SUICIDE

SKP 2501: INTRODUCTION TO PSYCHOLOGY 1

Table of Contents

INTRODUCTION ....................................................................................................................................... 2
HISTORY OF SUICIDE ........................................................................................................................... 2
SUICIDE DEATHS .................................................................................................................................. 3
What? : Definition Of Suicide .................................................................................................................. 5
Who? : Susceptible Person ..................................................................................................................... 6
Where? : Statistical Data of Suicide in Various Places ............................................................................ 7
International ....................................................................................................................................... 7
In Malaysia .......................................................................................................................................... 8
Specific place of suicide act ................................................................................................................ 9
How? : Suicide Methods ....................................................................................................................... 10
Why? : Factors of Suicide ...................................................................................................................... 12
PREVENTION ......................................................................................................................................... 17
TREATMENT .......................................................................................................................................... 19
CONCLUSION ......................................................................................................................................... 22
REFERENCES .......................................................................................................................................... 22

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INTRODUCTION
HISTORY OF SUICIDE
In Ancient Greece, suicide was generally regarded as not wrong in itself, but there
had to be a justification for it. Plato had defined that there were three important exceptions
which was regarded that suicide is not wrong which are for painful and incurable illness,
legally ordered by State, and when one is compelled to it by the occurrence of some
intolerable misfortune.

Two other Greek philosophers, Democritus and Speusippus, both
committed suicide because of health problems when they were very elderly (the former
died at the age of 90). Then, the Epicureans generally felt that when life became
unbearable, suicide was justified. And, the Stoics also believed that suicide was permissible,
especially if one had an incurable illness.

In Ancient Rome, there was usually no prohibition of suicide for citizens. However,
suicide was forbidden for slaves and soldiers. Because life was not considered as a gift of the
gods, most leading Romans supported the idea of suicide for specific situations, such as
individuals preferring death to dishonour, or those who wished to avoid the decrepitude of
old age.
In the Middle Ages, suicide was often regarded as the result of diabolical temptation,
induced by despair or madness. Savage penalties were charged on the dead body such as
dragging it through the streets where the deceased had lived, and hanging it. The estates of
these persons were confiscated, and Christian burial was forbidden. Sometimes, the corpse
of a suicide was buried at a busy crossroads, pinned down by a wooden stake through the
chest thus preventing, it was hoped, the spirit emerging to bother the living.
Across Europe, suicide was slowly decriminalized, although it was not until 1961 that
the Suicide Act was finally adopted in England and Wales which removed the penalties
which had been in place for this deed (this Act was not applicable to Scotland, where suicide
had never officially been considered as a crime). However, assisting someone to commit
suicide, in the United Kingdom, remains a crime to this day - it is strange to think that
helping someone now in a non-crime is still a crime.
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SUICIDE DEATHS

The Centers for Disease Control and Prevention (CDC) collects data about mortality
in the U.S., including deaths by suicide. In 2010 (the most recent year for which data are
available), 38,364 suicides were reported, making suicide the 10th leading cause of death
for Americans (Figure 1). In that year, someone in the country died by suicide every 13.7
minutes.


To measure changes in the prevalence of suicide over time, the CDC calculates the
countrys suicide rate each year. The suicide rate expresses the number of suicide deaths
that occur for every 100,000 people in the population for which the rate is reported.
Over the 20-year period from 1990 to 2010, suicide rates in the U.S. dropped, and
then rose again (Figure 2). Between 1990 and 2000, the suicide rate decreased from 12.5
suicide deaths to 10.4 per 100,000 people in the population. Over the next 10 years,
however, the rate generally increased and by 2010 stood at 12.1 deaths per 100,000.

