Suicide 2.0 by Aashray
Suicide 2.0 by Aashray
Suicide 2.0 by Aashray
A AMONGST YOUTH
DR. P PODDAR
PROJECT GUIDE
ACKNOWLEDGEMENT
OBJECTIVES
OBJECTIVES
RESEARCH METHODOLOGY
Secondary data refers to data which is collected by someone who is someone other
than the user. Secondary data analysis can save time that would otherwise be spent
collecting data and particularly in the case of quantitative data.
We begin with some basic facts about suicide, to set the stage for our later
analysis. While some of the facts are well known, others are not. 1. Since 1950,
suicide has tripled among youths and fallen among older adults and the
elderly. Figure 1, noted above, shows the change in suicide rates by age from
1950 to 1990. Suicide rates for youths tripled between 1950 and 1990, rising
from 4.5 per 100,000 to 13.8 per 100,000. In contrast, suicide among adults
has fallen by 10 percent and suicide among the elderly has fallen by half. To
highlight the differing trends by age, Figure 2 shows suicide rates by age at
decadal intervals over the 20th century. Suicide rates first peaked about 1910.
Suicide rates for adults and particularly the elderly rose again in the Great
Depression and have fallen substantially since then. Total suicide rates in 1997
are the same as they were in 1950. Suicide rates for youth, in contrast,
declined by 2.5 percent per year from their peak in 1908 through their trough
in 1955, and since then have risen by 2.4 percent per year. There is an increase
in youth suicide rate for every single year of age, as shown in Figure 3.
Between 1970 and 1980, the percentage increase was roughly the same for all
ages. Since 1980, suicide rates increased most rapidly among teenagers aged
15-19. One possible explanation for the rise in teen suicides is that teen deaths
might have been coded as accidents in previous years. While this is certainly
true to some extent, it does not change our findings materially. Figure 4 shows
the suicide rate, the gun accidental death rate, and the combined suicide and
gun accident rate for youths over time. Unfortunately, we cannot include
motor vehicle fatalities since motor vehicle deaths change for so many other
reasons over time (such as changes in car safety and legal driving speeds). The
gun accident rate declined over 8 time, but by nowhere near as much as the
suicide rate increased. Thus, the rise in suicide and gun accident deaths mirrors
the rise in suicide alone. The fact that suicide rates trend differently for young
adults, older adults, and the elderly suggests that different factors may be at
work for the three groups in the population. This is true cross-sectionally as
well. The correlation across states between youth and adult (elderly) suicide
rates is only .46 (.49), while the correlation between adult and elderly suicide
rates is .89. 2. Suicide is the third leading cause of death among youths. US
Vital Statistics records indicate that the annual suicide rate for youths (15-24)
is about 13 per 100,000, or .01 percent per year. Over the course of 10 years,
therefore, about .1 percent of youths will commit suicide. The leading cause of
death for youths is accidents (an annual rate of 38.5 per 100,000 in 1995),
followed by homicide (an annual rate of 20.3 per 100,000). 3. There are about
200 to 400 suicide attempts among youths for every completed suicide. There
are no national surveillance figures in the United States for suicide attempts;
estimates therefore come from a few national surveys, and from local
surveillance. As with suicide deaths, there is ambiguity in measuring suicide
attempts. There is wide variation in the lethality of intent; thus, the definition
of a “suicide attempt” varies considerably from one study to another. The term
“parasuicide” is sometimes used to refer to self-injury with low likelihood of
lethal outcome (for example, superficial cutting, minor overdoses), and
“deliberate self-harm” is sometimes used to refer collectively to self-injuries
across the full spectrum of lethality of intent. Our data on suicide attempts
come from the Adolescent Health Survey (AddHealth). Suicide attempts in
AddHealth (described in more detail below) are based on self-reports, and
leave the definition of “suicide attempt” open to the responding interviewee.
Table 1 shows data from AddHealth on suicide thoughts and attempts and
from Vital Statistics on successful suicides. About 14 percent of youths report
thinking of suicide in the past year, and 4 percent report attempting suicide.
