Dr. Saman Yousuf

15 June 201115 June 2011

SOCIO-DEMOGRAPHIC FACTORS

Male Being over 60 Separated, widowed or divorced Living alone Being unemployed or retired Indebted Occupation

SMOKING DRUG/ALCOHOL MISUSE HISTORY OF TRAUMA / ABUSE / BULLYING

PAST SUICIDE ATTEMPT / DELIBERATE SELF HARMAfter a suicide attempt that is seen in the Emergency

Room, about 1% per year take their own life, up to approximately 10% within 10 years

PSYCHIATRIC DISORDERSMost common psychiatric risk factor resulting in suicide

- Depression*- Major Depression- Bipolar Depression- Alcohol abuse and dependence- Drug abuse and dependence- Schizophrenia

*Especially when combined with alcohol and drug abuse

Other psychiatric risk factors account for significantly fewer suicides

- Post Traumatic Stress Disorder (PTSD)- Eating disorders

Prior suicide attempt 38.4 Eating disorders 23.1 Bipolar disorder 21.7 Major depression 20.4 Mixed drug abuse 19.2 Dysthymia 12.1 Obsessive-compulsive 11.5 Panic disorder 10.0 Schizophrenia 8.45 Personality disorders 7.08 Alcohol abuse 5.86 Cancer 1.80

General populationGeneral population 1.00 1.00

Adapted from A.P.A. Guidelines, part A, p. 16

MAJOR LIFE EVENTS

- Chronic physical pain - Major physical illness (especially if recent)

- Impending legal prosecution- Family/relationship breakdown- Impulsivity- Unwillingness to seek help- Difficulty accessing services

HOPELESSNESS

COGNITIVE THINKING DIMENSIONS

- Thought constriction- Polarized thinking

FAMILY HISTORY OF SUICIDE

FAMILY DISCORD / SEPARATION OR DIVORCE

POOR FAMILY SUPPORT

JOB OR FINANCIAL LOSS

EASY ACCESS TO LETHAL MEANS

RELATIONAL LOSS WITHIN COMMUNITY

LOCAL CLUSTERS OF SUICIDE / EXPOSURE TO

SUICIDE

MEDIA EXPOSURE TO SUICIDE

Lee Eun-ju (1980-2005)

Min-Jan Nee(1946-2005)

Leslie Cheung (1956-2003)

CULTURAL AND RELIGIOUS BELIEFS THAT GLORIFY SUICIDE

- Seppuku/Hara-Kiri ("stomach-cutting") is a form of Japanese ritual suicide by disembowelment -- originally reserved only for samurai -- Part of the samurai “bushido” honor code, used voluntarily by samurai to die with honor rather than fall into the hands of their enemies, as a form of capital punishment for samurai who had committed serious offenses, or performed for other reasons that had brought shame to them.

The ceremonial disembowelment, which is usually part of a more elaborate ritual and performed in front of spectators, consists of plunging a short blade,

traditionally a “tanto”, into the abdomen and moving the blade from left to right in a slicing motion

- Sati/Devanagari is a religious funeral practice among some indian communities which the recently widowed lady voluntarily or by coercion immolates herself – rare and outlawed practice in India since 1829

Demographic male; widowed, divorced, single; increases with age; white

Psychosocial lack of social support; unemployment; drop in socio-economic status; access to means, media regulation on reporting suicides

Psychiatric psychiatric diagnosis; comorbidity

Physical Illness malignant neoplasms; HIV/AIDS; peptic ulcer disease; hemodialysis; systemic lupus erthematosis; pain syndromes; functional impairment; diseases of nervous system

Psychological Dimensions

hopelessness; psychic pain/anxiety; psychological turmoil; decreased self-esteem; fragile narcissism & perfectionism

Behavioral Dimensions

impulsivity; aggression; severe anxiety; panic attacks; agitation; intoxication; prior suicide attempt

Cognitive Dimensions thought constriction; polarized thinking (part of depression or otherwise)

Childhood Trauma sexual/physical abuse; neglect; parental loss

Genetic & Familial family history of suicide, mental illness, or abuse

Effective clinical care for mental, physical and substance disorders

Easy access to clinical interventions and support for help-seeking

Restricted access to highly lethal means of suicide

Strong connections to family and community support

Support through ongoing medical/mental health care relationships

Skills in problem solving, conflict resolution and handling disputes

Cultural/religious beliefs discouraging suicide & supporting self-preservation

- Christianity : Forbids the act “Thou shalt not kill”

- Islam : Forbids the act

Having children at home (other than those of postpartum depression)

Pregnancy / Life Satisfaction

SOME LOCAL RESEARCH …

RISK FACTORSRISK FACTORS PROTECTIVE PROTECTIVE FACTORSFACTORS

What are the risk factors?What are the protective factors?