Figure 1
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Figure 2
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What? : Definition Of Suicide
Definition from World Health Organization (WHO):
Suicide is the act of deliberately killing oneself. Risk factors for suicide include mental disorder
(such as depression, personality disorder, alcohol dependence, or schizophrenia), and some
physical illnesses, such as neurological disorders, cancer, and HIV infection. There are effective
strategies and interventions for the prevention of suicide.
http://www.who.int/topics/suicide/en/

Definition from Centers for Disease Control and Prevention:

Death caused by self-directed injurious behavior with any intent to die as a result of the
behavior.
http://www.cdc.gov/violenceprevention/suicide/definitions.html

Definition from World Psychiatric Association:
Suicide or suicidal tendencies involve thinking about taking ones own life, making an attempt
to take ones own life, or completing suicide. In many countries around the world there has
been a substantial increase in suicide rates over the last several decades. In a number of
countries, suicide is one of the top causes of death in nearly every age category. People commit
suicide using a variety of methods, but the most common ones are use of a gun, suffocation, or
taking an excessive amount of a medication or use of a poison.
http://www.wpanet.org/detail.php?section_id=12&content_id=1099

Definition from National Suicide Registry Malaysia:
Suicide is a rare phenomenon with a high impact: Apart from the mental anguish and suffering
experienced by families due to the sudden death to their loved ones, the healthcare costs
needed to handle these cases may be tremendous and the public interest can be very acute.
Thus, it is a worthwhile focus of investigations for health professionals in Malaysia.
NATIONAL SUICIDE REISTRY MALAYSIA, ANNUAL REPORT 2009

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Who? : Susceptible Person
According to the National Suicide Registry Ministry, there were 328 cases of suicide
deaths reported in 2009; which was a suicide rate of 1.18/ 100,000 population. The age
range of the victims was 14 to 94 years, with a mean of 39.8 years. There were more men
than women; the gender ratio was 3:1 (males: females). 89% of suicide victims were
Malaysian citizens. Among the foreigners, the Indonesians and Nepalese contributed the
highest numbers with 4.3% or 14 deaths and 3% or 10 deaths respectively.
In terms of ethnicity, the Indians had the highest suicide rate at 3.67/100,000 Indian
population (70 deaths); followed by the Chinese at 2.44/100,000 Chinese population (156
deaths). The Malays and the Bumiputera of Sabah and Sarawak had lower rates of
0.32/100,000 Malay population (44 deaths) and 0.37/100,000 Bumiputera Sabah and
Sarawak population (11 deaths) respectively.
Estimated calculations for the different categories of marital status showed that the
divorced or separated group contributed the highest rate at 18.33/100,000 population or 23
deaths. Suicide rates among the widowed were 1.92/100,000 population or 13 deaths; for
married group it was 1.64 or 151 deaths and for the single it was 1.01 per 100,000
population or 134 deaths.
68 % of the suicide victims (1.99/100,000 population or 168 deaths) had received
secondary education. This was followed by those who did not have any formal education at
1.09/ 100,000 population or 23 deaths. By employment status, 52.8% or 69 cases were
employed at the time of their suicide.
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Where? : Statistical Data of Suicide in Various Places
International

Figure 1: Suicide Rate per 100 000 people

Figure 2: Top 10 countries according to the map
Source: www.suicide.org from World Health Organization.

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Based on the map shown, the dark maroon color represents the highest rate of
suicide which is Greenland and Lithuania with an average of 83 cases in 2011 and 31 cases in
2012 respectively. Based on the World Health Organization (WHO), statistic shows there is
one death every 40 seconds because of suicide. In Europe, particularly Eastern Europe, the
highest suicide rates are reported for both men and women. Contrary, the Eastern
Mediterranean Region and Central Asia republics have the lowest suicide rates.
Unfortunately, nearly 30% of all suicides worldwide occur in India and China because as we
all know, these countries have the highest population in the world.

In Malaysia


Figure 3: Number of Suicide Case in 2009
This study was conducted by the Ministry of Health Malaysia and named as National
Suicide Registry Malaysia (NSRM). From the data above, the distribution of cases according
to states showed that Johor had registered the biggest number of suicide deaths at the rate
of 2.69/ 100,000 population or 88 deaths. This is followed by Penang at 2.41/ 100,000 or 38
deaths. Kelantan had the lowest rate with 0.18/100,000 population.
Health Minister Datuk Seri Liow Tiong Lai said the ratio of suicides from 2007 to 2010
was 1.3 for every 100,000 people, but added that it could be higher. However, he said the
country's suicide rate was far lower than the global average of 16 for every 100,000 people.
Source: The Star, Tuesday June 5 2012.
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Specific place of suicide act


Figure 4: Specific Place based on NSRM 2009
The data obtained showed that, majority of suicides took place at the home of the
deceased (67.4%), followed by residential institution (9.8%) and farm/plantation (4.9%) and
trade service area (5.2%). There is correlation between place and method of suicide to
further studied. For example, those who committed suicide in home usually hanged
themselves.

