The Role of Social Isolation in Suicide

ABSTRACT: This paper reviews the literature which relates to the role of social isolation in suicide. Major areas reviewed include theories on suicide and social isolation, measures of social isolation, and empirical studies which concern the relationship of social isolation to suicide. Social isolation seems to be related to suicidal behaviors in a direct and fundamental way. Implications for helping contacts and the community are addressed.     

Decision Making in Social Context in Patients with Suicide Attempt History

Decision making has been found to be altered in suicide attempters, but little is known of their performance in social contexts. Twenty‐seven depressed suicide attempters (DSA), 25 nonsuicidal depressed patients (DP), and 60 healthy participants (HC) were evaluated by a decision‐making task in social context . Results indicated DSA and DP obtained lower gains and invested more money with angry partners. DSA were found to invest less money than DP and HC with happy partners. DSA showed insensitivity toward rewards/punishment contingency, and they did not use the socioemotional stimuli to guide their decisions.     

War and Suicide*

ABSTRACT: The suicide rate generally appears to decline during the time of war. The traditional psychodynamic explanation that this decrease results from the legitimization of outward aggression is questioned. World War II evidence from both occupied and neutral countries, together with fluctuations of the suicide rates among the Scandinavian countries, are better understood as reflecting the social conditions of wartime, rather than the presence of actual fighting. These data, and others, point to the hypothesis that the decreased suicide rate during wartime is tied to the greater social integration–increased patriotism, ease of promotions, greater sense of purpose, and so forth–resulting from a state of war.     

Suicide and the Generation Gap*

ABSTRACT: To explore psychological parameters of suicide as perceived by young adults, the middle-aged, and old people, an area sample of 317 Detroit subjects, whose ages placed them in one of these three generations, was administered a questionnaire concerning their beliefs about the generations and suicide and their self-reported relationship to suicide. A 3-way fixed-effects analysis of variance (generation × sex × socioeconomic status) indicated that all generations believed that the old (a) have the greatest desire to die, (b) know the least about suicide, (c) make the fewest attempts, (d) are the least frequently successful, and (e) are the least socially condemned for committing suicide. Self-appraisals indicated that (a) lower socioeconomic status is associated with a greater “death wish,” (b) young adults and males claim a greater knowledge about suicide, and (c) the generations do not differ in desire to die, considerations of suicide, and suicide attempts.     

Physicians View Death and Suicide*

ABSTRACT: Comparisons were made between physicians' attitudes toward death and suicide and those of a nonphysician control group. Results of the analysis revealed significant differences that may offer some insights as to why physicians have an elevated suicide rate.     

Dimensions of Religion Associated with Suicide Attempt and Suicide Ideation in Depressed,Religiously Affiliated Patients

There is substantial evidence to support the claim that religion can protect against suicide ideation, suicide attempts, and completed suicide. There is also evidence that religion does not always protect against suicidality. More insight is needed into the relationship between suicidal parameters and dimensions of religion. A total of 155 in‐ and outpatients with major depression from a Christian Mental Health Care institution were included. The following religious factors were assessed: religious service attendance, frequency of prayer, religious salience, type of God representation, and moral objections to suicide (MOS). Multiple regression analyses were computed. MOS have a unique and prominent (negative) association with suicide ideation and the lifetime history of suicide attempts, even after controlling for demographic features and severity of depression. The type of God representation is an independent statistical predictor of the severity of suicide ideation. A positive‐supportive God representation is negatively correlated with suicide ideation. A passive‐distressing God representation has a positive correlation with suicide ideation. High MOS and a positive‐supportive God representation in Christian patients with depression are negatively correlated with suicide ideation. Both are likely to be important markers for assessment and further development of therapeutic strategies.     

Caregiver Strain and Youth Suicide Attempt: Are They Related?

There are scant data documenting the relationship between caregiver strain and suicidal behavior among youth. This study includes data from the caregivers of 1,854 youth who received services through the Comprehensive Community Mental Health Services for Children and Their Families Program. Caregiver strain, family functioning, and youth functional impairment were assessed with the Caregiver Strain Questionnaire, Family Life Questionnaire, and Columbia Impairment Scale. Caregivers of suicidal and nonsuicidal youth differed in subjective internalizing strain (e.g., worry and guilt) and objective strain (e.g., constraints on activities). Differences in objective strain persisted even after controlling for family life and youth functional impairment.     

Suicide Disclosure in Suicide Attempt Survivors: Does Family Reaction Moderate or Mediate Disclosure's Effect on Depression?

Existing literature has found a link between disclosure of a stigmatized identity and improved mental health; however, research on the impact of suicide disclosure to family members is scarce. Suicide attempt survivors (n = 74) in the United States were examined to assess whether family reaction moderates or mediates the relationship between suicide disclosure and subsequent depression symptoms. Family reaction did not moderate but did mediate the relationship between disclosure and depression symptoms while controlling for time since most recent attempt. Higher rates of disclosure predicted more positive family reactions, which in turn predicted less severe depression symptoms. Findings indicate that family members can play an essential role in the recovery process after an attempt occurs, which has important implications for both researchers and clinicians who seek to decrease stigma for attempt survivors while simultaneously decreasing the likelihood of future attempts.     

