Suicide and trauma

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Suicide and trauma is the increased risk of suicide that is caused by psychological trauma.

Contents

Suicide

The National Institute of Mental Health defines suicide as a self-inflicted act of violence with the intention of death that leads to the actual death of oneself. [1] Although rates of suicide vary worldwide, suicide ranks as the tenth leading cause of death in the United States with rates increasing on average by one to two percent per year between 1999 and 2018, with the later years within that time span increasing at the greater rate. [2] [3] [4] In 2017, the United States alone accounted for 2,813,503 deaths by suicide. [4] Existing research has identified risk factors for suicide and the impacts of a suicide by a close other on a surviving individual.

Risk factors

Suicide research has commonly identified psychiatric disorders, particularly depression, as major risk factors for suicide. [5] [6] A systematic review found that more severe cases of depression and high levels of hopelessness indicate greater risk for suicide. [6] Other factors identified with increased suicide risk include being of the male gender, having a family history of mental illness and/or suicide, having previously attempted suicide and/or engaged in self-harming behaviors, having co-morbid mental disorders, having been recently released from inpatient care for mental health, and being in the period just prior to beginning and/or just following initiation of antidepressant treatment or psychotherapy. [2] [7] Employment status, physical illness, major life events, recent exposure to suicidal acts, and access to means are also known factors to generally increase the risk for suicide. [2] [8] [9]

Methods

Despite the variation in suicide methods used across countries and between cultures, common methods identified include the use of firearms, poison by drugs, poison by pesticides, jumping from heights, hanging, and suffocation. [10] [4] Prevalence of pesticide suicide has been shown to be higher in Asian countries, whereas suicide by firearms is more prevalent in the United States and some European countries where ownership of firearms is common within the home. [10]

Impact on families

Research has given particular consideration to the impacts of suicide within a family, whether by spouse, parent, or child. [11] However, most studies have not examined the quality of the relationships within the family or the effect of different family members’ reactions on the others. [11]

Suicide by a spouse has been associated with greater risk for mental illness, including depression, PTSD, and engagement in self-harming behaviors. [12] Spousal suicide has also been associated with adverse changes in physical health and social functioning, mortality, increased risk of suicide, and increased utilization of mental health services. [12] [13]

Changes in family dynamics and functioning has been reported in the context of suicide by a child, which researchers note may affect relationships and bonding with surviving children within a family. [14] More extreme types of family functioning with regard to cohesion and adaptability were associated with greater susceptibility to stress related to the death of a child such as the anniversary of one's birth and death and decisions regarding one's belongings. [14] Many families must also navigate other stressors such as addressing the needs of surviving children and family members, which researchers assert can place the family at risk for additional health implications. [14] Increases in utilization of mental health services and risk of suicide in parents has also been linked to experiencing suicide of a child. [13]

Studies have also shown the experience of a suicide or suicide attempt within a family is associated with greater engagement in risky behaviors in adolescents such as substance use, self-harm, and one's own suicidal ideation and attempts, and higher rates of depression in suicide-bereaved children relative to their non-suicide-bereaved counterparts. [15] [16] [17] Children of parents who have attempted suicide are at six times greater risk of attempting themselves. [18] Although most suicides and suicidal behaviors within the family occur in the context of mood disorders transmitted within the family, mood disorders do not account for the totality of this phenomenon. [18] Studies show increased risk of suicide and suicidal behaviors remain evident, despite familial transmission of mental illness. [18]

Implications

Exposure to suicide increases risk for mental illness and subsequent suicides. [11] Prevention efforts have focused on identifying at-risk groups. [5] [2] Suicide researchers have suggested providers monitor individuals' impulsivity, hopelessness, and access to means to increase prevention of suicidal acts. [10] [5] Detection and management of mental illness has also been suggested to be an effective method aimed at reducing rates of suicide. [5] In the context of exposure to suicide within a family, researchers have suggested providers aim to improve family functioning and responsiveness to suicide-related stressors and advocate for families’ mental health care and access to other services when indicated. [14]

