A look into the cause and latest status

1. SUICIDE IN MEDICAL
STUDENTS
DR. NOOR AHMED GIASUDDIN, MBBS, M PHIL, MS
ASSTT. PROF AND HOD, DEPARTMENT OF
PSYCHIATRY, FARIDPUR MEDICAL COLLEGE

2. PRESENTATION CONTENTS
• Suicide definition
• Theories of Suicide
• Assessment of Depression / Suicide risk
• Prevention of Suicide

3. DEFINITION OF SUICIDE
• The term suicide is applied to all cases of death
resulting directly or indirectly from a positive or
negative act of the victim himself, which he knows
will produce this result.

4. • Suicide at any age is an act of desperation. It is a negative
answer to the question – to be or not to be. The voluntary
act of taking one’s own life represents a failure in
communication between the individual and his meaningful
object relationships, together with an inability to cope
with the stresses of life.
• Sabbath (1969)

5. WHAT CAUSES MEDICAL
STUDENTS/GENERAL PEOPLE TO
COMMIT SUICIDE?
Theories of suicide

6. SOCIOLOGICAL THEORIES

7. SUICIDE: A STUDY IN SOCIOLOGY
• Durkeim (1897) argued that suicide results from society’s
strength or weakness of control over the individual (i.e., the
key role of social integration).
• In this approach there are basic types of suicide:
1. Egoistic—a lack of integration into society
2. Altruistic—an over-integration with a group
3. Anomic—a sudden change in one’s relation to society
4. Fatalistic—excessive societal regulation that restricts one’s freedom

8. SUICIDE MODELING:
THE “WERTHER EFFECT”

9. OVERVIEW TO THE WERTHER EFFECT
• The origins of the Werther Effect (Phillips, 1974).
• Following the suicide of Marilyn Monroe, Phillips
found a 12% increase in the US national suicide rate
in the month following her death.
• An excess of 303 more suicides than would otherwise
be expected.

10. PSYCHOLOGICAL THEORIES
Sigmund Freud

11. PSYCHOANALYTICALLY-ORIENTED
THEORIES
• Freud (1917) argued that suicide is hostility turned against
the self (i.e., murder in the 180th degree).
• Menninger (1938) theorized about the role of the death
instinct and hostility in relation to:
• The wish to kill
• The wish to be killed
• The wish to die

12. • Adler (1958) viewed suicide as an interpersonal act due to
insufficient social interest (i.e., suicidal people hurt others
by hurting themselves).

13. FAMILY SYSTEMS THEORY
• These theories tend to emphasize the suicidal influences
of a dysfunctional family system (e.g., Sabbath’s notion
of the “expendable child”).
• Wagner’s (1997) theory posits that youthful suicidal
behaviors may be:
• Child-driven
• Parent-driven
• Reciprocal (between parents and child)

14. BEHAVIORAL AND COGNITIVE THEORIES
• Beck’s work emphasized the role of hopelessness as a
significant contribution.
• Rudd, Joiner, and Rajab (2001) emphasizes the interaction of
cognitive, affective, behavioral, and motivational schemas.
• Williams (2001) argues that suicide is a “cry of pain”
• Linehan’s (1993) argues that suicidal behaviors are learned
maladaptive efforts to cope with low distress tolerance and
limited coping resources.

15. CONSTITUENTS OF THE DESIRE FOR DEATH
•Perceived Burdensomeness
•Thwarted Belongingness

16. THWARTED BELONGINGNESS
• The need to belong to valued groups or
relationships is a powerful, fundamental,
and extremely pervasive human
motivation.
• When this need is thwarted, numerous
negative effects on health, adjustment,
and well-being have been documented.

17. THWARTED BELONGINGNESS
• The view taken here is that this need is so powerful
that, when satisfied, it can prevent suicide even
when perceived burdensomeness and the acquired
ability to enact lethal self-injury are in place.
• This perspective is similar to the classic work of
Durkheim (1897), who proposed that suicide results,
in part, from failure of social integration.

18. THWARTED BELONGINGNESS: EMPIRICAL EVIDENCE
•Social isolation is a very strong risk
factor.
• Stirman and Pennebaker’s (2001) study of language
use by poets who died by suicide vs. non-suicidal
poets suggested escalating interpersonal
disconnection as the suicidal poets’ deaths neared.
As the suicidal poets’ deaths approached, their use of
interpersonal pronouns (e.g., “we”) decreased
noticeably.

