The results of the strati ﬁed effect modiﬁcation analysis reveal male suicides with a history of suicide attempt are nearly twice as likely to die by poisoning as those without a previous attempt. This may be explained by the increased underlying incidence of male suicides by ﬁre- arms with no history of attempt. Men in this sample with previous attempts were almost twice as likely to experi- ence a fatal attempt via poisoning. Based on the assumption that most attempts are via poisoning, this could mean that these men are not as inclined to switch to a more lethal method. This could also imply that they may have switched dosage or substance type, or were not expecting this attempt to be fatal. These results suggest that men with previous suicide attempts are a speci ﬁc subgroup with a high risk of a suicidedeath by poisoning. Female suicides with a history of suicide attempt were 16% more likely to die by poisoning. Women with a history of suicide attempt also show the same effect as men, but to a lesser magnitude. Underlying rates of suicide by poisoning among female suicides are greater than among men regardless of suicide attempt history; therefore, the observed effect of a history of suicide attempt on poisoning in female suicide victims is lower. The effect is attenuated by the women who die by suicide via poisoning on their ﬁrst attempt. The observations that women have higher rates of non-fatal suicide attempt 7 and have a higher likelihood of dying by poisoning are likely directly related.
We conducted ecological study and hypothesized that lower income by Gini-coefficient accompa- nied by higher incidence suicidedeath rate. There is a positive inequality due to Gini-coefficients in suicidedeath. Therefore, suicide rate more oc- curred in provinces that higher Gini-coefficients. This study could be a start for investigation of inequality source in geographical units and at the individual level in all provinces and whether is Gini-coefficient good predictor for suicidal be- haviors?
Once a client has stabilized in a Baker Act receiving facility, major next steps in the process are client discharge and reentry into his/her home community, and possible referral for follow-up therapeutic services. The process of risk assessment within both inpatient and outpatient settings is an important aspect of any treatment regimen, especially for individuals identified as having suicidal behaviors or ideation. Respondents reported routine assessments especially just prior to discharge. Thirteen respondents indicated that no-harm contracts were used in an attempt to secure patient safety upon their discharge. This could be problematic as there is no empirical evidence to support the efficacy of no-harm contracts related to suicide prevention (American Association of Suicidology Youth Suicide Prevention Task Force, 2008). No-harm contracts typically ask the patient not to harm him/herself without providing replacement behavior. Safety plans are an alternative that provide an opportunity for the client and therapist/ provider to create a plan for keeping the patient safe and the patient promises only that prior to acting on his/her suicidal thoughts, he/she will try all of the steps in their safety plan. The safety plan gives the patient specific, concrete, non- suicidal action steps (Rudd, 2006).
However, our data cannot be generalized, as the most relevant and discouraging aspect of our study was that most suicides (127 out of 142, 87.5%) took place in people who were not evaluated in the ED during the study period. In other words, the 15 suicides among our sample of suicide attempters are likely not representative of suicide completers in our catchment area. For in- stance, most individuals who died by suicide in our study were women with a history of previous suicide attempts. However, most suicides within our catchment area, but who were not evaluated in the ED during the study period, were men (70.1%). Literature is clear in this respect: most suicides are male in most countries. Our finding that most suicides in our catchment area were not included in our sample might be explained by the fact that 60% of suicides in our area died during the first attempt, and 92.3% of suicides occurred during the first or second attempt . Furthermore, most individ- uals who suicide are not followed up in mental health services, but rather in primary health services , thus making it difficult to identify individuals at risk.
on 21 October 1917 just prior to the battle of Passchendaele. Seven months later Sharpe jumped to his death from a Montreal hospital window on 25 May 1918. He had just returned to Canada from England where he had been recovering from the strain of nearly eleven months active service on the Western Front. Sharpe was one of the thousands of Canadian officers and soldiers who suffered mental stress injuries during the First World War. Commonly included under a broad definition of shell shock, the nervous debility and breakdown of soldiers represented a significant military and medical problem as well as a destabilising challenge to traditional gender and class assumptions. The suicidedeath of a prominent colonel and politician had the potential to undermine a cultural belief system that defined ideal masculinity through stoic strength, self-discipline, and willpower.
The range of responses that people exposed to suicide may experience following a death by suicide can be considered along a ‘continuum of suicide survivorship’ [ 12 ]. This nested model illustrates that people may perceive themselves to be exposed to suicide (i.e., those who knew or, identified with, or came into contact with the individual), affected by suicide (i.e., those who experienced significant distress following exposure), or bereaved by a suicidedeath (i.e., those who shared a close connection with the deceased and experience a clinically significant negative impact in the short or long term). In principle, health, social care, and education workers exposed to suicide may fall at any point within this continuum. Indeed, Cerel et al. [ 13 ] suggest that perceptions of closeness, as described by the suicide survivor, are key to understanding perceived impact of the death, and that those who feel impacted by a death by suicide may include individuals across a range of relationships with the deceased. Furthermore, perceptions of greater closeness and impact relate to higher incidences of depression, anxiety, post traumatic stress disorder (PTSD) and prolonged grief [ 13 ]. As such, a number of adverse effects have been reported by health, social care and education practitioners following a death by suicide. These range from professional doubt and fear of legal consequences [ 14 ], to feelings of responsibility for the death [ 15 ], emotional turmoil and stress reactions [ 14 ], and severe distress [ 16 ]. For some mental health professionals, post-traumatic responses such as intrusion, avoidance and hyper-arousal have been reported as being so severe and persistent that they fell within a clinical range [ 17 ]. Thus, health, social care, and education workers may perceive themselves to be affected or even bereaved by suicide and may also require postvention support.
