Causes of Suicide
Suicide will rank as the 10th top cause of death within the U.S (see below chart). Worldwide, around 700,000 individuals take their own lives yearly. In specific populations, like young adults and adolescents, suicide constitutes one of the leading three death causes. The phenomenon is all the more compelling due to, in most cases, suicides being prevented. Thus, clinicians have to realize the suicide risk factors as one method of intervening within a self-destructive cycle and event.
Treatment and diagnostic considerations
As it’s been assured that a patient is secure, the reasons for a person’s self-destructive behavior has to be discovered. The diagnosis needs a full psychiatric history, as well as mental status exam.
The selection of treatment will be dictated by the certain mental illness that affects a patient. Talking therapies may assist, and within most cases, medicine might relieve mental illness symptoms. However, finally, in spite of intervention, if a patient commits suicide, numerous measures could and should be taken for a patient’s family, additional patients, staff, and therapist.
A comprehension of the suicidal behavior causes won’t just clarify the roots of a patient’s self-destructive road, yet additionally assist the clinician in determining the suitable treatment for a patient. As a patient is safe, the underlying dynamics may be addressed.
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Numerous medicines were connected to suicidal behavior, that’s prompted the United States FDA to require warnings upon specific prescription medications, involving antidepressants, analgesics and anticonvulsants.
At first, the Food and Drug Administration and reports connected antidepressants to adolescent and childhood self-destructive patterns and needed a warning for these populations; but, experts discovered the same link for adults, too.
Investigators assessed information from all of the 287,543 residents of the British Columbia in Canada, eighteen years or up, who’d been put upon antidepressants between 1997 to 2005 and concluded this: ‘Our discovery of equal event rates across the antidepressant solutions will support the US FDA’s determination to treat every antidepressant alike within their advisory. Treatment determinations ought to be based upon efficacy, and clinicians must be vigilant in observance following initiating therapy with all antidepressant agents.
Within 2008, the Food and Drug Administration required a suicidal behavior warning be put into place upon anticonvulsants. Within an exploratory analysis of 2010, experts implied that the usage of Tiagabine, Oxcarbazepine, Lamotrigine, and Gabapentin as compared with the usage of Topiramate, might be related to a higher risk of violent deaths or suicidal acts.
Tramadol includes a narcotic-like pain reliever which, upon May 26th, 2010, obtained a Food and Drug Administration addition of a suicide threat warning (Ultram [tramadol hydrochloride] and Ultracet [tramadol acetaminophen/hydrochloride]). The Food and Drug Administration noted a link between tramadol prescriptions, as well as patients who have suicidal ideation and emotional instability, as well as higher self-destructive behavior.
Smoking cessation medicines
Experts decided that the threat of depression and self-injurious or suicidal behaviors is statistically significant and significantly increased with the usage of varenicline. The risk also was in existence, yet smaller, with bupropion, as well as was even smaller with nicotine replacement. Investigators implied that varenicline is inappropriate as a first-line product to help with smoking cessation.
One report by experts concluded that glucocorticoids raise the threat of neuropsychiatric disorders and suicidal behavior. The experts evaluated information from all patients in the United Kingdom general practices from 1990 – 2008. Of the 786,868 courses of oral glucocorticoids that were prescribed for 372,696 people, there were about 109 cases of suicide attempt or suicide and 10,220 incidents of serious neuropsychiatric conditions.
Eventhough mental illness generally is linked to premature deaths, specific mental conditions carry with them significantly high lifetime cases of suicide. As a matter of fact, 95 percent of individuals who commit suicide possess a mental illness. Within a generalized sense, mental illness oftentimes is an isolating experience, with this type of isolation related to suicide.
Hospitalization for psychiatric disorders is prevalent within the suicidal population, including for those who have depressive disorders, bipolar disorders, schizophrenia, posttraumatic stress disorders, phobias, substance use issues, dementia and delirium, as well as specific genetic factors.
All psychiatric disorders have their own unique mental status footprint. Mental status reviews are designed to assist in evaluating an individual’s potential for suicide.
Substances could contribute to self-destructive behaviors within all three stages of their usage—chronic usage, withdrawal and intoxication. Depressed individuals usually become very suicidal following a couple of drinks. At the same time, a few individuals could become suicidal following consuming LSD (lysergic acid diethylamide). Still other people encounter depression within substance withdrawal and will respond by committing suicide. (See graph).
Emergency department visitations for drug-associated suicide attempts by adult individuals aged twenty-five years and up, 2008.
