Disease causing Suicidal deaths ?

Dear Ahed Khatib,

I am very glad and thankful for your reply. As a young researcher, I am very eager and fortune to know what may be general conditions that can cause the patient to feel isolation from the family and society, leading to commit suicide.

Today we had a case of 32 years male typist committed suicide and has a death note writting on a paper, that infertility is his reason for his death. So, as the same there are many hidden diseases and medical complications that can change the patient psycology to commit suicide.

Recently, a 63 years old women consumed organophospharus with suicidal intend, due to severe joint pains and the patient has RA.

I wish to hear from esteem researcher like you that can help the physicians to provide the psychological support to these patients.

Eliza Leggatt

Low EPA/DHA status have been linked to increased suicidality risk as well as low cholesterol. Low cholesterol is a precursor to vitamin D, which deficiency in is often linked to depression and suicide as well.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3259251/

Akihiro Shiina

As far as I know, WHO announced that almost 90% of the person who had committed suicide had one or more particular mental disorders. Some researches in Japan support this result. To be shamed, Japan is suicide-rich country. I think that personal financial crisis is a big risk factor for suicide (through cause depression, maybe) in Japan.

isotretinoin used for acne treatment does have an occasional incidence of suicide.well coming to other diseases, HIV and AIDs do have the highest incidence due to the stigma attached, Cancer is another disease which can drive people to commit suicide.

Sunita Jagajathan

Hi Akshay:

I had a friend suffering from Ulcerative Colitis at a very young age. He committed suicide cause he couldn't eat. This would sound strange for some but unable to eat even what a normal human being can eat can make one feel miserable...Really pathetic..It is unfortunate that the disease has no cure, even the surgery doesnt work.

Regards

Sunita

Dear Researchers,

Thanks for your reply and I would like to add one recent incidents occur in our hospital. I agree with some patients that the pain and suffering is untolerable and patients some times feels that comitting suicide is the better option than getting treated early.

A 18 years girl staying alone at night and sudden pain on the belly area towards side of the back. She was helpless at that time and consumed hair dye available at the home. This states the mental status of the patient suffering at the acute stages and Hair dye poisoning is one which is most common in my region. Another case reveals the same that A 62 year old patient consumed Hair dye poisoning due to Joint pains, that means even for the Osteoporosis, Osteoarthritis and RA can also leads to suicidal intend. A typical case of observed recently that a 23 years young man burned himself, had a suicide note that the reason for his death is due to Asthma Excerbations which makes him discomfort every day and night. This all states only one reason that, when the patient was not happy with the suffering and unable cope up the pain leading to commit suicide. This is one of the important segment to look into it. If anyone interested to be a part of this work. I am very happy to welcome them.

Thanks for your interest and kindly write a casual mail to my mail id for the further communication sir. I will respond you as needed.

[email protected]

Valentin Radoi

I will just add several reasons for suicide to this already expanding list:

1. Mental disorders clearly represent the first case of suicide attempts and deaths due to suicide. One example would be BPD with 21% attempted suicides over 10 years (http://www.ncbi.nlm.nih.gov/pubmed/22995448). Out of all BPD patients, 10% die following a suicide according to a recent study (http://www.ncbi.nlm.nih.gov/pubmed/22686233).

2. Cancer represents another main reason of suicide. A recent study published in NEJM found a relative risk of suicide of 12.6 in patients diagnosed with cancers as opposed to persons without a cancer diagnosis (in other words an increased risk by 1260%). (http://www.nejm.org/doi/full/10.1056/NEJMoa1110307)

3. Hepatitis C represents another cause for suicide. Although the study referenced does not address directly this problem directly because it is done on a cohort of drug users, the 9.1% of patients who died following suicide, over a course a 15 years, especially seeing that this percent is bigger than the 7.5% due to liver disease raises an interesting question (http://www.ncbi.nlm.nih.gov/pubmed/22960427).

There are clearly more diseases that increase the risk of suicide, but if doing a study on this issue i highly suggest you take into account the most important ones as all diseases will probably increase the risk of suicide. However, several, such as mental disorders, cancer, incurable viral infections (hepatitis, HIV/AIDS etc.) and probably several others more than double or triple this risk.

