Suicide New 2020

Suicide
By
M. Zubair
Lecturer Kmu
Definition
 Suicide is the act of deliberately taking one’s
own life.
 Suicidal behavior is any deliberate action with
potentially life-threatening consequences,

such as taking a drug over-dose.
Several forms of suicidal behavior
 Suicidal attempt: it involves a serious act, such as
taking a fatal amount of medication, and someone
intervening accidentally. Without the accidental
discovery, the individual would be dead.
 Suicidal gesture: denotes a person undertaking an
unusual, but not fatal behavior as a cry for help or to

get attention.
 Suicide gamble: is for example, to ingest a fatal
amount of drugs with the belief that family members

will be home before death occurs. Patients gamble
their lives that they will be found in time and that
the discoverer will save them.
Components of suicidal ideation
 Intent:
Subjective expectation and desire for a self destructive act to
end in death.
 Lethality:
 Objective danger to life associated with a suicide method or
action. Lethality is distinct from and may not always

coincide with an individual’s expectation of what is
medically dangerous.
 Degree of ambivalence: wish to live, wish to die.
 Intensity, frequency
 Presence or absence of suicide note.
 Deterrents: ( e.g family, religion, positive therapeutic
relationships, positive support system- including work)

Methods of suicide
 The method of suicide can be relatively
nonviolent ( such as poisoning or overdose)
or violent ( such as shooting oneself.
 Males are more likely to choose violent
methods, which probably accounts for the

fact that suicide attempts by males are more
likely to be completed
 Many suicides involves a firearm. This is
especially true in elderly men, in which 80%

of suicides are performed with a gun.
Methods used by those who attempt
suicide in Pakistan.
 The principal mode of choice among those
who attempted suicide was household
poison(40%), pesticides (27%), followed by
hanging (12%), shooting (11%), cutting,
burning and drowning oneself (2%). The
remaining modes used were electrocution, hit
by train, car etc which accounted for 14
percent of attempted suicides.
Incidences
 According to national institute of mental health
suicide is a major, preventable public health
problem. In 2004, it was the eleventh leading cause
of death in U.S, accounting for 32,439 deaths. The
overall rate was 10.9 deaths per 100,000 people.
An estimated 8-25 attempted suicides occur per
every suicide death.
 In 2018, there were 48,344 recorded suicides up
from 42,773 in 2014 in U.S (CDC)
 In U.S the suicide rate increased by 24% between
1999-2014, from 10.5 to 13 suicides per 100,000
people.
Suicide rates in Pakistan
 In Pakistan, suicide rates have alarmingly increased
over the past few years, and a great majority of them
are among the youth of this nation. In 1999, more than
332 death suicide cases were reported; rising to 550 in
the year 2000. this figure jumped four fold in 2001
when 2386 suicidal cases were reported, suggesting
that approximately 6-7 suicides occur everyday in
Pakistan. These figures are the recognized reports from
different sources, yet the number of unreported
suicides is an unknown factor. Hence the actual figures
may be as high as 10 suicides per day, which would
translate to over 3,500 suicides in forthcoming year.
Recent suicide rate in Pakistan
 There are no official statistics on suicide in
Pakistan so far. But
 According to World bank the lowest death rate
was documented in the year 2016 which was

7.28 per 1000 people ( the lowest rate in the
2006-2018.
 Suicide represents approximately 1.2 % of all
deaths.
 According to dawn 15 July 2019; between 15 to
35 people end their lives in Pakistan every day.

And that’s as high as one person every hour.
Ctd..
 According to WHO, in 2012 the estimated
rate of suicide in Pakistan was 7.5 per
100,000 people, in other words around
13000 people killed themselves that year.
 In 2016, the estimate was 2.9 per 100,000.
 But experts say that the number of people
dying is likely somewhere between two

figures, but the truth remains hidden.
Ctd…
 A survey on dawn.com was published in 2018
in which the respondents (5157 responses)
findings were below:
 38% said the personally know someone who
has taken their own life.

 43% said they personally know someone who
has attempted suicide.

 45% said they have thought about suicide but
never acted on it
 9% said they have tried to end their lives.
Risk factors for suicide
 Depression an other mental disorders, or a
substance-abuse disorder ( often in
combination with other mental disorders). More
than 90 percent of people who die by suicide
have these risk factors.
 Stressful life events, in combination with other
risk factors, such as depression. However,

suicide and suicidal behavior are not normal
responses to stress, many people have these
risk factors, but are not suicidal.
 Prior suicide attempts.
Risk factors for suicide
 Family history of mental disorder or substance
abuse
 Family history of suicide
 Family violence, including physical or sexual
abuse
 Firearms in the home, the method used in more
than half of suicides
 Incarceration
 Exposure to the suicidal behavior of others, such
as family members, peer, or media figures.
Women verses man at risk for suicide
Suicide by Males % Female %
Fire arm 57 32
Suffocation 23 20
Poisoning 13 38
Reasons reported for attempting
suicide in Pakistan
 Economic ( poverty, unemployment) 192
(52%)
 Social exclusion 117 (32%)
 Failure in love 40 (11%)
 Police torture 3 (1%)
 Mental disorder 9 (3%)
 Not reported 5 (1%)
symptoms
 Early signs:
 Depression
 statements or expressions of guilt feelings
 Tension or anxiety
 nervousness
 impulsiveness
 Critical signs:
 Sudden change in behavior, especially calmness after a period
of anxiety
 Giving away belongings, attempts to “get one’s affairs in
order”
 Direct or indirect threats to commit suicide
 Direct attempts to commit suicide
Psychiatric symptoms associated with
suicide
 Hopelessness
 Impulsivity
 Anxiety
 Command hallucinations
Causative factors
Theories of
suicide
Psychological Biological Sociological

