exploringsuicide

This blog is about exploring suicide with the firm conviction that no one really wants to kill themselves but change their lives and suicide is the only option they find. That was my experience. My mother committed suicide when I was almost nine years old and I tried to commit suicide when I was twenty seven. Overcoming such experience has taken over twenty years but I am happy to say, life was never as beautiful as it is today. We can at least talk to each other. That helps!

Monday, 31 October 2011

Suicide/Parasuicide



Durkheim at the Movies: A Century of Suicide in Film
Pages 175-177
Steven Stack, Barbara Bowman
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Inequalities and Impact of Socioeconomic-Cultural Factors in Suicide Rates Across Italy
Pages 178-185
Maurizio Pompili, Marco Innamorati, Monica Vichi, Maria Masocco, Nicola Vanacore, David Lester, Gianluca Serafini, Roberto Tatarelli, Diego De Leo, Paolo Girardi
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Is the Emotional Response of Survivors Dependent on the Consequences of the Suicide and the Support Received?
Pages 186-193
Barbara Schneider, Kristin Grebner, Axel Schnabel, Klaus Georgi
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Wishes to Die in Older People: A Quantitative Study of Prevalence and Associated Factors
Pages 194-203
M.L. Rurup, D.J.H. Deeg, J.L. Poppelaars, A.J.F.M. Kerkhof, B.D. Onwuteaka-Philipsen
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Understanding Why Older People Develop a Wish to Die: A Qualitative Interview Study
Pages 204-216
M.L. Rurup, H.R.W. Pasman, J. Goedhart, D.J.H. Deeg, A.J.F.M. Kerkhof, B.D. Onwuteaka-Philipsen
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A Study of Deliberate Self-Harm and Its Repetition Among Patients Presenting to an Emergency Department
Pages 217-224
Paul S.F. Yip, Keith Hawton, Kayuet Liu, Kwong-sun Liu, Pauline W.L. Ng, Pui-man Kam, Yik-wa Law, Tai-wai Wong
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Mapping Suicide in London: A Brief Methodological Case Study on the Application of the Smoothing Technique
Pages 225-230
Mohsen Rezaeian, Graham Dunn, Selwyn St Leger, Louis Appleby
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SUICIDE/Parasuicide


244 SUICIDE/Parasuicide
end-of-life practices. Since 1995, the demand for physician-assisted death has not risen among patients (0.3% of all deaths in the Netherlands), and physi- cians seem to have become somewhat more reluctant in their attitude towards this practice. Even if assisted suicides are not so frequent, 57% of all medical doc- tors in the Netherlands have performed euthanasia or physician-assisted suicide since the law was imple- mented. How this phenomenon can be considered according to the ethical code of medical doctors is a major ethical debate, now widely discussed in many developed countries.
See Also
Autoerotic Death; Deliberate Self-Harm, Patterns; Fo- rensic Psychiatry and Forensic Psychology: Suicide Predictors and Statistics; Murder–Suicide; Suicide: Parasuicide; Youth Suicide
Further Reading
Charlton J, Kelly S, Dunnell K, Evans B, Jenkins R (1993) Suicide deaths in England and Wales: trends in factors associated with suicide deaths. Popuation Trends 71: 34–42.
Chesnais J-C (2003) Les morts violentes dans le monde. [Violent deaths in the world.] Population et Socie ́te ́s 395: 1–4.
De Leo D, Scocco P, Marietta P, et al. (1999) Physical illness and parasuicide: evidence from the European Parasuicide Study Interview Schedule (EPSIS/WHO-EURO). Interna- tional Journal of Psychiatry and Medicine 29: 149–163.
DeVivo MJ, Black KJ, Richards JS, Stover SL (1991) Suicide following spinal cord injury. Paraplegia 29: 620–627. Hawton K (2000) Gender differences in suicidal behaviour.
British Journal of Psychiatry 177: 546–550. Hepple J, Quinton C (1997) One hundred cases of attempted suicide in the elderly. British Journal of Psychiatry 171:
42–46. Kleespies PM, Hughes DH, Gallacher FP (2000) Suicide in
the medically and terminally ill: psychological and ethi- cal considerations. Journal of Clinical Psychology 56: 1153–1171.
Knight B (1991) Murder, suicide or accident? In: Arnold E (ed.) Simpson’s Forensic Medicine, 10th edn., pp. 117– 127. London.
Kreitman N, Carstairs V, Duffy J (1991) Association of age and social class with suicide among men in Great Britain. Journal of Epidemiology and Community Health 45: 195–202.
Lewis G (1998) Suicide, deprivation, and unemployment: record linkage study. British Medical Journal 317: 1283–1286.
Marc B, Baudry F, Zerrouki L, Ghaiath A, Garnier M (2000) Suicidal incised wound of a fistula for hemodialysis access in an elderly woman. American Journal of Forensic Medicine and Pathology 21: 270–272.
Marzuk PM, Leon AC, Tardiff K, et al. (1992) The effect of access to lethal methods of injury on suicide rates. Archives of General Psychiatry 49: 451–458.
Onwuteaka-Philipsen BD, Van der Heide A, Koper D, et al. (2001) Euthanasia and other end-of-life decisions in the Netherlands in 1990, 1995, and 2001. Lancet 362: 395–399.
Sainsbury P (1986) The epidemiology of suicide. In: Roy A (ed.) Suicide, pp. 17–40. Baltimore, MD: Williams and Wilkins.
Shah A, Hoxey K, Mayadunne V (2000) Suicidal ideation in acutely medically ill elderly inpatients: prevalence, corre- lates and longitudinal stability. International Journal of Geriatric Psychiatry 15: 162–169.
Parasuicide
R Nathan, Merseyside Forensic Psychiatry Service, St Helens, UK K J B Rix, Leeds Mental Health Teaching Trust, Leeds, UK
ß 2005, Elsevier Ltd. All Rights Reserved.
Introduction
The term ‘‘parasuicide’’ embraces an enormous vari- ety of behaviors. Between 1 and 5% of respondents to community surveys in the USA and Europe have deliberately harmed themselves, although higher rates have been reported. The problem of parasuicide is especially pressing in forensic populations. Rates among offenders are significantly elevated and the management of parasuicide in forensic settings poses particular difficulties. Furthermore, courts may be more likely to seek the evidence of an expert witness when the proceedings relate to an individual with a history of parasuicide.
Definition
The clinical judgment as to whether an event such as a deliberate overdose or self-laceration represents para- suicide is usually straightforward. However, given the different types of actions and intentions, a single de- scriptive term that can be applied universally has proved elusive. ‘‘Attempted suicide’’ suggests suicidal intent, which cannot be assumed. ‘‘Suicidal behavior’’ covers suicide and attempted suicide, but is often used more broadly to describe all fatal and nonfatal delib- erate self-harm. Although ‘‘deliberate self-harm’’ does not refer to suicidal intent, it implies harm, which is not a necessary condition. A deliberate overdose should not be excluded from consideration because either the individual unwittingly took too low a dose
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DELIBERATE SELF-HARM, PATTERNS


