Suicide: Risk Factors, Assessment, Methodological Problems: Sweta Sheth Chair: Dr. Rajesh Gopalakrishnan
Suicide: Risk Factors, Assessment, Methodological Problems: Sweta Sheth Chair: Dr. Rajesh Gopalakrishnan
Suicide: Risk Factors, Assessment, Methodological Problems: Sweta Sheth Chair: Dr. Rajesh Gopalakrishnan
METHODOLOGICAL PROBLEMS
SWETA SHETH
CHAIR: DR. RAJESH GOPALAKRISHNAN
OVERVIEW
DEFINITION AND THEORIES
EPIDEMIOLOGY
AETIOLOGY AND RISK FACTORS
ASSESSMENT OF SUICIDE
RESEARCH INTO SUICIDE
INDIAN SCENARIO- LEGAL STATUS,
METHODOLOGICAL ISSUES AND CONTROVERSIES
MEDIA PORTRAYALS
CYBER SUICIDE
PREVENTION
CONCLUSION
DEFINITIONS
Suicide: self inflicted death with evidence that the person
intended to die
Suicide attempt: self injurious behavior with a nonfatal
outcome and evidence that the person intended to die
Aborted suicide: attempt-potentially self injurious behavior
with evidence that the person intended to die but stopped
before physical damage occurred
Suicide ideation: thoughts of serving as the agent of one’s own
death
DEFINITONS (contd.)
Suicidal intent: subjective expectation and desire for self-
destructive act to end in death
Lethality objective: danger to life associated with suicide
action or method
Deliberate self harm: wilful self-infliction of painful,
destructive or injurious acts without intent to die
APA PRACTICE GUIDELINE FOR ASSESSMENT AND TREATMENT OF PATIENTS WITH SUICIDAL
BEHAVIOUR, 2006
AETIOLOGICAL THEORIES OF SUICIDE
1. PSYCHOLOGICAL
2. NEUROBIOLOGICAL FACTORS
PSYCHOLOGICAL THEORIES
Émile Durkheim divided suicide into “egoistic, anomic and
altruistic” types.
Edwin Schneidman : the victim suffers unbearable mental pain,
“psychache,” and terminally, his or her perceptions narrow
(“tunnel vision”) and he or she can see only one solution—his or
her death.
Sigmund Freud, in Mourning and Melancholia, wrote of
aggression turned inward when one internalizes a lost object and
then turns this rage on oneself.
Karl Menninger added to this when he wrote of the suicidal triad:
A wish to die, a wish to kill, and a wish to be killed—as
components of all suicides
INTERPERSONAL THEORY (Van Orden et al): People die by suicide because they can and
because they want to. The theory has 3 central constructs
Hypotheses of the Interpersonal Theory
1. Thwarted belongingness and perceived burdensomeness are proximal and
sufficient causes of passive suicidal ideation.
2. The simultaneous presence of thwarted belongingness and perceived
burdensomeness, when perceived as stable and unchanging (i.e.,
hopelessness regarding these states), is a proximal and sufficient cause of
active suicidal desire.
3. The simultaneous presence of suicidal desire and lowered fear of death
serves as the condition under which suicidal desire will transform into
suicidal intent.
4. The outcome of serious suicidal behavior (i.e., lethal or near lethal suicide
attempts) is most likely to occur in the context of thwarted belongingness,
perceived burdensomeness (and hopelessness regarding both), reduced fear
of suicide, and elevated physical pain
BIOLOGICAL THEORIES
Most biological theories are focused on depression and the
amines associated with depressive disorder
Numerous studies have found a decreased level of serotonin
(5-HT) in the brains of depressed decedents and of 5-hydroxy
indoleatic acid (5-HIAA), CSF of living depressed patients.
In addition, depressed individuals who have made suicide
attempts or completed suicide have lower levels of 5-HT
than depressed patients who are not suicidal.
Furthermore, those who have made more violent suicide
attempts or completions have lower levels than those
employing less violent means
The relation between risk factors can be described in
explanatory models of suicide, such as the stress– diathesis
model