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Suicide and Suicidal Behavior

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Suicide and Suicidal Behavior Matthew K. Nock, Guilherme Borges, Evelyn J. Bromet, Christine B. Cha, Ronald C. Kessler, and Sing Lee Epidemiol Rev. 2008 ; 30(1): 133 ... – PowerPoint PPT presentation

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Title: Suicide and Suicidal Behavior


1
Suicide and Suicidal Behavior
  • Matthew K. Nock, Guilherme Borges, Evelyn J.
    Bromet, Christine B. Cha, Ronald C. Kessler, and
    Sing Lee
  • Epidemiol Rev. 2008 30(1) 133154.
    doi10.1093/epirev/mxn002.

2
Introduction
  • An updated review of the epidemiology of suicide
    and suicidal behavior.
  • Extend earlier reviews in this area in two
    important ways
  • Provide an update on the prevalence of suicidal
    behavior over the past decade.
  • Review data from multiple countries, on all age
    groups, and on different forms of suicidal
    behavior, providing a comprehensive picture of
    the epidemiology of suicidal behavior.

3
Outline of the article
  • In this review, the authors
  • First, review data on the current rates of and
    recent trends in suicide and suicidal behavior in
    the United States and cross-nationally.
  • Next, review data on the onset, course, and risk
    and protective factors for suicide and suicidal
    behavior.
  • Finally, summarize data from recent suicide
    prevention efforts and conclude with suggestions
    for future research.

4
Terminology and definitions in suicide research
  • Suicide the act of intentionally ending one's
    own life.
  • Nonfatal suicidal thoughts and behaviors
  • suicide ideation thoughts of engaging in
    behavior intended to end one's life
  • suicide plan the formulation of a specific
    method through which one intends to die
  • suicide attempt engagement in potentially
    self-injurious behavior in which there is at
    least some intent to die.
  • Nonsuicidal self-injury self-injury in which a
    person has no intent to die (not the focus of
    this review)

5
Materials and Methods
  • Main data sources
  • Suicide
  • The National Vital Statistics System of the
    Centers for Disease Control and Prevention (CDC)
  • WHO
  • Suicidal behavior
  • CDC (the National Electronic Injury Surveillance
    System)
  • US National Library of Medicine's PubMed
    electronic database

6
Results
  • Suicide in the United States
  • Current rates Recent trends
  • Cross-national suicide rates
  • Current rates Recent trends
  • Suicidal behavior in the United States
  • Current rates Recent trends Onset and course
  • Suicidal behavior cross-nationally
  • Current rates Recent trends Onset and course
  • Risk factors
  • Protective factors
  • Prevention/intervention programs

7
1. Suicide in the United States Current rates
  • In the United States, suicide occurs among
  • 10.8 per 100,000 persons, is the 11th-leading
    cause of death, and accounts for 1.4 percent of
    all US deaths.
  • A more detailed examination of the data by sex,
    age, and race reveals significant
    sociodemographic variation in the suicide rate.

8
Numbers of suicide deaths in the United Statesby
race, sex, and age group, 2005.
9
1. Suicide in the United States-Recent trends
Numbers of suicide deaths in the United States by
sex, age group, and year, 19902005.
10
2. Cross-national suicide rates Current
rates
  • International data from the WHO indicate that
    suicide occurs in approximately 16.7 per 100,000
    persons per year
  • The 14th-leading cause of death worldwide
  • Accounts for 1.5 percent of all deaths.

11
Numbers of suicide deaths in numerous nations for
the most recent year available
Eastern Europe
United States, Western Europe, Asia
Central and South America
1.31
0.91
3.1-7.51
2.01
12
2. Cross-national suicide rates Recent
trends
  • Definitive data do not exist on worldwide trends
    in suicide mortality because of cross-national
    differences in reporting procedures and data
    availability.
  • Nevertheless, the data maintained by the WHO
    suggest that
  • the global rate of suicide increased between 1950
    and 2004, especially for men.
  • the number of self-inflicted deaths will increase
    by as much as 50 percent from 2002 to 2030.