19. THWARTED BELONGINGNESS: EMPIRICAL EVIDENCE
•Twins die by suicide at lower rates
than others despite having slightly
higher rates of mental disorders.
Tomassini et al. (2003). Risk of suicide in twins: 51 year follow up.
British Medical Journal, 327, 373-374 .

20. THWARTED BELONGINGNESS:
EMPIRICAL EVIDENCE
• It is interesting to consider, then,
whether teams’ success affects
suicidality; from the present
perspective, it might, in that increased
belongingness should be associated
with lower suicidality.

21. NEUROSCIENCE THEORIES

22. SEROTONIN THEORY
• Many post-mortem studies have been
done on the brains of suicide victims
(e.g., Asberg, 1990).
• Measured: Post-synaptic serotonin 5-HT
& metabolite 5-HIAA.
• Findings: Decreases in CSF serotonin is
associated with suicide, homicide, and
violent behavior.

23. THE IMPORTANCE OF THE PREFRONTAL CORTEX
• Mann (1998) posits that ventral
pre-frontal cortex is centrally
implicated in suicidal behaviors.
• Mann has further proposed a
stress-diathesis model for
suicide.

24. GENETIC WORK
• Brent, Johnson, and Connolly’s (1996) controlled
family studies of adolescent suicide underscored
possible role of family transmission.
• Joiner, Johnson, and Soderstrom (2002) examined the
potential role of variations in the serotonin
transporter gene in relation to suicidal behaviors.

25. Suicidal Theories: Conclusions?

26. HOW CAN WE CONTRIBUTE TO
PREVENTION?

27. • Part I: Suicide Risk Assessment
• Part II: Depression Risk Assessment

28. PART I: SUICIDE RISK QUESTIONNAIRE
Have you heard someone say:
Life isn't worth living
My family would be better off without me
Next time I'll take enough pills to do the job right
Take my (prized collection, valuables) - I don't need this
stuff anymore
I won't be around to deal with that
You'll be sorry when I'm gone
I won't be in your way much longer
I just can't deal with everything -- life's too hard
Nobody understands me -- nobody feels the way I do
There's nothing I can do to make it better
I'd be better off dead
I feel like there is no way out

29. Have you observed:
Getting affairs in order (paying off debts, changing a will)
Giving away articles of either personal or monetary value
Signs of planning a suicide such as obtaining a weapon or
writing a suicide note

30. PART II: DEPRESSION RISK QUESTIONNAIRE
Have you noticed the following signs of depression:
Depressed mood
Change in sleeping patterns (too much/little, disturbances)
Change in weight or appetite
Speaking and/or moving with unusual speed or slowness
Loss of interest or pleasure in usual activities
Withdrawal from family and friends
Fatigue or loss of energy
Diminished ability to think or concentrate,
slowed thinking or indecisiveness
Feelings of worthlessness, self-reproach, or guilt
Thoughts of death, suicide, or wishes to be dead

31. If depression seems possible, have you also
noticed:
Extreme anxiety, agitation,
irritability or risky behavior
Racing thoughts, excessive energy,
reduced need for sleep
Excessive drug and/or alcohol use or abuse
Neglect of physical health
Feelings of hopelessness

32. ANY EASY SOLUTION?

33. 33
The Army Suicide Prevention Model
.
• Emphasize Suicide Awareness and Vigilance
• Integrate/synchronize Unit and
Community-wide Support Agencies
• Ensure Problem Resolution
• Identify High Risk Soldiers
• Encourage Caring and Proactive Leaders
• Encourage Help-seeking Behaviors
• Enable Positive Life Coping Skills
• Safeguard Soldiers
• Provide Psychiatric Treatment
• Provide Psychiatric Assessment

34. 34
The Suicide Prevention Model
.
• Emphasize Suicide Awareness and Vigilance
• Integrate/synchronize small groups and
Community-wide Support Agencies
• Ensure Problem Resolution
• Identify High Risk Students
• Encourage Caring and Proactive Leaders
• Encourage Help-seeking Behaviors
• Enable Positive Life Coping Skills
• Safeguard Students
• Provide Psychiatric Treatment
• Provide Psychiatric Assessment

35. THANK YOU
Now it is our time to turn the learning into
action