I am quite interested in this subject so feel free to message me or e-mail me at [email protected]

P.S. If you are interested in publishing the results of a study (review or any other sort of study) regarding suicide related to cancer or hematological diseases please contact me as I am a chief-editor for a journal in this domain (oncolog-hematolog.ro).

P.S.2. Sorry for giving the links to the study in parentheses and not as attachments but RG won't allow me to attach more than one link.

All the best.

Carlo Lazzari

Hi,

I have seen another implication of suicide linked to HIV/AIDS. It is not much about suicide as a consequence of knowing to be infected. Instead HIV negative people with borderline or suicidal ideation choose to be partner of HIV positive people in order to become infected. This emerged in the Centre for the HIV Couple University of Bologna. Thereafter, there has been a confirmation that suicidal ideation of HIV negative people can choose HIV as a tool for. This study is reported in a letter to AIDS Patients Care in my research gate.

Carlo Lazzari

Raveendhara Bannuru

Research shows that risk factors for suicide include:

- depression and other mental disorders, or a substance-abuse disorder (often in combination with other mental disorders). More than 90 percent of people who die by suicide have these risk factors.

- prior suicide attempt

- family history of mental disorder or substance abuse

- family history of suicide

- family violence, including physical or sexual abuse

- firearms in the home, the method used in more than half of suicides (Miller M, Azrael D, Hepburn L, Hemenway D, Lippmann SJ. The association between changes in household firearm ownership and rates of suicide in the United States, 1981-2002. Injury Prevention 2006;12:178-182)

- incarceration

- exposure to the suicidal behavior of others, such as family members, peers, or media figures.

However, suicide and suicidal behavior are not normal responses to stress; many people have these risk factors, but are not suicidal. Research also shows that the risk for suicide is associated with changes in brain chemicals called neurotransmitters, including serotonin. Decreased levels of serotonin have been found in people with depression, impulsive disorders, and a history of suicide attempts, and in the brains of suicide victims. (Arango V, Huang YY, Underwood MD, Mann JJ. Genetics of the serotonergic system in suicidal behavior. Journal of Psychiatric Research. Vol. 37: 375-386. 2003)

Frustrations,lead to suicide.

Sudden pain or helplessness, feeling of loneliness, may contribute to suicidal tendency.

Disease per se may not lead to suicide but the attitude of the patient does.

Lack of family support, fear that the disease may cost a lot of money, and fear of rejection, by society and friends, may also contribute

Carlo Lazzari

Dear researcher,

Here is a publication linked to my previous reply:

AIDS has an increasing diffusion within the heterosexual population [letter].

C Lazzari, P Costigliola, M A Di Bari, D De Ronchi, V Volterra, F Chiodo

AIDS patient care 07/1994; 8(3):106.

Nevertheless I have been working with suicidal patients with HIV/AIDS and found that pre-test counselling is almost essential in order to work with overvalued ideas that people bear when having HIV test for the first time. Pre-test counselling also reduce suicidal ideation and feeling of sterotipy ater a positive diagnosis. From there on, individual counselling, initially, after diagnosis, and group couselling, after a few months, can reduce suicidal intent. We found that pre-test counselling helped people waiting for HIV test in dealing with "death and dying issues". Furthermore, pre-test counselling, when possible, helps HIV candidates to deal with resilience. Furtermore, post-test counselling (1-2 meetings weekly, after a positive HIV diagnosis) can reduce suicidal risks. People with AIDS (PWA) need a lot of information and support and they like the opportunity to discuss with a clinical psychologist their unsupported fears (e.g., "People can see from my face that I have AIDS").

People with HIV infection also get a lot of support by meeting others who are, let's say, "more experienced" in the HIV infection. Interpersonal support in self-help group is an additional resource.

For what instead concerns HCV and suicide, I have not an extensive research, but years ago our group first discovered the effect of Interferon therapy on mood. Today, the implications of Interferon, depression, (and suicide?) are known in HCV positive people.

For what concerns psychotherapy during AIDS I might suggest:

Death and Dying During AIDS

Carlo Lazzari, Diana De Ronchi, Vittorio Volterra, Francesco Chiodo

Aids Patient Care. June 1993: 166-168.

