The Werther effect and assisted suicide

Investigating the relationship between euthanasia and/or assisted suicide and rates of non-assisted suicide: systematic review

BACKGROUND

Euthanasia and assisted suicide (EAS) are practices that aim to alleviate the suffering of people with life-limiting illnesses, but are controversial. One area of debate is the relationship between EAS and suicide rates in the population, where there have been claims that availability of EAS will reduce the number of self-initiated deaths (EAS and suicide combined). Others claim that legislation for EAS makes it acceptable to end one's own life, a message at variance with that of suicide prevention campaigns.

AIMS

To examine the relationship between the introduction of EAS and rates of non-assisted suicide and self-initiated death.

METHOD

We conducted a systematic review to examine the association between EAS and rates of non-assisted suicide and of self-initiated death. We searched PubMed, Scopus, PsycINFO and Science Direct, until 20 December 2021. Studies that examined EAS and reported data on population-based suicide rates were included.

RESULTS

Six studies met the inclusion criteria; four reported increases in overall rates of self-initiated death and, in some cases, increased non-assisted suicide. This increase in non-assisted suicide was mostly non-significant when sociodemographic factors were controlled for. Studies from Switzerland and Oregon reported elevated rates of self-initiated death among older women, consistent with higher rates of depressive illnesses in this population.

CONCLUSIONS

The findings of this review do not support the hypothesis that introducing EAS reduces rates of non-assisted suicide. The disproportionate impact on older women indicates unmet suicide prevention needs in this population.

The debate about physician assisted suicide and euthanasia in Ireland - Implications for psychiatry

At present, Physician-Assisted Suicide and Euthanasia are illegal in Ireland, and are forbidden under the Irish Medical Council's ethical guidelines. With the recent introduction of a Bill in the Irish Dáil (Parliament) which would have permitted Physicial-Assisted Suicide in that country, Physician-Assisted Suicide and Euthanasia (PAS-E) has become the subject of debate, both within the medical profession and in the wider community. Geographical and historical considerations mean that the Irish situation may have relevance to many other countries, which have apparently little similarity among themselves. PAS-E is becoming more widespread and more acceptable in many countries throughout the world. There are ramifications for many aspects of medical care, and matters such as the broadening of euthanasia criteria beyond terminal illness, attitudes toward suicide, and the determination of capacity and voluntariness, suggest that it will be an important issue, not only for psychiatrists, but for the wider medical community as well, in the coming years.

Cost-Effectiveness of a Multi-Disciplinary Emergency Consultation System for Suicide Attempts by Drug Overdose in Young People and Adult Populations

The purpose of this study was to compare the characteristics of suicide attempts by drug overdose between young people and adults, and evaluate the cost-effectiveness of a multi-disciplinary emergency consultation system (MECS) for suicide attempters with drug overdose. It was verified by comparing and analyzing data from June 1, 2017 to May 31, 2018 (before the MECS was implemented; pre-MECS), and from June 1, 2018 to May 31, 2019 (after the MECS was implemented; post-MECS). The data were retrospectively reviewed for a total of 251 such patients with suicide attempts by drug overdose who visited the emergency room of a university hospital in Seoul during the period. The young people group were shown to be more likely to use painkillers and less likely to use psychoactive drugs for a suicide attempt (p < 0.01), had more unplanned attempts than planned ones (p < 0.01), and had lower levels of intentionality for suicide (p = 0.04) and of suicide lethality (p = 0.02), compared to the adult group. We defined suicide attempts as being "serious" when there was both high intentionality and lethality. On this basis, the young people group had less serious suicide attempts, compared to the adult group (p = 0.02). Young people in the post-MECS group had lower intensive care unit (ICU) costs (p = 0.01) and lower costs in the 6-months after the suicide attempt (p = 0.02) compared to those in the pre-MECS group. Young people, both with serious (p < 0.01) and non-serious attempts (p < 0.01) in the post-MECS group had lower ICU costs compared to those in the pre-MECS group. Adults with non-serious attempts in the post-MECS group had lower ICU costs (p < 0.01) compared to those in the pre-MECS group. Therefore, it can be concluded that fast and precise cooperation from the multidisciplinary departments for patients who attempted suicide by drug overdose reduced unnecessary ICU treatment and costs, especially in young attempters and those with lower levels of intentionality and lethality.

