Suicide Why? How to deal with it?

1999/09/01 Callado Hernando, Luis Felipe Iturria: Elhuyar aldizkaria

• Osasuna

Despite the difficulty of assessing the incidence, prevalence and trend of suicidal behavior, we can undoubtedly consider that there are several factors associated with suicide. In this sense, epidemiological studies conducted from large samples of suicide episodes indicate the existence of important social and psychiatric risk factors associated with suicidal behavior. Knowledge and resolution of these risk factors can lead to advances in suicide prevention.

Psychiatric diseases

In 1959, Robins et al. demonstrated for the first time that there are connections between suicide and psychiatric diseases. In the study conducted by these researchers, 94% of the suicides studied demonstrated a psychiatric illness during suicide. 45% had affective problems and 23% had alcoholism as a diagnosis. Other studies have confirmed that depression, alcoholism, drug abuse, and schizophrenia are psychiatric illnesses closely related to suicide.

Depression

Depression is undoubtedly the most common psychiatric disease associated with suicide. At the same time, it is estimated that the risk of suicide in patients suffering from major depression is 19%. Therefore, despite the difficulty of suicide prevention, it seems essential to determine the severity of the depressive event to analyze the actual risk of suicide in depressed patients.

Depressive diseases have shown differences between patients who were undoubtedly diagnosed with major depression and those who did not meet all the requirements for it. For example, in this second group, suicide occurs mostly in men, often related to alcohol abuse or dependence, identity problems, or severe depressed physical illness. On the contrary, major depression occurs mainly in women and in many cases the diagnosis is unique.

Moreover, in the first three months of major depression or repeated depressive episodes, the risk of suicide is higher.

The duty of psychiatric treatment and assistance necessary to prevent and prevent the suicide of depressed patients has sparked serious debate. According to some studies, appropriate psychological and/or pharmacological treatments of depression are very important to reduce risk factors for suicide. Therefore, in the antidepressant treatment some drugs should be used, especially in those cases where the risk of suicide is evident.

Older people, social isolation, loneliness and lack of communication with people lead to suicide.

However, in the study conducted by Isometsä et al. in 1994 the real situation was revealed. For example, only 45% of suicides with depression were in psychiatric treatment when they committed suicide, while only 3% had taken antidepressant drugs at appropriate doses. According to another study, more than half of the depressed were with a doctor during the three months prior to suicide, but only half of them received an antidepressant drug and only a third of them contained remnants of antidepressants in the autopsy. According to all these data, lack of treatment, inadequate treatment or poor compliance with treatment could facilitate suicidal behavior. It has also been shown that both appropriate diagnoses and antidepressant drug treatments significantly reduce the risk of suicide in depressed patients.

Alcoholism

In alcohols the number of suicides is also much higher than in the general population. It has been published that the risk of suicide of current alcoholists is 8-11%, but that in the alcohols in treatment drops to 3.4%. However, it is observed that more than half of alcoholic suicides suffer other types of psychiatric illnesses before they die. According to this, the interaction between alcoholism and other psychiatric diseases is an important risk factor for suicidal behavior.

Alcoholism and depression often appear together, with alcoholics at twice as much risk of depression as non-alcoholics. Both problems are more frequent in women at once, but in addition the order of appearance would also be related to gender. For example, in 78% of men alcoholism appears first and become depressed as a result of this alcoholism. In women, however, the first problem is depression in 66% of cases, and probably because of that depression appears alcoholism.

On the other hand, alcohol abuse seems to have a lot to do with youth suicide. For example, 50% of young Finns who died of suicide had enough blood alcohol to detect. In the young population, more and more, besides alcohol, other drugs appear as one of the most important factors related to suicide.

Schizophrenia

Singleness or separation are social situations that can encourage suicide from being unemployed or living alone.

Schizophrenia is often another psychiatric disease related to suicide. Patients with schizophrenia are 10 to 20 times more at risk of suicide than normal people, while one of the main causes of premature death in schizophrenics is suicide. This risk is higher in young men and, unlike other people, decreases with age. On the other hand, the risk of suicide in schizophrenic patients during their hospital stay is lower, but doubles when leaving the hospital. Schizophrenic patients use much more violent and usually more deadly forms to commit suicide.

In most cases schizophrenia presents two types of symptoms: negative (lack of emotion, disappearance of affectivity, distrust and lack of relationship with people…) and positive (hallucinations, agitation, hyperactivity, paranoid suspicions…). As positive symptoms become more evident than negative symptoms, the risk of suicide will be higher.

As for treatment, for many years neuroleptics have been used as alternative drugs against schizophrenia. Unfortunately in schizophrenics there is a group of patients resistant to neuroleptics, with higher risk of suicide in patients. The solution for this group of schizophrenics may be the use of new drugs called atypical neuroleptics. Evidence of this is research showing an 85% decrease in the risk of suicide in schizophrenic patients treated with clozapine (first model of atypical neuroleptics). However, one of the most important and serious problems of schizophrenia is that the patient himself has no awareness of his own disease. Therefore, patients suffering from schizophrenia have a tendency to doctors totally negative and irreproachable, so they will not normally require psychiatric assistance. In addition, although treatment is initiated, schizophrenics see the need to take drugs as an aggression and will usually attempt to abandon treatment with any excuse, increasing the risk of suicide.

Social risk factors

In addition to all of the above, a number of social factors have been shown to be related to suicidal behavior. Apparently, being single or separated, being unemployed or living are only social situations that can encourage suicide. In the same line, age and gender can also be related to suicidal behavior. For example, suicide is higher in men and seems, except for exceptions, that the influence is greater with age. However, in recent times there has been a noticeable increase in the suicide rate in younger people, and especially in boys. For example, in the United States between 1980 and 1992, in the 15-19 year stretch, the number of suicides increased by 28% and in 10-14 by 120%. In the case of young people, family problems, learning problems and ill-treatment suffered by their parents are largely the reason for suicide. Older people, on the contrary, are driven to suicide by social isolation, loneliness and lack of communication with people.

Patients suffering from schizophrenia have a totally negative and irreproachable tendency to physicians, so they will not normally require psychiatric assistance.

The number of suicides in battles is lower. But in times of economic depression, the risk of suicide increases as people's economic situation decreases. For example, the economic crisis caused by the disappearance of the Soviet Union has caused the suicide rate in Russia to increase by 4%. In this context, the risk of suicide of immigrants or immigrants will be very high, since in them the bad economic situation joins the loneliness and isolation of the society in which they live.

Finally, suicide is more common during the day than at night; it is also more common at the beginning of the week and in the spring.

Conclusions

In short, there are many risk factors that may be related to suicidal behavior and it seems that their research is critical to addressing true suicide prevention. We cannot forget that, according to statistics, 5% of the population thinks of suicide at least once throughout their lives. In addition, many people who commit suicide turn to the doctor in months or days before. The assessment of each patient's suicide risk should take into account all its components to prevent suicide. In addition, in most cases, suicide will announce its decision before. Therefore, special attention must be paid to suicide sessions, since from now on 10% of them will perform a real suicide.

In general, health professionals should be attentive to all these factors to assess the need for specialized assistance or assistance in each case and to guide the patient in the most appropriate way.