For what instead concerns counselling in people with serious illnesses you might find interesting to read (you can find it on Amazon):

Lazzari, C. (2009). Spiritual Counselling in Medicine. iUniverse, Bloomington, USA.

Personally I feel that any disease that starts feelings of hopelessness and helplessness into clients can trigger suicidal ideation. For example, people with cancer, or people with untreatable diabetes, MS, etc.

I hope you might find this information useful for your research.

Kind regards,

Carlo Lazzari

Suicidal behavior is considered a symptom of depression. Depressions may have both neurotic and psychotic origin; and any psychotrauma can lead to neurotic depression. Clearly any life-threatening disease may lead to psychotrauma and become a cause for a neurotic depression. This is mental health perspective.

Besides that, many biochemical disturances which may accompany various diseases can manifest in depressions. This is rather a biomedical perspective. For example, anaemic women are more likely depressed.

So in most cases not a particular disease but those psychological or biochemical disturbances it causes lead to increased suicidal ideation or behaviors.

Jagdish Khubchandani

Cristina Fernandez and Tatiana Andreeva did a good job providing you with the correlates of suicide. As is, any disease can be associated with suicide, if the disease leads to alteration of mental health status resulting in suicide. Also, causation would not be the right word (needs a RCT)- we can use the terms correlates, predictors, or associated factors.

Causation just cannot be straightforward in this case. It's a matter of a long causal pathway with many mediators and modifiers. Once a person does not have a predisposing value of an effect measure modifier, the expected predictor is not a cause any more.

I agree that RCTs are considered to a wider extent than they in fact deserve. There are many areas or studies about humans where RCTs are not applicable. They constitute 'gold standard' in only quite narrow range of research questions.

there is only one disease other are comorbidities that can be put as risk factors. The risk factors in this case have 3 main caracteristics: do harm that its untreated , make the pacient feel lost, his aquired cultural values refer to suicide as a way of solving his own dead isuue. the morbid state is called depresion and its a longer subject

Steven Stack

I believe that Clare HaRRIS & Brian barraclough (1994) produced the only meta analysis of physical illness factors/disease and suicide risk. Only a series of particular diseases (e.g., HIV/AIDS, brain cancer) significantly predict suicide risk. See Harris & Barraclough. 1994 Suicide as an outcome for medical disorders MEDICINE, 73 (6): 281-296.

The suicide mortality ratio (SMR), accross studies) for the more high risk physical disorders were:

Head/neck cancer 1,139 (CI=521-2163)

HIV/AIDS SMR=665

Systemic Lupus erythematosis SMR=435

Renal Disease 1,449

Some medical disorders had no impact on odds of suicide

some were associated with lower suicide risk

-dr steven stack

wayne state university,

detroit, MI

Volker Dicken

Check http://www.cancer.gov/cancertopics/pdq/supportivecare/depression/HealthProfessional/page4

it indicates that a cancer diagnosis is a risk factor for suicide especially so for a recent cancer diagnosis in men with some often smoking related forms of cancer. The same may hold for some forms of dementia c.f. http://www.ncbi.nlm.nih.gov/pubmed/12145457

Lynne McCormack

The discussion is interesting, however it is not considerate enough of the social, religious and cultural factors of a particular environment or country that will increase the suicide risk if diagnosed with a particular disease. Is it the HIV itself that increases the risk, or as you said Akshay - due to "social discrimination, compramised life and Family isolations"? I suggest it is primarily the result of the latter.

If you say that sepuku or other cultural psttern is irelevant your wrong like all the eurepeans chat about

Just put the question in your mind and you'll see the answer don't be so open to a matter thats so hot to asians and other culters and i don't mean to make a label but ther is a point about it

As we have already discussed earlier in this thread, it looks natural to theorize in terms of a causal pathway with mental health and biomedical mediators. Taking into accout upper suggestions, sociocultural variables can be added as potential effect measure modifiers.

Sushma Dahal

Over 90 percent of people who die by suicide have a mental illness at the time of their death. Untreated mental illness (including depression, bipolar disorder, schizophrenia, and others) is the cause for the majority of suicides.

