Treatment for Alcohol-Use Disorder

• Alcoholics Anonymous (AA) regards alcoholism as a disease and advocates total abstinence
• Positive long-term outcomes for AA
• Controlled drinking is a controversial idea
• Medication has modest effects, and genetic characteristics of individuals undergoing alcohol treatment are associated with differential responses
• More research is needed on treatments and access to alcohol treatment

Definition and Facts about Suicide

• Suicide is the intentional, direct, and conscious taking of one's own life.
• It has been extensively researched, and risk factors and protective factors have been identified.
• Strategies to successfully intervene have been identified.
• Up to 90% of people who contemplate suicide have a mental illness, often undiagnosed.
• Depression and bipolar disorder are the highest risk factors.
• Suicide is the tenth leading cause of death in the United States.
• Most people who attempt suicide do not want to die, but rather want their pain to end and are unable to see other solutions.

Common Characteristics of Suicide

• The belief that things will never change and that suicide is the only solution.
• Triggering events include intense interpersonal conflict and feelings of depression, hopelessness, guilt, anger, or shame.
• Ambivalence about suicide: there is a strong underlying desire to live.

Occupational Risk Factors

• Jobs with high rates of suicide in men include: farmworkers, fishermen, loggers, carpenters, miners, electricians, and installers.
• A high percentage of workplace injury, possibly leading to loss of employment and stress.
• For women, the highest rates of suicide occur among firefighters, police, and correctional officers.
• It is difficult to discuss mental health (trauma, etc.) because of stigma and fear of discrimination.
• Among medical professionals, psychiatrists have the highest suicide rate and pediatricians have the lowest.

Effects of Suicide on Friends and Family

• Consistent themes among surviving friends include 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.