Trauma

Psychological trauma often occurs when an individual faces an extensive degree of stress in which they are unable to cope with, resulting in difficulties processing and integrating the stressful event. [19] Definitions of trauma have been extended over the past few decades to include a wider range of traumatic experiences, including the sudden or unexpected death of a close other (e.g. suicide). [20] More recent definitions of trauma have also evolved such that greater emphasis is placed on the individual's perceptions of the traumatic event as opposed to its objective features, giving rise to the notion that similar events can lead to grossly different outcomes across individuals. [20] Despite high rates of exposure to trauma, only a small percentage of those exposed go on to develop clinically significant symptoms of post-traumatic stress disorder, achieving criteria for a full diagnosis. [20] However, studies have demonstrated a connection between exposure to traumatic events and negative mental health outcomes, including depression, anxiety, substance use, and other externalizing disorders. [21]

Repercussions

While the act of suicide itself is often an independent act, suicide has the ability to affect broader social networks such as family, friends, and the community and can be experienced as traumatic. [22] [11] Exposure to violent deaths, such as suicide, have been associated with grief and trauma, and traumatic events as such may create a greater risk for the development of post-traumatic stress disorder. [14] [23] Consideration has also been given to the impact of client suicide on providers such as mental health professionals. [24] A review of 57 studies revealed that the nature of the relationship between the departed and the surviving individual or individuals is associated with the adverse outcomes in the latter's mental and social health. [13]

See also

Related Research Articles

<span class="mw-page-title-main">Causes of mental disorders</span> Etiology of psychopathology

A mental disorder is an impairment of the mind disrupting normal thinking, feeling, mood, behavior, or social interactions, and accompanied by significant distress or dysfunction. The causes of mental disorders are very complex and vary depending on the particular disorder and the individual. Although the causes of most mental disorders are not fully understood, researchers have identified a variety of biological, psychological, and environmental factors that can contribute to the development or progression of mental disorders. Most mental disorders result in a combination of several different factors rather than just a single factor.

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event and can include triggers such as misophonia. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

<span class="mw-page-title-main">Physical abuse</span> Medical condition

Physical abuse is any intentional act causing injury or trauma to another person or animal by way of bodily contact. In most cases, children are the victims of physical abuse, but adults can also be victims, as in cases of domestic violence or workplace aggression. Alternative terms sometimes used include physical assault or physical violence, and may also include sexual abuse. Physical abuse may involve more than one abuser, and more than one victim.

Psychological trauma is an emotional response caused by severe distressing events, such as bodily injury, sexual violence, or other threats to the life of the subject or their loved ones; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples of distressing events include violence, rape, or a terrorist attack.

Adjustment disorder is a maladaptive response to a psychosocial stressor. It is classified as a mental disorder. The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual, causing marked distress, preoccupation with the stressor and its consequences, and functional impairment.

<span class="mw-page-title-main">Suicidal ideation</span> Thoughts, ideas, or ruminations about the possibility of ending ones life

Suicidal ideation, or suicidal thoughts, is the thought process of having ideas, or ruminations about the possibility of completing suicide. It is not a diagnosis but is a symptom of some mental disorders, use of certain psychoactive drugs, and can also occur in response to adverse life circumstances without the presence of a mental disorder.

A major depressive episode (MDE) is a period characterized by symptoms of major depressive disorder. Those affected primarily exhibit a depressive mood for at least two weeks or more, and a loss of interest or pleasure in everyday activities. Other symptoms can include feelings of emptiness, hopelessness, anxiety, worthlessness, guilt, irritability, changes in appetite, difficulties in concentration, difficulties remembering details, making decisions, and thoughts of suicide. Insomnia or hypersomnia and aches, pains, or digestive problems that are resistant to treatment may also be present.

Sex is correlated with the prevalence of certain mental disorders, including depression, anxiety and somatic complaints. For example, women are more likely to be diagnosed with major depression, while men are more likely to be diagnosed with substance abuse and antisocial personality disorder. There are no marked gender differences in the diagnosis rates of disorders like schizophrenia and bipolar disorder. Men are at risk to suffer from post-traumatic stress disorder (PTSD) due to past violent experiences such as accidents, wars and witnessing death, and women are diagnosed with PTSD at higher rates due to experiences with sexual assault, rape and child sexual abuse. Nonbinary or genderqueer identification describes people who do not identify as either male or female. People who identify as nonbinary or gender queer show increased risk for depression, anxiety and post-traumatic stress disorder. People who identify as transgender demonstrate increased risk for depression, anxiety, and post-traumatic stress disorder.