Suicide is also associated with several physical disorders, including cancer (head and neck cancers in particular), HIV/AIDS, multiple sclerosis, epilepsy, peptic ulcer, renal disease etc.

Similarly, adoption data show a significantly greater frequency of suicide among the biological relatives of suicides. Studies on brain tissue and CSF show that many people who kill themselves, especially those who use violent methods, have low levels of chemical neurotransmitter that is serotonin.

So for the suicidal indentation, different physical and psychological factors contribute.

Due to the fact that a mental illness do not kiills in his nature but by the action and because the ill is part of a society the suicid can have a lot to do with education other may be the lack of affetion and i will state suicide as terminal nevrotic disease for the main fact that is an afectiv matter and no other factor is more important.

Ana C. Amaya-Arias

In our study we found that people with chronic pain presented more risk of suicide and suicide ideas that general population. My study was observational but is possible due the discapacity and lose in quality of life in this population.

Dear Ana,

Yes, the pain is one of the most important factor, to our previous observation studies.. we had found the similar results as you mentioned above. But still I feel that many underlying causes to be evaluated to findout the root cause of Disease causing suicidal Intend. Yes, Cancer, HIV and Psychiatric Disorders are the leading causes for the suicidal Intension. Especially for the elders we had found some of the clinical features that, Patient with Muscular Skeletal disorders are more prone to develop suicidal intension due to acute pain and therapeutic failure are most common in the geriatric population.

Even many drugs causes the suicidal intension but lack of monitoring of these patients leading deaths.

Hanne Krage Carlsen

Dear Akshay

Researchers using Sweidsh register data have studied this in a number of diseases,

A recent study found high ORs post prostate cancer diagnosis, the risk was highly correlated with the prognosis.

http://www.nejm.org/doi/full/10.1056/NEJMoa1110307

See also other studies by Fang Fang

Best

/Hanne

Parag Arun Narkhede

Loss of hope from/about anything can lead to suicide.

loss of trust

breakup from relationship

non-curable disease

mental depression

public insult

stress etc.

can be the causes of Suicidal deaths.

Particularly its Psychological imbalance which can develop Suicidal tendency in mind which leads to actual suicidal death.

David Dias Neto

I agree with most of you in highlighting the importance of assigning meaning to illness in the mediation between illness and suicide

AIDS may be an important useful area of study considering that the prognosis and treatment associated with the disease has changed dramatically in the recent years. Once it was considered a certainly fatal disease, while now it can be seen as a manageable disease.

I wonder whether the perceptions of the patients about the disease with regards both to this & to social stigma will influence suicide ideation or intention.

Suicide is extreme act of self defiance and not accepting the truth. Disease does not cause suicide but the pain and suffering do.. Cancer may cause death in many but some will learn to live for they have the support. Fear is the greatest enemy of man. Overcome it to live long

Hanne Krage Carlsen

@Ahed Khatib, the studies I posted are purely descriptive, using register data, and no qualitative measures. so they can only speculate as to the causes; which include a lot of what has been discussed in the above; shock, stress, despair, depression, not wanting to be a burden when the illness progresses, in some cases shame.

@ David Dias Neto: Efforts to reduce social stigma improved AIDS treatment adherence in this study from Cambodia, could be a likely factor in suicide risk;

http://www.ncbi.nlm.nih.gov/pubmed?term=hiv%20diabetes%20clinic%20stigma

Lisa Harber-Aschan

The WHO World Mental Health Surveys have examined this and found that many chronic physical conditions were associated with suicidal behaviours (ideation and attempts) after adjusting for comorbid mental disorders. Chapter 11 of their book on Suicide goes through these findings in detail (Suicide: Global Perspectives from the WHO World Mental Health Surveys, Editors: Nock, Borges and Ono, 2012), and there is also a paper by Scott, Hwang, Chiu et al. (2010) in Psychosomatic Medicine using this data.

In general, my take on the aetiology of suicide is that is is incredibly complex and it's very difficult to separate out the relative contributions of social, biological and psychological factors involved.

