The lecture has been given on Feb. 8th, 2011 by Dr. Nazar M. Mohammad Amin.

1. Suicide 1

2. Suicide According to Cambridge dictionary “ The act of killing yourself intentionally.” “Any act which has the effect of causing your own defeat.” Wikepedia: Suicide (Latinsuicidium, from sui caedere, "to kill oneself") is the act of a human being intentionally causing his or her own death. a fatal act of self-injury (self-harm) undertaken with more or less conscious self-destructive intent, however vague and ambiguous. 2

3. suicide Suicides are generally under reported therefore the statistics do not reflect actual numbers. However, it is rare for non suicidal deaths to be misclassified as suicide. Most misclassified suicides fall into the category of undetermined deaths and are more like suicides than accidents. 3

4. Suicide Methods of suicide Overdose of drugs Paracetamol, sedatives etc… Poisoning CO, rat poisons Burn, self immolation Gun shot Drowning Electrocution Jumping from height Cutting the wrist or neck vein hanging 4

5. 2/8/2011 5 SuicideEpidemiology In about half of all suicides a previous attempt is found in the person's history, which offers, in theory, an opportunity for suicide intervention wherever suicide attempts occur. A precipitating factor may well be decisive in explaining the precise timing of suicide in the long course of a person's suicide process.

6. 2/8/2011 6 SuicideEpidemiology Imitation means learning the use of a specific suicide method from a model which is overtly available in a culture, community, institution, or mass media. The risk of imitation emerges if an emotionally loaded suicide model is presented in detail on television. Imitation may have a significant effect on the choice of a suicide method, especially at schools, in psychiatric hospital wards, and in the general population of young people.

7. 2/8/2011 7 SuicideEpidemiology Every year more than one million people commit suicide, accounting for 1 to 2 per cent of total global mortality. According to World Health Organization (WHO) statistics, globally 1 per 6000 persons commits suicide every year. Everywhere, the male suicide rate is two to four times higher than the female rate; China is the only exception with a very high female suicide rate. The suicide rate of elderly people has been higher than in the younger age groups almost universally. during the past 20 to 30 years the suicide rate has been rising in many Western countries and Japan , especially among young males.

8. 2/8/2011 8 SuicideEpidemiology Sociodemographic variables that makes people at risk of suicide: Male, low socioeconomic status, unmarried, divorced, widowed, separated, living alone, unemployed, poor social support and low social integration. Adverse life events, spring and autumn season of the year.

9. 2/8/2011 9 SuicideEpidemiology Clinical determinants of suicide Include past history of suicidal attempts, presence of any mental disorder and family history of suicide and mental disorder, symptoms of helplessness, hopelessness and worthlessness, poor physical health including terminal illness and availability of suicidal method.

10. 2/8/2011 10 SuicideEpidemiology In the older age groups repeated attempts appeared to be predictive for suicide in women and severe attempts predictive in men. BMC Psychiatry 2009, 9:62 Repetition and severity of suicide attempts across the life cycle: a comparison by age group between suicide victims and controls with severe depression

11. 2/8/2011 11 SuicideEpidemiology There is a pronounced difference between genders after adulthood (age 15 and up). The mortality rate is higher in females. Most of the burns occurred in the home: a public health education campaign might help reduce the incidence of these injuries. Epidemiology of burns at the Italian Red Cross Hospital in Baghdad L. Carini a, F.R. Grippaudo b,*, A. Bartolini c Burns 31 (2005) 687–691

12. 2/8/2011 12 SuicideEpidemiology Age patterns of suicide by burning suggest that psychotic and/or substance-related disorders may be present in a substantial proportion of victims. General Hospital PsychiatryVolume 29, Issue 3, May-June 2007, Pages 244-250 findings did confirm that suicide exists as a serious problem in the society in Kurdistan, particularly among females. Vian Nissan Hanna a; Abdulbaghi Ahmad bc(2008)'

13. 2/8/2011 13 Suicide psychoneurobiology of suicide Psychoanalysis believe it is an introjection of anger, familial occurrence of suicide indicates a genetic transmission and there low levels of 5HIAA which is a 5HT metabolite in the CSF of the patients.

