Editor: Maurizio Pompili

Suicide: A Global Perspective

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Library License: US $196
ISBN: 978-1-60805-427-5 (Print)
ISBN: 978-1-60805-049-9 (Online)
Year of Publication: 2012
DOI: 10.2174/97816080504991120101

Introduction

In the year 2000, approximately one million people died from suicide: a "global" mortality rate of 16 per 100,000, or one death every 40 seconds.

In the last 45 years suicide rates have increased by 60% worldwide. Suicide is now among the three leading causes of death among those aged 15-44 years (both sexes); these figures do not include suicide attempts up to 20 times more frequent than completed suicide. Suicide worldwide is estimated to represent 1.8% of the total global burden of disease in1998, and 2.4% in countries with market and former socialist economies in 2020. Although traditionally suicide rates have been highest among the male elderly, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of countries, in both developed and developing countries. Mental disorders (particularly depression and substance abuse) are associated with more than 90% of all cases of suicide; however, suicide results from many complex sociocultural factors and is more likely to occur particularly during periods of socioeconomic, family and individual crisis situations (e.g., loss of a loved one, employment, honour).

The economic costs associated with completed and attempted suicide are estimated to be in the billions of dollars. One million lives lost each year are more than those lost from wars and murder annually in the world. It is three times the catastrophic loss of life in the tsunami disaster in Asia in 2005. Every day of the year, the number of suicides is equivalent to the number of lives lost in the attack on the World Trade Center Twin Towers on 9/11 in 2001.

Everyone should be aware of the warning signs for suicide: Someone threatening to hurt or kill him/herself, or taking of wanting to hurt or kill him/herself; someone looking for ways to kill him/herself by seeking access to firearms, available pills, or other means; someone talking or writing about death, dying or suicide, when these actions are out of the ordinary for the person. Also, high risk of suicide is generally associated with hopelessness; rage, uncontrolled anger, seeking revenge; acting reckless or engaging in risky activities, seemingly without thinking; feeling trapped – like there’s no way out; increased alcohol or drug use; withdrawing from friends, family and society, anxiety, agitation, unable to sleep or sleeping all the time; dramatic mood changes; no reason for living; no sense of purpose in life.

Table 1.

Understanding and helping the suicidal individual should be a task for all.

Suicide Myths How to Help the Suicidal Person Warning Sights of Suicide Myth:Suicidal people just want to die.Fact:Most of the time, suicidal people are torn between wanting to die and wanting to live. Most suicidal individuals don't want death; they just want to stoop the great psychological or emotional pain they are experiencing
  • -Listen;
  • -Accept the person's feelings as they are;
  • -Do not be afraid to talk about suicide directly
  • -Ask them if they developed a plan of suicide;
  • -Expressing suicidal feelings or bringing up the topic of suicide;
  • -Giving away prized possessions settling affairs, making out a will;
  • -Signs of depression: loss of pleasure, sad mood, alterations in sleeping/eating patterns, feelings of hopelessness;
Myth:People who commit suicide do not warn others.Fact:Eight out of every 10 people who kill themselves give definite clues to their intentions. They leave numerous clues and warnings to others, although clues may be non-verbal of difficult to detect.
  • -Remove lethal means for suicide from person's home
  • -Remind the person that depressed feelings do change with time;
  • -Point out when death is chosen, it is irreversible;
  • -Change of behavior (poor work or school performance)
  • -Risk-taking behaviors -Increased use of alcohol or drugs
  • -Social isolation -Developing a specific plan for suicide
Myth:People who talk about suicide are only trying to get attention. They won't really do it.Fact:Few commit suicide without first letting someone know how they feel. Those who are considering suicide give clues and warnings as a cry for help. Over 70% who do threaten to commit suicide either make an attempt or complete the act.
  • -Express your concern for the person;
  • -Develop a plan for help with the person;
  • -Seek outside emergency intervention at a hospital, mental health clinic or call a suicide prevention center
Myth:Don't mention suicide to someone who's showing signs of depression. It will plant the idea in their minds and they will act on it.Fact:Many depressed people have already considered suicide as an option. Discussing it openly helps the suicidal person sort through the problems and generally provides a sense of relief and understanding.