Karen Jean Galway

Risk factors for suicide are very well documented. See key authors such as Hawton and Appleby. But my general response would be that suicide risk is incredibly complex - mirroring answers above. The interaction effects or confounding variables involved are almost endless in number. e.g. A major risk factor such as loss, can emerge as a result of serious chronic conditions such as cancer or MS. However mechanisms such as hope, acceptance and social support can alleviate the risks. Humans are complicated, but essentially we are survivalists. Suicide remains a relatively rare occurrence, thankfully.

Nagusa Dani

I was thinking about what are the different etio-pathologic means of increase in suicidal intent. When we apply Beck's suicide intent scale with different diseases like depression, we come out with results like chronic highly morbid conditions (under a neuro-transmitter based platform) which is well known.HIV/AIDS as such creating suicidal intent in otherwise a normal mental frame is little difficult to consider unless encephalopathic changes bringing differences in neurobiology of the brain and all HIV cases dont manifest encephalopathy. Its an interesting question indeed to study the neurobiochemistry of brain in relation to suicidal ideations..

Kastriot Mark Shytaj

Culture, education, social support I believe are more important that the kind of diseases (except the psychiatric diseases )..

Teresa Beck

My undergrad thesis explored this subject in adults. One finding that was immediately evident, even as an undergrad was Beck's scale had many flaws. None of my professors disagreed with my statistical analysis, and I was hired by one of the best psychiatrists in the area based on that paper. I would never use Beck’s scale to determine suicidal tendencies. The Hopelessness Scale is a good indication of depression, but not necessarily the degree of suicidal thoughts or tendency. You will find good and bad published literature on the Hopelessness Scale.

Predicting suicidal tendencies is as much an art as a science. I can say this with confidence. After completing my Master's I had the opportunity to work with severely mentally ill adolescents who were placed in a residential treatment facility. The average length of stay was 18 months. Their placement was often due to suicidal thoughts, ideation and/or homicidal thoughts, ideation. I spent 40 - 60 hours a week with 6 - 10 adolescents for 8 years providing intense cognitive behavioral therapy. You can also find quality published literature to support the statement that predicting suicide is not a science.

The behavior and thoughts of suicide were strongest when an adolescent was admitted without family or social support systems in place; that is, they did not have anyone to visit them and they did not have anyone to visit outside the facility. This is similar to the social problems you are seeing in HIV/AIDs patients. Illicit drug abuse prior to admission, and/or increased levels of psychotropic medication was another strong predictor of suicidal and homicidal tendencies. I suspect the large levels of pharmaceuticals that HIV/AID’s patients are required to take also play a large role in their suicidal thoughts and behaviors. A clear statistical relationship exists between pharmacology and suicidal thoughts; its relationship is cited in most PDR's. The reality is drugs used to treat symptoms may be causing many more problems than they solve, especially if they are not prescribed appropriately.

To get a clear picture of the adolescent’s behavior and reach a meaningful diagnosis requires a large investment of time and resources. In the 8 years I worked with the severely mentally ill only a tiny percentage needed what I call “heavy hitter psychotropic’s” (a long list with an even longer list of side-effects).

Additionally, as the patient’s overall physical health improved there was a reduction in suicidal thoughts and behavior. A strong relationship between physical illness and depression is very well documented in the literature. It is very unfortunate that the average Family Physician cannot identify and treat underlying illnesses such as PMDD, thyroid dysfunction, iron deficiency, obesity, high blood pressure, and poor nutrition to name a few. One recurring symptom of a metabolic disorder often includes suicidal thoughts, behavior and ideation. Not surprising.

There are the socioeconomic factors that must be considered as well. These factors include a higher incidence of exposure to environmental hazards such as lead, mercury, formaldehyde, poor pre-natal care, etc. etc. etc. Socioeconomic factors and the relationship to environmental hazards are well documented in the literature. It is not surprising to anyone that physically healthy adolescents are often mentally healthy. There are subsets whose underlying physical illnesses will not be accurately diagnosed and they will continue through life with DSM labels such as bi-polar. However, mental illness professionals will often continue to medicate the individual in an effort to keep them safe, and society safe, even with the high suicidal risks that many medications carry. If the patient is lucky the medication will improve the quality of their life.