Suicide risk assessment is a process of estimating the likelihood for a person to attempt or die by suicide. The goal of a thorough risk assessment is to learn about the circumstances of an individual person with regard to suicide, including warning signs, risk factors, and protective factors. Risk for suicide is re-evaluated throughout the course of care to assess the patient's response to personal situational changes and clinical interventions. Accurate and defensible risk assessment requires a clinician to integrate a clinical judgment with the latest evidence-based practice, although accurate prediction of low base rate events, such as suicide, is inherently difficult and prone to false positives.

Childhood trauma is often described as serious adverse childhood experiences. Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse. They may also witness abuse of a sibling or parent, or have a mentally ill parent. These events can have profound psychological, physiological, and sociological impacts leading to lasting negative effects on health and well-being. These events may include antisocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Additionally, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.

As defined by the United States Department of Veterans Affairs, military sexual trauma (MST) are experiences of sexual assault, or repeated threatening sexual harassment that occurred while a person was in the United States Armed Forces.

Youth suicide is when a young person, generally categorized as someone below the legal age of majority, deliberately ends their own life. Rates of youth suicide and attempted youth suicide in Western societies and elsewhere are high. Female youth are more likely to attempt suicide than male youth but less likely to die from their attempt. For example, in Australia, suicide is second only to motor vehicle accidents as its leading cause of death for adolescents and young adults aged 15 to 25.

<span class="mw-page-title-main">Suicide</span> Intentional act of causing ones own death

Suicide is the act of intentionally causing one's own death. Mental disorders, physical disorders, and substance abuse are common risk factors.

<span class="mw-page-title-main">Depression in childhood and adolescence</span> Pediatric depressive disorders

Major depressive disorder, often simply referred to as depression, is a mental disorder characterized by prolonged unhappiness or irritability. It is accompanied by a constellation of somatic and cognitive signs and symptoms such as fatigue, apathy, sleep problems, loss of appetite, loss of engagement, low self-regard/worthlessness, difficulty concentrating or indecisiveness, or recurrent thoughts of death or suicide.

Childbirth-related post-traumatic stress disorder is a psychological disorder that can develop in women who have recently given birth. This disorder can also affect men or partners who have observed a difficult birth. Its symptoms are not distinct from post-traumatic stress disorder (PTSD). It may also be called post-traumatic stress disorder following childbirth (PTSD-FC).

<span class="mw-page-title-main">Prolonged grief disorder</span> Medical condition

Prolonged grief disorder (PGD), also known as complicated grief (CG), traumatic grief (TG) and persistent complex bereavement disorder (PCBD) in the DSM-5, is a mental disorder consisting of a distinct set of symptoms following the death of a family member or close friend. People with PGD are preoccupied by grief and feelings of loss to the point of clinically significant distress and impairment, which can manifest in a variety of symptoms including depression, emotional pain, emotional numbness, loneliness, identity disturbance and difficulty in managing interpersonal relationships. Difficulty accepting the loss is also common, which can present as rumination about the death, a strong desire for reunion with the departed, or disbelief that the death occurred. PGD is estimated to be experienced by about 10 percent of bereaved survivors, although rates vary substantially depending on populations sampled and definitions used.

<span class="mw-page-title-main">Effects of climate change on mental health</span>

The effects of climate change on mental health and wellbeing are being documented as the consequences of climate change become more tangible and impactful. This is especially the case for vulnerable populations and those with pre-existing serious mental illness. There are three broad pathways by which these effects can take place: directly, indirectly or via awareness. The direct pathway includes stress-related conditions caused by exposure to extreme weather events. These include post-traumatic stress disorder (PTSD). Scientific studies have linked mental health to several climate-related exposures. These include heat, humidity, rainfall, drought, wildfires and floods. The indirect pathway can be disruption to economic and social activities. An example is when an area of farmland is less able to produce food. The third pathway can be of mere awareness of the climate change threat, even by individuals who are not otherwise affected by it. This especially manifests in the form of anxiety over the quality of life for future generations.

