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Suicide - Current Maze

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Suicide - Current Maze & Future Movement by Dr. Lakshmi Vijayakumar M.B.B.S., D.P.M., Ph.D., FRCPsych. (Hon.) Founder, SNEHA Member, W.H.O. International Network for ... – PowerPoint PPT presentation

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Title: Suicide - Current Maze


1
Suicide - Current Maze Future Movementby
Dr. Lakshmi Vijayakumar
M.B.B.S., D.P.M., Ph.D., FRCPsych.
(Hon.) Founder, SNEHA Member, W.H.O.
International Network for Suicide Research Hon .
Associate Professor, University of
Melbourne Member, International Academy of
suicide research
2
Global Suicide rates, 2008
3
Distribution of WHO regions by change in total
suicide rate since 2000 (Mishara, 2010, based
upon WHO 2009 latest year available)
4
Magnitude
  • Suicide 1 million
  • Suicidal Attempts 10 20 million
  • Affected by Suicide 50 120 million
  • 1998 1.8 Global burden
  • 2010 2.4

5
500,000 suicides a year
61 of world suicides
6
A global perspective on the magnitude of suicide
mortality
  • 5 14 15 24 25 34 35 44 45 54 55
    64 65 74 75
  • Male 1.4 21.1 29.3 37.0 42.5 40.9 40.7 52.1
  • Female 0.4 4.8 6.2 7.8 9.7 10.6 12.3 15.9

7
Gender Specific Rates
Suicide rate
Gender
HDILevel
Asia Transition Economics Europe South Total
North Central Central
Asia Europe America Americas Aus.
NZ the caribbean
Medium 12.5 17.5 61.2 NA 5.9 15.4 HDI High 20.
4 NA 36.1 19.5 8.6 19.3 HDI
  • Male

Medium 13.0 3.8 11.7 NA 1.8 11.7 HDI High 9.8
NA 8.7 5.8 2.5 5.9 HDI
Female
8
CDC Uniform Definitions for Self-Injurious
Behavior
Self-injurious behavior
Suicidal self-injurious behavior
Non-suicidal self-injurious behavior
Undetermined self-injurious behavior
Suicide attempt
Other suicidal behaviors
Suicide (death)
Other behaviors with some intent to die that
are not suicide or suicide attempt such as
interrupted attempts or aborted attempts
A. Crosby (2009)
9
Ecological Model
Community
Individual
Society
Peer/Family
10
Suicide and Mental Disorders general population
studies (N15,629)
11
Life time risk of suicide
  • Life time risk of suicide following onset of
    mental disorders have been estimated to be high.
  • In an often cited review Miles (1977) estimated
    that 15 percent of persons affected with
    depression would die from suicide, 15 per cent
    with alcoholism and 10 per cent with
    schizophrenia.


12
  • A complete national sample of all persons born in
    Denmark between 1 January 1955 and 31 December
    2006 (3.51 million people)
  • Danish Psychiatric Case register (since 1969)
  • Danish National Patient Register (since 1979)
  • Danish Cause of Death Register (1970-2006)
  • M Nordentoft in press

