Lecture 10: The psychology of suicidal behaviour

Question 1

myths about suicide

Answer 1

• Asking about suicide puts an idea into someone’s head
• Most people die by suicide during the Christmas holidays
• Someone thinking of suicide wants to die
• The media influence the number of suicides
• Antidepressants increase the risk of suicide
• Artists have an increased risk of suicide
• Suicide runs in the family
• Women mostly talk about suicide, men die more often
• Suicide rate rises during an economic recession

Question 2

suicide=

Answer 2

the act of deliberately killing oneself

Question 3

suicide attempt=

Answer 3

any non-fatal suicidal behaviour, intentional self-inflicted poisoning, injury or self-harm, which may or may-not have a fatal intent or outcome

Question 4

suicidal behaviour refers to a range of behaviours that include…

Answer 4

thinking about suicide (or ideation), planning for suicide, attempting suicide and suicide itself.

Question 5

hoeveel mensen overlijden aan suicide elk jaar

Answer 5

more than 700.000 people worldwide, 1850 in NL

Question 6

suicide is the … leading cause of death

Answer 6

4th

Question 6

hoeveel .. van de suicides in low en middle income countries

Answer 6

77%

Question 7

most common methods

Answer 7

ingestion of pesticide, hanging and firearms

Question 8

language matters:

Answer 8

In Dutch:
* “Suïcide” often used by researchers and policy makers
* “Zelfmoord” in media and debate
* Bereaved give preference to “zelfdoding”

In English
* Instead of commited suicide we use died by suicide
* Instead of suicide attempters we use people that did a suicide attempt

Question 9

gender paradox in suicide

Answer 9

females more depression, thoughts and attempts, but more deaths in males

• more aggresive
• worse in talking about feelings
• cultural aspect? (in china meer vrouwen die doodgaan door suicide)

Question 10

wat is lastig aan suicide meten

Answer 10

ze geven per land op hun eigen manier door wat voor doodsoorzaak er was, dus dit kan in sommige landen beter gemeten worden dan in andere landen

Question 11

vulnerability paradox =

Answer 11

hoe meer geld er in gestopt wordt (meer resources, meer investeringen), hoe meer suicide, depressie en ptsd

• more individualized?
• betere registratie?
• minder dood gaan door andere oorzaken? (infecties, homocide)

Question 12

wat is de trend in suicides

Answer 12

according to the WHO, suicides are actually decreasing, behalve in americas (however, according to media - they are increasing). het aantal zelfdodingen is sinds 2013 min of meer stabiel

Question 13

change in suicide rates 2000 - 2009

Answer 13

• Absolute figures: reduction from 883,000 to 703000
• Age standardized suicide rate reduced by 36%
• 17% reduction eastern Mediterranean region
• 47% reduction in EU region
• 49% reduction in Western Pacific
• In the Americas Region, rates increased by 17% in the same time period

Question 14

suicide attempt kenmerken burden

Answer 14

• Social and economic burden
• Impact on the person and loved one’s
• Utility of health services
• Best predictor of future suicidal behavior

Question 15

suicide monitoring

Answer 15

• Monitoring helps prevention strategies
• Combined with suicidal deaths helps to estimate the case fatality rate of suicidal behavior
• Two methods of data collection:
  1. Self reports in surveys of community residents (In the Netherlands Nemesis)
  2. From medical records

Question 16

methodological challenges of measuring suicide attempts

Answer 16

• Different survey instruments
• Different sample
• Different language
• Literacy of sample
• Time-frame
• Stigma
• Fluctuations of suicidal behavior over time

Question 17

nemesis II

Answer 17

• Large longitudinal national study on the occurrence of mental health problems in the Netherlands
• First was in 1996, second in 2007. New wave started in 2019.
• In new wave different instrument was used (CIDI 3 versus CIDI 1).
• For first time as a separate topic, not as part of depression section
• CIDI-3 asked in an indirect way about suicidality, via cards

Question 18

NEMESIS 2 uitslagen prevalentie suicidal thoughts and suicide attempt

Answer 18

• thoughts = 8.3
• attempt = 2.2

Question 19

wat is de relatie tussen suicidal thoughts and depression

Answer 19

• Of the people with suicidal thoughts, 58% had depression
• THE OTHER WAY AROUND: 26% of people with depression had suicidal thoughts

Question 20

wat is de relatie tussen suicide attempts en depression

Answer 20

• 70% of people with a history of a suicide attempt also had depression
• THE OTHER WAY AROUND: 8.4% of people with depression also made a suicide attempt

Question 21

hoe zit het in nl met suicidepreventie

Answer 21

in NL veeeeel investeringen gedaan, maar sinds 2013 is het stabiel -> had het geen nut? of was het anders hoger geweest?