About 1 percent of youths reported being seen medically for a suicide 9
attempt. Other data from the National Hospital Discharge Survey indicate that
about 0.2 percent of youths are hospitalized for self-injury each year. As shown
in the last column, these numbers are substantially greater than the fatal
suicide rate. There are about 300 self-reported suicide attempts, about 100
“medically seen” suicide attempts, and about 16 medically hospitalized suicide
attempts for every completed suicide. These numbers in themselves suggest
that not all teen suicide attempts are truly youths who wish to die. Many
youths may instead be engaged in ‘strategic’ suicide attempts – suicide
attempts of varying severity, designed to get attention, to punish parents or
other role models for perceived mistreatment, or to embarrass parents or
other family members. Indeed, common sense suggests that succeeding at
suicide is not all that difficult. After all, either tall buildings or rope are often
available, half of all households own a gun, and medications such as aspirin or
acetomenophen are even easier to find, and less frightening to use. As such,
unsuccessful attempts must usually be thought of as actions which are, for the
most part, designed to elicit a response other than one’s own death. Successful
attempts, on the contrary, most probably reflect a desire to actually end one’s
life. As such, we will discuss the theories of successful suicides and suicide
attempts separately. 4. Girls attempt suicide more often than boys; boys
commit suicide more often than girls. Table 1 shows suicide rates for various
demographic groups. The rate of suicide attempts is twice as high for girls as
for boys, but the rate of successful suicides is 6 times higher for boys than for
girls. Differences in suicide rates are evident throughout the life cycle. Figure 5
shows suicide rates by age and gender. Male suicide rates are roughly 3 times
female rates for adults, before increasing dramatically after age 65. Female
rates, in contrast, have a relative peak in late middle-age. 5. Suicide attempts
decrease with age after adolescence. Table 2 shows suicide attempts by single
year of age for youths (from AddHealth) and adults (from Crosby et al., 1999).3
The peak age for suicide attempts is 15; attempt rates for 18 year- 3 These
data are from a recent telephone survey of a nationally representative sample
of adults. 10 olds are 15 percent below the rate for 15 year-olds.4 Suicidal
thoughts decline in frequency from middle adolescence into adulthood and
older years. 6. Rates of suicide and homicide are positively correlated in the
national data. Figure 6 shows suicide and homicide rates over time. There is a
clear positive correlation between the two. Both rates rose substantially from
1910 through 1930 and then fell through 1960. In both cases, rates rose again
through 1975. Total suicide rates began to fall again in the mid-1980’s, while
homicide rates fell in the early 1980s, rose in the late 80’s and early 90’s, and
then have again fallen since 1994. The association between suicide and
homicide is even stronger for youths, as shown in Figure 7. Both rates rose
from 1910 through 1933, fell over the next 20 to 30 years, and then began a
prolonged increase, with a recent fall in both beginning in 1994. 7. Rural,
western states have the highest youth suicide rates and the fastest rate of
increase. Figure 8 shows the geographic dispersion in youth suicide rates in
1950 and 1990. Table 3 shows the states with the highest and lowest suicide
rates. Because Alaska and Hawaii were not states in 1950, they are not
included in the figure. Suicide rates in 1990 are above those in 1950 for all
states. But there is substantial dispersion in changes in suicide rates over time.
In 1950, suicide rates averaged 4.6 per 100,000, with a standard deviation of
2.0 (1.3 without Nevada). In 1990, the average rate was 15.3 with a standard
deviation of 5.4. Most surprisingly, suicide rates in 1990 are highest in rural,
Mountain states and lowest in urban, Northeastern and Mid-Atlantic states.
The highest suicide rates in 1990 are in Alaska, Wyoming, Montana, New
Mexico, and South Dakota. This pattern became particularly pronounced
between 1950 and 1990. Montana, New Mexico, and Wyoming were high in
1950, but not as far above average; South Dakota was actually below average.
