Suicide As Decision Making And Risk Factors

Suicide as decision making and risk factors

Suicide defines it as, death produced by oneself with the precise intention of ending one’s life), the term is polysemic. In fact, beyond consummated suicide, suicidal behaviors that appear in the psychological clinic.

Suicide weakens emotional and social networks. The decision making of a person who implies in suicidal behavior there are three basic components to identify:

1. Emotional, intense suffering
2. At a behavioral level, a lack of psychological resources to face
3. At a cognitive level, deep despair before the future, accompanied by the perception of death as the only way out.

Therefore, suicide is not a moral problem. That is, those who try to commit suicide are not cowardly or brave, they are only people who suffer, who are overwhelmed by suffering and who do not have the slightest hope in the future (Bobes, Giner and Saiz, 2011).

Types of suicide

Durkheim (author who classified the types of suicide), should be understood that the suicide rate depends more on the type of society in which they occur that on the psychological circumstances of particular individuals who finally choose to take their lives.

Altruistic suicide

 It is the one caused by a low importance of the self. Durkheim gives the example of the Celtic peoples, among whom the suicide of the elders became honorable when they were unable to obtain resources for themselves.

The modern example is the army, Durkheim emphasizes that in countries where societies commit suicide more (for selfish suicide), in the army they commit suicide less, and vice versa.

Selfish suicide

 It takes place when social ties are too weak to compromise suicide with their own life. In the absence of the pressure and coercion of society, the suicide is free to carry out its will to commit suicide. This form of suicide tends to occur more in modern societies, in which the dependence of the family or clan is less than in traditional.

Anomic suicide

 It is the one that occurs in societies whose institutions and whose coexistence ties are found in a situation of disintegration or anomia. In societies where social and natural limits are more flexible, this type of suicides happens. For example, in countries where marriage has a lower weight, due to the existence of divorce, suicide is greater. Is the suicide of societies in transition. Another example is trade and industry, where change (and therefore, also anomic suicide) is chronic.

Fatalistic suicide

It occurs where the rules to which individuals are subjected are too strong so that they conceive the possibility of abandoning the situation in which they are. Slave societies, would be examples of situations in which this suicide occurs.

Risk factor’s

Thoughts, consideration or planning of suicide could lead to a very imminent suicidal ideation, which is why we must evaluate and assess which are the various determining or predisposing factors so that the person reaches that behavior in their personality.

These risk factors are divided into two groups:

Modifiable risk factors: These are characterized to social, psychological or psychopathological factors, in which it is possible to be clinically modified.

Non -modifiable risk factors: these are linked to the subject itself or the social group that belong, characterized by their maintenance over time and because mainly their change is foreign to the clinician, that is, it cannot be modified.

Among the modifiable risk factors are many variables between them can be:

Psychiatric disorders

According to WHO data, within the group of people who commit suicide 80-85% present depression, substance abuse or schizophrenia.

In turn, mental disorders are associated with a high index of 90% of consummated suicidal cases. Among them are:

Depression

These patients will have a greater probability of suicide risk, which will be 20 times higher compared to the general population. Depression usually occurs in people with severe anhedonia, obsessive-compulsive personality features and high despair, since they present a greater risk to kill themselves.

Abuse or substance dependence

The association between suicidal ideation and the consumption of illicit drugs also have a strong association.

The majority of people who consume it are under the influence of sedative drugs such as alcohol or benzodiazepines at the time of committing suicide, that is why alcohol and benzodiazepines are present between 15% and 61% of cases, alsoThere is the consumption of heroin and cocaine in 3% and 35% in the causes of suicide deaths.

Schizophrenia

This group of patients have a probability up to 9 times greater than ending their own life and also increases the risk if the person with schizophrenia has depression, obsessive compulsive disorder or a negative attitude to psychiatric treatment.

Post -traumatic stress disorder

These patients also increase the risk of suicide because they have intense feelings of guilt, so they can have a persistent, frequent and very durable suicidal ideation.