Chhabil Kumar

Lack of awareness, social stigma, delayed medical care,high stress life and lack of support by parents and friends are responsible max suicidal death

Anne Timms

Never underestimate previous suicidal attempts and any history of family members or significant others who have suicide. Adds a risk factor to one of the choices when people consider their options.

David Alderson MacQueen

Many non-psychiatric disorders are associated with increased suicidality (e.g., HIV, cancer). Chronic pain is likely a common link. See:

Ratcliffe, G. E., Enns, M. W., Belik, S.-L., & Sareen, J. (2008). Chronic Pain Conditions and Suicidal Ideation and Suicide Attempts: An Epidemiologic Perspective. The Clinical Journal of Pain, 24(3), 204-210 210.1097/AJP.1090b1013e31815ca31812a31813.

Naeem Aslam

Psychological disorders like Major depression, and patients with Schizophrenia (especially those who are under the influence of commanding hallucinations) are more vulnerable for suicide. Moreover, patients with chronic medical conditions are reported to be having the suicidal ideations.

Joann Kleinfelder

The depressive disorders and substance abuse disorders account for a significant share of suicides. Impulsiveness that often accompanies these disorders heightens the probability and is correlated with very low levels of serotonin. Contrary to popular belief, many of these people do not take their lives when they are in the lowest depth of depression because they lack the physical energy to carry out the act, although some do. During the beginning stage of recovery, energy starts to return and they can now put the suicide plan into action. Thus, the recovery period is a very vulnerable time and can be a lengthy process. Multiple sclerosis was also associated with suicide in a Swedish study that you may find interesting: Neuroepidemiology. 2003 Mar-Apr;22(2):146-52. Elevated suicide risk among patients with multiple sclerosis in Sweden.

Fadzisai Makonyonga

Check other (None Communicable Diseases) NCDs such as obesity heart problems etc chronic kidney failure these conditions lead to depressive symptoms and hence excerbate suicidal tendencies

Harsh Kushwah

I would recommend that disorders like Bipolar Disorder are best case of understanding why people become suicidal.

If one look at this disease, its high incidence rate, high suicide rate, characteristics, challenges to diagnose this disease, effect on a patient and people around him/her, give a good description and a test subject to study the Suicidal Behavior of people.

One can draw analogies from this disease and suicides that occur due to it, which is among the highest for all the mental diseases, for understanding suicides of people suffering from other diseases.

I would like to discuss with it further.

P.S. Kindly contact on email for detailed discussion.

Dr.Deepak Wankhede

Mental disorder like psychosis,schizophrenia.acute depression,chronic tuberculosis and positive HIV patients have more suicidal tendencies.

Janina Žiberna

I see it's already an old post. However, maybe it could be of your intereset the following articles on this topic:

Risk of completed suicide after bariatric surgery: a systematic review.

C Peterhänsel, D Petroff, G Klinitzke, A Kersting, B Wagner

Burkhard PR, Vingerhoets MD, Berney A, Bogousslavsky J, Villemure J-G, Ghika J. Suicide after successful deep brain stimulation for movement disorders. Neurology. 2004;63:2170-2172.

Akilesh Ramasamy

Chronic neuralgic pain disorders especially Trigeminal Neuralgia is one such disease. Trigeminal Neuralgia has been describe as a condition in which the patient complains that the pain is so severe that they feel that suicide is the only solution to obtain relief. I have personally heard two patients suffering and complaining in desperation during an acute episode of neuralgic pain. Though after the pain subsided, they have not felt any such tendencies further, I believe chronic pain especially of the head and neck region can be associated with increased suicidal tendencies.

Like many others have pointed out, it's a mental state and the impact on the quality of life as well as the coping with the issues of the individual towards the effects of the disease / disorder that has a more bearing on this issue of diseases more concerned with suicidal tendencies.

Regards,

Akilesh. R

Chennai, India

Venkatesh Sankarasetty

so many genetically disorder causing diseases are not curable and they will lead the patients to mental depression and suicides.but ultimate AIDS & CANCER incidents are major suicidal causing diseases.