Construction and Validation of an Analytical Grid about Video Representations of Suicide ("MoVIES")

Background. Exposure to fictional suicide scenes raises concerns about the risk of suicide contagion. However, researchers and clinicians still lack empirical evidence to estimate this risk. Here, we propose a theory-grounded tool that measures properties related to aberrant identification and suicidal contagion of potentially harmful suicide scenes. Methods. The items of the Movies and Video: Identification and Emotions in reaction to Suicide (MoVIES) operationalize the World Health Organization’s recommendations for media coverage of suicide, and were adapted and completed with identification theory principles and cinematographic evidence. Inter-rater reliability (Cohen’s kappa) and internal consistency (Cronbach’s alpha) were estimated and optimized for two series of 19 and 30 randomly selected movies depicting a suicide scene. The validity of the scale in predicting identification with the suicidal character was tested in nine unknowledgeable participants who watched seven suicide movie scenes each. Results. The MoVIES indicated satisfying psychometric properties with kappas measured at 0.7 or more for every item and a global internal consistency of [α = 0.05]. The MoVIES score significantly predicted participants’ strength of identification independently from their baseline empathy ((β = 0.20), p < 0.05). Conclusions. The MoVIES is available to scholars as a valid, reliable, and useful tool to estimate the amount of at-risk components of fictional suicidal behavior depicted in films, series, or television shows.

External built residential environment characteristics that affect mental health of adults

External built residential environment characteristics include aspects of building design such as types of walls, doors and windows, green spaces, density of houses per unit area, and waste disposal facilities. Neighborhoods that are characterized by poor quality external built environment can contribute to psychosocial stress and increase the likelihood of mental health disorders. This study investigated the relationship between characteristics of external built residential environment and mental health disorders in selected residences of Nakuru Municipality, Kenya. External built residential environment characteristics were investigated for 544 residents living in different residential areas that were categorized by their socioeconomic status. Medically validated interview schedules were used to determine mental health of residents in the respective neighborhoods. The relationship between characteristics of the external built residential environment and mental health of residents was determined by multivariable logistic regression analyses and chi-square tests. The results show that walling materials used on buildings, density of dwelling units, state of street lighting, types of doors, states of roofs, and states of windows are some built external residential environment characteristics that affect mental health of adult males and females. Urban residential areas that are characterized by poor quality external built environment substantially expose the population to daily stressors and inconveniences that increase the likelihood of developing mental health disorders.

The Werther effect reconsidered in light of psychological vulnerabilities: results of a pilot study

BACKGROUND

Findings from three decades of epidemiological studies suggest that media diffusion of stories about suicide is related to increases in suicidal behaviours in the population exposed to the media reports. However, we still know little about the psychological processes and personal vulnerabilities that prompt some people to engage in suicidal behaviours after exposure to media presentations of suicides. This cross-sectional study explored the possible impact of exposure to film suicide in normal young people.

METHODS

Undergraduates from a university (mean age 23 years) completed a questionnaire on exposure to suicide portrayal in fictional films, in which assessment of negative emotional and cognitive reactions resulting from exposure, as well as emotional reactivity, dissociation, thought suppression, and suicidal tendencies were made.

RESULTS

Of the 101 participants, 70% reported being distressed by the portrayal of a suicide in a fictional film. Among those, 33% stated they felt distressed about the portrayal for several days to several weeks. The majority of the affected participants (71%) indicated having been mentally preoccupied for some time by the portrayal and experienced intrusive memories (68%). Emotional reactivity and dissociation tendencies were significant predictors of the negative reactions to the suicide film they viewed. Participants who reported that the idea had crossed their mind to imitate the suicidal protagonist in the film were 3.45 times more likely to be suicidal and tended to present higher dissociation and thought suppression propensities compared to those who did not report these thoughts.

LIMITATIONS

The results showing possible influences of suicide portrayal in fictional film on suicide related cognitions were based on a survey methodology.

CONCLUSION

Results suggest that fictional suicide portrayals in the media may have a deleterious impact on viewers, and such impacts do not appear to be limited to people having a clinical profile of mental disorders, as previously assumed by researchers in the field.

Adolescent volunteerism in Hong Kong after 1997: a critical review

Adolescent volunteerism is an integral part of positive youth development. Since the reunification of Hong Kong to the PRC in 1997, the Government of the Hong Kong Special Administrative Region has been promoting adolescent volunteerism actively. In this review, both government agencies heavily involved in the volunteerism movement and non-governmental organizations providing volunteer services are discussed. The profiles and characteristics of adolescent volunteerism in the local contexts are also examined. The present review identified several problems in adolescent volunteerism in Hong Kong, including service overlap and neglect, truncated service provision among agencies and poor coordination, inflexible resource allocation, lack of long-term planning and lack of evidence-based practice for adolescent volunteerism.

