Self-directed violence: Suicide and Self-harm
Lecture 5
Susantha Rasnayake

Brainstorming questions
•
•Have you ever felt that life is not worth living?
•Have you ever met a person with a suicidal mind?
•If yes, what was your response?
•‘‘All healthy men have thought of their suicide’’(Camus, 1955, p.5)
•Approximately 70% of people with suicidal ideation do not convert thoughts into suicide attempts.
•At the same time, some people suffer from suicidal ideation throughout their life
•
> Depressed mature woman lying in bed with bottle of pills top view, covering head with pillow,
unhappy older female suffering from insomnia or depression, psychological problem, overdose concept

Silueta hlavy problémové osoby. - Bez autorských poplatků Úzkost - Ustaranost Stock fotka
Related terms
•Suicide
•Suicidality
•Suicidal ideation
•Suicidal behaviour
•Suicide attempt
•Deliberate self-harm
•Suicidal threats
•Suicidal gestures

Historical accounts
•Historically suicide has been condemned by various human societies except for a few occasions.
•For instance, Sati puja (India), Hara-kiri (Japan), as a way of saving one’s honour
•Ancient Greece allowed convicted criminals to take their own lives
•Many religions including Islam, Judaism, Christianity, and Buddhism condemned suicide
•Many societies interpreted suicide as a punishable offence
•
•

Today
•Committing suicide is not socially and morally approved in human society
•Except for euthanasia for the terminally ill in some societies.
•However, suicide is a major global public health issue
•Over one million commit suicide annually.
•According to WHO (2019) records, over the last 45 years, suicide rates have surprisingly increased
by 60% across the world.
•Suicide is more central in Asia, reporting 60% of death by suicide (Beautrais et al., 2006)

Definitions
•“the act of intentionally taking own life” or “killing oneself”.
•Emil Durkheim’s definition, provided in his remarkable work on suicide (1857, 1951)
•Durkheim’s classification of suicide
•Egoistic
•Altruistic
•Anomic
•Fatalistic

Most risk groups
•More frequent in older age
•But it is the second cause of death in late childhood and adolescence (15–29) along with road
injury and interpersonal violence,
•Statistical evidence indicates an elderly person commits suicide every 1 hour 37 minutes, and a
young person commits suicide every 2 hours and 7 minutes (Barker, 2011, p.613).
•Deaths by suicide contribute to 8.5% of all deaths worldwide among adolescents and young adults
(15–29 years) (WHO, 2017).
•Why do youth become risk
•biological, psychological, and social changes that take place during this period
•

Where is the risk mostly available?
•Out of the total, 73% is reported from developing countries
•WHO (2015), out of 800,000 global deaths by suicide, 78% of all completed suicides occurred in low
and middle-income countries
•But in the recent past, youth suicide rates have increased unexpectedly in developed countries For
example, in the United States, between 2007 and 2017, the suicide rate aged 10-24 group increased
by 56%.
•Finland, New Zealand, Lithuania, Japan, and Latvia are the other countries that report the highest
youth suicide rate (Standley, 2020).
•Therefore, some research recognizes youth suicide epidemiology as a problem in economically more
advanced societies (Cha et al., 2018; Doran & Kinchin; 2020).

•



Youth Suicide rate per 100,000 persons in selected countries by age
Country
Year
5-14 years
15-19 years
Lithuania
2015
1.3
24.3
New Zealand
2012
1.4
20.7
Finland
2014
0.2
17.7
Japan
2014
0.8
15.8
Latvia
2014
0.3
14.5
Uzbekistan
2014
2.8
13.3
Sweden
2015
0.8
13.1
Iceland
2015
-
13.0
United States of America
2014
1.0
13.0
Ireland
2013
0.3
12.9
Republic of Korea
2013
0.8
12.7
Trinidad and Tobago
2010
1.1
12.6
Mauritius
2014
1.6
12.4
Belgium
2013
0.4
12.6
Estonia
2014
1.5
11.3
Canada
2012
0.8
10.3
Chile
2014
1.1
10.2
Australia
2014
0.7
9.6
Colombia
2013
1.1
9.3
Costa Rica
2014
1.0
9.2
Austria
2014
0.4
9.2
Norway
2014
0.3
9.0
Hungary
2014
0.2
9.0
Czech Republic
2015
0.7
8.8
Slovenia
2015
0.5
8.6
Switzerland
2013
0.4
8.1
Republic of Moldova
2015
0.7
7.6
Romania
2015
0.7
7.6
The Netherlands
2015
0.4
7.3
Slovakia
2014
0.1
7.2
Kyrgyzstan
2015
2.3
7.2
Mexico
2014
0.9
7.1
Croatia
2015
0.7
6.9
Germany
2014
0.3
6.7
Cuba
2014
0.8
6.1
United Kingdom
2014
0.2
6.0
St Vincent & the Grenadines
2014
1.2
4.9
Denmark
2015
0.2
4.8
Israel
2014
0.4
4.3
Italy
2012
0.1
3.8
Luxembourg
2014
0.8
3.8
Spain
2014
0.2
3.8
Sri Lanka*
2018
-
11.6
Macedonia
2013
0.3
3.6
Malta
2014
1.7
3.2
Brunei Darussalam
2014
-
1.7
Bahamas
2013
-
1.6