13
Cumulative absolute risk of suicide
Men Men Women Women
Disorder Cumulative incidence (95 confidence interval) Cumulative incidence (95 confidence interval) Cumulative incidence (95 confidence interval) Cumulative incidence (95 confidence interval)
Schizophrenia 6.47 (5.78-7.25) 4.87 (4.00-5.93)
Schizophrenia like disorders 5.72 (5.06-6.46) 3.97 (3.23-4.88)
Bipolar affective disorder 7.63 (5.91-9.85) 4.74 (3.46-6.50)
Other affective disorders 6.54 (5.61-7.63) 3.70 (3.00-4.56)
Substance abuse, psychiatric 4.68 (4.22-5.19) 3.42 (2.86-4.09)
Substance abuse , somatic 2.44 (2.13-2.81) 1.63 (1.33-2.00)
Anorectic disorder 6.42 (2.62-15.73) 1.97 (0.87-4.44)
Any mental illness 3.63 (3.36-3.91) 1.89 (1.68-2.12)
No mental illness 0.68 (0.60-0.78) 0.20 (0.14-0.28)
14
Co-morbid substance abuse Cumulative absolute
risk of suicide
Men Men Women Women
Disorder Cumulative incidence (95 confidence interval) Cumulative incidence (95 confidence interval) Cumulative incidence (95 confidence interval) Cumulative incidence (95 confidence interval)
Schizophrenia 5.82 (4.86-6.97) 6.78 (4.78-9.61)
Schizophrenia like disorders 6.17 (5.15-7.40) 5.68 (4.36-7.40)
Bipolar affective disorder 9.89 (6.33-15.48) 5.09 (2.76-9.38)
Other affective disorders 6.71 (5.22-8.62) 6.95 (4.65-10.37)
Anorectic disorder 6.59 (1.74-24.96) 4.40 (2.28-8.46)
15
Mental disorders suicide
  • India China Taiwan
  • Depression 35 40 89
  • Schizophrenia 8 7 7.9
  • Comorbidity 30 6 55
  • Prior psychiatric treatment 10 7 25
  • Alcoholism
    34 7
    44

16
  • Previous Suicide Attempt (26 42)
  • Family history of Suicide and Mental
    Disorders (12 18)

17
Personality Characteristics
  • 1. Impulsivity / Aggressive
  • 2. External Locus of Control
  • 3. Hopelessness
  • 4. Reduced Specific Memory

18
Genes and Suicidality
  • Genes 43 Environment 57
  • TPH2, 5HT2A Receptor gene
  • 5HTTLPR Polymorphism SS, SL LL
  • SS SL Left frontal, prefrontal middle
    temporal gyri

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Source Morrell S et al, Soc. Sci. Med. 1993 Vol
36, 6, 749-756
21
Results trends in suicide rates in East Asia
Chang et al Soc Sci Med 2009
22
Association between unemployment and suicide
rates (non poisons and gases) in 25-34 year old
males (1921-1995)
Gunnell et al BJPsych 1999
23
SEV Suicide Rate
  • Socio-economic Annual
    suicide ratevariables
    Total
    Male
    Female
  • Human Development 0.21 (n 26) 0.27 (n
    24) - 0.12 (n 24) index, 1995
  • Human Development 0.19 (n 33) 0.24 (n
    31) - 0.01 (n 31) Index, 2001
  • Education Index 0.26 (n 33) 0.31 (n
    31) - 0.06 2001
  • Urban population 0.03 (n 33) 0.18 (n
    31) - 0.04 (n 31) as a percent of total
    population 2001
  • Telephone density 0.36 (n 33) 0.44 (n
    31) 0.32 (n 31) 2001
  • Gender development 0.26 (n 27) 0.26 (n
    25) 0.004 (n 25) index 2001

24
SEV Suicide Rate (Contd...)
  • Socio-economic Annual
    suicide ratevariables
    Total
    Male
    Female
  • Gini Ratio - 0.33 (n 29) - 0.31 (n 27)
    - 0.23 (n 27) (inequality)
  • Cigarette consumption 0.41 (n 27)
    0.46 (n 25) 0.40 (n 25) per head
  • Alcohol (total) 0. 13 (n 30) 0.20 (n
    29) - 0.02 (n 29) consumption per head
  • Alcohol consumption 0.19 (n 30) 0.23 (n
    29) 0.24 (n 29) (spirits) per head
  • Unemployment rate 0.08 (n 19) 0.14 (n
    17) - 0.15 (n 17) 2001
  • Crime rate - 0.03 (n 15) - 0.007 (n 15) -
    0.14 (n 15) (in major cities)
  • Pesticide consumption - 0.06 (n 24) - 0.10
    (n 22) - 0.25 (n 22) (per hectare of
    land)

25
Domestic violence suicidal ideation
Brazil 48 Egypt 61 Phillippines 28
India 64 Indonesia 11
26
Proportion of suicides () in Hong Kong
27
Religion Countries
Suicide rates according to religion (per 100,000)
45
40
35
30
25
20
15
10
5
0
Muslim 1985,87
Hindu 1995
Buddhist 1986
Atheist 1995,96
Christian 1994
total
male
female
28
TBI and Suicide 1979 1993
  • No Suicide SMR
  • Concussion 126114 750 3.0
  • Cranial fracture 7560 46 2.7
  • Cerebral contusion and ICM 11766 99 4.1

