Risk Factors of Suicidal Phenomenon: Prevention and Intervention

Around the world suicide has caused more deaths per year than homicide or war (World Health Organization, 2002). Suicidal attempts (the person survives) and suicidal ideation (thinking seriously about suicide) are others dimensions of the suicide phenomenon. A number of risk factors have been considered as factors contributing to the increased likelihood of suicidal ideation, attempts, and completions. Sociological (external) factors and psychological (internal) factors have been considered in increasing suicidal risk. Beyond the individual factors research has also explained the family, social, and community aspects of the suicidal phenomenon. Helping professionals planning suicide intervention and prevention strategies need to be aware of both the myths and misperceptions of the suicide phenomenon, as well as research based risk factors. 1 Meyer: Risk Factors of Suicidal Phenomenon: Prevention and Intervention Published by Cornerstone: A Collection of Scholarly and Creative Works for Minnesota State University, Mankato, 2005 Suicide is the “conscious, deliberate attempt to take one’s life quickly. ” Suicidal attempts (the person survives) and suicidal ideation (thinking seriously about suicide) are others dimensions of the suicide phenomenon. Suicide represents a major national public health problem with about 30,000 deaths in the United States each and every year. The estimated cost to the nation in lost income alone is 11.8 billion dollars per year. Suicide is the eleventh leading cause of death for all ages in the United States, and the third leading cause of death among adolescents. During the period of the Vietnam War, four times the number of Americans died by suicide than died in combat. Two hundred thousand more people died of suicide than died of AIDS in the past 20 years (Institute of Medicine,2001). Because suicide has been considered such a “taboo” subject to think or to talk about, there are a lot of misconceptions about which individuals may be at risk, about when, how and why people might consider killing themselves, and about how best to help yourself or someone else who is contemplating suicide. Four common myths are: Myth: "People who die from suicide don't warn others. " Fact: Out of 10 people who kill themselves, eight have given definite clues to their intentions. They leave numerous clues and warnings to others, although some of their clues may be nonverbal or difficult to detect. Myth: "People who talk about suicide are only trying to get attention. They won't really do it. " Fact: WRONG! Few people commit suicide without first letting someone else know how they feel. Those who are considering suicide give clues and warnings as a cry for help. In fact, most seek out someone to rescue them. Over 70% who do threaten to carry out a suicide either make an attempt or complete the act. Myth: "Discussing suicide may cause someone to consider it or make things worse. Fact: Asking someone if they’re suicidal will never give them an idea that they haven’t thought about already. Most suicidal people are truthful and relieved when questioned about their feelings and intentions. Doing so can be the first step in helping them to choose to live. Myth: “It’s best to keep someone’s suicidal feelings a secret. ” Fact: Never, ever keep your or someone else’s suicidal thoughts and feelings a secret – even if you’re asked to do so. Friends never keep deadly secrets! Psychological Factors that should be considered are: 1. Cognitive Distortions; 2. Hopelessness; 3. Self-Efficacy; and 4. Coping Style and Affect Regulation. Individuals with mental disorders, especially those with depression, often display cognitive distortions such as rigid or dichotomous thinking, overgeneralization, exaggeration or minimization of events, drawing conclusions based on insufficient/contradictory evidence or selectively attending to relevant information, and falsely attributing causality to themselves. Studies have found greater cognitive distortions, in particular, cognitive rigidity (dichotomous thinking), among suicidal youths and adults than among non-suicidal mentally ill or healthy controls (Weishaar and 2 Journal of Undergraduate Research at Minnesota State University, Mankato, Vol. 5 [2005], Art. 16 https://cornerstone.lib.mnsu.edu/jur/vol5/iss1/16 Beck, 1990). Such rigid thinking appears related to the interpersonal and general problem-solving deficits commonly seen in suicidal individuals. Cognitive behavioral and problem solving therapy specifically target such variables and appear effective in reducing suicidality. The relationship between hopelessness and suicidality has been the subject of studies for over 25 years. Hopelessness appears to arise from multiple sources, including low self-esteem combined with interpersonal losses and lack of confidence in one’s ability to regulate mood or solve personal problems (Catanzaro, 2000). Cognitive behavioral therapy is designed to reduce