Gender Paradox of Youth Suicidality
•
•Suicide is considered a more male-focused problem
•in 2016, the global age-standardized suicide rate was 13.7 per 100 000 for males while it was 7.5
per 100 000 for females.
•At the same time, in the highest suicide-rated countries, the male suicide rate was 45 per 100 000
and the rate for females was 30 per 100, 000 (WHO, 2019)
•Why do more men commit suicide than women?
•this gender difference is influenced by multiple risk factors including biological, psychological,
and socio-cultural

Why gender paradox???
•Masculine values influence male suicide
•Independence, aggressiveness, risk-taking behaviour, the pursuit of power, and dominance are used
to describe male gender role
•Female gender role is described by opposite meanings of these characteristics
•At the same time anxiety or depression come out through various life stressors is not acknowledged
by the male gender role
•Men – committing suicide as a way of showing the braveness of their personality
•Females use less lethal or soft methods while males use more lethal methods in suicide
•Help-seeking behaviours is low among male than female

Risk factors of Suicide
•Psychological theories  - mental disorders
•Sociological theories- social factors
•Bio-psycho-social model- combination of biological, individual, social and environmental

•Individual level
·Previous suicide attempt
·Mental illness, such as depression
·Social isolation
·Criminal problems
·Financial problems
·Impulsive or aggressive tendencies
·Job problems or loss
·Serious illness
·Substance use disorder
•
> A continuous one-line drawing of a woman with confused feelings is worried about poor mental
health. Problems, stress, sad and depression in the style of doodles. Illustration Line Vector -
Royalty Free Line Art Vector Images

portrait of sad girl being alone and worried outdoors
Relationship Level
·Adverse childhood experiences such as child abuse and neglect
·Bullying
·Family history of suicide
·Relationship problems such as a break-up, violence, or loss
·Sexual violence
•
•

Community level
·Barriers to healthcare
·Lack of mental healthcare facilities
·Social stigma associated with mental disorders including suicidality
·Cultural and religious beliefs such as a belief that suicide is a noble resolution of a personal
problem
·Suicide cluster in the community
·Violence culture
•
•
> Office Hara-kiri Stock Photo, Picture And Royalty Free Image ...

•
Activity
Identify individual, relationship-level and community-level risk factors

Protective Factors
·Coping and problem-solving skills
·Promotion of cultural and religious beliefs that discourage suicide
·‘Befriending’-Connections to friends, family, and community support
·Supportive relationships with care providers (help-seeking)
·Availability of physical and mental health care
·Limit access to lethal means among people at risk
·Identification of early warning signs
•

Activity:
1. Read the following two suicide narratives and identify early warnings
2. What are the clues that indicate low supportive response of family members
•We did not expect that he would make this type of decision. Usually, he is a very aggressive
person. Since aggressiveness is natural in old age, we did not worry about such behaviors. A few
days before his death, he quarreled with my elder son and me. At that time, he aggressively told us
that he no longer wanted to live. But now we understand that perhaps we could have saved his life
if we had referred him to a doctor (interview data)
•
•We noticed that my mother’s behavior had changed from earlier. But we never thought that she would
commit suicide. Religiously, she was a devotee. Usually, she likes to stay alone and speaks very
little. Two to three months before the incident, she often worried about her physical difficulties
and dependence on someone else. She thought she had become a burden to everyone and said that
further living was meaningless. But we thought she was just saying these types of things (interview
data).

•“People who commit suicide don’t want to die but to end their pain,” says Rainey (2020).
•
•
• THANK YOU