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Kassaw C, Alemayehu S. The Trends of Suicidality Over the Past 10 Years (1999-2022) in the Ethiopian General Population and the Way Forward in Tackling It. Psychol Res Behav Manag 2023; 16:3231-3236. [PMID: 37599797 PMCID: PMC10439282 DOI: 10.2147/prbm.s419426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/07/2023] [Indexed: 08/22/2023] Open
Abstract
Suicide is defined as a death caused by willful acts of taking one's own life. It might be a way for people to get away from suffering or anguish. Globally, an estimated a million people individuals lose their life due to suicide annually. Before the age of 50 years old more than half (58%) of all suicide deaths occur. This commentary aims to highlight the Ethiopian context, feasible preventive measures, and the way forward in tackling suicidal behavior. Worldwide in adolescent age groups between the ages of 15 and 29, suicide is the fourth leading cause of death. Even though suicide occurs everywhere in the world, according to data in 2019, 77% of all suicides that occurred in the world reside in developing countries. Due to the numerous psychosocial pressures present in Ethiopia, one in four citizens suffers from a mental disorder. According to Ethiopian national data figures, suicide ideation affects 9%, 5-16% of people, whereas suicidal attempt affects 4%, 1-8%. Even though, there is a variation of prevalence over the years based on the variation in design, settings, and sample size. There is an increment in the prevalence's suicidal ideation and attempts in the past 10 years. The country's Ministry of Health needs to act to address and prevent this urgent public health situation. The prevention of suicide should be a top concern, and working with numerous stakeholders is an efficient and practical approach.
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Affiliation(s)
| | - Selamawit Alemayehu
- Departments of Psychiatry, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Kammeraat M, van Rooijen G, Kuijper L, Kiverstein JD, Denys DAJP. Patients requesting and receiving euthanasia for psychiatric disorders in the Netherlands. BMJ MENTAL HEALTH 2023; 26:e300729. [PMID: 37423642 PMCID: PMC10335461 DOI: 10.1136/bmjment-2023-300729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/25/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Euthanasia and assisted suicide (EAS) for patients with psychiatric disorders occupies a prominent place in the public debate, but little is known about the psychiatric patients requesting and receiving EAS. OBJECTIVE To compare the social demographic and psychiatric profile of the patients who make a request for EAS and those who receive it. METHOD We carried out a review of records from 1122 patients with psychiatric disorders who have filed a potentially eligible request for EAS at Expertise Centrum for Euthanasia (EE) in the period 2012-2018. FINDINGS The majority of the patients requesting EAS were single females, living independently with a comorbid diagnosis of depression with a history of undergoing psychiatric treatment for more than 10 years. From the small number of patients who went on to receive EAS in our sample, the majority were also single women, with a diagnosis of depressive disorder. A small subgroup of patients whose diagnoses included somatic disorders, anxiety disorders, obsessive-compulsive disorders and neurocognitive disorders were over-represented in the group of patients receiving EAS compared with the applicant group. CONCLUSION The average demographic and psychiatric profile of patients requesting and receiving EAS were found to be broadly similar. The majority of patients requesting EAS had received a comorbid diagnosis, making this a difficult-to-treat patient group. Only a small number of patients requesting had their requests granted. Patients from different diagnostic groups showed patterns in why their requests were not granted. CLINICAL IMPLICATIONS Many of the patients who withdrew their requests for EAS benefited from being able to discuss dying with end of life experts at EE. Health professionals can make a difference to a vulnerable group of patients, if they are trained to discuss end of life.
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Affiliation(s)
- Monique Kammeraat
- Psychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Expertisecentrum Euthanasia, The Hague, Netherlands
| | - Geeske van Rooijen
- Psychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Dijklander Ziekenhuis, Hoorn, Netherlands
| | - Lisette Kuijper
- Psychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
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van Veen SMP, Evans N, Ruissen AM, Vandenberghe J, Beekman ATF, Widdershoven GAM. Irremediable Psychiatric Suffering in The Context of Medical Assistance in Dying: A Delphi-Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:758-767. [PMID: 35311599 PMCID: PMC9510999 DOI: 10.1177/07067437221087052] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Patients with a psychiatric disorder are eligible to request medical assistance in dying (MAID) in a small but growing number of jurisdictions, including the Netherlands and Belgium. In Canada, MAID for mental illness will become possible in 2023. For this request to be granted, most of these jurisdictions demand that the patient is competent in her request, and that the suffering experienced is unbearable and irremediable. Especially the criterion of irremediability is challenging to establish in patients with psychiatric disorders. The aim of this research is to establish what criteria Dutch and Belgian experts agree to be necessary in characterising irremediable psychiatric suffering (IPS) in the context of MAID. METHODS A two-round Delphi procedure among psychiatrists with relevant experience. RESULTS Thirteen consensus criteria were established: five diagnostic and eight treatment-related criteria. Diagnostically, the participants deem a narrative description and attention to contextual and systemic factors necessary. Also, a mandatory second opinion is required. The criteria concerning treatment show that extensive biopsychosocial treatment is needed, and the suffering must be present for several years. Finally, in the case of refusal, the participants agree that there are limits to the number of diagnostic procedures or treatments a patient must undergo. CONCLUSIONS Consensus was found among a Dutch and Belgian expert group on potential criteria for establishing IPS in the context of MAID. These criteria can be used in clinical decision-making and can inform future procedural demands and research.
