Rethinking suicides as mental accidents: Towards a new paradigm

Ethological Problems with the Interpersonal Theory of Suicide

Joiner and colleagues' Interpersonal Theory of Suicide (IPTS), a prominent "desire-capability" model of suicide-based on the common-sense idea that people take their own lives because they want to, and can-is critiqued from a biological perspective. Tinbergen's ethological "four questions" guide the analysis: evolution, survival value, ontogeny, and proximate causation, each addressing a different aspect of biological understanding. Problems for IPTS emerge with all four. As a parsimonious solution, the desire-capability hypothesis is reconceived as an ultimate, instead of proximate, mode of explanation. By this light, desire and capability for suicide combined in our species' ancestral past, thus making suicide a recurrent survival threat, and driving the evolution of special-purpose defensive adaptations. This stance tallies with the pain-brain theory of the evolution of suicide, and with Joiner and colleagues' own investigation into organismic anti-suicide defenses, which appears to conflict conceptually with IPTS. These defenses' evolved algorithm may make suicide an intrinsically aleatory phenomenon, opaque to usefully accurate prediction. Positive implications for prevention and research are proposed.

Trends in suicide methods in Switzerland from 1969 to 2018: an observational study

BACKGROUND

Suicide is a serious societal and health problem. We examined changes in rates of completed suicides in Switzerland between 1969-2018 with particular regard to different methods of suicide used in different subgroups of the resident population.

METHODS

We used data of the Swiss cause of death statistics and Poisson regression models to analyse annual incidence rates and calendar time trends of specific suicide methods used in population subgroups by sex (men vs women), age (10-29, 30-64, >64 years), and nationality (Swiss vs other citizenship).

RESULTS

There were 64,996 registered suicides between 1969 and 2018. Across these 5 decades, the overall suicide rate was higher in men than in women (incidence rate ratio [IRR] 2.62, 95% confidence interval [CI] 2.58-2.67), in Swiss citizens than in foreigners (IRR 2.02; 95% CI 1.97-2.07), and in older residents (>64 years) than in the age groups 30-64 years (IRR 1.35, 95% CI 1.32-1.37) and 10-29 years (IRR 2.37, 95% CI 2.32-2.43). After peaking in the 1980s, the overall suicide rate had declined in all of these population subgroups, with flattening trends over most recent years. The most common specific methods of suicide were hanging (accounting for 26.7% of all suicides) and firearms (23.6%). The rates of the specific suicide methods were usually higher in men, in Swiss citizens and in older residents, and they had typically declined over most recent decades in the population subgroups examined. However, some methods diverged from this general pattern, at least in some population subgroups. For instance, railway suicides most recently increased in younger and in male residents whereas suicides by gas and by drowning were only at a low level after rapid declines in the last millennium.

CONCLUSIONS

Restricting access to lethal means (e.g., detoxification of domestic gas), improvements in health care and media guidelines for responsible reporting of suicides are possible explanations for the generally declining suicide rates in Switzerland. Whereas some methods (e.g., poisoning by gases or drowning) had become rare, others continue to account for many suicides every year, at least in some population subgroups (e.g., firearms in older Swiss men or railway suicides in younger and in male residents). As different methods of suicide are chosen by different people or subgroups of the population, preventive efforts should include differentiated strategies and targeted measures to further reduce suicides in Switzerland and elsewhere.

Suicidal ideation and self-injury in LGB youth: a longitudinal study from urban Switzerland

BACKGROUND

Adolescent suicidality, suicidal ideation (SUI) and self-harming behaviour (SI) are major public health issues. One group of adolescents known to be particularly prone to suicidality and mental health problems is lesbian, gay and bisexual (LGB) youth. Although the social acceptance of the LGB community has increased in recent years, LGB individuals are still at risk of mental health issues and suicidal behaviour. More longitudinal research looking into the associations between sexual orientation (SO) and facets of mental health across adolescence is warranted.

METHODS

This research examined associations between sexual orientation, suicidal ideation and self-injury at 15, 17 and 20 years of age in a community-based sample of 1108 Swiss adolescents (51.1% females/48.9% males). At the age of 15 years, participants provided information regarding their SUI and SI. At 17 and 20 years of age, participants also reported their SO.

RESULTS

Twelve percent of the female participants and 4.4% of the male participants reported identifying as LGB at 17 and 20 years of age. Self-reports of bi- or same-sex attraction increased over time in both genders, with the increase being more pronounced in females. LGB adolescents of both genders showed significantly higher percentages of SUI and SI at the ages of 17 and 20 years than their heterosexual peers.

CONCLUSIONS

The findings confirm a higher risk of SUI and SI in adolescents who identify as LGB. Future studies should develop interventions targeting mental health from early adolescence with the aim of reducing disparities related to SO.

Application of an accident approach to the study of acute suicidal episodes through repeated in-depth interviews

We modified an accident analysis model for the study of acute suicidal episodes (ASEs). Our aim was to use this model (SCREAM, Suicidal Cognitions' Reliability and Error Analysis Method) as a lens to understand the worst-ever ASEs of nine patients who took part in repeated in-depth interviews. Guided by the theory of SCREAM including four predetermined categories, nine themes were identified. ASEs were triggered by interactions with the interpersonal and physical environment and spiraled into a state of lost control. Timing and the availability of promoters and barriers in the environment were salient features. Findings may aid person-centered safety planning.