One individual who engages in chronic drug and alcohol usage oftentimes experiences numerous major losses, involving of her or his job, family and spouse, and they, as a result, contribute to that person becoming suicidal.
Even individual in drug recovery plans stay at risk. For instance, patients within opiate dependency plans, particularly the ones who have chronic pain, the ones who have firearm availability, the ones who use additional street drugs, and the ones new to the plan, are especially at risk.
Within a United States study, experts discovered that overdose and suicide are connected, but distinct, issues. Patients with a history of suicide attempts and nonfatal overdoses might possess poor psychological functioning, and a more serious drug issue.
The mental and physical health effects related to methamphetamine use were documented; but, little is understood concerning the effects of injection meth and suicidal behavior.
VIDUS (Vancouver Injection Drug User Study) discovered that meth injection was related to an eighty percent increase within the threat of attempted suicide, implying that people who inject meth must be observed for suicidal behavior. This study elicited data concerning sociodemographics, drug usage habits, and mental health issues, involving suicidal behavior. Of the 1873 eligible attendees, 149 (eight percent) stated a suicide attempt.
Dementia and Delirium
Dementia and delirium include the lack of memory, hallucinations, disorientation, poor judgment and delusions. Those conditions oftentimes cause self-destructive behavior. One instance may be an accountant who gradually begins to experience trouble solving addition problems and recalling numbers. Even though other people may see these issues as minimal, he might feel as if he’s losing his career and mind, causing him to commit suicide.
Bulimia is accompanied by suicidal behavior. Predisposing issues involve stimulant use, feelings of loneliness, family history of psychiatric conditions, trouble handling the public, and childhood abuse.
There’s a unique difference in suicide rates as it relates to sex. Males possess a substantially higher completed suicide rate than women do. There are almost four times the amount of completed suicides amongst males than amongst females. But, females possess a higher rate of suicidal attempts. Oftentimes, females choose methods like an overdose of medicine, which permit more intervention time. Males frequently utilize methods like firearms that are a lot more lethal.
Women more often utilize poison while attempting suicide. One study investigated the risks related to the repetition of purposeful self-poisoning. The related factors for repeated suicide attempt were sex (f), living without family, utilizing antidepressants, as well as a psychiatric treatment history. Earlier psychological intervention and close monitoring is needed for people who meet these criteria.
A few authorities think that genetic factors by themselves might be included within suicide, that suicide will run in families, as well as that possessing a relative who commits suicide is, in fact, a risk factor. Thus, family history of suicide will be extremely significant. Careful evaluations of a family history of mental illness as well as suicide ought to be a regular element of patient assessment.
Reports continually exhibit the gene connection within suicidal behavior. Genes associated with serotonin were implicated within histories of 2nd suicidal attempts. Most of the discussed mental conditions (that is, bipolar disorder) aren’t just risk factors for suicide, yet additionally possess solid genetic elements.
Family history of suicide behavior will represent a substantial risk factor for the exact same behavior within offspring. Within a few families, suicide will constitute a dynamic to handle crises. Experts assessed the literature upon those associations and discovered such a relationship. Experts additionally decided that the relation is more solid with maternal suicide behavior vs. paternal suicide behavior and that this risk is higher more in kids than within adults or adolescents.
Availability of firearms
The number one method of suicide is firearms (see chart). As an individual in a depressed mood drinks alcohol and possesses a handgun on-hand, the situation easily could turn lethal.
Suicide methods utilized in the US
Of the 34,598 completed suicides, 17,352 of those utilized guns. Thus, a psychiatrist has to look into not just an individual’s suicidal plans and ideation, yet additionally into the existence of firearms. Medical professionals additionally have to understand their state statutes regarding people who have mental illness owning guns. Of interest, the limitation of the buying of guns by state and local background checks decreased the rate of suicidal attempts by firearms.
Information from the Nat’l Institute of Mental Health upon the differences in between women and men and suicide methods include:
- Suicide by poisoning – Females (40%), Males (13%)
- Suicide by suffocation – Females (21%), Males (24%)
- Suicide by firearms – Females (30%), Males (56%)
Suicide often is encountered within patients with a serious clinical issue. The threat for suicide rises in the face of a progressively debilitating, painful, protracted disease.
