Suicide causes, numbers, warning signs, what to do to intervene in time, prevention and treatment
Suicide causes, numbers, warning signs, what to do to intervene in time, prevention and treatment. Suicide is intentional self-injurious behavior designed to end one’s life. Suicidal behavior includes suicide, attempted suicide (not completed) and suicidal ideation (suicide ideation and planning).
It cannot be ascribed to one specific cause; rather, it is due to the interaction of multiple factors. These include distal factors such as genetic and traumatic (especially childhood) factors, developmental factors such as personality and cognitive deficits, and proximal factors that include psychiatric, psychological, and socioeconomic disorders.
By themselves, the risk factors are not capable of causing suicidal behavior but are mutually reinforcing. WHO considers suicide a very complex public health problem and has created guidelines and provided recommendations for suicide prevention interventions that are efficient and effective.
It is a self-harming behavior carried out by a person in order to end his/her life. Suicidal behavior includes complete suicide, suicide attempt and suicidal ideation.
What is suicide and what is meant by suicidal risk or behavior
It is a term derived from the Latin “sui” (genitive of the reflexive pronoun) meaning to “self,” and the suffix “-cida” (from the verb caedere, to kill) meaning “slayer.”
It is not a disease but a behavior that may (or may not) be a consequence of psychopathology or psychological distress. Thus, suicidal behavior includes suicide, attempted suicide and suicidal ideation.
We could call this behavior species-specific, characteristic of human beings. It is, in fact, not found in other animal species although self-injurious behavior has been observed in animals kept in captivity.
Often, it represents, for the perpetrator, the best way out of a situation of physical or psychological suffering. Trivially, one might think that it is exclusively about the individual, the suicidal person.
In reality, when someone dies by suicide, their death affects not only their family and relatives but also their friends and the small community of which they were a part (religious group, sports group, peers, neighbors, classmates).
This is self-injurious behavior characterized by lethal intent. It should not be confused with self-injurious behavior whose sole purpose is to cause physical pain in the absence of suicidal intent.
Suicidal behavior includes:
Suicide. Conscious and intentional act by which one takes one’s own life.
Attempted suicide. It is incomplete suicide, a self-injurious and intentional act that was intended to lead to one’s own death but did not occur.
Suicidal ideation. It is defined as all those thoughts and planning (where, when and how) related to suicide that an individual has. Suicidal ideation can be defined as “active” when the individual imagines and plans his or her own death in detail (ways, circumstances and means), or “passive” when no specific plan is conceived but only the desire to die is present.
The transition from suicidal ideation to enactment is not always straightforward. The transition most often occurs when there is comorbidity of major depressive disorder with other psychological disorders and other risk factors are present. The transition to action also is either favored or disfavored by the presence and accessibility of means and opportunities for suicide.
This means that:
- Although an individual manifests suicidal ideation he or she may never take action (depends on various factors and circumstances).
- Despite an individual’s intent to act and having planned ahead, he or she may fail to do so because he or she cannot access the means to do so (pesticides, weapons, ropes, etc.).
This is the risk that an individual will enact suicidal behavior. Risk is influenced by multiple factors. The bio-psycho-social model proposes that genetic and biological factors, psychological and clinical factors, social and experiential factors all contribute to the modification of suicide risk.
All these factors, however, do not have the same outcome on different individuals because there are protective factors that can decrease the same risk.
- Strength of family and social network.
- Age (younger than 15 and older than 75).
Risk factors can also be distinguished into proximal, developmental or distal factors (see later).
Types of suicide
It is a self-injurious act that an individual enacts in order to end his or her own life. There are several types of suicide that differ in circumstances.
Impulse suicides. These are suicides that are enacted without reflection, planning or forethought. This does not mean that the individuals who enact it are impulsive but only that their act was committed on impulse under extraordinary and unforeseen circumstances. There are generally no warnings or warning signs that would predict it.
Non-impulsive suicides. Planned suicides are those that typically occur; they are the most common. They are generally triggered by a series of circumstances and triggering events reinforced by the presence of numerous risk factors.
Protest suicide. These are suicides in which the individual ends his or her own life as an act of sacrifice for a greater cause that he or she thinks is worthy of it. The underlying motivation generally is religious or political and is the most extreme form of protest.
Mass Suicide. Mass suicide is the simultaneous suicide of several people, who generally belong to the same social group. These can be distinguished into heteroinduced mass suicides, as in the case of mass suicides occurring in oppressed and colonized populations, and self-induced suicides. The latter are mass suicides typical of sects in which the motivation for the suicidal act is related to a distorted perception of reality (mystical delusion).
The term euthanasia is derived from the Greek word “eu-thanatos” meaning “good death.”
It represents any act performed by doctors or others to hasten the death or end the life of an individual who explicitly requests it (when capable).
Euthanasia is often confused with assisted suicide.
- -Direct Active Euthanasia. The physician or other professional acts directly by intentionally administering medication to the patient for the purpose of inducing the individual’s death. It does not require the active participation of the individual who requests it. It is the physician who administers the drug.