The Questionnaire was designed as a means of quantifying suicidal attitude and sui- cidal thought induction. Under the theory of cognitive resonance  individuals up- grade or downgrade their decisions based on competing experiences and additional in- sight. In doing this survey respondents were subjected to changing scenarios which progressively increased the complexities and severity of life events. The question is whether the suicide attitude scale is sensitive enough to the thought process of the res- pondents. In other words, did level of severity of an adverse life event have an impact on the respondents answer to shift attitudes toward suicide? And, is this questionnaire sensitive enough to pick up respondents’ re-evaluation and change of decision?
All adolescents with symptoms of depression should be asked about suicidal ideation, and an es- timation of the degree of suicidal intent should be made. No data indicate that inquiry about suicide precipitates the behavior. In fact, adolescents often are relieved that someone has heard their cry for help. For most adolescents, this cry for help repre- sents an attempt to resolve a difficult conflict, escape an intolerable living situation, make someone under- stand their desperate feelings, or make someone feel sorry or guilty. Suicidal thoughts or comments should never be dismissed as unimportant. Adoles- cents must be told by pediatricians that their plea for assistance has been heard and that they will be helped.
Suicide is the third-leading cause of death for adolescents 15 to 19 years old. Pediatricians can take steps to help reduce the incidence of adolescent suicide by screening for depression and suicidal ideation and behavior. This report updates the previous statement of the American Academy of Pediatrics and is intended to assist the pediatrician in the identification and management of the adolescent at risk of suicide. The extent to which pediatricians provide appropriate care for suicidal adolescents depends on their knowledge, skill, comfort with the topic, and ready access to appropriate community resources. All teenagers with suicidal thoughts or behaviors should know that their pleas for assistance are heard and that pediatricians are willing to serve as advocates to help resolve the crisis.
appropriate. Although confidentiality is important in adolescent health care, for adolescents at risk to themselves or others, safety takes precedence over confidentiality; the adolescent should have this explained by the pediatrician so that he or she understands that at the onset. Pediatricians need to inform appropriate people, such as parent(s) and other providers, when they believe an adolescent is at risk for suicide and to share with the adolescent that there is a need to break confidentiality because of the risk of harm to the adolescent. As much as is possible, the sequence of events that preceded the threat should be determined, current problems and conflicts should be identified, and the degree of suicidal intent should be assessed. In addition, pediatricians should assess individual coping resources, accessible support systems, and attitudes of the adolescent and family toward intervention and follow-up. 53
Suicide and Assisting Suicide A Critique of Legal Sanctions SMU Law Review Volume 36 | Issue 4 Article 3 1982 Suicide and Assisting Suicide A Critique of Legal Sanctions H Tristram Engelhardt Jr Miche[.]
As we know, suicide generally is considered to be the result of a combination of risk factors. Inpatient suicides may also carry the same risk factors in addition to few others, specific to the setting or environment. The common risk factors considered for inpatient suicide include male gender, history of previous suicide assessments, emotional difficulties, poor relationships with family and staff, and implementation of violent methods in an attempt to commit suicide previously (Cheng et al., 2009). In addition, other associated factors like older age, having a chronic physical condition like pain or terminal illness, family history of suicide attempts and completions should be considered as well (Cheng et al., 2009). Also, psychopathology of the disease, especially for psychiatric illnesses like depression, schizophrenia (Li et al., 2008) and other affective disorders, is an important risk factor that is to be considered (Large et al., 2011; Bowers et al., 2010). Moreover, co-morbidities like anxiety and agitation should be regarded as equally important in the risk assessment and never underestimated (Busch et al., 2003). Similarly, patients with treatment-resistant cases and patients suffering serious side- effects from the medications are to be given prime importance and monitored carefully (Neuner et al., 2008). The primary risk factor for inpatient suicide, which is always under-emphasized, is the intimidating experience for the patients to be around in a new environment with other mentally ill patients which might increase suicidal ideation during this period (Bose et al., 2016). A study has concluded that inpatient suicides mainly occur due to the inherent factors in that hospitalization (Large et al., 2014). Also, studies have demonstrated that patients who are hospitalized for longer periods are at risk for suicide by getting sick of the surrounding environment (Neuner et al., 2008).