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Affiliation(s)
- Sisco M P van Veen
- Department of Psychiatry, Amsterdam University Medical Center, the Netherlands.,Department of Ethics, Law and Humanities, Amsterdam University Medical Center, the Netherlands.,113 Suicide prevention, Amsterdam, the Netherlands
| | - Natalie Evans
- Department of Ethics, Law and Humanities, Amsterdam University Medical Center, the Netherlands
| | - Andrea M Ruissen
- Department of Ethics, Law and Humanities, Amsterdam University Medical Center, the Netherlands
| | | | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Center, the Netherlands
| | - Guy A M Widdershoven
- Department of Ethics, Law and Humanities, Amsterdam University Medical Center, the Netherlands
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Yun YH, Sim JA, Choi Y, Yoon H. Attitudes toward the Legalization of Euthanasia or Physician-Assisted Suicide in South Korea: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095183. [PMID: 35564575 PMCID: PMC9105789 DOI: 10.3390/ijerph19095183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/16/2022] [Accepted: 04/23/2022] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate the general South Korean public attitudes toward the legalization of euthanasia or physician-assisted suicide (EAS) and examine the reasons underpinning these attitudes. From March–June 2021, we conducted a cross-sectional survey of a representative national sample of 1000 South Koreans aged 19 years or older. Three in four participants (76.4%) expressed positive attitudes toward the legalization of EAS. Participants who agreed with this legalization reported “meaninglessness of the rest of life” and “right to a good death” as their main reasons. Participants who disagreed with the legalization of EAS reported “respect for life”, “violation of the right to self-determination”, “risk of abuse or overuse”, and “violation of human rights” as theirs. In the multivariate logistic regression analyses, participants with poor physical status (adjusted odds ratio [aOR]: 1.41, 95%; confidence interval [CI]: 1.02–1.93) or comorbidity (aOR: 1.84, 95%; CI: 1.19–2.83) showed positive attitudes toward the legalization of EAS. In summary, most of the general South Korean population regards the legalization of EAS positively, especially participants with poor physical status or comorbidity.
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Affiliation(s)
- Young Ho Yun
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul 03080, Korea; (Y.C.); (H.Y.)
- Department of Family Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
- Correspondence: ; Tel.: +82-2-740-8417
| | - Jin-Ah Sim
- School of AI Convergence, Hallym University, Chuncheon 200160, Korea;
| | - Yeani Choi
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul 03080, Korea; (Y.C.); (H.Y.)
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Hyejeong Yoon
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul 03080, Korea; (Y.C.); (H.Y.)