14. 2/8/2011 14 Mental disorders and suicide Virtually all mental disorders carry an increased risk of suicide, except for mental retardation and dementia. In five studies conducted about suicide, depressive disorders and substance use disorders were frequent and comorbidity was common. Alcohol and drugs, often combined, are a major risk or a precipitating factor for suicide.

15. 2/8/2011 15 Attempted suicide and deliberate self-harm Is a condition in which the patient deliberately inflict harm upon him or herself without a fatal outcome. It is thought that the great majority of those patients do not actually try to kill themselves. Non-fatal suicidal behaviours can have very different motivations, varying from an intention to die to a cry for help

16. 2/8/2011 16 Attempted suicide and deliberate self-harm Attempted suicide is more common in young females. People attempting suicide without fatal outcome indicate that their future is hopeless, but they still seem to have a faint hope, however ambiguous this may be, that the future might improve.

17. 2/8/2011 17 Attempted suicide and deliberate self-harm Repetition is one of the core characteristics of suicidal behaviour. Among those who commit suicide up to 40 per cent attempted before. Among suicide attempters ‘repeaters' are probably commoner than ‘first-evers'. Between 30 and 60 per cent of suicide attempters made previous attempts, and between 15 and 25 per cent did so within the last year. Prospectively, suicide attempters have a high risk of committing suicide. Between 10 and 15 per cent eventually die because of suicide.

18. 2/8/2011 18 Attempted suicide and deliberate self-harm The same risk factors apply for attempted suicide mainly stressful life events such as broken homes and family violence, especially physical and mental maltreatment by partners.

19. 2/8/2011 19 Literature on suicide BMJ VOLUME 325 13 JULY 2002 bmj.com Recognising mental illness in young people and dealing with it appropriately could help prevent suicides. BMJ VOLUME 326 10 MAY 2003 bmj.comChanges in suicide rates and exposure to antidepressants in Australia for 1991-2000 are significantly associated. This effect is most apparent in older age groups, in which rates of suicide decreased substantially in association with exposure to antidepressants.

20. 2/8/2011 20 Literature on suicide Suicide in the Kurdistan Region of Iraq, state of the art Nord J Psychiatry 2005;59:000. Oslo. ISSN 0803-9488. Because of insufficient documentation and lack of systematic registration, the data on suicide were scattered and difficult to evaluate. However, the findings did confirm that suicide exists as a serious problem in the society in Kurdistan, particularly among females. Urgent attention is demanded from the responsible authorities and organizations concerned in the region.

21. 2/8/2011 21 Literature on suicide Suicide attempts by burning accounted for 231 (24.8%) of all burn patients admitted to hospital. Suicidal burns occurred predominantly in the age group 15 to 24 years (49.1%). Most (71.4%) self-burning cases were female. Self-inflicted burn injuries in southwest Iran. Mohammadi AA, Danesh N, Sabet B, Amini M, Jalaeian H. J Burn Care Res. 2008 Sep-Oct;29(5):778-83.

22. 2/8/2011 22 Literature on suicide Suicide, by burning oneself, is very rare in the western world, but more frequent in the eastern world, especially in India, where it is also linked to religious traditions [3,4]. In 1982, the method most often used to commit suicide in Delhi was burn injury. Thirty-nine point eight percent of all suicides were achieved by self-immolation and 80% of these were committed by women, who were mostly married and aged between 15 and 24 [5]. G. Ca6e Bondi et al. : Burns 27 (2001) 227–231

23. 2/8/2011 23 Suicide pact Mass suicide

24. Management of suicide Diagnosis Risk assessment Finding causes and precipitating factors Treatment of medical disorders. Psychotherapy Treatment of co morbid disorders Follow up after discharge. 24