theory theory theory
Nursing consideration
 Attend to issue of patient’s safety

 Assess treatment plan/setting/alliance.
Somatic treatment modalities

 ECT- used to treat acute suicidal behavior
 Benzodiazepenes: may reduce risk by treating anxiety
 Antidepressants
 Lithium
 Anticonvulsants
 Antipsychotics- recent study on clozapine
 Psychotherapeutic interventions: widely used as helpful for suicidal
patients, evidence is limited

 Provide education to patient and family
 Monitor psychiatric status and response to treatment
 Reassess for safety and suicide risk frequently

Characteristics of a suicide plan
Risk/ rescue issues:
 Method
 Time
 Place
 Available means
 Arranging sequence of events
Components of suicide assessment
 Appreciate the complexity of suicide/ multiple
contributing factors
 Conduct a thorough psychiatric examination,
identifying risk factors and protective factors and

distinguishing risk factors which can be modified
from those which cannot
 Ask directly about suicide; specific suicide inquiry
 Determine level of suicide risk; low, moderate, high
 Determine treatment setting and plan
 Document assessment
What to document in suicide
assessment
Document
 The risk level
 The basis for the risk level
 the treatment plan for reducing the risk
Example:
This 62 years old recently separated man s experiencing
his first episode of major depressive disorder. In spite of
his denial of current suicidal ideation, he is at moderate
risk for suicide, because of his serious suicide attempt
and his continued anxiety and hopelessness. The plan is
to hospitalize the with suicide precautions and
medications, consider ECT. Reassure tomorrow
Treatment
 Emergency measures may be necessary after

a person has attempted suicide. First aid,
CPR, or mouth to mouth breathing may be
required.
 Hospitalization is often needed to treat the
recent actions and to prevent future attempts

 Psychiatric interventions is one of the most
important aspects of treatment

Somatic treatments
ECT Evidence for short term reduction of suicide but not
long term
Benzodiazepene May reduce risk by treating anxiety

s
Antidepressants A mainstay treatment of suicidal patients with
depressive illness/ symptoms. No cunclusive
evidence of suicide reduction
Lithium and Lithium has a demonstrated anti-suicide effects, anti

Anti- convalsants do not
convalsants
Antipsychotics Evidence for clozapine reducing suicidality in
schizophrenia and schizoaffective disorder
Prevention
 Research has shown that mental and substance-
abuse disorders are major risk factors for suicide,
may programs also focus on treating these
disorders
 Studies showed that a type of psychotherapy called
cognitive therapy reduced the rate repeated suicide
attempts by 50% during a year of follow up. A
previous suicide attempt is among the strongest
predictors of subsequent suicide and cognitive
therapy helps suicide attempters consider
alternative actions when thoughts of self harm arise.
Prognosis
 Suicide attempts and threats should always
be taken seriously. About one third of people
who attempt suicide will repeat the attempt
within one year, and about 10% of those who
threaten or attempt suicide eventually do kill
themselves.
 Complications:
Vary depending on the type of suicide attemtp

Message
 A person who threatens or attempts suicide
MUST be evaluated immediately by a mental
health professional. NEVER IGNORE A SUICIDE
THREAT OR ATTPMPT.

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Suicide

potentially life-threatening consequences,

unusual, but not fatal behavior as a cry for help or to

amount of drugs with the belief that family members

action. Lethality is distinct from and may not always

relationships, positive support system- including work)

methods, which probably accounts for the

especially true in elderly men, in which 80%

was documented in the year 2016 which was

35 people end their lives in Pakistan every day.

dying is likely somewhere between two

has taken their own life.

has attempted suicide.

risk factors, such as depression. However,

Suicide by Males % Female %

Psychological Biological Sociological

 Attend to issue of patient’s safety

Somatic treatment modalities

 Benzodiazepenes: may reduce risk by treating anxiety

 Antipsychotics- recent study on clozapine

 Psychotherapeutic interventions: widely used as helpful for suicidal

patients, evidence is limited

 Monitor psychiatric status and response to treatment

 Reassess for safety and suicide risk frequently

identifying risk factors and protective factors and

 the treatment plan for reducing the risk

 Emergency measures may be necessary after

recent actions and to prevent future attempts

important aspects of treatment

Benzodiazepene May reduce risk by treating anxiety

Lithium and Lithium has a demonstrated anti-suicide effects, anti

Vary depending on the type of suicide attemtp

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