Suicide and Specific Populations

• The suicide rate for young people is at its highest since 2000 and appears to be climbing.
• Possible reasons for the increase include social media use and substance abuse.
• There is an increase in suicidality among African American children and adolescents.
• Barriers to identification and treatment of depression.
• The role of school experiences such as racial discrimination, low teacher expectations, or inequitable and harsh discipline practices.
• The academic environment can function as a significant stressor for children and adolescents.
• Bullying is a significant risk factor for suicide.
• LGBTQ+ teens are at exceptionally high risk for both bullying and suicide.
• Cyberbullying seems to be more strongly related to suicide attempts.
• Copycat suicides can occur due to media reports of suicides, and journalists should follow best practice guidelines for reporting.Here are the study notes in detailed bullet points:
• Food and Drug Administration Warning of Increased Suicide Risk for Children Taking SSRIs*
• A warning is required to be distributed with all antidepressant medications (SSRIs) for children
• Recent study confirmed an increase in suicidality in youth taking antidepressants and validated the black box warning
• Medical professionals should monitor suicidal ideation in children taking antidepressants
• The Impact of 13 Reasons Why*
• After the show aired, there was a 20% increase in searches for suicide-related terms
• Significant increase in mental health issues for youth, particularly among males (12% increase) and females (20% increase)
• Suicide Among Those Who Serve in the Military*
• Increasing rate of suicides in the military
• Factors contributing to suicide:
  • Stigma and trauma
  • Many believe the military creates a culture that dismisses and stigmatizes emotional symptoms
  • Barriers to mental health care in the military
  • Financial or personal problems associated with serving in the military
  • Mental health issues such as bipolar disorder, opioid use, depression, and PTSD
  • The rate of suicide in veterans in 2017 was 1.5 times that of nonveterans
• Suicide Among College Students*
• A comprehensive study of suicidal ideation in students at 108 colleges
• 20% of students surveyed had thought about suicide, and 9% had attempted suicide
• Asian American and multiracial students reported the highest rates of suicidal ideation
• Transgender students showed elevated rates of suicidal ideation, suicide attempts, and self-injury
• Stress from various sources was strongly related to suicide attempts and mental health diagnoses
• Campus prevention and intervention efforts are critically important
• Suicide Among the Elderly*
• Suicide rates for elderly men are the highest of any age group
• Factors contributing to suicide:
  • Bereavement
  • Physical ailments
  • Social isolation
  • Financial difficulties
  • Discrimination and prejudice
• 9-4 A Multipath Perspective of Suicide*
• Biological Dimension:
  • Suicide influenced by low serotonin levels in the brain
  • Genetics and specific endophenotypes associated with suicide
  • Sleep difficulties, including nightmares and trouble falling or staying asleep
  • Alcohol use and Chronic Traumatic Encephalopathy (CET) are implicated in suicide
• Psychological Dimension:
  • Psychological pain associated with maltreatment in childhood
  • Rumination, shame, discouragement, and distress over academic or social pressures
  • Many people who commit suicide have a history of mental illness
  • Personal problems that precipitate social withdrawal
• Sociocultural Dimension:
  • Emile Durkheim's sociocultural theory
  • Inability to integrate oneself into society
  • Lack of close ties deprives one of the support systems necessary for adaptive functioning
  • Alienation and isolation experienced by many LGBTQ youth
• 9-5 Preventing Suicide*
• Preventing Suicide:
  • Early detection and successful intervention
  • Understanding risk and protective factors
  • Paths to intervention:
    • Self-referrals or referrals from concerned family or friends
    • Gatekeeper training designed to learn about risk factors and screening methods
  • Three-step process:
    • Know which factors increase the likelihood of suicide
    • Determine the probability that a person will act on suicide wishes
    • Implement appropriate actions
• Lecture 10: Eating Disorders*
• Anorexia Nervosa*
• Typical onset: early adolescence
• Characteristics:
  • Extreme thinness
  • Restricting or binge-eating/purging
  • Loss of weight or failure to gain weight
  • Fear of gaining weight
  • Distorted body image
• Bulimia Nervosa*
• Onset: mid to late adolescence
• Characteristics:
  • Recurrent episodes of binge eating
  • Loss of control over eating
  • Self-evaluation influenced by weight or shape
  • Recurrent attempts to compensate for binge eating (e.g., self-induced vomiting)
• Binge-Eating Disorder (BED)*
• Onset: late adolescence or early adulthood
• Characteristics:
  • Recurrent episodes of binge eating
  • Feeling of loss of control over eating
  • Marked distress over binge eating episodes
  • No compensatory behaviors (e.g., self-induced vomiting)
• Physical Complications and Associated Characteristics of Eating Disorders*
• Anorexia Nervosa:
  • Highest mortality rate out of eating disorders
  • Irregular heart rate, low blood pressure, heart damage, kidney disease, bone loss, and enlarged salivary glands
• Bulimia Nervosa:
  • Dehydration, swelling of the salivary glands, and inflammation of the esophagus, stomach, and rectal area
  • May abuse drugs and engage in risky behaviors
• Binge-Eating Disorder (BED):
  • Often leads to obesity and associated health problems
  • Complications include Type 2 Diabetes, high blood pressure, and high cholesterol levels
• Course and Outcome of Eating Disorders*
• Anorexia Nervosa:
  • Highly variable and unpredictable course
  • Mortality rate is elevated, especially among those who exercise excessively
• Bulimia Nervosa:
  • Begins in late adolescence or early adulthood
  • Mortality rates are elevated, especially among those who exercise excessively
  • Prognosis is more positive than anorexia nervosa
• Binge-Eating Disorder (BED):
  • Remission rates are higher than those of anorexia or bulimia nervosa
  • Most individuals with BED make a full recovery over 5 years
• Other Specified Feeding or Eating Disorders*
• Disturbed eating patterns not meeting criteria for anorexia or bulimia nervosa
• Individuals of normal weight who meet other criteria for anorexia nervosa
• Individuals who meet criteria for bulimia nervosa but binge less than once a week
• Night-eating syndrome
• Many individuals who receive this diagnosis will eventually meet the diagnostic criteria for an eating disorder### Substance Abuse
• Adult population affected by substance abuse: 18%
• Twice as likely to develop in men
• Alcoholism progresses more quickly in women