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How? : Suicide Methods
Based on National Suicide Registry Malaysia 2009

Figure 1: Methods Of Suicide
This study shows that the most favored suicide method among Malaysian is hanging,
strangulation and suffocation (X70). By referring to the table above, it shows that 53.6% out
of 328 cases were within the X70 classification. Similarly, according to the National Suicide
Statistic at a Glance, Percentage of Self-harm Injuries 2002-2006, suffocation was the
second highest method of suicide in the United States. A study of suicide in the northern
part of Thailand showed similar results to ours; whereby the most common method of
suicide was hanging, followed by pesticide ingestion. (Source: Lotrakul 2005)

Figure 2: Hanging
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The second widely chosen method was exposure to pesticide (X68) at 13.1% and
followed closely by jumping from high places (X80) which makes up 10.4% of the suicide
cases. These three common methods of suicide contribute to 77.1% of the total suicide
cases. These may be attributed to the availability of hanging appliances, as well as
accessibility to high-rise buildings and pesticides in Malaysia.

Figure 3: Jumping from high place
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Why? : Factors of Suicide

Theory from American psychologist called Thomas Joiner, states that there are three
factors that cause someone to turn to suicide. Firstly is perception which usually mistaken
that they are alone in the world and that no one really cares about them. Second is a feeling
that usually mistaken that they are a burden on others and that people would be better off
if they were dead and lastly is fearlessness towards pain and death.
There are many factors that associated with suicide. Which are:
1. Mental illness
Estimated that 90% of people who attempt or die by suicide have one or
more mental health conditions. Cavanagh, Carson, Sharpe, & Lawrie, 2003 said that
the vast majority of people who die by suicide are suffer from mental disorders.
Besides, certain mental disorders contribute higher risk for suicidal behavior than
others.
- Severe depression
Severe depression causes symptoms of low mood, tiredness, loss of interest,
despair and hopelessness that interfere with a person's life. Depression is clearly
associated with suicide, perhaps more than half are depressed (Barraclough, Bunch,
Nelson, et al., 1974; Murphy, 1983). Severe depression is always accompanied by a
pervasive sense of suffering as well as the belief that escapes from it is hopeless. The
pain of existence often becomes too much for severely depressed people to bear.
The state of depression warps their thinking, allowing ideas like "Everyone would all
be better off without me" to make rational sense.
-Bipolar disorder
Based on British Journal Psychiatry 1997, bipolar disorder, with estimates
suggesting a 15-fold increased risk for suicide (Harris & Barraclough, 1997). Bipolar
disorder causes a person's mood to swing from feeling very high and happy to
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feeling very low and depressed. About one in three people with bipolar disorder will
attempt suicide at least once.
-Schizophrenia
Schizophrenia is a long-term mental health condition that typically causes
hallucinations which seeing or hearing things that are not real, delusions which
believing in things that are not true and changes in behavior. It is estimated that 1 in
20 people with schizophrenia will take their own life. Based on Palmer, Pankratz, &
Bostwick, 2005, schizophrenia will contribute suicide rates between 1.8% - 5.6%.
Schizophrenics are just as likely to talk freely about the voices commanding them to
kill themselves. People with schizophrenia are most at risk of suicide when their
symptoms first begin. This is because they frequently suffer loss at this time. For
example, loss of employment and relationships. The risk tends to reduce over time.
People with schizophrenia tend to risk of self-harm.