Medical conditions

Health diseases such as chronic pain, cancer, renal failure in patients who have hemodialysis, AIDS or systemic lupus erythematosus, usually these patients may have suicidal tendencies, since they are considered diseases that do not have any cure that canRemove your discomforts or ailments.

Psychosocial factors

Certain people opt for suicide to somehow escape situations such as bullying, prejudice or a history of child sexual abuse.

In some studies they believe that sexual abuse contributes about 20% of the total risk.

Poverty in turn is also related.

Another cause to have a suicidal ideation is in divorced or separate people who have a risk of suicide greater than those married. This is especially in the case of divorced men, who have up to eight times more likely to take their lives than divorced women. However, a statistical difference between married and divorced women has not been found.

Among the non -modifiable risk factors are variables such as:

Genetic factors

Various WHO studies estimate that between 43% and 45% of suicidal behavior would be explained by genetic load and between 55% and the remaining 57% are influenced by environmental factors.

The inheritance of suicidal behavior is usually more related to:

• The transmission of mental illness itself
• The transmission of certain personality characteristics such as impulsivity or aggressiveness.

Sex

It is more related to men since they have higher consummate suicide rates, that is, if they manage to commit suicide, instead women have a greater number of attempts and usually use less lethal methods, in which they fail to commit suicide.

Age

This is why both suicide and suicidal attempt are exceptional and increase in adolescence associated with the presence of comorbidity, especially mood disorders and abuse of psychoactive substances. The percentages of consummated suicide are markedly increased in late adolescence and continue to increase to about 20 years.

Ethnicity

Ethnic differences can reflect as a very frequent suicidal ideation problem, for example: in isolated groups instead of cultural differences, such as in Canada, suicide in young aborigines is about 5 to 6 times more than in non -aboriginal young people. In the US, the percentage of young suicides is greater among Native Americans, followed by whites and African Americans and minor among those of the Pacific Asian ethnicity.

Previous suicide attempt

One of the suicide risk factors that come to be considered more powerful are the previous attempts made by the person. The more times I have tried, the more likely it is that in the future I can try again. In addition, the risk is higher if a series of additional variables are taken into account, for example:

• If previous attempts have been serious.
• If there has been an intense desire to die.
• If the person has tried to avoid being discovered, making sure that at that time no one was going to get home
• If especially lethal methods have been used that cause considerable physical damage.

Causes of suicide

In all age groups, the number of men who committed suicide exceeds that of women in a proportion of 4 to 1. The reasons are not clear, but the following factors may be involved:

• When men have problems, they are less likely to seek help, either from family or friends and/or health professionals.
• Alcohol abuse and drug abuse, which seem to contribute to suicidal behavior, are more common among men.
• Men are more aggressive and use more lethal media when they try suicide.

Depression is related to more than 50% of suicide attempts. The presence of:

• Matrimonial relationship problems.
• Have been arrested recently or have problems with the law.
• Difficult love relationships or conclude.
• Conflicts with parents (in the case of adolescents).
• The recent loss of a loved one (especially in the elderly population), can be some of the triggers of depression.

Often a certain factor or event such as:

• The rupture of an important personal relationship constitutes the event that culminates the person’s ability to face unpleasant circumstances.
• However, depression may appear ‘out of nowhere’, especially if there is a family history of a mood or suicide disorder. The risk of suicide is greater if people with depression also suffer a significant degree of anxiety.

Other mental health disorders such as:

• Depression is also associated with a higher risk of suicide.
• People with schizophrenia or other psychotic disorders may suffer delusions (fixed false beliefs) with which they find it difficult to live together, or can hear voices (auditory hallucinations) that order them to kill themselves.
• People with personality limit disorder or with antisocial personality disorder, especially those who present a violent behavior history, also have a higher risk of suicide.
• Antidepressants (Clayton, 2016)
• There may be a genetic propensity to suicide.