13
3. Suicidal behavior in the US -Current rates
Rates of nonfatal self-injury in the US by sex
and age group, 2006 (CDC)
14
3. Suicidal behavior in the US -Current rates
(paper)
Adults (ages 18 years) Adolescents (ages 1217 years)
Suicide Ideation Lifetime prevalence 5.614.3 19.824.0
Suicide Ideation Twelve-month prevalence 2.110.0 15.029.0
Suicide Plans Lifetime prevalence 3.9
Suicide Plans Twelve-month prevalence 0.77.0 12.619.0
Suicide Attempts Lifetime prevalence 1.98.7 3.18.8
Suicide Attempts Twelve-month prevalence 0.22.0 7.310.6
  • Adults have a lower lifetime prevalence than
    adolescents?
  • One possible explanation is the rates of
    suicidal behavior in the US are increasing
    dramatically among adolescents, but this is
    inconsistent with data on trends in adolescent
    suicide and suicidal behaviors.
  • A more likely explanation is that adults
    underreport lifetime suicidal behaviors.

15
3. Suicidal behavior in the US Recent trends
Rates of nonfatal self-injury in the United
States by age group, and year, 20012006(CDC)
16
3. Suicidal behavior in the US Recent trends
  • CDC data shows the rate of nonfatal self-injury
    (both suicidal and nonsuicidal in nature)
    increased during this period.
  • Data from systematic review
  • Data on the 12-month prevalence of suicidal
    behaviors among adults has remained stable in
    recent years.
  • In the decade between 19901992 and 20012003,
    the 12-month prevalence did not change
    significantly for suicide ideation (2.8?3.3),
    suicide plans (0.7?1.0), or suicide attempts
    (0.4?0.6).
  • Data on the 12-month prevalence of suicidal
    behaviors among adolescents has decreased.
  • From 1991 to 2005 there was a decrease in the
    rates of suicide ideation (29.0?16.9) and plans
    (18.6?13.0) but no such decrease for attempts
    (7.3?8.4).

17
3. Suicidal behavior in the US Onset and course
  • Onset
  • The most consistently reported pattern is that
    the risk of first onset for suicidal behavior
    increases significantly at the start of
    adolescence (12 years), peaks at age 16 years,
    and remains elevated into the early 20s.
  • This means that adolescence and early adulthood
    are the times of greatest risk for first onset of
    suicidal behavior.
  • Early stressors such as parental absence and
    family history of suicidal behavior have been
    associated with an earlier age of onset.

18
3. Suicidal behavior in the US Onset and course
  • Course (few researches)
  • 34 of lifetime suicide ideators go on to make a
    suicide plan
  • 72 of persons with a suicide plan go on to make
    a suicide attempt
  • 26 of ideators without a plan make an unplanned
    attempt
  • Majority of these transitions occur within the
    first year after onset of suicide ideation (60
    for planned first attempts and 90 for unplanned
    first attempts).

19
4. Suicidal behavior cross-nationally
Current rates
There is considerable cross-national variability
in the prevalence of suicidal behaviors.
Adults (ages 18 years) Adolescents (ages 1217 years)
Suicide Ideation Lifetime prevalence 3.156.0 21.737.9
Suicide Ideation Twelve-month prevalence 1.821.3 11.726.0
Suicide Plans Lifetime prevalence 0.919.5 3.0
Suicide Plans Twelve-month prevalence 0.512.2 5.015.0
Suicide Attempts Lifetime prevalence 0.45.1 1.512.1
Suicide Attempts Twelve-month prevalence 0.13.8 1.88.4
20
4. Suicidal behavior cross-nationally
Current rates
  • Three recent cross-national studies use
    consistent measurement strategies across
    countries
  • the WHO/EURO Multicentre Study on Parasuicide
  • the WHO Multisite Intervention Study on Suicidal
    behaviors
  • the WHO World Mental Health Survey
  • All three studies revealed wide cross-national
    variation in suicidal behaviors.