? Females Age 21 59 years (Teasdale
Engberg JNN S Psy, 2001)
29
  • Refugees 15.2 million
  • Asylum seekers 827,000 (0.83 m)
  • IDP 26 million
  • Repatriated 604,000

30
Location
  • 80 in developing countries
  • 50 in urban areas
  • 33 in refugee camps

31
Socio demographic factors
  • Age 25 40
  • Gender Females
  • Marital status Single
  • SES Higher, Educated
  • Countries Far and S.E. Asia Eastern Europe
    Latin America

32
Method
  • Blunt force Jumping
  • Water torture Drowning
  • Sharp force Stabbing / cutting

One million refugees and A.S. at risk of suicide
33
Cyber suicides Japan
  • First in October 2000
  • Published 2003

34
Cyber bullying
  • Online bullying - 1/3 of children
  • Every 30 mts a child attempts suicide due to
    bullying

35
Suicide Prevention Strategies
  • Psychopharmacology
  • Lithium
  • Clozapin
  • Psychotherapy
  • D.B.T.
  • Environmental
  • Reduced access to Methods
  • Enlightened Media Reporting
  • Cluster Prevention
  • Individuals at Risk
  • Identifying and Easy access
  • Education of GPs
  • Crisis Line

36
  • Biopsychosocial Environmental Sociocultural
  • Universal Screening for ? access to Positive
    portrayal alcoholism Pesticide of women in
    media ? alcohol
  • Selective Improve recognition Prevent Pre / Post
    exam referral of M.D. Domestic counseling by
    crisis workers Violence Assertiveness Intergene
    rational Conflict resolution
  • Indicated A.D. in P.H.C. Safe haven Community
    support Management for suicidal of poisoning

37
Alcohol consumption
  • ? 1 litre of alcohol consumption ? in suicide
    rate
  • Sweden 13
  • Hungary 5
  • USA Canada 4
  • France Protugal 3
  • Switzerland 0

Perestroika 1984 84 Men ? 32 Women ? 19
38
Edge study
  • Post Cards W 1, 2, 3, 4, 6, 8, 10, 12

TAU INT 394 378 Repetition 21.2 22.8
39
Cumulative readmissions to hospital for treatment
of self-poisoning (24 months unadjusted for
multiple admissions).
Carter, G. L. et al. Br J Psychiatry
2007191548-553
40
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42
Pesticides
  • 300,000 deaths in South Asia Asia Pacific

? toxicity ? medical management ? access ? bio
pesticides
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44
Suicide Attempted suicide Study villages A B
in North Western Province
Year Study Village A Study Village A Study Village B Study Village B
Total attempts Deaths Total attempts Deaths
2000 2 0 1 0
2001 1 0 3 0
2002 3 0 1 0
2003 6 0 2 1
2004 3 1 1 0
2005 0 0 0 0
45
Suicide Attempted suicide Control villages A1
B1 in North Western Province
Year Control Village A1 Control Village A1 Control Village B1 Control Village B1
Total attempts Deaths Total attempts Deaths
2000 0 0 1 1
2001 1 1 2 2
2002 1 0 0 0
2003 2 0 4 1
2004 4 2 1 0
2005 4 0 2 1
46
  • Suicide in NPM Villages
  • Village Year Before NPM After NPM
  • Punnukula 2001 3 -
  • Pullaigudem 2003 3 1
  • Kodipunjalavagu 2002 4 1
  • Devijathanda 2003 4 1

Suicides in CP Villages 1998 - 2003
2003 - 2006 Keshavapuram 4 2 Pandurangapuram 5 3
Rangapuram 3 2 Bikkuthanda 3 1
47
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48
Lives saved
  • 15 ? in pesticide suicide 45,000
  • 1 litre ? in alcohol 30,000

75,000 lives can be saved every year
49
Thank You
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