- -Indirect active euthanasia. Similar to direct euthanasia, the physician or another person administers medication to the patient that serves to relieve suffering but indirectly may hasten death. It does not require the active participation of the individual who requests it. It is the physician who administers the drug.
- -Passive. In this case, the individual gives up resuscitation or life support. It does not require the active participation of the individual who requests it. The physician refrains from any maneuver or intervention that might prolong the patient’s life.
- -Assisted suicide. In this case, the individual plays an active role in his or her own death. In fact, it is the individual himself who consciously determines his own death by self-administering lethal doses of famarci. In assisted suicide, the physician’s sole purpose is to prepare the drug (assist the patient) but it will be taken independently by the patient.
Suicide: some statistics
This is a phenomenon that has increased rapidly in recent years and is likely to experience further growth and surges in the future. Suicide and suicide attempts are not phenomena confined to a particular social and/or cultural class, but ubiquitous phenomena that can affect any family and in any context.
Certainly there are many risk factors such as gender, age, sociocultural and economic aspects, psychiatric and psychological aspects, substance and alcohol abuse that increase the likelihood of suicidal behavior. However, by themselves, these factors cannot be identified as the cause of suicidal behavior.
Suicides, according to WHO, the World Health Organization, are more than 800,000 worldwide each year, and according to ISTAT about 4,000 each year in Italy.
In the past, until about the 1980s, suicide rates were always higher for adult men than for other age groups. Over time, suicide has become increasingly common and frequent in very young age groups.
In fact, although the age group with the highest rate of suicide is 45-64 years old, suicide is the fourth leading cause of death in youth (15-29 years old).
Another demographic risk factor is gender. In fact, data show a higher incidence of suicide for men than women for all age groups with a ratio of about 4 to 1.
Geographical location, on the other hand, would not seem to be a relevant factor, although some research shows a higher number of suicide deaths in Italy in the North than in the South and in the South than in the center.
As for suicide attempts, the data are even more alarming. WHO estimates that about 20 suicide attempts are made for every 1 suicide that is committed (many attempts are not even recorded) especially among young people (15-24 years old).
Other studies have also shown gender differences such that men would tend to commit completed suicide more frequently than women, while the latter more suicide attempts.
Suicides rapidly increasing
Suicide is a phenomenon that has always been present in the world and in Italy, but over time, starting around the 1980s, it has been steadily and slowly declining until the historic lows of 2007.
Since 2008, there has been a gradual increase in suicide rates in Italy, initially only among the elderly and then among the young and very young. From 2020 to 2022, the effects of isolation (a preventive measure for the spread of the Covid-19 pandemic) on sociality, especially among young people, have been disastrous.
The economic crisis that has accompanied these years and is expected in the coming years is also not reassuring but worries scientists. It would represent another major risk factor for the psychological and physical well-being of the individual.
According to the researchers, the suicide rate in the world is expected to increase over the years due to numerous factors that are expected to influence its trend.
These certainly include economic crises and the climate crisis. Technological advancement also has its cons; with the Internet we are losing the ability to cultivate interpersonal relationships vis a vis. We don’t know how to relate to each other, recognize emotions and empathize with our interlocutor; we don’t know how to be present to each other.
All this increases feelings of loneliness and social isolation that can lead to psychological distress and suicide.
Suicides and climate change
In 2050, the figures for suicide rates and suicide attempts are likely to be staggering. One of the most absurd causes, but one that would seem to play a role, is climate change.
As we know, all kinds of environmental change (physical, climatic, social) directly and indirectly affect our health and our bodies by subjecting them to stress.
Stress is a psychophysiological response of the body to an environmental stimulus and can cause more or less severe physical and/or organic symptomatology.
A team from Stanford University has shown that rising temperature is correlated with an increase in suicide rates. It is presumable that with the climate crisis ahead and the increase in general temperatures, there will be an increase in the suicide rate worldwide. From a psychological perspective, climate change generates two types of consequences: cognitive and emotional.
At the cognitive level, high temperatures have negative effects on a wide range of abilities. Perception is altered (e.g., pain is perceived as more intense when it is hot) as is information processing (with high temperatures comes greater difficulty in solving simple problems) and psychomotor skills.
Emotionally, these climatic changes cause much concern about the future especially in young people.
These increasingly manifest feelings of helplessness, guilt, anger and anxiety. The ill effects of physical and psychological stress can lead to psychopathologies and in the most severe cases to suicide.
Causes of suicide and individuals at risk
No single factor alone is an absolute predictor of suicide. Risk factors result in a change in the likelihood of suicidal behavior.
Suicide cannot be ascribed to one specific cause. In most cases, it is the interaction between circumstances, experiences, and risk and protective factors that determine the likelihood of suicide risk.
In general, no single risk factor alone is likely to directly cause suicide, and the same risk factor may be more or less important for different individuals.
