Showing posts with label suicide prevention. Show all posts
Showing posts with label suicide prevention. Show all posts

Male Suicide - Gender Factor in Suicide

Statistics
  • More men than women die by suicide. The gender ratio is 4:1.

  • 72% of all suicides are committed by white men.

  • 80% of all firearm suicides are committed by white men.

  • Among the highest rates (when categorized by gender and race) are suicide deaths for white men over 85, who had a rate of 59/100,000.

Suicide and men


Suicide accounts for 1 in 100 deaths. The majority of those who die in this way are men.


A worrying recent trend is the increasing rate of suicide among younger men (a trend not seen among young women). The majority of these men have not asked for help before their deaths.


The suicide rate in men also increases in those aged between 65 and 75 years. In contrast, the suicide rate in women varies less with age.


The higher suicide rate among men is a worldwide phenomenon. A few exceptions to the general rule exist, for example, among elderly women in Hungary and in some Asian countries. The reasons why men are more likely to kill themselves than women are complex and ill-understood. However, several pointers help our understanding.


Image and video hosting by TinyPic


Risk factors for suicide


As well as being male, several other risk factors for suicide have been identified.


  • Age: suicide in men peaks in the 20s and again in the 60s and 70s.

  • Unemployment: the suicide rate has been shown to rise and fall with the unemployment rate in a number of countries – half of the record 33,000 people who committed suicide in Japan in 1999 were unemployed.

  • Social isolation: those who kill themselves often live alone and have little contact with others. They may have been recently widowed or have never married. They usually are not being able to form or sustain meaningful relationships.

  • Chronic illness: any chronic illness increases the risk of suicide.

  • Certain occupations: people with certain occupations are more likely to die by suicide, for example farmers (who usually work alone, may be unmarried and have access to the means of suicide, such as a shotgun or poisonous weedkiller).

  • Drug abuse: using drugs and/or alcohol to help cope with emotions, relationships, pressure of work etc.

  • A history of physical and sexual abuse.

  • Imprisonment.

  • Subject of bullying: being bullied at school/college/work.

Many of the above risk factors affect men more than women. It is important to remember that many people are subject to these factors, but only a tiny minority of them will end their own lives.


Other factors are also significant. The most important risk factor is the presence of a mental illness. The most important protective factor is the presence of good support from family or friends.


Mental illness


Research has shown that the vast majority of those who kill themselves are mentally ill at the time of their death. Two thirds are troubled by a depressive illness and 20 per cent by alcoholism.


Of people with severe depressive illnesses, 10 to 15 per cent will commit suicide.


Paradoxically, as mentioned above, depressive illnesses are more common in women, but suicide is more common in men.


Several possible explanations exist for this apparent discrepancy.
  • The more severe the depression is, the more likely it is to lead to suicide. So one possibility is that more severe forms of depressive illness are equally common in men and women. In addition, once men are depressed, they are more likely to end their lives. They are also more likely to choose especially lethal methods when they attempt suicide, for example, hanging or shooting. Depressive illness among people under 25 years of age is probably much more common now than it was 50 years ago, which may be one reason why the suicide rate is increasing in young men.

  • Alcoholism leads to suicide in 10 per cent of affected people. Alcoholism is much more common in men (though it is increasing rapidly among women).

  • Schizophrenia (a relatively uncommon condition affecting 1 in 100 of the population) leads to suicide in 10 per cent of affected people.

 Why is the male suicide rate rising?


The reasons why the number of men taking their own lives has risen in recent years are far from clear. All of the proposed explanations share a common feature – the changing role of men in society.
  • Adolescence has been prolonged, with adulthood and independence reached at a much later age than previously. Two generations ago, work began at the age of 14; one generation ago at 16 years for most; now many men only achieve financial independence in their mid 20s.

  • Men have a more stressful time in achieving educational goals than in the past and are now less successful in this regard than women.

  • Work is much less secure now and periods of unemployment are the norm for many (psychologically the threat of unemployment is at least as harmful as unemployment itself).

  • Alcohol use, and abuse, has increase markedly since the Second World War. Such use is often an attempt to cope with stress and to self-medicate symptoms.

  • Illegal drug abuse has become much more common (a correlation between the youth suicide rate and the rate of convictions for drug offences has been demonstrated in some countries).

  • Changes that are assumed to be symptoms of the 'breakdown of society' are associated with a rising suicide rate (examples include the rising divorce rate and falling church attendances).



Image and video hosting by TinyPic


Boys don't cry


In many societies, expressing emotions, for example sadness, fear, disappointment or regret, is seen as being less acceptable for boys than girls.