In colleges and universities in the United States, suicide is one of the most common causes of death among students. Each year, approximately 24,000 college students attempt suicide while 1,100 attempts end up being fatal, making suicide the second-leading cause of death among U.S. college students. Roughly 12% of college students report the occurrence of suicide ideation during their first four years in college, with 2.6% percent reporting persistent suicide ideation. 65% of college students reported that they knew someone who has either attempted or died by suicide, showing that the majority of students on college campuses are exposed to suicide or suicidal attempts.

<span class="mw-page-title-main">Trauma and first responders</span> Trauma experienced by first responders

Trauma in first responders refers to the psychological trauma experienced by first responders, such as police officers, firefighters, and paramedics, often as a result of events experienced in their line of work. The nature of a first responder's occupation continuously puts them in harm's way and regularly exposes them to traumatic situations, such as people who have been harmed, injured, or killed.

The social determinants of mental health (SDOMH) are societal problems that disrupt mental health, increase risk of mental illness among certain groups, and worsen outcomes for individuals with mental illnesses. Much like the social determinants of health (SDOH), SDOMH include the non-medical factors that play a role in the likelihood and severity of health outcomes, such as income levels, education attainment, access to housing, and social inclusion. Disparities in mental health outcomes are a result of a multitude of factors and social determinants, including fixed characteristics on an individual level – such as age, gender, race/ethnicity, and sexual orientation – and environmental factors that stem from social and economic inequalities – such as inadequate access to proper food, housing, and transportation, and exposure to pollution.