21
4. Suicidal behavior cross-nationally
Recent trends
  • Our search did not yield any cross-national
    studies of trends in suicidal behavior.
  • Suggest but by no means confirm there has been
    no major change in trends over time.

22
4. Suicidal behavior cross-nationally
Onset and course
  • The onset and course of suicidal behaviors are
    quite consistent cross-nationally.
  • Similar to data in the US.
  • Onset
  • The risk of first onset of suicide ideation
    increases sharply during adolescence and young
    adulthood and then stabilizes in early midlife.
  • Course
  • There is consistency in the timing and
    probability of transitioning from suicide
    ideation to suicide plans and attempts, with
    33.6 of ideators going on to make a suicide plan
    and 29.0 of ideators making an attempt.

23
5. Risk factors
  • Demographic factors
  • Suicide male, an adolescent or older adult,
    non-Hispanic White or Native American (in the US)
  • Suicidal behaviors female, younger, unmarried,
    having lower educational attainment, unemployed
  • Psychiatric factors
  • Mood, impulse-control, alcohol/substance use,
    psychotic, personality disorders
  • Psychological factors
  • Hopelessness , anhedonia, impulsiveness , high
    emotional reactivity
  • Biologic factors
  • disruptions in the functioning of serotonin
  • Stressful life events
  • Diathesis-stress model
  • family conflicts, legal problems, child
    maltreatment
  • Other factors access to lethal, chronic or
    terminal illness,

24
6. Protective factors
  • Protective factors are those that decrease the
    probability of an outcome in the presence of
    elevated risk.
  • Religious beliefs, religious practice, and
    spirituality
  • Moral objections to suicide
  • Social support
  • Being pregnant and having young children

25
7. Prevention/intervention programs
  • Means-restriction programs can decrease suicide
    rates by 1.523.
  • Primary-care physician education and training
    programs show reductions of 2273.
  • Although effective prevention programs exist
  • Many people engaging in suicidal behavior do not
    receive treatment of any kind.

26
Discussion
  • Summary of findings
  • First, global estimates suggest that suicide
    continues to be a leading cause of death and
    disease burden and that the number of suicide
    deaths will increase substantially over the next
    several decades.
  • Second, the significant cross-national
    variability reported in rates of suicide and
    suicidal behavior appears to reflect the true
    nature of this behavior and is not due to
    variation in research methods.

27
Discussion
  • Summary of findings
  • Third, there is cross-national consistency in the
    early age of onset of suicide ideation, the rapid
    transition from suicidal thoughts to suicidal
    behavior, and the importance of several key risk
    factors.
  • Fourth, despite significant developments in
    treatment research and increased use of
    health-care services among suicidal persons in
    the United States, there appears to have been
    little change in the rates of suicide or suicidal
    behavior over the past decade.

28
Discussion
  • Research directions
  • Testing theoretical models
  • diathesis-stress models
  • gene-environment interactions
  • which factors predict transitions from ideation
    to plans and attempts
  • Incorporating methodological advances
  • Low base-rate problem
  • telephone surveys and Web-based surveys
  • Detection of suicidal behavior
  • computer-based interviews, presenting survey
    items in written form
  • behavioral methods
  • Conducting epidemiologic experiments
  • increased use of epidemiologic experiments on
    prevention and intervention procedures
  • Natural experiments
  • Quasi-experiments
  • True experiments

29
Comment
  • Plentiful resources from government include
    suicide and suicidal behaviors
  • Urban-rural differences
  • Compare between US and cross-national and China

US Cross-national China
Suicide Suicide Suicide Suicide
Current rate 10.8/100000 16.7/100000 23/100000
Recent trends decline increase decline
Suicide Behavior Suicide Behavior Suicide Behavior Suicide Behavior
Current rate
Recent trends increase stable
30
Comment
  • Understanding of variation of suicide rate
  • Due to difference in measurement methods.
  • Cross-national studies use consistent
    measurement.
  • true variation?
  • Understanding of consistency of suicide trends
    cross-national

31
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