The internet and suicide: A double-edged tool

Many physicians are unaware of the power of the internet. In an era of an empowered public and patients, the internet may be a more powerful determinant of health-seeking behaviour than medical opinion. In the same way, it may provide more information for self-harm than was ever available to the public domain in the past. The internet is effective across cultural and geographical boundaries. In addition to reporting and romanticising suicide, it has a significant impact in assisting and promoting suicide. It provides services and information ranging from general information to online orders of prescription drugs or other poisons that bypass government regulations and custom controls. This bridges the gaps of locality and accessibility, which previously formed a natural divide in selecting the means of suicide. In addition to these negative effects, there is a vast potential to harness these properties to a beneficial effect. The wide acceptance of the internet makes it a powerful tool for recognition of the at-risk individual, for preventing suicide and supporting survivors, with chat rooms taking the place of telephone help lines. In an information age, it is vital for physicians to use all available means of informing and empowering the public and patients. The internet also has a role in training, providing accessible self-help sites for suicidal persons and web-based prevention services, all of which remain sadly under-utilised. The challenge to physicians of the 21st century is to harvest the internet in a beneficial manner.

Use of army weapons and private firearms for suicide and homicide in the region of Basel, Switzerland

OBJECTIVES

Switzerland has one of the highest rates of firearm suicides in the world. International studies show a positive correlation between the rate of households with guns and femicides with guns. Because its defense system requires a militia to keep personal firearms at home, Switzerland has a high rate of households with a gun.

METHODS

Records of suicides in the region of Basel between 1992 and 1996 were reviewed. Suicides with either army weapons or private firearms and suicides by other means were compared. Methods and types of homicides that occurred in the region at the same time were also analyzed.

FINDINGS

Firearm suicides were clearly the most frequent means of suicide. They were also used in 30.0% of domestic homicides, although other means were used at similar rates. Firearms for suicide were mainly used by men, especially army weapons. These men were younger, professionally better qualified, and fewer had ever been treated in one of the local state psychiatric services.

DISCUSSION

The use of firearms for suicide, rather than homicide, and particularly of army weapons by young, well-educated men, requires more attention in debates and informed policy regarding access to firearms and suicide prevention in Switzerland.

Urban built environment and depression: a multilevel analysis

STUDY OBJECTIVE

To assess the relations between characteristics of the neighbourhood internal and external built environment and past six month and lifetime depression.

DESIGN AND SETTING

Depression and sociodemographic information were assessed in a cross sectional survey of residents of New York City (NYC). All respondents were geocoded to neighbourhood of residence. Data on the quality of the built environment in 59 NYC neighbourhoods were collected from the United Status census, the New York City housing and vacancy survey, and the fiscal 2002 New York City mayor's management report.

MAIN RESULTS

Among 1355 respondents, residence in neighbourhoods characterised by a poor quality built environment was associated with greater individual likelihood of past six month and lifetime depression in multilevel models adjusting for individual age, race/ethnicity, sex, and income and for neighbourhood level income. In adjusted models, persons living in neighbourhoods characterised by poorer features of the built environment were 29%-58% more likely to report past six month depression and 36%-64% more likely to report lifetime depression than respondents living in neighbourhoods characterised by better features of the built environment.

CONCLUSIONS

Living in neighbourhoods characterised by a poor quality built environment is associated with a greater likelihood of depression. Future prospective work designed to assess potential mechanisms underlying these associations may guide public health and urban planning efforts aimed at improving population mental health.

Securing a suicide hot spot: effects of a safety net at the Bern Muenster Terrace

The city of Bern has a high percentage of suicides by jumping (28.6%). Related to other local hotspots, the highest number of deaths (mean 2.5 per year) is found at the Muenster Terrace in the old city. In 1998, after a series of suicides, a safety net was built to prevent people from leaping from the terrace and to avoid further traumatization of people living in the street below. We analyzed the numbers of suicides by jumping before and after the installation of the net. We also assessed the number of media reports referring to this suicide method. After the installation of the net no suicides occurred from the terrace. The number of people jumping from all high places in Bern was significantly lower compared to the years before, indicating that no immediate shift to other nearby jumping sites took place. Furthermore, we found a moderate correlation between the number of media reports and the number of persons resident outside Bern committing suicide by jumping from high places in the city.

Urban health: evidence, challenges, and directions

Urbanization is one of the most important demographic shifts worldwide during the past century and represents a substantial change from how most of the world's population has lived for the past several thousand years. The study of urban health considers how characteristics of the urban environment may affect population health. This paper reviews the empirical research assessing urban living's impact on population health and our rationale for considering the study of urban health as a distinct field of inquiry. The key factors affecting health in cities can be considered within three broad themes: the physical environment, the social environment, and access to health and social services. The methodologic and conceptual challenges facing the study of urban health, arising both from the limitations of the research to date and from the complexities inherent in assessing the relations among complex urban systems, disease causation, and health are discussed.