Mood disorders, especially depressive disorder, are the most common cause of suicide (about 60 percent). In depression, as in other psychopathologies, the serotonergic neural pathway is altered. Serotonin is a neurotransmitter known as the “mood hormone” involved in mood regulation, sexual behavior, and pain regulation.
In depression, suicide risk is very high in the early stages of psychopathology and when drug therapy is not taken properly.
In addition to depression, other psychiatric disorders with a high suicide risk are:
- Borderline and antisocial personality disorder.
- Schizophrenic disorder.
Some research has shown an increased risk of suicide as a result of taking particular antidepressant drugs. This research, however, is not unambiguous, definitive, or clear.
In fact, studying the link between antidepressant use and suicide is very difficult mainly because suicide is not as common as major depressive disorder is. In addition, not all those who manifest major depressive disorder have suicidal behaviors.
Finally, the possibility that antidepressant is not a useful tool for preventing suicide in all types of depression should be considered.
Although the link between antidepressants and suicide is not clear and direct, the implications in clinical practice are very important.
In individuals with severe depression, antidepressants have been shown to be useful and necessary associated with psychotherapy. In contrast, this has not been demonstrated in subjects with mild depression.
A second class of disorders involved in suicidal behavior is neurodegenerative or aggravating medical conditions with chronic pain. chronic pain, in fact, significantly reduces the quality of life.
Many daily actions are precluded, assistance is often needed, and the pain is continuous, incessant, and unbearable. This has significant psychological implications; it generates emotions of anger, a sense of worthlessness and burden, despair, and agitation.
Isolation is a very likely consequence and it is common to develop a depressive disorder with abuse of analgesics, opioids or drugs to lessen the pain.
Depression and suicide are also very common in those with syndromes such as multiple sclerosis, Parkinson’s disease (up to 17%), and Huntington’s chorea.
They can also occur with some frequency in other diseases such as AIDS and temporal lobe epilepsy, which affect brain functioning.
Suicide can be a consequence of substance abuse such as Cannabis (prolonged use), Ecstasy, Amphetamine, Cocaine, drugs especially analgesics. An important clarification should be made. As a result of substance intake and abuse, the onset of major depressive disorder is very common, which increases the likelihood of suicide.
However, it is also true that substance abuse can be a complication (consequence) of some psychopathologies such as schizophrenia, depression itself, and personality disorders. The link, therefore, between substance abuse, especially alcoholism, mood disorders and suicide is as close as it is complex.
Scientific evidence shows that suicide risk is about 6 times greater for those with a substance abuse disorder than for an individual who does not use. The use of cocaine, opioids, and sedatives generates a greater likelihood of suicide in those who use them than the use of other substances.
As mentioned many times, drugs, as well as analgesics, can be used as a “remedy” for social or psychopathological distress. Often to escape a reality that we do not like or satisfy, or to relieve the symptoms of a depressive disorder, alcohol seems to be a good solution.
Being a substance with disinhibitory effects, however, it can facilitate the transition from suicidal ideation, which often characterizes depression, to the actual act. In fact, alcohol is one of the determining substances in suicidal behavior.
Suicide Warning Signs
Warning signs to look out for are:
- Previous suicide attempts.
- Research on methods of suicide.
- Jokes or statements about the desire to end one’s life.
- Depression _
- Feeling trapped and with no way out.
- Inability to see and find solutions and to cope with stressful situations.
- A sense of uselessness and emptiness.
- Guilt and shame.
- Recurring thoughts of death.
- Depressed mood, mood swings, extreme sadness, often not justified by circumstances.
- Risky and erratic, aggressive and impulsive behavior.
- Sudden anger
- Sudden changes in habits, behavior and attitudes.
- Sudden changes in weight.
- Sleep changes.
- Feeling alone even in the presence of others, always feeling out of place.
- Tendency to withdraw from friends and family.
- Difficulty maintaining or adequately managing social relationships.
- Difficulty or inability to maintain a job, sudden school difficulties.
- Neglect of one’s physical appearance and hygiene compared to the previous situation.
- Alcohol or drug consumption (or increased consumption).
- Get rid of things that used to be important to you.
- Take care of unfinished business, bills and/or situations.
- History of physical, sexual, psychological and verbal abuse.
- Death by suicide of a loved one or friend.
- Collecting large quantities of drugs or narcotics.
- Requesting access to unusual tools (firearms, fireworks, chemicals, ropes).
Phrases and behaviors to watch out for
- I’d rather die.
- I want to finish
- There’s no point in living, it’s not worth it.
- Soon I won’t suffer anymore.
- I’m tired of fighting all the time, it won’t last long.
- What hopes do I have for the future?
- No one would notice if I wasn’t here.
- Everyone would be happier if I were dead.
- I can’t take it anymore, I’m tired of everything and everyone.
- I am a failure, I have failed in everything, there is no hope for me.
- I am alone, nobody loves me and nobody cares.
- Everything has lost its meaning.
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