-Borderline personality disorder
Based on the Duberstein & Witte, 2008 borderline personality disorder,
contribute between 45% to suicide. Borderline personality disorder is characterized
by unstable emotions, disturbed thinking patterns, impulsive behavior and intense
but unstable relationships with other people. Self-harm is often a key symptom of
this condition. It is estimated that just over half of people with borderline personality
disorder will make at least one suicide attempt. People with a borderline personality
disorder often have a history of childhood sexual abuse and have a particularly high
risk of suicide.
2. Alcohol abuse
In previous meta-analysis studies, the lifetime risk of suicide was found to be
7% for alcohol dependence (Inskip et al 1998). There is a significantly higher rate of
suicide among people who abuse alcohol and or drugs. Alcohol is involved in an
estimated 30% of suicides. Alcohol causes depressed mood, lowers inhibitions, and
impairs judgment, any or all of which may set up vulnerable people to act on suicidal
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plans. In the Northern Ireland suicide study, which was a case-control psychological
autopsy, the estimated risk of suicide in the present of current alcohol misuse or
dependence was eight times greater than its absent.
3. Burdensomeness on family
The Interpersonal Theory of Suicidal Behavior presence of two interpersonal
constructs which are thwarted belongingness and perceived burdensomeness. In
perceptions of burdensomeness on family is the key factor in Sabbaths (1969) family
systems theory of adolescent suicidal behavior. Adolescents perceptions that they
are expendable members of the family. The causal factors leading to adolescent
suicidal behavior, according to the theory, are pathogenic parental attitudes toward
the adolescent that are interpreted by the adolescent that he/she is not needed in
the family, and in fact, that the family would be better off if the adolescent were
dead. In a direct test of Sabbaths theory, perceptions of expendability in the family
were found to be positively correlated with suicidal behavior in adolescents
(Woznica & Shapiro, 1990).
4. Family History
According to the National Institute of Mental Health, family history of suicide
and mental or substance abuse disorder are among the most prevalent risk factors
for suicide in the United States. Evidence that suicide can run in families has been
found in both case reports and epidemiological studies. People who have not been
exposed to suicide, suicidal parents and the whole idea of suicide are much less likely
to have thoughts of suicide. But it makes a high chance of suicide when experiencing
the suicide of a loved one. When life gets really tough for person, she/he do think
about suicide because they think that this is how to stop the pain as what their
family or relative member did. When the pain is really bad, they will do the same
thing.




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5. Childhood trauma
Childhood trauma is a general term used to describe events or situations that
override a childs ability to compensate mentally or emotionally for the effects of
stress. Example are situation involve in accidents, parent death or family member,
exposure to natural disasters or terrorism, abandonment by parents or caretakers,
neglect by parents or caretakers, physical abuse, sexual abuse, exposure to bullying,
witnessing violent behavior between ones parents, living in an otherwise violent
home environment, living in a persistently chaotic home environment, and
witnessing violence in ones community. When they are under trauma, their emotion
is totally unstable and they will make a decision that can solve their problem in a
hurry without thinking. In men and boys with such a predisposition, the effects of
violent childhood trauma may act as a trigger that turns suicidal potential into
suicidal reality.


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PREVENTION
Implementing Strategies
In 2001, the U.S. Department of Health and Human Services, under the direction of the
Surgeon General, published the National Strategy for Suicide Prevention, establishing a
framework for suicide prevention in the U.S. The document calls for a public health
approach to suicide prevention, focusing on identifying patterns of suicide and suicidal
behaviour throughout a group or population. The document also outlines 11 specific
objectives, listed below:
1. Promote awareness that suicide is a public health problem that is preventable
2. Develop broad-based support for suicide prevention
3. Develop and implement strategies to reduce the stigma associated with being a
consumer of mental health, substance abuse and suicide prevention services
4. Develop and implement community-based suicide prevention programs
5. Promote efforts to reduce access to lethal means and methods of self-harm
6. Implement training for recognition of at-risk behavior and delivery of effective
treatment
7. Develop and promote effective clinical and professional practices
8. Increase access to and community linkages with mental health and substance abuse
services
9. Improve reporting and portrayals of suicidal behavior, mental illness and substance
abuse in the entertainment and news media
10. Promote and support research on suicide and suicide prevention
11. Improve and expand surveillance systems



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Direct talks
The World Health Organization has noted a very effective way to assess suicidal
thoughts is to talk with a person directly, to ask about depression, and assess suicide plans
as to how and when it might be attempted. Contrary to popular misconceptions, talking
with people about suicide does not plant the idea in their heads. However, such discussions
and questions should be asked with care, concern and compassion. The tactic is to reduce
sadness and provide assurance that other people care. The WHO advises to not say
everything will be all right nor make the problem seem trivial, nor give false assurances
about serious issues. However, some people who have talked about suicide have later
attempted it, so the discussions should be gradual and specifically when the person is
comfortable about discussing his or her feelings.
Screening
The U.S. Surgeon General has suggested that screening to detect those at risk of
suicide may be one of the most effective means of preventing suicide. There are various
screening tools in the form of self-report questionnaires to help identify those at risk such as
the Beck Hopelessness Scale and Is Path Warm?. A number of these self-report
questionnaires have been tested and found to be effective for use among adolescents and
young adults. There is however a high rate of false-positive identification and those deemed
to be at risk should ideally have a follow-up clinical interview. The predictive quality of these
screening questionnaires has not been conclusively validated so it is not possible to
determine if those identified at risk of suicide will actually commit suicide.





