Suicidal Behavior

Résumé

Le but de cet article pourrait être de revisiter les concepts théoriques qui portent sur les aléas du travail de séparation psychique chez les adolescents gravement suicidaires en s’appuyant sur une situation clinique particulièrement éprouvante. La position « intraitable » de ce jeune patient semble en effet témoigner de la validité de l’hypothèse soutenant que la recherche active de la mort peut constituer un moyen de renouer avec un état d’indifférenciation. Tout se passe en effet comme si la disparition du sujet constituait la condition requise pour échapper aux tourments d’une conscience séparée, et récupérer ainsi, sous couvert d’un fantasme de fusion, l’amour inconditionnel des objets primaires. L’enjeu thérapeutique pourrait être d’accompagner les adolescents pris dans ce piège narcissique dans une élaboration de la honte liée à leur corps sexué et aux sentiments ambivalents éprouvés à l’égard de leurs parents, afin qu’ils soient moins en nécessité défensive de soutenir cette mortelle quête d’union symbiotique avec « l’objet primaire ».
Abstract

Clinicians who work with hospitalized teenagers often face some young patients’ relentless suicidal determination: these patients seem to have sentenced themselves to death. For several months, sometimes years, no one manages to revoke this incomprehensible capital punishment. This painful conviction that they are unworthy often comes with depressive affects that resist on a long-term basis, despite the combination of antidepressants and a psychotherapeutic approach. Thinking is too stressful: they long to suspend any psychic life, to stop the emergence of any desire and to end any relational impulse. They keep trying to stay in a factitious world, far from real life requirements, as a temporary alternative to death. Through the anaesthesia it produces, the use of drugs offers them a strong protection from their pain. The regressive search for a feeling of lacking psychic differentiation seems to confirm a defect of development within the first phase of the separation individuation process. Narcissistic vulnerability is often underlined in most psychopathological studies concerning suicide attempts during teenage years. Combined with the incapacity to endure any loss, this last element seems to imply that a “relationship of encroachment” exists between the subject and its environment, as well as a persistence of a broad area of lacking differentiation within the maternal imago. From this theoretical point of view, suicidal gestures from these patients are often understood as desperate and paradoxical attempts to reach their boundaries, to maintain their identity and to “withdraw themselves from the object of alienation”. These relevant interpretations hide the “search of a narcissistic state of undifferentiated union” that F. Ladame highlighted during the psychoanalytical counselling of numerous young and seriously suicidal patients. Through this article, we propose to try and re-examine the theoretical concepts related to the ups and downs of the psychic separation work needed by teenagers, particularly for those who went through serious suicide attempts. The presentation of a particularly difficult clinical situation will help us bring context to our subject. The uncompromising posture of this young patient seems to give credence to the hypothesis claiming that the active pursuit of death may be a way to reconnect with an undifferentiated state. In the case of our teenager, everything is going as if his disappearance was the only way to escape from the torments of a separate consciousness, and therefore recover the unconditional love from primary objects through the guise of a fusion fantasy. How can we guide adolescents caught in this narcissistic trap? The therapeutic challenge could be to guide them through the elaboration of the shame attached to their sexual body and of the ambivalent feelings they experience towards their parents. The aim would be to allow them be less dependent on their defensive way to support this deadly quest of symbiotic union with the “primary object”.

Suicidal ideation and suicidal thinking are relevant phenomena to study given their high incidence among university students in higher education, even more so if during the academic period students are affected by a pandemic such as COVID-19. Consequently, this systematic review's objective was to determine the prevalence of suicidal ideation and suicidal thinking in university students during the COVID-19 pandemic and, as a secondary objective, to establish possible risk factors. The search was performed following the PRISMA model in the Web of Science, Scopus, PubMed, and Medline search engines between January 2020 and January 2021, and the Newcastle-Ottawa Scale (NOS) was used to evaluate the methodological quality of the studies. Regarding the results, at the end of the search, nine relevant studies were identified for analysis: four on suicidal thoughts, four on suicidal ideation, and one on suicide as a continuous variable. In conclusion, it was possible to stipulate that the average prevalence of suicidal ideation and suicidal thoughts were 17.8% for the university population. Likewise, the risk factors associated with the appearance of suicidal thoughts and ideation in university students during the COVID-19 pandemic were ethnographic, psychological, contextual, and health factors.

Ces dernières années, le lien entre suicide et orientation sexuelle a été au cœur de préoccupations et de recherches sur les comportements suicidaires. Des études récentes ont mesuré le lien positif existant entre l’appartenance à une minorité sexuelle et les tentatives de suicide ou les idéations suicidaires. Les résultats disponibles en France montrent des effets différenciés selon le genre et l’activité sexuelle. Ils semblent indiquer que l’hypothèse d’un lien entre homophobie et comportement suicidaire est la plus solide pour comprendre cette sursuicidalité. Outre l’appartenance à une minorité sexuelle, la non-conformité de genre expose également à un risque plus élevé. Des pistes pour la prévention sont évoquées.

Since the 1990s, many studies have estimated a higher risk for suicidal behavior among sexual minorities than among heterosexual people. The first results in France confirm those found in the international literature. Homophobia as a risk factor for suicidal behavior is the strongest hypothesis explaining the high suicide attempt prevalence among gay, lesbian and bisexual people. Exclusion, disregard, stigmatization, can produce a loss of self esteem, lower confidence in the future and towards others. Specific prevention strategies have to be implemented or reinforced, especially among young people, to fight scapegoat phenomenon and social exclusion.