This cultural stereotype is very difficult to shake off, though the advent of 'new men' in the 1990s, and 'metrosexual' men in this century, have made it more acceptable for men to open up to others.


If a man, particularly an older man, does cry openly, this is often a sign of severe depression and is taken very seriously indeed by health professionals.


Deliberate self-harm


Some of those who 'attempt' suicide, do not actually intend to kill themselves. They mimic the act of suicide by taking an overdose or cutting themselves.


They do so in an attempt to change an intolerable situation or gain attention from significant other people in their lives. This process is known as deliberate self-harm or parasuicide.


Such people can get considerable relief of tension and anxiety from these acts.


Deliberate self-harm is more common in women, though the proportion of men who self-harm is increasing.


Some 10 to 15 per cent of those who attempt suicide go on to complete suicide. Of course this means that 85 to 90 per cent do not.


Is Suicide Preventable?


Not all suicide attempts succeed and many people who set out with the clear intention of ending their own lives find that with good emotional and practical support they are able to adjust their circumstances to live a complete and fruitful life. The warning signs listed above do not inevitably lead to suicide attempts although where suicide is attempted and fails that person is much more likely to try again and be successful. People who feel suicidal often report a certain kind of tunnel vision, of being unable to see the broader picture and thinking only in terms of black and white. In such circumstances that individual may not be motivated to seek out help for themselves and it falls on others to offer support by listening, offering encouragement and sometimes even challenging the preconceptions that people hold about themselves such as their abilities and their worth to society.


Image and video hosting by TinyPic


How does suicide affect others?


It's not true that suicide hurts no one except the person who takes his or her life.


Those who are left behind will typically go through a number of stages as they grieve – denial, anger, guilt, confusion, a protective wish to prove death was accidental, and, perhaps, depression and anxiety.


Barriers to effective treatment of depression in men


  • Men are less likely to recognize that they are under stress or unhappy, let alone ill.

  • Men are less likely to consult their doctor when distressed.

  • If they do consult their doctor, they are more likely to complain of physical symptoms (for example, stomach ache) or vague ill-health.

  • Health professionals are often less likely to consider a diagnosis of mental illness in men.

  • Some of the young men who kill themselves without ever seeking help seem to not have an identifiable mental illness. Rather, they are troubled by a philosophical dilemma, a disease of the soul, for which suicide seems the solution.



Sources and Additional Information:




Depression and Suicide - Preventing Suicidal Attempts

Types of Suicidal Behavior



The concept of suicide is relatively straightforward, as it is defined by a legal judgment where there is clear evidence that the person intended to take his or her own life. Cases where clear evidence is lacking but the suspicion is of suicide are usually recorded as undetermined deaths and are often included in the suicide statistics. Non-fatal suicidal behavior is more complicated because of the range of behaviors encompassed and the variety of terms used.


The terms usually imply something about the level of intent to die; for example, ‘attempted suicide’ implies a strong intention to die, whereas ‘deliberate self-harm’ does not. It is tempting to make judgments about the level of intent, but this is difficult to do in practice.


People are often unaware of the medical lethality of the overdose they have taken (by far the most common type of self-harm), thus rendering this a poor criterion. Moreover, when asked, most commonly, people simply say they wanted to escape; they may not be clear about whether they wanted to die or not. Finally, individuals with more than one episode of self-harm are quite likely to have a mixture of levels of intent across different episodes. One solution suggested by Kreitman (1977) was to use the term ‘parasuicide’ as a descriptive term to cover all deliberate but non-fatal acts of self-harm, thus, remaining neutral about level of intent to die.


Image and video hosting by TinyPic


Signs of Possible Suicidal Intentions



Although suicide is very hard to predict, there are some reliable indicators of risk.
  • Those who are seriously depressed are quite likely to have thoughts of suicide. (NOTE: 'thoughts' does not necessarily imply an attempt or even a desire to act on the thoughts.)

  • Other emotional illnesses such as severe anxiety or confusion can lead to the idea that "life is not worth living."

  • The person is always talking or thinking about death. It might be even perceived as obsession.

  • Anyone who has previously attempted suicide is at increased risk.

  • Recent losses, particularly deaths of close relatives or friends, heighten vulnerability.

  • Alcohol and drugs can dissolve inhibitions against suicide.

  • Having a "death wish," tempting fate by taking risks that could lead to death such as driving fast or running red lights.

  • Preparations for death, such as giving away possessions or acquiring a gun, are cause for great concern. It might show up as putting affairs in order, tying up loose ends, changing a will, or visiting or calling people to say goodbye.

