Two models of suicide

Latent groups from multidimensional factors and effects on suicidal ideation in older adults

BACKGROUND

Suicide is a serious social problem among older adults. However, little is known about how multidimensional factors affect suicide of older adults.

AIMS

We classify the multidimensional suicidal risk types of older adults based on their characteristics and identify differences in suicidal ideation.

METHOD

Data were obtained via a nationwide online survey targeting 612 older adults over the age of 55 years. A latent profile analysis identified three profiles, one of which represented the optimal situation for these adults.

RESULTS

We identified three distinct multidimensional suicidal risk types in older adults: high-risk predicament (24.5%), moderate-risk predicament (57.7%) and abundant internal/external resources (17.8%). In particular, depression, a major risk factor for suicide, was found together with self-neglect in each group. Multiple regression analysis showed that older adults in the moderate-risk predicament and high-risk predicament groups were more likely to have suicidal ideation than those in the abundant internal/external resources group.

CONCLUSIONS

Our findings suggest that co-occurrence of depression and self-neglect represents a suicide risk pattern in high-risk older individuals. Therefore, local communities need to urgently screen and provide interventions for such older adults and strengthen their capacity for multidimensional aspects of life to prevent suicide in the long term.

Predicament suicide: an update

OBJECTIVE

We aim to outline the notion of predicament suicide and progress in the field.

CONCLUSION

The term predicament suicide was initially applied when the individual without mental disorder completed suicide to escape intolerable circumstances. Subsequently, painful untreated or unresponsive mental disorder was conceptualized as an internal predicament and the term was applied to all suicide. It continues to be used in both the restricted and broad forms. Our group has substantiated the restricted form by describing suicide in the setting of financial loss, forced marriage and other predicaments. The broad form gave rise to the Operationalized Predicaments of Suicide tool for use in quantitative research. Some literature from other workers supports the general thrust of the notion.

Suicidal behaviours in South East London: prevalence, risk factors and the role of socio-economic status

BACKGROUND

Low socio-economic status (SES) is an established risk factor of suicidal behaviours, but it is unknown to what extent its association is direct, indirect or confounded, given its strong association to mental health. We aimed to (I) estimate the prevalence of suicidal behaviours; (II) describe relevant risk factors; and (III) investigate direct and indirect effects of SES on suicidal behaviours.

METHODS

We used cross-sectional community survey data of adults from randomly selected South East London households (SELCoH). Suicidal outcome measures replicated the 2007 Adult Psychiatric Morbidity Survey in England (APMS). Lifetime prevalence was described by socio-demographics, SES, mental health indicators, and life events. Structured symptom screens and a drug use questionnaire measured mental health. Structural equation models estimated direct and indirect effects of a latent SES variable on suicidal ideation and suicide attempts, adjusting for covariates.

RESULTS

20.5% (95% CI: 18.4-22.7) reported suicidal ideation and 8.1% (95% CI: 6.8-9.7) reported suicide attempts (higher than APMS estimates: 13.7%, 4.8%, respectively). Unadjusted risk factors included poor mental health, low SES, and non-married/non-cohabitating relationship status. Black African ethnicity was protective, and women reported more suicide attempts. SES was directly associated to suicide attempts, but not suicidal ideation. SES had indirect effects on suicidal outcomes via mental health and life events.

LIMITATIONS

The cross-sectional design and application of measures for different time periods did not allow for causal inferences.

CONCLUSIONS

Suicidal behaviours were more prevalent than in the general UK population. Interventions targeting low SES individuals may prove effective in preventing suicide attempts.

Suicide by couples from the public record

OBJECTIVE

The aim of this paper was to examine accounts on the public record of suicide by couples, with a view to extending our clinical understanding of such events.

METHOD

A collection of print reports was examined and a web search was conducted. Cases were generally only accepted when the names, ages, locations and method of death of the individuals were provided, along with sufficient detail to convey the rudiments of the social and physical setting. Cases were then arranged into groups and classified using a typology of suicide.

RESULTS

Twelve cases were identified which provide valuable insights into the lives of couples who suicide. We found 11 married female-male couples and one female-female couple. A large group (seven couples) was characterized by severe or terminal illness in one or both partners. A small group (three couples) was characterized by serious legal problems. One couple was grieving the loss of an only child, and one example involved a psychotic individual, folie a deux and consequent social stressors. The terminal illness group, the legal difficulties group and the bereaved couple could be classified as 'Type 3 suicide' according to the first author's suicide classification. The case involving the psychotic individual and consequent social stressors could be classified as a combination of Type 1 and Type 3 suicide.

CONCLUSION

Reports on the public record of suicide by couples provide valuable insights into the lives of participants, and their suicides could be grouped (terminal illness, legal difficulties, other) and classified using a typology.

Two cases of 'Type 3' suicide

OBJECTIVE

The aim of this paper was to examine two cases of suicide (apparently 'Type 3', according to a new classification) by individuals without high public profiles that appeared in the press in February 2010, and to determine shared characteristics.

METHOD

All the available public record evidence was examined. Comprehensive accounts of the events of the lives of the individuals were compiled, and a comparison of characteristics was performed.

RESULTS

Andrew Joseph Stack III and Brodie Rae Constance Panlock differed in country of residence, gender, age, and marital, parenting, educational and employment status. However, neither manifested evidence of a mental disorder and both were in a predicament created by external factors. They met criteria for Type 3 suicide (suicide when there is no mental disorder and the predicament to which the individual is exposed is very clear to the observer).

CONCLUSION

These cases support the concept of Type 3 suicide. Apart from the absence of mental disorder and the presence of an external predicament, there were no other shared characteristics, suggesting that Type 3 suicide is not restricted to a particular group.