Depression is the one of the leading cause of disability for both males and females, the burden of depression is 50% higher for females than males. To evaluate and compare the efficacy of Escitalopram (SSRI) and Amitriptyline (TCA)  in reducing suicidal risk in patients with depression.  Patients attending the OPD of Psychiatry department of MIMS were screened for selection criteria after obtaining written informed consent. After fulfilling the selection criteria, patients were randomized into two groups. Group – 1 were kept on tablet Amitriptyline 50mg /BD for 6 weeks and Group – 2 were on tablet Escitalopram 10 mg/BD for 6 weeks. Total 60 patients who were newly diagnosed with moderate –severe  depression after fulfilling the selection criteria were included in our study. The study duration for each patient entering the study was 6 weeks.  The results shows HAM-D, Pre & post treatment for Group 1 (Amitriptyline group) was significant (<0.001)*. P value of BSIS, Pre & Post treatment for Group 1 (Amitriptyline group) was significant (<0.001). (P< 0.05 is considered as significant). p value of HAM-D before & after treatment for Group 2 (Escitalopram group) was significant (<0.001)*. P value of BSIS before & after treatment for Group 2 (Escitalopram group) was significant (<0.001). Decreased suicidal risk, after treatment of Amitriptyline & Escitalopram (P value significant for both treatment groups). Suicidal behavior correlates with inadequate prescription of antidepressants. In the most antidepressant prescriptions are for female patients and most suicides are committed by male individuals.

Mental health is an important contributor to the well-being of individuals, families and communities. The majority of epidemiological studies on mental health have focused on outcomes of poor mental health, such as the occurrence of violence, rather than assessing the prevalence and correlations of underlying mental health conditions. Increasingly, the importance of underlying mental health issues such as anxiety, depression, suicidal ideation, addictions, interpersonal and social difficulties have been acknowledged. These issues are distributed disproportionately among different populations, highlighting inequities and the importance of targeting mental health research and service resources to particular populations in greatest need. Research studies conducted among these populations help generate policies and service delivery configurations that best meet and are delivered, according to their unique needs.

Mortality data indicates that suicide is the fourth leading cause of death among young males globally. Comprehensive and evidence-based mental health services could contribute to the prevention of many of these deaths. 

Numerous factors have the potential to lead to suicidal ideation in individuals, including stigmatization and social exclusion. Individuals whose behaviors or identities do not conform to India’s socially acceptable norms, including those related to gender roles, sexual behavior, and/or sexual identity, are highly stigmatized and discriminated against. The internalization of frequent experiences of stigma and discrimination may result in depression, anxiety, and other mental health conditions.

Este artigo objetiva uma melhor compreensão da morte a partir do fenômeno do suicídio. O suicídio se apresenta como um analisador desta discussão, pois compreende-se como a fuga, pela morte, a uma aniquilação presente em vida. O artigo se utiliza, principalmente: dos estudos de Karl Menninger (1938/2018) sobre comportamentos autodestrutivos, tais como automutilação e acidentes propositais; da experiência de Elisabeth Kluber-Ross (1969/1981) com pacientes terminais e de suas impressões sobre a lida de pessoas próximas e da equipe médica desses pacientes com o estreitamento da morte; e da análise de Maria Julia Kovács (1992) acerca da morte durante o desenvolvimento humano, bem como das mudanças de significação do corpo morto, no decorrer dos séculos; juntamente com demais autores para complementar a sustentação teórica do artigo. Com eles, argumenta-se que os comportamentos autodestrutivos buscam, muitas vezes, a preservação do sujeito, ao invés de seu total aniquilamento, e que a retirada da morte de seu lugar inacessível na cultura é uma das possíveis formas de evitá-la. A partir disso, conclui-se que a preservação da vida a todo custo promove mais morte do que vida e aniquilamento de subjetividade, que poderia ser considerada uma morte em vida, como nos dirá Kovács (1992). A evitação da morte propõe sua negação e mudez em torno de comportamentos supostamente destrutivos relacionados a ela.

Purpose: Determine the differences between those attempting the suicide for the first time and those having the recurrent suicide attempts. Material & method: The consecutive 144 patients applied to the emergency department with the suicide attempt reason were prospectively evaluated. The patients attempting the suicide in previous years were grouped as the Recurrent Suicide Attempt (RSA) and patients attempting the suicide for the first time were grouped as the First Suicide Attempt (FSA), and their results were analyzed. Results: 144 patients, whose ages were between 18 and 74 years old and age averages were 28.03 ± 9.9/ years, were included in our study. 67% (n ¼ 97) of the patients was female and 32.6% (n ¼ 47) of them was male, and the female/male rate was 2.06. It was determined that the recurrent suicide attempts were more risky as 8.45 fold (p ¼ 0.001, S.E ¼ 0.650, HR: 8.45 (1.361e30.219.9)) in the smokers and 2.66 fold (S.E. ¼ 0.476, p ¼ 0.04, HR ¼ 2.66 (1.047e6.765)) in the alcohol abusers with reference to the logistic regression analysis. Conclusion: There are many risk factors depending on the individual and social environment in the RSA attempts. It was determined in our study that just the smoking and drinking alcohol increased the recurrent suicide attempt risk.