Transcultural Attitudes toward Homicide and Suicide*

ABSTRACT: Using the concept that homicide and suicide are complex sociopsychiatric phenomena clearly influenced by cultural norms and values that define which behaviors are viewed as deviant, the investigators constructed a small-sample model to determine relevant qualitative attributes of public opinion. A stratified factorial sample of 258 subjects distributed among eight large cities throughout the world was selected for interviewing. The 2,603 resulting statements were then subjected to content analysis and categorization. Results indicated that people in cities, regardless of location, are most concerned about crimes of violence, especially homicide, and those against property. Other kinds of life-threatening offenses such as arson, war, and suicide are seldom seen as important “crimes.” Many people endorse a problem-solving approach to dealing with crime and criminals, but a reservoir of traditional, punitive attitudes clearly remains among the less educated, lower socioeconomic classes. A commonality of many attitudes in these various urban centers does suggest that modern communication techniques may well have a modulating effect on culture-bound orientations toward crime.     

Risk and Protective Factors that Distinguish Adolescents Who Attempt Suicide from Those Who Only Consider Suicide in the Past Year

Data from the 2010 Minnesota Student Survey was analyzed to identify risk and protective factors that distinguished adolescents across three groups: no suicidality, suicidal ideation only, and suicide attempt. The population‐based sample included 70,022 students in grades 9 and 12. Hopelessness and depressive symptoms emerged as important risk factors to distinguish youth who reported suicidal ideation or behavior from those without a history of suicidality. However, these factors were not as important in differentiating adolescents who attempted suicidal from those who considered suicide but did not act on their thoughts. Instead, for both genders, self‐injury represented the most important factor to distinguish these youth. Other risk factors that differentiated the latter groups, but not the former groups, for males were dating violence victimization and cigarette smoking, and for females was a same‐sex sexual experience. Running away from home also seemed to increase the risk of a suicide attempt among youth in this study. Parent connectedness and academic achievement emerged as important protective factors to differentiate all the groups, yet neighborhood safety appeared to protect against the transition from suicidal thoughts to behavior. Findings from this study suggest risk and protective factors practitioners should target in clinical assessments and intervention programs to help prevent suicidal behavior among youth at greatest risk.     

Suicide in the Subway: Psychodynamic Aspects*

ABSTRACT: Fifty-one cases of suicide attempts in the subway have been investigated to examine the question of whether the method used has psychodynamic significance or is merely adventitious. We found that no single characteristic distinguished subway suicide from all other suicide modalities, although as a group the subway cases had a higher proportion of psychotic and previously suicidal patients than other series quoted in the literature. However, there were important differences between subway suicide cases seeking a “traumatic” death (jumping in front of a train; lying across the track awaiting destruction) and those seeking a “nontraumatic” death (electrocution on the live “third rail”). The traumatic group had histories of exposure to violence, other traumatic suicide attempts, hostile or destructive delusions, and many “destroy” words on psychological test protocols. The smaller nontraumatic group had no such history of exposure to violence; their previous suicide attempts were nontraumatic; delusions, when present, were not menacing; and the psychological tests showed more “escape” words than “destroy” words.     

Future Well-Being Among People Who Attempt Suicide and Survive: Research Recommendations

Over 48,000 people died by suicide in 2018 in the United States, and more than 25 times that number attempted suicide. Research on suicide has focused much more on risk factors and adverse outcomes than on protective factors and more healthy functioning. Consequently, little is known regarding relatively positive long-term psychological adaptation among people who attempt suicide and survive. We recommend inquiry into the phenomenon of long-term well-being after nonfatal suicide attempts, and we explain how this inquiry complements traditional risk research by (a) providing a more comprehensive understanding of the sequelae of suicide attempts, (b) identifying protective factors for potential use in interventions and prevention, and (c) contributing to knowledge and public education that reduce the stigma associated with suicide-related behaviors.     

Suicide Attempt Risk in Youths: Utility of the Harkavy–Asnis Suicide Scale for Monitoring Risk Levels

The Harkavy–Asnis Suicide Scale (HASS), one of the few self‐report scales assessing suicidal behavior was evaluated and ideation, was evaluated and predictors of suicide attempts (SAs) were identified with the goal of developing a model that clinicians can use for monitoring SA risk. Participants were 131 pediatric emergency department (ED) patients with suicidal behavior. The HASS and Diagnostic Interview Schedule for Children (DISC‐IV) were administered approximately 2 months after ED presentation. When compared with DISC‐IV ratings, sensitivity of the HASS SA items was excellent (100%), and overall classification accuracy was 72%. SA planning was the strongest predictor of SAs.     

A Measure of Adolescent Potential for Suicide (MAPS): Development and Preliminary Findings

This paper describes an instrument designed to assess the suicide potential of youth 14–18 years of age who are at risk for suicidal behaviors. A comprehensive measurement theory provides the basis for three central constructs in the Measure of Adolescent Potential for Suicide (MAPS): direct suicide risk factors, related risk factors, and protective factors. The MAPS entails an introductory questionnaire followed by a computer-assisted, structured interview. Two samples were used to examine psychometric properties of the MAPS (n = 43; n = 123). Results revealed generally strong validity (content, criterion, construct) and reliability (internal consistency) for the MAPS. Further verification studies with large and diverse samples are warranted.