DELIBERATE SELF-HARM, PATTERNS 153
DELIBERATE SELF-HARM, PATTERNS
J Payne-James, Forensic Healthcare Services Ltd, London, UK
ß 2005, Elsevier Ltd. All Rights Reserved.
Introduction
Individuals may harm themselves in many ways and for many different reasons. These factors may them- selves be influenced by a variety of personal and cultural factors. In many cases, the method of self- harm is clear and unambiguous. An individual who survives an attempt at self-harm will generally be able to give an account as to the reasons for the attempt. In fatal self-harm, the circumstances may not clearly indicate self-harm and thus investigation will be required to determine the circumstances sur- rounding the death. The stigma associated with self- harm in some societies means that it is important to establish clearly whether suicide was intended. In some jurisdictions (e.g., England and Wales), a coro- ner will give a verdict of suicide only when strict criteria have been applied to the circumstances. A belief that a suicide attempt was intended may be a misinterpretation in other circumstances, e.g., auto- erotic asphyxia. An attempt at hiding criminal activ- ity may result in the staging of a death to look like suicide. It is thus clear that the investigation of puzzling or unusual deaths should be rigorous and extensive. This article will focus predominantly on the range of physical patterns of injury where the question of deliberate self-harm may be obscured, misinterpreted, or misleading.
Range of Self-Harm
In the living individual attempts at self-harm or self- multilation may indeed be deliberate acts, but can occasionally mask other activities. One example is the need to try and differentiate between injuries in torture cases, where it may be extremely difficult to determine whether an injury is self-inflicted or acci- dental by evaluating solely the distribution of trau- matic lesions or scars on the patient’s body. Table 1 gives further examples of the potential motives for self-harm, over and above an intent to commit suicide because of depression.
It is important to realize that patterns of delib- erate self-harm vary from country to country, from culture to culture and also depend on the occupation and characteristics of the self-harmer. Reviews of studies from around the world indicate variations in
incidence and methods of self-harm that may result in death or injury. In Oman, most cases involve females, students, or the unemployed, with a high incidence of family, marital, and psychiatric or social problems. The methods used most often are the use of analgesics (e.g., paracetamol) and nonpharmaceutical medica- tions. Self-burning is rare in Europe, but a study from Iran showed a high incidence, with an average age of 27 years, 83% of them being female. Most were married homemakers with high-school education; 62% had had an impulsive suicidal intention and the major motive was marital conflict. The mortality rate was 79%. A similar study on cases of self- inflicted burns in Australia showed the presence of schizophrenia, depression, and personality disor- der in 71%, with the majority of the remainder showing evidence of intoxication. These cases were divided into attempted suicides almost all of which involved males, and 60% had a major psychiatric illness, and ‘‘self mutilations,’’ where the self-harmers suffered much less serious burns and all survived. In the UK, a recent study found that self-harm in 15–16-year-old schoolchildren was more common in females than males (11.2% vs. 3.2%). For females, the factors associated with self-harm included: self- harm by friends, self-harm by family members, drug misuse, depression, anxiety, impulsivity, and low self- esteem. For males, the associated factors were suicidal behavior in friends and family members, drug use, and low self-esteem. Other diagnoses with strong links with potential for self-harm include bulimia (almost 25% reporting suicide attempts), and this increased to about 50% where there is a dual diagnosis of alcoholism. A recent review of the epidemiology of parasuicide (defined as suicide attempts and deliberate self-harm inflicted with no intent to die) from the USA showed an annual rate of parasuicide within the last three decades as ranging from 2.56 to 11 000 per 100 000 and lifetime prevalence rates ranging from 720 to
Table1 Examplesofreasonswhyindividualsmayself-harm
Psychiatric and associated disorders Malice (attempting to give the impression that the individual has
been assaulted by another) Allegationsofsexualassault To avoid work (prevented by the injury) To ‘‘reinforce’’ or ‘‘re-emphasize’’ an injury that already exists Attention-seeking behavior Insurance fraud Benefits fraud Factitious injury – to imply a medical problem (e.g., a slow-
healing skin ulcer)
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seasonal relationship between assault and homicide