Suicide is preventable. Most suicidal individuals desperately want to live; they are just unable to see alternatives to their problems. Most suicidal individuals give definite warnings of their suicidal intentions, but others are either unaware of the significance of these warnings or do not know how to respond to them. Talking about suicide does not cause someone to be suicidal; on the contrary the individual feel relief and has the opportunity to experience an empathic contact.

Suicide profoundly affects individuals, families, workplaces, neighbourhoods and societies. The economic costs associated with suicide and self-inflicted injuries are estimated to be in the billions of dollars. Surviving family members not only suffer the trauma of losing a loved one to suicide, and may themselves be at higher risk for suicide and emotional problems.

Mental pain is the basic ingredient of suicide. Edwin Shneidman calls such pain “psychache” [1], meaning an ache in the psyche. Shneidman suggested that the key questions to ask a suicidal person are ‘Where do you hurt?’ and ‘How may I help you?’. If the function of suicide is to put a stop to an unbearable flow of painful consciousness, then it follows that the clinician’s main task is to mollify that pain. Shneidman (1) also pointed out that the main sources of psychological pain, such as shame, guilt, rage, loneliness, hopelessness and so forth, stem from frustrated or thwarted psychological needs. These psychological needs include the need for achievement, for affiliation, for autonomy, for counteraction, for exhibition, for nurturance, for order and for understanding. Shneidman [2], who is considered the father of suicidology, has proposed the following definition of suicide: ‘Currently in the Western world, suicide is a conscious act of self-induced annihilation, best understood as a multidimensional malaise in a needful individual who defines an issue for which the suicide is perceived as the best solution’. Shneidman has also suggested that ‘that suicide is best understood not so much as a movement toward death as it is a movement away from something and that something is always the same: intolerable emotion, unendurable pain, or unacceptable anguish.

Strategies involving restriction of access to common methods of suicide have proved to be effective in reducing suicide rates; however, there is a need to adopt multi-sectoral approaches involving other levels of intervention and activities, such as crisis centers. There is compelling evidence indicating that adequate prevention and treatment of depression, alcohol and substance abuse can reduce suicide rates. School-based interventions involving crisis management, self-esteem enhancement and the development of coping skills and healthy decision making have been demonstrated to reduce the risk of suicide among the youth. Worldwide, the prevention of suicide has not been adequately addressed due to basically a lack of awareness of suicide as a major problem and the taboo in many societies to discuss openly about it. In fact, only a few countries have included prevention of suicide among their priorities.

Reliability of suicide certification and reporting is an issue in great need of improvement. It is clear that suicide prevention requires intervention also from outside the health sector and calls for an innovative, comprehensive multi-sectoral approach, including both health and non-health sectors, e.g., education, labour, police, justice, religion, law, politics, the media.

REFERENCES

[1] Shneidman ES. Suicide as psychache. A clinical approach to self-destructive behavior. Nortvale, Aronson, 1993.

[2] Shneidman ES. Definition of suicide. Northvale, Aronson; 1985.

Contributors

Editor(s):
Maurizio Pompili
Department of Neurosciences
Mental Health and Sensory Functions, Sapienza University of Rome
Rome
Italy
/
McLean Hospital, Harvard Medical School
USA




Contributor(s):
Antonella Spacca
Department of Neurosciences
Mental Health and Organs Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome
Rome
Italy


Antoon A. Leenaars
1500 Ouellette Avenue, Suite 203
Windsor
ON, N8X 1K7
Canada


Bijou Yang
Drexel University
Philadelphia
PA
USA


C.K. Law
Hong Kong Institute of Asia-Pacific Studies , The Chinese University of Hong Kong
Hong Kong
China


Candi M.C. Leung
Department of Psychology
The University of Hong Kong
Hong Kong
Republic of China


Erminia Colucci
Centre for International Mental Health, School of Population Health
Level 5, 207 Bouverie St, Carlton
Melbourne
VIC, 3053
Australia


Ingo W. Nader
Department of Basic Psychological Research and Research Methods
School of Psychology, University of Vienna
Liebiggasse 5
Vienna, A-1010
Austria


Cristina Di Vittorio
Department of Neurosciences Division of Psychiatry
Rome
Italy


Luigi Janiri
Department of Neurosciences, Day-Hospital of Psychiatry
Catholic University of the Sacred Heart
Rome
Italy


Mario Amore
Department of Neurosciences
Division of Psychiatry, University of Parma
Italy, Str. Del Quartiere, 2
Parma
IT, 43100
Italy