clinical symptoms by changing thoughts and behaviors. Numerous studies show cognitive behavioral therapy is effective in reducing depression and hopelessness in various populations including adolescents (Brent et al., 1999). Self-efficacy beliefs, the assessment of one’s ability to manage or control external and internal threats, exert a primary influence on human emotion, cognition and behavior. Positive self-efficacy beliefs represent the opposite of hopelessness and appear to protect individuals from suicidality. Coping self-efficacy beliefs affect physiological stress responses involving the catecholamines, opiods, and the hypothalamic-pituitary adrenal axis, and directly contribute to emotional arousal, psychological distress and well-being, and anxiety (Cantanzaro and Mearns, 1999). Emerging research on school-based suicide prevention programs for at-risk youth demonstrates increased self-efficacy and decreased suicidality in program participants. Coping and emotion regulation styles refer to how individuals manage stressful conditions or events (actively or passively) and how they regulate their own emotional, physiological, behavioral, and cognitive reactions to stress. Coping styles contribute to physical and mental health following stressors or trauma. Active coping styles such as planning, engaging problems, and seeking social support, and cognitive reinterpretation coping (finding meaning and benefit from adverse events) appear to decrease symptoms of psychological disorder. Maladaptive coping styles generally correlate with negative outcomes. Suicidologists consistently find ineffective coping styles for mood and impulse regulation and interpersonal problem-solving among suicidal individuals. Suicidal individuals use fewer active coping strategies and more avoidant (passive) coping styles such as suppression and blame. Impulsive problem-solving style and difficulty regulating mood are related to increased rates of suicide attempts (Catanzaro, 2000). Sociological Factors that should be considered are: 1. Marital Status and Parenthood; 2. Social Support; 3. Religion/Spirituality; and 4. Economic/Socioeconomic Status. The social and cultural factors correlated with suicide have been considered at different levels. The level I write about is the individual focus on the influence of specific events in someone’s life and their affiliation with and participation in social groups. An approach at this level assumes that critical life events or circumstances are responsible for suicides. Across societies, family attachments influence suicide probability. In general, across many cultures, being in a marriage is associated with lower overall suicide rates, 3 Meyer: Risk Factors of Suicidal Phenomenon: Prevention and Intervention Published by Cornerstone: A Collection of Scholarly and Creative Works for Minnesota State University, Mankato, 2005 while divorce and marital separation are associated with increased suicide risk. Widowed persons are also more likely to complete suicide. Being single also influences the likelihood of committing suicide. Being a parent, particularly for mothers, appears to decrease the risk of suicide. Pregnant women have a lower risk of suicide than women of childbearing age who are not pregnant. Having a young child appears to be a significant protective factor for women (Qin et al., 2000). Those who enjoy close relationships with others cope better with various stresses, including bereavement, rape, job loss, and physical illness and enjoy better psychological and physical health (Institute of Medicine, 2001). Research has demonstrated that social support moderates suicidal ideation and risk of suicide attempts among various racial/ethnic groups, abused youths and adults, those with psychiatric diagnoses, and those facing acculturation stresses. Men and women may differ in use of types of social support (Mazza and Reynolds, 1998). In general, participation in religious activities is a protective factor for suicide. In the United States, areas with higher percentages of individuals without religious affiliation report correspondingly higher suicide rates. The protection afforded by religion may have several components. Involvement with religion may provide a social support system through active social networks. Suicide may be reduced with religious affiliation because of the proscription against the act. Belief structures and spirituality may also be protective at an individual level as a coping resource and via creating a sense of purpose and hope (Werner, 1996). Epidemiological analyses reveal that occupation, employment status, and socioeconomic status affect the risk of suicide (Institute of Medicine, 2001). Police officers, manual laborers, physicians and dentists have elevated suicide rates. While some find that blue-collar workers are more likely to complete suicide, others find high suicide among professional classes, confirming earlier theories suggesting that the risk of suicide is elevated at both ends o