References

  1. ↑ "NIMH » Suicide in America: Frequently Asked Questions". www.nimh.nih.gov. Retrieved 2020-10-14.
  2. 1 2 3 4 Hawton K, van Heeringen K (2009). "Suicide". The Lancet. 373 (9672): 1372–1381. doi:10.1016/S0140-6736(09)60372-X. PMID   19376453. S2CID   208790312.
  3. ↑ "Products - Data Briefs - Number 361 - March 2020". www.cdc.gov. 2020-04-07. Retrieved 2020-10-14.
  4. 1 2 3 Kochanek KD, Murphy SL, Xu J, Arias E (June 2019). "Deaths: Final Data for 2017" (PDF). National Vital Statistics Reports. 68 (9): 1–77. PMID   32501199.
  5. 1 2 3 4 Cavanagh JT, Carson AJ, Sharpe M, Lawrie SM (April 2003). "Psychological autopsy studies of suicide: a systematic review". Psychological Medicine. 33 (3): 395–405. doi:10.1017/S0033291702006943. PMID   12701661. S2CID   7469249.
  6. 1 2 Hawton K, Casañas I, Comabella C, Haw C, Saunders K (May 2013). "Risk factors for suicide in individuals with depression: a systematic review". Journal of Affective Disorders. 147 (1–3): 17–28. doi:10.1016/j.jad.2013.01.004. PMID   23411024.
  7. ↑ Simon GE, Savarino J (July 2007). "Suicide attempts among patients starting depression treatment with medications or psychotherapy". The American Journal of Psychiatry. 164 (7): 1029–34. doi:10.1176/ajp.2007.164.7.1029. PMID   17606654.
  8. ↑ Milner A, Page A, LaMontagne AD (April 2014). "Cause and effect in studies on unemployment, mental health and suicide: a meta-analytic and conceptual review". Psychological Medicine. 44 (5): 909–17. doi:10.1017/S0033291713001621. PMID   23834819. S2CID   32442599.
  9. ↑ Valenstein M, Kim HM, Ganoczy D, McCarthy JF, Zivin K, Austin KL, et al. (January 2009). "Higher-risk periods for suicide among VA patients receiving depression treatment: prioritizing suicide prevention efforts". Journal of Affective Disorders. 112 (1–3): 50–8. doi:10.1016/j.jad.2008.08.020. PMC   2909461 . PMID   18945495.
  10. 1 2 3 Ajdacic-Gross V, Weiss MG, Ring M, Hepp U, Bopp M, Gutzwiller F, Rössler W (September 2008). "Methods of suicide: international suicide patterns derived from the WHO mortality database". Bulletin of the World Health Organization. 86 (9): 726–32. doi:10.2471/blt.07.043489 (inactive 5 December 2024). PMC   2649482 . PMID   18797649.{{cite journal}}: CS1 maint: DOI inactive as of December 2024 (link)
  11. 1 2 3 4 Cerel J, Jordan JR, Duberstein PR (2008). "The impact of suicide on the family". Crisis. 29 (1): 38–44. doi:10.1027/0227-5910.29.1.38. PMID   18389644.
  12. 1 2 Erlangsen A, Runeson B, Bolton JM, Wilcox HC, Forman JL, Krogh J, et al. (May 2017). "Association Between Spousal Suicide and Mental, Physical, and Social Health Outcomes: A Longitudinal and Nationwide Register-Based Study". JAMA Psychiatry. 74 (5): 456–464. doi:10.1001/jamapsychiatry.2017.0226. PMC   5470398 . PMID   28329305.
  13. 1 2 3 Pitman A, Osborn D, King M, Erlangsen A (June 2014). "Effects of suicide bereavement on mental health and suicide risk". The Lancet. Psychiatry. 1 (1): 86–94. doi:10.1016/S2215-0366(14)70224-X. PMID   26360405.
  14. 1 2 3 4 5 Lohan JA, Murphy SA (2002). "Family Functioning and Family Typology after an Adolescent or Young Adult's Sudden Violent Death". Journal of Family Nursing. 8 (1): 32–49. doi:10.1177/107484070200800103. S2CID   145132516.
  15. ↑ Brent D, Melhem N, Donohoe MB, Walker M (July 2009). "The incidence and course of depression in bereaved youth 21 months after the loss of a parent to suicide, accident, or sudden natural death". The American Journal of Psychiatry. 166 (7): 786–94. doi:10.1176/appi.ajp.2009.08081244. PMC   2768496 . PMID   19411367.
  16. ↑ Cerel J, Roberts TA (April 2005). "Suicidal behavior in the family and adolescent risk behavior". The Journal of Adolescent Health. 36 (4): 352.e9–16. doi:10.1016/j.jadohealth.2004.08.010. PMID   15780792.
  17. ↑ Pfeffer CR, Karus D, Siegel K, Jiang H (2000). "Child survivors of parental death from cancer or suicide: depressive and behavioral outcomes". Psycho-Oncology. 9 (1): 1–10. doi:10.1002/(SICI)1099-1611(200001/02)9:1<1::AID-PON430>3.0.CO;2-5. PMID   10668054. S2CID   23589929.
  18. 1 2 3 Brent DA, Oquendo M, Birmaher B, Greenhill L, Kolko D, Stanley B, et al. (September 2002). "Familial pathways to early-onset suicide attempt: risk for suicidal behavior in offspring of mood-disordered suicide attempters". Archives of General Psychiatry. 59 (9): 801–7. doi: 10.1001/archpsyc.59.9.801 . PMID   12215079.
  19. ↑ Van der Kolk BA (2003). Psychological Trauma. American Psychiatric Publishing, Inc.
  20. 1 2 3 Balliett N, Newman E (2009-04-03). Friedman MJ, Keane TM, Resick PA (eds.). "Handbook of PTSD: Science and Practice". Journal of Trauma & Dissociation. 10 (2): 222–223. doi:10.1080/15299730802607622. ISSN   1529-9732. S2CID   143277872.
  21. ↑ Lilly MM, Valdez CE, Graham-Bermann SA (August 2011). "The mediating effect of world assumptions on the relationship between trauma exposure and depression". Journal of Interpersonal Violence. 26 (12): 2499–516. doi:10.1177/0886260510383033. PMID   20829232. S2CID   45115155.
  22. ↑ Purdie N, Dudgeon P, Walker R (2014). Working together: Aboriginal and torres straight islander mental health and wellbeing principles and practice. Commonwealth of Australia. ISBN   978-1-74241-090-6.
  23. ↑ Murphy SA, Braun T, Tillery L, Cain KC, Johnson LC, Beaton RD (April 1999). "PTSD among bereaved parents following the violent deaths of their 12- to 28-year-old children: a longitudinal prospective analysis". Journal of Traumatic Stress. 12 (2): 273–91. doi:10.1023/A:1024724425597. PMID   10378166. S2CID   40487268.
  24. ↑ Jordan JR, McIntosh JL, eds. (2011-01-19). Grief After Suicide. doi:10.4324/9780203886045. ISBN   9780203886045.
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