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TREATMENT

Psychotherapies
Psychotherapy, or talk therapy, is a way to treat people with a mental disorder by
helping them understand their illness. It teaches people strategies and gives them tools to
deal with stress and unhealthy thoughts and behaviors. Psychotherapy helps patients
manage their symptoms better and function at their best in everyday life. Sometimes
psychotherapy alone may be the best treatment for a person, depending on the illness and
its severity. Other times, psychotherapy is combined with medications. Therapists work with
an individual or families to devise an appropriate treatment plan.
There are many kinds of psychotherapy exist. There is no "one-size-fits-all"
approach. In addition, some therapies have been scientifically tested more than others.
Some people may have a treatment plan that includes only one type of psychotherapy.
Others receive treatment that includes elements of several different types. The kind of
psychotherapy a person receives depends on his or her needs.
Cognitive behavioral therapy (CBT) is a blend of two therapies: cognitive therapy (CT)
and behavioral therapy. CT was developed by psychotherapist Aaron Beck, M.D., in the
1960's. CT focuses on a person's thoughts and beliefs, and how they influence a person's
mood and actions, and aims to change a person's thinking to be more adaptive and healthy.
Behavioral therapy focuses on a person's actions and aims to change unhealthy behavior
patterns. CBT helps a person focus on his or her current problems and how to solve them.
Both patient and therapist need to be actively involved in this process. The therapist helps
the patient learn how to identify distorted or unhelpful thinking patterns, recognize and
change inaccurate beliefs, relate to others in more positive ways, and change behaviors
accordingly.


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Medications
Many medications are available to treat depression, the most common of which are
antidepressants. About 22 medications are currently approved by the FDA. Since there is no
accurate test to match a persons symptoms and complaints with the right medication,
there is no way to know which drug will work best for a particular person. The person who
may be depressed should discuss with their doctor the medication choice and how to take it
as well as the potential side effects. The doctor needs to be told all the other prescription
medications the person is taking as well as non-prescription medications, vitamins and
supplements and his/her daily alcohol intake. Alcohol intake should be minimal while taking
an antidepressant or any psychotropic medication. Sometimes there is the need to try a few
different medications before finding the one that gives the best result with minimum side
effects.

Psychotherapy Counseling

Organization In Malaysia
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CONCLUSION

Suicide is a rare event in the general population, but it is quite common among
patients with mood disorder who are in contact with different levels of the health care
system. It is very important to detect suicide risk factors, particularly in patients with mood
disorder, as early as possible and intervene prior to the person making the first suicide act.
Moreover, widespread and effective treatment of major mood disorders should result in the
decline of suicide mortality of these patients.
REFERENCES

National Suicide Registry Ministry, Annual Report 2009
http://soars.org.uk/index.php/history-of-suicide/a-brief-history-of-suicide
http://www.afsp.org/understanding-suicide/facts-and-figures
http://www.nhs.uk/Conditions/Suicide/Pages/Causes.aspx
http://www.psychologytoday.com/blog/happiness-in-world/201004/the-six-
reasons-people-attempt-suicide
(Journal of The Interpersonal Theory of Suicide Kimberly A. Van Orden, Tracy K.
Witte, [...], and Thomas E. Joiner, Jr., 2010)
https://www.myptsd.com/c/threads/family-history-of-suicide-makes-increases-
chances-of-suicide.9951/
http://www.elementsbehavioralhealth.com/behavioral-health-news/family-history-
childhood-trauma-increase-suicide-risk-for-men/
http://www.who.int/mental_health/media/en/59.pdf
http://profiles.nlm.nih.gov/ps/access/NNBBBH.pdf
http://www.nimh.nih.gov/health/topics/psychotherapies/index.shtml
http://www.afsp.org/preventing-suicide/treatment