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. 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 that are outside the normal range of human experiences, with extreme examples being violence, rape, or a terrorist attack. The event must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; 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.

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">Suicide prevention</span> Collective efforts to reduce the incidence of suicide

Suicide prevention is a collection of efforts to reduce the risk of suicide. Suicide is often preventable, and the efforts to prevent it may occur at the individual, relationship, community, and society level. Suicide is a serious public health problem that can have long-lasting effects on individuals, families, and communities. Preventing suicide requires strategies at all levels of society. This includes prevention and protective strategies for individuals, families, and communities. Suicide can be prevented by learning the warning signs, promoting prevention and resilience, and committing to social change.

<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 ending one's own life. 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 events without the presence of a mental disorder.

Gender 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 (ACEs). 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, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.

<span class="mw-page-title-main">Military sexual trauma</span> U.S. legal term for sexual assault or harassment during military service

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.

<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 risk factors. Some suicides are impulsive acts due to stress, relationship problems, or harassment and bullying. Those who have previously attempted suicide are at a higher risk for future attempts. Effective suicide prevention efforts include limiting access to methods of suicide such as firearms, drugs, and poisons; treating mental disorders and substance abuse; careful media reporting about suicide; improving economic conditions; and dialectical behaviour therapy (DBT). Although crisis hotlines are common resources, their effectiveness has not been well studied.

<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.

<span class="mw-page-title-main">Transgenerational trauma</span> Psychological trauma

Transgenerational trauma is the psychological and physiological effects that the trauma experienced by people has on subsequent generations in that group. The primary modes of transmission are the uterine environment during pregnancy causing epigenetic changes in the developing embryo, and the shared family environment of the infant causing psychological, behavioral and social changes in the individual. The term intergenerational transmission refers to instances whereby the traumatic effects are passed down from the directly traumatized generation [F0] to their offspring [F1], and transgenerational transmission is when the offspring [F1] then pass the effects down to descendants who have not been exposed to the initial traumatic event - at least the grandchildren [F2] of the original sufferer for males, and their great-grandchildren [F3] for females.

<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> Effects of climate change on mental health

The effects of climate change on mental health and wellbeing are documented. 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.

<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.

Mental health consequences of immigration detention include higher rates of depression, anxiety, PTSD, conduct issues, hyperactivity, compared to the general population. These harmful impacts exist regardless of past traumatic experiences, age, or nationality, or even time elapsed. Immigration detention may take place at country or state borders, in certain international jurisdiction zones, on offshore islands, boats, camps, or could even be in the form of house arrest. The use of immigration detention around the world has increased recently, leading to greater concerns about the health and wellbeing of detained migrants. A 2018 scoping review from BMC Psychiatry gathered information showing that immigration detention consistently results in negative impacts on detainees.

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.

People who are LGBT are significantly more likely than those who are not to experience depression, PTSD, and generalized anxiety disorder.

References

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