These states replaced states that were relatively rural in 1950 but became
more urban over the time period: California, Utah, and Arizona. 4 A peak at
around age 15 is also found for suicide attempts among girls in Oregon. 11 The
states with the lowest suicide rates also changed. In 1950, the lowest suicide
rates were generally in Southern states (Alabama, Tennessee, Mississippi, and
Arkansas). By 1990, the lowest suicide states were the District of Columbia,
New Jersey, Delaware, Massachusetts, and New York. The high rate of suicide
in Mountain states does not appear to result from coding differences between
accidents and suicides. The correlation between teen suicide rates and teen
accidental death rates in 1990 is .50. 8. Blacks attempt and complete fewer
suicides than whites. Table 1 shows racial differences in suicide attempts and
completions. Blacks attempt suicide about one-quarter less frequently than do
whites, and complete suicides about one-third less. The lower rate of suicide
for blacks than whites suggests that youth suicides are not just a result of poor
economic prospects. By any measure, whites have much greater economic
prospects than do blacks. This ethnic difference also argues against some
family composition explanations, such as the hypothesis that the lack of a
father in the household leads to more youth suicides. However, during the
1980's, suicide rates increased most rapidly among young black males, so some
changing factors are clearly important in this relationship. 9. Economic
differences are moderately correlated with suicide rates. The last rows of Table
1 show suicide thoughts and completions in urban and rural areas, and
between richer and poorer families.5 Suicidal thoughts are moderately higher
in urban areas, although suicide rates are higher in rural areas. Youths in
poorer families are more likely to attempt and complete suicide than youths in
richer families. These economic differences are not overwhelmingly large; the
difference between rich and poor areas, for example, is much smaller than the
difference in suicide between blacks and whites, and between boys and girls. 5
In the last rows, the suicide rate is based on whether the county had median
income above or below average. 12 10. Teen suicide is primarily accomplished
with guns. Table 4 shows the methods that youths use to commit suicides in
1950 and 1990. In both years, the overwhelmingly large share of deaths results
from guns. Guns were 50 percent of deaths in 1950 and 64 percent in 1990.
Hanging is second most important in 1990, followed by poison. Suicide rates by
all methods except poison have increased over time. The increase is
particularly pronounced for gun deaths. The predominance of guns in teen
suicides and the association between rural, mountainous states and suicide
initially inclines one towards a means theory of higher suicide rates: the
availability of guns has increased youth suicides. The cross-state evidence
suggests otherwise, however: if anything, we would expect that guns were
relatively more available in rural, mountainous states in 1950 than in 1990. In
contrast to successful suicides, suicide attempts almost never use guns. Poison
is used in over 80 percent of suicide attempts (for example, drug overdoses).
CHAPTER 5
RESULTS
Learning that a loved one has died by suicide can absolutely be traumatic. In
addition to all the feelings that anyone would feel about the death of a loved one,
when the death is a suicide, there are additional feelings like:
Anger or resentment at the person who chose to take his or her own life
Confusion
Distress over unresolved issues (many of which often exist in families where
one person has a mental illness, which is common in people who die by
suicide)
Screening
The U.S. Surgeon General has suggested that screening to detect those
at risk of suicide may be one of the most effective means of preventing
suicide in children and adolescents. There are various screening tools in
the form of self-report questionnaires to help identify those at risk such
as the Beck Hopelessness Scale and Is Path Warm?. A number of these
self-report questionnaires have been tested and found to be effective for
use among adolescents and young adults.] There is however a high rate
of false-positive identification and those deemed to be at risk should
ideally have a follow-up clinical interview The predictive quality of these
screening questionnaires has not been conclusively validated so it is not
possible to determine if those identified at risk of suicide will actually
commit suicide Asking about or screening for suicide does not create or
increase the risk.
In approximately 75 percent of completed suicides, the individuals had
seen a physician within the year before their death, including 45 to 66
percent within the prior month. Approximately 33 to 41 percent of those
who completed suicide had contact with mental health services in the
prior year, including 20 percent within the prior month. These studies
suggest an increased need for effective screening. Many suicide risk
assessment measures are not sufficiently validated, and do not include
all three core sociality attributes (i.e., suicidal affect, behaviour, and
cognition). A study published by the University of New South Wales has
concluded that asking about suicidal thoughts cannot be used as a
reliable predictor of suicide risk.
Underlying condition
The conservative estimate is that 10% of individuals with psychiatric
disorders may have an undiagnosed medical condition causing their
symptoms,] upwards of 50% may have an undiagnosed medical
condition which if not causing is exacerbating their psychiatric
symptoms Illegal drugs and prescribed medications may also produce
psychiatric symptoms Effective diagnosis and if necessary medical
testing which may include neuroimaging to diagnose and treat any such
medical conditions or medication side effects may reduce the risk of
suicidal ideation as a result of psychiatric symptoms, most often
including depression, which are present in up to 90–95% of cases.
Interventions
A photo illustration produced by the Defense Media Agency on suicide
prevention
Many methods have been developed in an effort to prevent suicide. The
general methods include: direct talks, screening for risks, lethal means
reduction and social intervention. The medication lithium may be useful
in certain situations to reduce the risk of suicide. Talk therapiesincluding
phone delivery of services may also help.
Direct talks
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