For instance, patients who undergo dialysis for end-phase renal disease possess an increased suicide rate than that of the generalized population. Additional diseases conferring an increased suicide risk involve COPD (chronic obstructive pulmonary disease), HIV (human immunodeficiency virus), cancer, AIDS (infection/acquired immunodeficiency syndrome), multiple sclerosis, quadriplegia, serious whole-body burns, and severe heart failure.
Specific recent life circumstances could precipitate suicide behavior. They involve romance-associated losses, like the ending of a love relationship or divorce; job termination, or loss of a beloved pet. These acute losses might be devastating.
A variety of past life circumstances also are connected with suicide. The most critical is suicide by a friend or a family member. Not infrequently, the history of a mother, sibling, or father committing suicide will correlate with suicide by an additional member of the family.
Status and Economic Instability
Periods of economic change, particularly economic depressions, also have been related to suicides. The beginning of the Great Depression within the U.S. was accompanied by a good amount of suicides. One expert noted that within periods of massive societal change, as the rules are in flux, as well as individuals don’t understand what’s expected of them, self-destructive rates increase. The expert termed this time of cultural alterations anomie. Low income and poverty, with concomitantly fewer opportunities and options, additionally relate to suicide.
Within many instances, suicidal behavior will result from an individual acting impulsively. Experts proved that lack of executive functioning within the format of bad impulse control inhibition will represent a suicidal risk. Impulsivity often can divide individuals who only possess suicidal ideation from the ones who really attempt suicide.
But, experts have implied that impulsive attempts possess valid significance and are like premeditated attempts regarding completed suicide risk. Therefore, an evaluation of an individual’s impulse control is crucial.
Individuals who are married will be less suicidal than are the ones who are widowed, divorced, or single. Isolated people are at a higher suicide risk than are the ones included with other people and their neighborhood.
Incarceration and hospitalization
If a person feels or is in fact trapped, particularly the ones who are incarcerated, they’re at risk for suicide. Inmates possess a higher suicide rate; it’s typical within the initial hours to initial week of becoming put into confinement. On the other hand, within the initial week following an individual’s discharge from the psychiatric unit or hospital, the suicide risk is especially high. For most, the transition is anxiety provoking, challenging, as well as difficult.
The threat of suicide ought to be extended to all people included with our criminal justice system. Experts determined that major social and health issues constantly coexist within this population, involving suicidal, psychopathology, and offending behavior. Further strategies for prevention are required for this circle, that include better mental health service provisions for everyone within the criminal justice system, especially the ones discovered not guilty and the ones not provided custodial services. Improved coordination is required within public services in order to handle coexisting social and health issues.
Lack of Light
Loss of daylight will correlate with suicide and depression. Areas that have dark, long winters, like parts of Alaska and Scandinavia, possess higher suicide rates. In fact, people who have SAD (seasonal affective disorder) residing within these areas have depression within the inexistence of sunlight and, therefore, possess an increased susceptibility toward depression– that might cause suicide.
One correlation long has been noted in between reduced levels of serum cholesterol, as well as activity of suicide. Experts discovered reduced cholesterol levels within people who attempted suicide, implying serum cholesterol levels possibly could be utilized as a biologic marker for probable risk of suicide.
Sleep problems remain one indicator for not just anxiety disorders and depression, yet additionally a suicide risk factor. Experts researched sleeping issues and suicide within 75,000 Norwegian adults for twenty years. They came to the conclusion that issues with sleeping, maybe in combination with or as a result of depression and anxiety, ought to be considered a suicide risk marker.
Even though more research is required, one study by one specialist implied that reduced serum DHA (docosahexaenoic acid) levels might be a suicide risk factor. The specialists researched active-duty United States military personnel then discovered that the suicidal death risk was fourteen percent higher/standard deviation of reduced docosahexaenoic acid percentage. Amongst males, the risk of suicidal death was sixty-two percent higher with reduced serum docasahexaenoic acid status.
National Institute of Mental Health. Suicide in the U.S.: Statistics and Prevention. Available at http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention.shtml
National Center for Health Statistics (NCHS). FastStats: Suicide and Self-Inflicted Injury. Available at http://www.cdc.gov/nchs/fastats/suicide.htm
Comer RJ. Suicide. In: Abnormal Psychology. 6th ed. New York, NY: Worth Publishers; 2007:278-307.
Schneeweiss S, Patrick AR, Solomon DH, et al. Variation in the risk of suicide attempts and completed suicides by antidepressant agent in adults: a propensity score-adjusted analysis of 9 years’ data. Arch Gen Psychiatry. May 2010;67(5):497-506.