More frequently, suicidal thoughts can be the result of feelings that you cannot face when an overwhelming situation in your life is presented. If you think there is no hope in the future, you may think, wrongly, that suicide is a solution. It is possible that you experience a kind of narrowness of criteria where, in the midst of a crisis, you feel that suicide is the only way out. (Clinic, 2018)

• Bipolar disorder
• Borderline personality disorder
• Depression
• Alcohol or drug use
• Post -traumatic stress disorder (PTSD)
• Schizophrenia
• Stressful life issues, such as serious financial problems or in interpersonal relationships (Commerce, 2018)

Methods used for suicide

The choice of suicide method is usually influenced by cultural factors or availability reasons. Some methods such as: 

• Throwing from the top of a building makes survival almost impossible,
• Drug overdose (they leave the possibility of rescue open).
• However, the choice of a method that is not deadly of necessity does not necessarily imply that the attempt is less serious than the one that leads to use more mortal methods.
• Pharmacological overdose and poisoning are the main procedures used in suicide attempts.

Violent methods such as:

• Fire shooting or hanging, are rare in suicide attempts, since they usually result in the death of the person.
• For consummated suicides:
• Men most frequently use firearms (56%), followed by hanging, poisoning, jump from a height and use of white weapon.
• Women use poisoning more frequently (37%), followed by firearms, hanging, jump from a height and drowning. (Clayton, 2016)

Treatment

The treatment of thoughts and suicidal behavior depends on the specific situation, which includes the level of suicide risk and the basic problems that can cause such thoughts or behavior.

People with depression have an important risk of suicide and must be carefully controlled by suicidal behaviors or ideas. The risk of suicide can be increased at the beginning of the treatment of depression, when psychomotor and indecision delay have improved but depressed mood has only partially risen. When antidepressants begin or when doses are increased, some patients experience agitation, anxiety and increased depression, which can increase suicidal tendency.

A recent public health warning on the possible association between the use of antidepressants (in particular paroxetine) and suicidal thoughts and attempts in children, adolescents and young adults produced an important reduction (> 30%) of antidepressant prescriptions in those populations. However, youth suicide rates increased by 14% during the same period. Therefore, by discouraging pharmacological treatment in depression, this warning could have temporarily produced more, and no less, suicide deaths. Together, these results suggest that the best approach is to encourage treatment, but with appropriate precautions such as

• Antidepressant administration in subletal amounts
• Most frequent visits at the beginning of treatment
• Give a clear warning to patients and family and other people close to being alert to the worsening of symptoms or suicidal ideation
• Instruct patients, family and other people close to call the treating doctor immediate

Several studies have shown that lithium, when administered with atypical antidepressants and antipsychotics, reduces the number of suicide deaths in patients with major depression or bipolar disorder. Lithium, even in low doses, is highly effective as an anti suicidal drug for recurring depression. In addition, clozapine reduces suicide risk in patients with schizophrenia.

Electroconvulsive therapy is still used for the treatment of severe depression and suicide depression.

SAD Persons scale

The SAD Persons scale is a proof that knows the risk of suicide both in men and women. In a situation of doubt, a psychiatric evaluation focused on nature, frequency, intensity, depth, duration and persistence of suicidal ideation in order to help the patient and guide it in their suicidal decision is advisable.

It presents 10 items in which each score equals one, added these numbers will give a result in which we must assess whether that person must be admitted or can go home, in the event that the patient has a certain score must remain or notIn the institution, it must also be accompanied by a relative in the event that they want to leave the place.

• Sex (sex): +1 if men.
• AGE (age): +1 if it is less than 19 or greater than 45
• Depression (depression)
• Previous Attempt (previous suicide attempts)
• Ethanol Abuse (alcohol abuse)
• Rating Thinking Loss (Cognitive Disorders)
• Social Supports Lacking (without social support)
• Organized Plan (Organized Suicide Plan)
• No Spouse (without stable partner)
• Sickness (somatic disease)

0 – 2: If they present up to two points, outpatient monitoring should be done.

3 – 4: If you present these values, deeper monitoring should be done, you can also consider income, after intense and detailed monitoring.

5 – 6: In this score, income is recommended, especially if there is no social support. Why there is no family control.

7 – 10: The patient’s income is mandatory and even against his will. Since the risk of immediate death.

This scale this design for patient with a possible risk of taking your life, since it is difficult to reach exact and safe conclusion of who will try suicide and who will not do it.

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