- College of Liberal Studies, Seoul National University, Seoul 03080, Korea
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Beekman ATF, van Veen SMP. Death With Dignity and Suicide Compared. Am J Geriatr Psychiatry 2022; 30:221-222. [PMID: 34419364 DOI: 10.1016/j.jagp.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Center/VUmc Department of Psychiatry (ATFB), the Netherlands
| | - Sisco M P van Veen
- GGzinGeest and Amsterdam UMC/VUmc Department of Psychiatry (SMPvV), the Netherlands; Department of Medical Ethics, Amsterdam University Medical Center, Law and Humanities Amsterdam (SMPvV), the Netherlands
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De Hert M, Loos S, Sterckx S, Thys E, Van Assche K. Improving control over euthanasia of persons with psychiatric illness: Lessons from the first Belgian criminal court case concerning euthanasia. Front Psychiatry 2022; 13:933748. [PMID: 35928783 PMCID: PMC9343580 DOI: 10.3389/fpsyt.2022.933748] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/30/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Belgium is one of very few countries that legally allow euthanasia for suffering caused by psychiatric illness. In the first criminal trial in Belgium of physicians involved in euthanasia, three physicians recently faced the accusation of "murder by poisoning," for allegedly having failed to comply with several requirements of the Belgian Euthanasia Law in granting the euthanasia request a woman suffering from psychiatric illness. Although all three physicians were acquitted, the case generated much debate among policy makers, medical professionals, and the general public. METHOD We use this trial as the starting point for a critical analysis of the adequacy of the three-level control system established in the Euthanasia Law, as it is applied in the evaluation of euthanasia requests from persons who suffer unbearably from a psychiatric illness. This analysis is based on information presented during the criminal trial as well as information on the euthanasia that was published in the press. RESULTS Our analysis highlights substantial problems in the assessment and granting of the euthanasia request. The patient was euthanized without it having been substantiated that her psychiatric illness had no prospect of improvement and that her suffering could not be alleviated. The three-step control system enshrined in the Law and promoted by the Federal Control and Evaluation Commission for Euthanasia appears to have failed at each level. CONCLUSION To evaluate requests for euthanasia for mental suffering caused by psychiatric illness, the requirements of the Belgian Euthanasia Law should be complemented by mandating the advice of two psychiatrists, and face-to-face discussions between all physicians involved. In parallel with the process of evaluating the euthanasia request, a treatment track should be guaranteed where reasonable evidence-based treatments and recovery-oriented options are tried.
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Affiliation(s)
- Marc De Hert
- University Psychiatric Centre, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Neurosciences, Centre for Clinical Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Brain Institute, Katholieke Universiteit Leuven, Leuven, Belgium.,Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
| | - Sien Loos
- Research Group Personal Rights and Property Rights, Faculty of Law, University of Antwerp, Antwerp, Belgium.,Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sigrid Sterckx
- Bioethics Institute Ghent, Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
| | - Erik Thys
- University Psychiatric Centre, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Neurosciences, Centre for Clinical Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Kristof Van Assche
- Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium.,Research Group Personal Rights and Property Rights, Faculty of Law, University of Antwerp, Antwerp, Belgium
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Snijdewind MC, de Keijser J, Casteelen G, Boelen PA, Smid GE. "Only One Way Out"-Partners' Experiences and Grief Related to the Death of Their Loved One by Suicide or Physician-Assisted Dying Due to a Mental Disorder. Front Psychiatry 2022; 13:894417. [PMID: 35873257 PMCID: PMC9304962 DOI: 10.3389/fpsyt.2022.894417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous research has provided insight into the grief of suicide survivors, but little is known about grief following physician-assisted dying (PAD), and no prior study specifically focused on grief following PAD due to a mental disorder. The current study aims to increase insight into experiences preceding PAD or suicide of a loved one due to a mental disorder and their impact on mental health symptoms. METHODS We performed a survey study and in-depth interviews with 27 bereaved life partners. The deceased had been in treatment for mental disorders and had died by PAD (n = 12) or suicide (n = 15). Interviews explored grief experiences and experiences with mental health care. In the survey, we assessed self-reported symptoms of grief, post-traumatic stress, anxiety, depression, quality of life, and impairments in social, and occupational functioning. RESULTS All participants reported generally low levels of mental health symptoms. Longer time since death and death by PAD were associated with lower grief intensity. Interviews showed various degrees of expectedness of the partners' death, and a varying impact of being present at the death on bereaved partners. CONCLUSION Expectedness of the death of the partner, absence of suffering of the partner at the time of dying, and presence of physician support may in part explain the protective effects of PAD against severe grief reactions. Physicians considering their position regarding their personal involvement in PAD due to a mental disorder could take grief reactions of the bereaved partner into account.
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Affiliation(s)
- Marianne C Snijdewind
- ARQ Centrum'45, Diemen, Netherlands.,Department of Ethics, Law and Humanities, Amsterdam UMC, Academic Medical Centre, Amsterdam, Netherlands
| | - Jos de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
| | | | - Paul A Boelen
- ARQ Centrum'45, Diemen, Netherlands.,ARQ National Psychotrauma Centre, Diemen, Netherlands.,Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, Netherlands
| | - Geert E Smid
- ARQ Centrum'45, Diemen, Netherlands.,ARQ National Psychotrauma Centre, Diemen, Netherlands.,Department of Humanistic Chaplaincy Studies, University of Humanistic Studies, Utrecht, Netherlands
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