Nestor D. Kapusta
Department of Psychoanalysis and Psychotherapy
Medical University of Vienna
Währinger Gürtel 18-20
Vienna
A, 1090
Austria


Karolina Krysinska
Faculty of Psychology and Educational Sciences, KU Leuven
University of Leuven
Belgium


Leonardo Tondo
Faculty of Psychology
University of Cagliari
Rome
Italy


Michele Raja
Private Practice
Via Prisciano 26
Rome, 00136
Italy


Roger Pycha
Psychiatric Service
Brunico
Italy


Ross J. Baldessarini
Department of Psychiatry, Harvard Medical School
Psychopharmacology Program, McLean Division of Massachusetts General Hospital
Boston
Massachusetts
USA


Thomas Stompe
Department of Psychiatry and Psychotherapy
Medical University of Vienna
Währinger Gürtel 18-20
Vienna, A-1090
Austria


Giancarlo Giupponi
Via Böhler No. 4
Bolzano, 39100
Italy


David Lester
The Richard Stockton College of New Jersey
New Jersey
USA


T. Maniam
Department of Psychiatry UKM Medical Centre
National University of Malaysia
Kuala Lumpur
Malaysia


Paul S.F. Yip
Department of Social Work and Social Administration
The University of Hong Kong and HKJC Centre for Suicide Research and Prevention, The University of Hong Kong
Hong Kong
China


Gernot Sonneck
Ludwig Boltzmann Institute for Social Psychiatry
Lazarettgasse 14A-912
Vienna, A-1090
Austria


Maurizio Pompili
McLean Hospital - Harvard Medical School
MA
USA


Karl Andriessen
Parenting and Special Education, Faculty of Psychology and Educational Sciences
University of Leuven
Belgium


Jorge Forero Vargas
Professor of Psychiatry, Latin American Psychiatry Association (Apal)
Universidad El Bosque, Coordinator Suicide Prevention Presidential´s Program
Bogota
Colombia


Jorge Tellez-Vargas
Professor of Psychiatry, Associate Secretary Treasurer World Federation of Societies of Biological Psychiatry
Bogota
Colombia


Elmar Etzersdorfer
Furtbach Hospital
Furtbachstraße 6
Stuttgart, D-70178
Germany


Christine Tartaro
The Richard Stockton College of New Jersey
Pomona
NJ
USA


Denise Erbuto
Department of Neurosciences, Mental Health and Organs Functions
Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome
Rome
Italy


Désirée Harnic
Department of Neurosciences
Day-Hospital of Psychiatry, Catholic University of the Sacred Heart
Rome
Italy


Gianluca Serafini
Department of Neurosciences, Mental Health and Organs Functions
Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome
Rome
Italy


Kristina Ritter
Department of Psychiatry and Psychotherapy
Medical University of Vienna
Währinger Gürtel 18-20
Vienna, A-1090
Austria


Marco Innamorati
Department of Neurosciences
Division of Psychiatry, University of Parma
Str. Del Quartiere, 2
Parma
IT, 43100
Italy
/
Department of Neurosciences, Mental Health and Sensory Functions
Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome
Italy


Martin Voracek
Department of Basic Psychological Research and Research Methods
School of Psychology, University of Vienna
Liebiggasse 5
Vienna, A-1010
Austria


Michele Battuello
Department of Neurosciences, Mental Health and Organs Functions
Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome
Rome
Italy


Paolo Girardi
Department of Neurosciences, Mental Health and Organs Functions
Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome
Rome
Italy


Paolo Roma
Department of Neurosciences, Mental Health and Organs Functions
Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome
Rome
Italy


Sara Martino
The Richard Stockton College of New Jersey
USA


Stefano Baratta
Department of Neurosciences, Division of Psychiatry
University of Parma
Str. Del Quartiere, 2
Parma
IT, 43100
Italy


Stefano Ferracuti
Department of Neurosciences, Mental Health and Organs Functions
Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome
Rome
Italy


Thomas Niederkrotenthaler
Department of General Practice and Family Medicine
Center for Public Health, Medical University of Vienna
Währingerstraße 13a
Vienna, A-1090
Austria
/
Department of Medical Psychology
Center for Public Health, Medical University of Vienna
Severingasse 9
Vienna, A-1090
Austria




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