  • A sudden lift in spirits in a depressed person can mean a decision has been reached that will "end the misery."

Factors associated with increased suicide risk after acts of deliberate self-harm



The individual, who has performed an actual self-harm attempt, can be considered as stepping closer in the group of risk, whose mere thoughts have been already translated to the practical actions. Watch for the following behavioral factors that are associated with higher risk of the suicide. 
  • Act of deliberate self-harm planned long in advance.

  • Suicide note written.

  • Acts taken in anticipation of death (e.g. writing a will).

  • Being alone at the time of deliberate self-harm.

  • Patient making attempts to avoid discovery.

  • Not seeking help after deliberate self-harm.

  • Stating a wish to die.

  • Believing the act of deliberate self-harm would prove fatal.

  • Being sorry the act of deliberate self-harm failed.

  • Continuing suicidal intent.

Two particular groups of patients are at significantly increased risk of suicide: those with a history of suicide attempts; and those recently discharged from psychiatric inpatient care. About 1% of all deliberate self-harm patients commit suicide within 12 months of a suicide attempt, and up to 10% may eventually die by suicide. In addition 10–15% of patients in contact with health services following a suicide attempt will eventually die by suicide, this risk being greatest during the first year after an attempt. Up to 41% of suicide victims have received psychiatric inpatient care in the year prior to death, and up to 9% of suicide victims kill themselves within 1 day of discharge.


Depression and Suicidal Attempts



Those with depression have a greater risk of deliberate self-harm and suicide. A recent meta-analysis estimated the standardized mortality ratio for completed suicide of those who had previously attempted suicide to be over 4000, higher than the risk attached to any particular psychiatric disorder, including major depression or alcoholism. Other risk factors for suicide include:
  • older age

  • male gender

  • single status

  • personality disorder

  • history of aggression

  • suicidal thoughts

  • social isolation

  • physical illness

  • alcohol abuse

  • recent suicide attempt

Suicide and Bereavement (loss of something or someone that one loves)



There is an increased risk of suicidal gestures, completed suicide and death from accidents following the death of a spouse or a parent. The suicide risk for those widowed was first observed over a century ago by Durkheim who found that suicide was higher amongst those widowed compared to those married.


When compared to the general population Mergenhagen and colleagues found the mortality ratio for suicide in young widowers (45–64 years of age) was about four and a half times the rate for married men of similar age. Most studies have found a gender bias with younger men being at the greatest risk of suicide, although Heikkinen and coworkers found evidence of an association between widowhood and women aged 60–69 years.
Several longitudinal studies have found that the risk of suicide is greatest for the period immediately following the loss. The risk of suicide among the widowed population was generally higher in the first 4 years after the death of the spouse, the risk of suicide in the first year was 2.5 times higher, and in the first, second and third years about 1.5 times higher.


Image and video hosting by TinyPic


Relation between depression and suicide



There is a strong link between depression and suicidal behavior, but there is also high divergence, as shown especially by the fact that the vast majority of depressed people do not commit or attempt suicide. The presence or absence of other factors might help explain this divergence. Factors such as other psychiatric diagnoses, especially personality disorder; protective factors; and other psychological factors, such as personality and affective traits, and problem-solving skills, have all been shown to distinguish suicidal from non-suicidal depressed individuals.


The relationship between depression and suicide is mainly dependent on one particular facet of depression—hopelessness about the future. Hopelessness appears to consist mainly of a lack of positive thoughts about the future rather than preoccupation with a negative future. Risk assessment and intervention in suicidal behavior are difficult because of the relatively low base rate of suicidal behavior and the heterogeneity of those who engage in it. Predictive models, whether using depressive hopelessness or a range of factors, are able to identify those at risk only through incorrectly classifying unacceptably high numbers of people as at risk. Because of predictive inaccuracy, the emphasis has shifted to assessment of relative risk rather than absolute risk.


Treatments of depression are themselves never likely to be effective treatments for suicidal behavior per se. The majority of studies testing specific interventions for suicidal behavior have shown no benefit over treatment as usual, though a number of studies have shown positive results. There is no obvious pattern to the successful interventions in terms of their content, though they do seem either to target a specific subgroup of parasuicides or to involve a brief, flexible treatment delivered at home. Both these strategies potentially limit the problem of heterogeneity. A modular approach provides a framework for incorporating a range of treatment strategies derived from the interface between basic and applied research. Developing strategies to tackle depressive hopelessness, particularly lack of positivity about the future, is one of the most needed and promising lines for future research.