Opioids

• Pain-killing agents that depress the central nervous system
• Can be illegal substances (e.g. heroin, opium) or prescription pain relievers (e.g. morphine, codeine, oxycodone)
• Highly addictive and can produce euphoria and drowsiness
• Fentanyl, a highly lethal painkiller, is 50-100 times more potent than morphine

Sedatives, Hypnotics, and Anxiolytics

• Have calming effects
• Used to treat agitation, muscle tension, insomnia, and anxiety
• Include hypnotics (induce sleep) and anxiolytics (reduce anxiety)
• Examples: barbiturates and benzodiazepines
• Can produce rapid and anxiolytic effects in moderate doses and hypnotic effects in higher doses

Stimulants

• Speed up central nervous system activity
• Produce feelings of euphoria and well-being
• Can improve mental and physical performance, reduce appetite, and prevent sleep
• Unwanted effects include anxiety, restlessness, agitation, and paranoia
• Tolerance develops rapidly
• Examples: cocaine, methamphetamine, caffeine, and Adderall

Caffeine

• Stimulant found in coffee, chocolate, tea, and soft drinks
• Most widely consumed psychoactive substance in the world
• 90% of adults in North America use daily
• Withdrawal symptoms include headache, fatigue, irritability, and difficulty concentrating

Amphetamines

• Also known as "uppers"
• Speed up central nervous system activity
• Prescribed for attention and sleep disorders, but increasingly used illicitly
• Can cause psychosis and brain damage
• Examples: methamphetamine, which can cause delusions, hallucinations, and permanent heart damage

Cocaine

• High potential for addiction
• Crack is a potent form of cocaine produced by heating cocaine with other substances, typically smoked
• Produces immediate but short-lived effects
• Withdrawal symptoms include lethargy and depression
• Users may experience acute psychiatric symptoms and have a shortened lifespan

Hallucinogens

• Produce vivid sensory awareness
• Effects can vary significantly, resulting in "good trips" or "bad trips"
• Can cause hallucinogen persisting perception disorder, where users experience distressing recurrences of hallucinations or other sensations weeks or even years after drug intake
• 2% of the population used hallucinogens in 2018

Substances with Mixed Chemical Properties

• Substances that have varied effects on the brain and CNS
• Examples: nicotine, which releases both adrenaline and dopamine
• Cannabis (marijuana) is the most commonly used illicit drug worldwide
• Inhalants were once considered a silent epidemic among children and adolescents
• Ecstasy has both stimulant and hallucinogenic properties

Etiology of Substance-Use Disorders

• Typical progression from substance use to abuse:
  • Experimentation
  • Drug use becomes essential; consumption continues
  • Brain chemistry becomes altered from chronic use, resulting in physiological dependence, withdrawal symptoms, and cravings
  • Lifestyle changes occur due to chronic abuse

Psychological Factors

• Huge impact on substance use disorders
• Coping with psychological stress and emotional symptoms is a primary motive for substance use
• Stress plays a role in the development of alcoholism and relapse
• Almost half of abusers have a concurrent psychiatric disorder
• Four categories of life stressors influence substance use: general life stress, stress resulting from trauma or catastrophic events, childhood stressors or maltreatment, and the stress of everyday discrimination
• Behavioral under control: personality characteristics associated with rebelliousness, impulsivity, and risk-taking

Social Factors

• Influence varies across the lifespan
• Childhood: victimization and stressful events (neglect)
• Adolescence: parental attitudes and behaviors, lack of parental monitoring, peer pressure, and desire to assert independence and rebel
• College: vulnerable transitional period, abrupt changes in parental supervision, increased competition and pressure to achieve, easy access to alcohol, and exposure to peers who drink heavily
• Social media increases the acceptability and frequency of alcohol use in college
• Fall Consensus Effect: a self-esteem management strategy where individuals overestimate the extent of alcohol and marijuana use by peers to maintain a positive view of themselves.