As the global annual rate of suicide approximates 15 per 100,000 individuals, it is estimated that one million people worldwide commit suicide each year. Annual rates of non-fatal suicidal behaviour are 10–20 times higher than those of completed suicide (Kerkhof, 2000). Suicidal behavior thus constitutes a major public health problem. This indicates the necessity of effective theoretical frameworks for suicide prevention. During the past 30 years, economists have contributed insights about the economic motivations underlying suicidal behavior. Hamermesh and Soss (1974) formalized a model of the utility maximization decision faced by those contemplating suicide. Their paper, and subsequent work by economists, developed the notion that suicide occurs when the temporally-discounted stream of expected utility (subjective well-being) over a person’s lifetime is sufficiently low, perhaps negative, by assuming the subject’s decision-making is rational. However, recent studies in behavioral economics and neuroeconomics revealed that people are irrational in terms of economic theory. Therefore, introducing neuroeconomic frameworks is important for a better understanding of suicidal behavior. Also, recent neurobiological studies on suicidal behavior demonstrated that several neurobiological substrates such as serotonin, dopamine, and neuroactive steroid hormones in the brain regions such as the prefrontal cortex and the limbic structures are important determinants of suicidal behavior. Therefore, combining neuroeconomic theory with these neurobiological finding is necessary to establish molecular neurobiological theory of suicidal behavior (―molecular neuroeconomics‖ of suicide).
Alan D. Lieberson, Issues of Concern When Drafting a Physician-Assisted Suicide Statute, 2 Q UINNIPIAC H EALTH L.J. 149, 149 (1999). In Vacco v. Quill, the Supreme Court found that New York’s legalization of the withdrawal of life support, while it continues to prohibit PAS, does not “violate the Equal Protection Clause of the Fourteenth Amendment.” See infra note 143 and accompanying text. 521 U.S. 793, 796-97 (1997). The second time voters approved the DWDA, the vote was “60% to 40%.” Lindsay R. Kandra, Questioning the Foundation of Attorney General Ashcroft’s Attempt to Invalidate Oregon’s Death with Dignity Act, 81 OR. L. REV. 505, 511 (2002).
^The work of Professor E. Stengel was both implicitly and explicitly referred to in the Parliamentary debates on the Suicide Bill. Implicitly when Viscount Kilmuir said "Recent research suggests...that those who attempt suicide are often making an appeal for help" (Hansard - Lords 2 March 1961 col. 247, and explicitly w4ien Kenneth Robinson in Committee said "The man who has done most research in this country is Professor Stengel of Sheffield University, who for a long time has campaigned for the reform embodied in the Bill. (House of Commons Official Report, Standing Committee E, 25 July 1961, col. 5. Leo Abse referred to Durkheim (Hansard 19 July 1961 col. 1410 and to various social surveys on suicides in Wales (col. 1413-14). Baroness Wootton referred to the Sainsbury study, saying that London boroughs with high suicide rates were ones of social disorganisation and lack of cohesion and to a study that showed "rates [of suicide] at Oxford and Cambridge were enormously higher among undergraduates than it is for the same age group" (Lords 2 March 1961) ^File MEPO 10121 at the Police Record Office, Wellington House, Buckingham Gate has an exchange of letters about the Samaritans in the spring of 1962. It begins with the Commissioner of the Met, A. Townsend, writing to J. Goyder, Assistant Commissioner at the City of London Police to ask if he knows anything about the Samaritans. Goyder replies that he is fact does, having called for a report about them in the spring of 1960 after having seen a television show about them. The reply from Goyder to Townsend is dated 2 May 1962 and says as far as he knows the Samaritans are all right. On 10 May 1962 Townsend wrote to Chad Varah saying, "Although it is no longer a crime to attempt to commit suicide, you will appreciate that the police of the Force are still frequently called upon in these cases, and it is part of their duty to do all they can to ensure that the person who has made the attempt is placed in the care of someone who will look after him (or her) and give help and advice." Chad V ar^ replied (letter dated only "May, 1962): "I was very pleased to receive your enquiry as we are most anxious that the Met Police should act in the same way as the City of London Police by referring to the Samaritans any potential or attempted suicide who can be persuaded to agree ... We are currently dealing with 3000 new cases a year of which at least 40% are suicide risks."
The passage of the Death in Custody Reporting Act of 2000 (DICRA, PL 106-297) dramatically altered programs collecting data on inmate deaths. Prior to the act, BJS conducted annual counts of State prisoner deaths. Counts of jail inmate deaths were collected in the Census of Jails, which is conducted every 5 or 6 years. For both popula- tions, death counts were obtained by gender and by general cause categories, such as illness/natural causes, AIDS, suicide, and homicide. These aggregate counts of deaths did not allow for analysis of individual death cases. DICRA was attached as a grant requirement of the Violent Offender Incarceration and Truth-in-Sentencing (VOI/TIS) incentive grant program. Beginning in 1996, these grants provided over $2.5 billion to all 50 States and U.S. Territo- ries for expanding prison capacity to house violent offend- ers for longer periods. Each State receiving VOI/TIS funds was required under DICRA to report:
The most painful loss in a person’s existence would be the loss of his wholesome health. Each and every being in this world is living a competitive life in order for their survival and to defeat death. But, astonishingly, some people seek their own death and request other fellow beings for their end. These circumstances occur only when the person has gone hitting mental, physical, and psychological problems. The ways that are used to end their lives are suicide, euthanasia, physician-