Sources and Additional Information:




Link Acne Drug with Depression: True, False, Possible…

One of the most wide-known cases, when the medications was directly linked to the potential development of the depressive disorder is Accutane, drug used in treating severe forms of acne, in case other drugs have not been able to treat the condition. It is very effective as an acne-cure. However, the regular use of this drug has been associated with depression amongst the users. A number of suicide cases have been linked to the use of this drug.





The powerful drug manufactured by Roche Pharmaceuticals was first approved in the year 1982 as a medication to treat persistent acne problems, targeting the severe conditions associated with forward in the treatment of acne vulgaris, the most egregious and resistant form of the disease. But Accutane has been linked to serious health risks, including: strokes, suicide, depression, inflammatory bowel disease, Pancreatitis, and Crohn’s disease.



It is very potent and can cause severely birth defects if taken by women who are pregnant or of childbearing potential. Women using this drug must sign consent forms and promise to use at least two contraceptive procedures to prevent pregnancy during the course of using this drug. Accutane’s most common side effects are gastrointestinal. According to the Food and Drug Administration, the gastrointestinal adverse reactions include: "…inflammatory bowel disease, hepatitis, Pancreatitis, bleeding and inflammation of the gums, colitis, ileitis, nausea, other nonspecific gastrointestinal symptoms."




The long list of the possible side effects is provided at http://accutanesideeffects.net/.
People from different social strata have been long up in arms against the free availability of this particular drug. They are convinced that it creates suicidal tendencies among teenagers many of whom go to the extent of actually becoming suicidal.



In February of 1998 the manufacturer of Accutane, Roche Laboratories, issued a letter to physicians in which they added the following to the WARNINGS section of Prescribing Information for Accutane: Psychiatric disorders: Accutane may cause depression, psychosis and, rarely, suicidal ideation, suicide attempts and suicide. Discontinuation of Accutane therapy may be insufficient; further evaluation may be necessary.







A study published in Experimental Biology and Medicine offers a possible explanation for how the acne drug Accutane (isotretinoin) may cause depression. The authors speculate that it decreases the availability of serotonin, a neurotransmitter which is believed to be involved in the regulation of mood.



Using cell cultures, scientists from the University of Bath (UK) and University of Texas at Austin (USA) were able to observe the effect of the drug on serotonin-producing cells. They found that the cells significantly increased production of proteins and cell metabolites that are known to reduce the availability of serotonin. A reduction in serotonin, say the scientists, could be a cause of depression in patients using the drug.



However, there is not enough evidence to prove that Accutane is the reason behind such occurrences. Recently, a study was conducted to establish a link between the drug and teenage suicides. The study confirmed to an extent that there was nothing like accutane depression. The teenagers on the drug did not show any significant mood swing compared to others treated with different drugs.





These findings were far from conclusive. According to a scientist, the sample group was rather small. The sample group should not have been less than 1000 if a relation were to be established comprehensively. A more recent research found that Accutane induces some changes in the frontal lobe region of the brain, which is identified as the centre of our emotions. Therefore, there is the possibility of a causative link between Accutane use and depression.



A different Canadian study has also found no association between the acne medication isotretinoin, which is sold in the U.S. under the brand name Accutane, and depression.



This study, which was conducted in a community dermatology clinic, looked at acne patients who were beginning treatment with isotretinoin. The control group were treated with either oral antibiotics or medication applied to the skin. The Center for Epidemiologic Studies Depression scale and the Zung Depression Status Inventory were used to assess depression both at the beginning of treatment and at the end of two months.
At the end of the two month period, the researchers found that neither depression assessment indicated any association between treatment with isotretinoin and depression.



The authors conclude that denying patients with significant acne treatment with isotretinoin, which is a very effective treatment, may not be warranted at this time as it does not appear to be associated with depression.



Why the Controversy?
While countless case reports suggest a relationship between Accutane use and depression, proving this connection has been difficult. Some studies suggest acne itself is more likely to cause depression in sufferers than Accutane use. Others have found no definitive link between Accutane use and an increased risk of depression.



Many acne sufferers find they are depressed because of their acne, and isotretinoin helps to clear their skin, making them feel less depressed and more confident.




Accutane is a miracle cure for acne treatment, a claim that most users will uphold. However, it is advisable to use the drug with caution, at least until the drug is proven innocuous beyond reasonable doubt.







Sources and Additional Information:
http://acne.about.com/od/acnetreatments/a/sideeffectsaccu.htm

 
Support : Creating Website | SEO Template | Free Template
Copyright © 2011. Depression: Symptoms and Treatment - All Rights Reserved
Proudly powered by Blogger