The seasonal relationship between assault and homicide in England and Wales
Daniel J. Rocka, Corresponding Author Contact Information, E-mail The Corresponding Author, Kevin Juddb, Joachim F. Hallmayerc

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aCentre for Clinical Research in Neuropsychiatry, Graylands Hospital and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Australia
bSchool of Mathematics and Statistics, University of Western Australia, Australia
cDepartment of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
Accepted 26 March 2008. Available online 26 July 2008.

Summary

Investigating the seasonal asymmetry of violent behaviour has a long history. Despite this, there still remains considerable debate about the nature and aetiology of this phenomenon. Reports on homicide, for example, are mixed: some have found homicide seasonality but most have not. In contrast, all published studies on assault report that this behaviour is seasonal. Moreover, only two studies, both using US data, have examined the seasonal variation of assault and homicide in the same population over the same period of time. One group found assault was seasonal but homicide was not, whilst the other found, overall, that both homicide and assault were seasonal. This first of these findings seems paradoxical, in that there is no seasonal variation in injury related deaths (i.e. homicides), despite the antecedent behaviour (i.e. assaults) having a seasonal pattern of occurrence. We examined the seasonal variation in homicide and assault in UK and found a similar result. Furthermore, our findings are not easily understandable using conventional social models of seasonal behaviour and we suggest biologically mediated seasonal variation in the capacity of equally injured individuals to survive trauma may also play a role, which should be investigated further.
Keywords: Seasons; Homicide; Assault; Periodicity; Trauma response


Corresponding Author Contact InformationCorresponding author at: CCRN, Locked Bag No. 1, Claremont, Western Australia 6910, Australia.

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study of juvenile perpetrators of homicide


A population-based study of juvenile perpetrators of homicide in England and Wales
Cathryn Rodway Corresponding Author Contact Information, E-mail The Corresponding Author, Victoria Norrington-Moore1, David While, Isabelle M. Hunt, Sandra Flynn, Nicola Swinson, Alison Roscoe, Louis Appleby, Jenny Shaw
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The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Suicide Prevention, Floor 2, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK
Available online 10 April 2010.

Abstract

This study aimed to describe the social, behavioural and offence characteristics of all convicted perpetrators of homicide aged 17 and under; to examine their previous contact with mental health services, and to discuss strategies for homicide prevention. An eight-year (1996–2004) sample of 363 juvenile homicide perpetrators in England and Wales was examined. The majority of perpetrators were male, used a sharp instrument, and most victims were acquaintances or strangers. Over half had previously offended. A history of alcohol and/or drug misuse was common, as was the prevalence of family dysfunction, abuse, educational difficulties or discipline problems. Previous contact with mental health services was rare. Earlier intervention targeting social and psychological adversity and substance misuse could help to reduce the level of risk for future violence, and may reduce homicide rates among juveniles. Strengthening engagement with young offenders and increasing resources to prevent recidivism may also be beneficial.
Keywords: Homicide; Juveniles; Mental illness; Youth; Violence

Corresponding Author Contact InformationCorresponding author. Tel.: +44 161 2750707; fax: +44 161 2750712.
1Present address: Guild Lodge, Lancashire Care NHS Foundation Trust, Guild Park, Whittingham, Preston, Lancashire PR3 2JH, UK.

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