Question 22

waarom zit er zo’n verschil tussen de economische recessie en covid

Answer 22

bij covid iedereen in hetzelfde schuitje, toen geen increase in suicides

Question 23

do’s in suicideprevention

Answer 23

• provide info on where and how to seek help
• recognize that media professions may themselves be affected when covering these stories
• do apply caution when reporting celebrity suicides
• do educate the public wit hthe facts about suicide and suicide prevention based on accurate information
• educate the public with facts about suicide
• report stories of how to cope with stressors/thoughts, and importance of help seeking
• apply caution when interviewing family members

Question 24

donts about suicide prevention

Answer 24

- dont use sensational language - dont describe the method used - dont name or provide details about the site or location - dont report details about notes - dont oversimplify the reason for suicide, or reduce it to a single factor - dont use photographs/videos/audios - dont use language/content which sensationalizes, romanticises, or normalizes suicide - dont unduely repeat such stories and dont put it as the top content

Question 25

wat is nog meer lastig aan het meten van het aantal suicide attempts

Answer 25

mensen veranderen hun mening over of ze ooit een suicide attempt hebben gedaan, wat het dus nog lastiger maakt om dit goed te kunnen meten

Question 26

wat is een revolutie in suicide research

Answer 26

het wordt nu gezien als een onafhaneklijk proces, niet meer als een onderdeel van depressie ("suicide behaviour")

Question 27

goethe of werther effect =

Answer 27

any positive attention to suicide can lead to more suicides (dit was vroeger dus al een bekend fenomeen)

Question 28

papageno effects =

Answer 28

positieve aandacht naar suicides in media kan ook een positief en beschermend effect hebben

Question 29

13 reasons why ...

Answer 29

heeft zo ongeveer alle regels verbroken van suicide preventie. in USA zagen ze zogenaamd een increase in suicide hierdoor, maar dat was daarvoor ook al een increase

Question 30

strategic goals national agenda:

Answer 30

1. dare and talk about suicide 2. train professionals (vragen op een specifieke manier stellen, en weten hoe je moet reageren op suicide) 3. invest in suicide prevention in the neighbourhood 4. increase reach specific risk groups 5. improve collaborations (government, loved ones) 6. limit access to means 7. learning data: national learning system

Question 31

interpersonal theory of suicidal behaviour

Answer 31

thwarthed belonginess (i am alone) capability for suicide perceived burdensomness (i am a burden) tussen tp & pb -> desire for success tussen alledrie -> lethal part (or near lethal)

Question 32

wat bedoelen ze met capability for suicide

Answer 32

weten hoe het moet, ook echt doorzetten, tools, etc

Question 33

wat was er met dit interpersonal theory of suicidal behaviour

Answer 33

de eerste die een verschil aangaf tussen attempts and thoughts

Question 34

wat zeiden O'connor en Nock

Answer 34

suicide behaviour should be studied as behaviour

Question 35

moderators =

Answer 35

when you dont know how to cope with the experiences many people have

Question 36

o connor model

Answer 36

premotivational phase: background factors & triggering events = diathesis + environment + life events motivational phase: ideation/intention formation = defeat & humiliation + threat to self -> entrapment + motivational moderators -> sucidal ideation & intent + volitional moderators -> suicidal behaviour

Question 37

entrapment

Answer 37

- The experience of "defeat" and "humiliation" from which there is no escape - Internal entrapment: I want to escape from myself/my own thoughts - External entrapment: I want to escape from my situation

Question 38

welke factoren spelen mee in dat iemand van suicidal ideation and intent naar suicidal behaviour gaat

Answer 38

- access to means - planning (if-then plans) - exposure to suicide - impulsivity - physical pain toleration/edurance - fearlessness about death - mental imagery - past suicidal behaviour

Question 39

what two cognitive factors are there

Answer 39

- cognitive rigidity - problem solving

Question 40

welke twee factoren passen bij zelfdoding

Answer 40

- rumination - autobiographical memory bias (suicidal behaviour= less ability to recall specific autobiographical memories)

Question 41

wat is belangrijk aan het inzetten van interventies

Answer 41

* Recognize that there are no interventions that give great effects. We also don't know which treatment works best in which situation * Many interventions give small effects. It is important to offer at-risk patients one or more of these interventions. * Also look at scalability of an intervention

Question 42

op welke van de factoren die belangrijk zijn om van ideation naar behaviour te gaan kunnen we de preventiemethoden vooral inzetten

Answer 42

access to means: mensen zullen niet heel snel een andere methode kiezen als je er eentje blokkeert. bv golden gate bridge. misschien komt dit door mental imagery (als je het je zo hebt voorgesteld, dan niet op een andere manier doen?)

Question 43

hoe genetisch is suicidal behaviour

Answer 43

het heeft wat genetic risk, maar waarschijnlijk vooral leergedrag van ouders overnemen. ook vooral agressie en impulsiviteit is hierbij belangrijk

Question 44

wat is een treatment voor suicidal behaviour

Answer 44

1. It is worth considering offering a problem-solving or cognitive therapy focused on suicidality in the treatment of patients with suicidal behavior. => CBT or IPT 2. dialectical behavioural therapy: individual psychotherapy, group skills training, out-of-session coaching, therapist consultation team meeting. lasts one year.

Question 45

hoe ziet CBT-SP er uit

Answer 45

* 10–12 outpatient sessions * first phase, suicide risk assessment, treatment plan, collaboratively create a crisis response plan or safety plan, and conduct skills training focused on emotion regulation and crisis management. * In the second phase, clinicians and patients focus on identifying and challenging the patient's maladaptive beliefs and self-statements which contribute to suicidal behaviors (e.g., hopelessness, perceived burdensomeness, entrapment). * In the third phase, clinicians and patients complete a relapse prevention task to facilitate the consolidation of skills and to prepare patients for effectively managing stressful situations in the future.