I sugest all dissease and conditions which lead to feeling of hopelesnes, social rejection, mental pain, isolation,worthlessness... . Not only realy ones but perceived too. So question is not easy to answer and probably it is something multimodal, Why patient with deep and severe chronic repetitive depression does not commit suicide and someone who score less on depression meassures did it? Also I like to look on suicidality as distinct impulse control issue not related to any disease. So yo probably need impulsivity too. I think that suicidal patients do not want to die as much as they whan to escape emotional states mentioned above and thay are so overwhelmed with them that they can not se other direction of escape beside death.

Chandra Mohan Kumar

Suicidal intent is associated with the type of disease but it is much much more related to the mental health of the person concerned. It can be understood by the fact that if 100 people commit suicide hardly 2-3 have some incurable diseases. Similarly if 100 cancers patients die hardly 1-2 die due to suicides. So it can be said with conviction that suicide rates are less than 5% in both the scenarios thus fall outside 2 sd in distribution.

Factors which determine suicidal ideations are 1. Pre illness mental status of the person 2. Availability of quality health care services and 3. Family/peer/social support, not the type of the disease.

Dear Chandra,

I agreee but would not say mental health, my recomend is to se it as psyhological traits + other conditions+ other thins you mentioned.

you are correct disease is not main factor. The more imprortant factors are coping, social suport health services etc.

Tomi Gomory

Unfortunately the notion of self murder (suicide) has become medicalized and depersonalized. It is an act not a happening. In fact the association with "mental illness" is tautological. It is one of the criteria for the DSM constructs such as Major Depressive Disorder. So if its part of the definition by which one is found to be mentally ill, it cannot be caused by it. "He killed himself. Well it was because of his mental illness" or "Well he has MDD, so watch out for suicidal behavior." parts of constructs are logically incapable of causing the label and visa versa.

Why people decide to take their lives of course is an existential dilemma about a person's take on their circumstances in the world and is not primarily a medical question per se. We have by medicalizing volitional behavior removed the understanding of individual responses based on life history and personal choice as appropriate aspects of understanding and responding to such tragic life experiences. Tom Szasz who has written many eloquent books about what mental illness is and is not ,wrote an important book addressing these problems, Fatal Freedom that you might wish to review to see what the discussion ought to be about http://www.amazon.com/Fatal-Freedom-Ethics-Politics-Suicide-ebook/dp/B001EQ638M/ref=sr_1_4?s=books&ie=UTF8&qid=1384433513&sr=1-4&keywords=szasz+suicide

Best.

Tomi

Tomi I agree,

But on one side we can not declare suicide victims mentally ill but on other side is it insane to take own life. The truth is possible somewhere on the middle of Gaussian curve.

From my point of view and real experience in our city. A male took his life after he killed all his family. Retrospectively it was found that he was asking help in different town (fear of stigma) because he probably was depressed. He was advised to seek help in our facility but did not do that. After tragic incident, witnesses in fragments put up considerable part of story. After he was in other city for help his condition worsened he was talking that he had incurable disease, that his family is lost, that they in dangerous.

He kill wife, 11 ys son and preschool daughter, at the end lied down on floor right behind her and shoot himself.

Questions are

is this suicide?

are these homicides?

or he was try to save his family from "danger"

Also is it suicide when psychotic manic patient throw himself from high building because he thought that he can fly.

So according to my opinion even if data about 90 percent or more mental ill suicide victims I wonder are those all were suicides. because you need to be accountable.

You need intent, act, awareness about irreversibility.....

Best

Tomislav

Tomi Gomory

Thanks Tomislav. I would respond that the acts were suicide (self murder) and murder of family members, he actually took complex steps that require important and complex behaviors which he intended to do (load, point the gun, and shoot) impossible without "intention" or understanding what he was doing, after all he could have killed others, not shot or used other means. Everything else I think is post facto speculation we will never know.

As to the flying psychotic. We need to know much more. Was he on psychoactive drugs? Was he receiving "psychiatric" medication? With first of course real chemically induced hallucinations and delusions can occur. if on the latter, typically always the case for such major diagnoses, the adverse effects are all very serious brain disorders (movement disorders, tardive dyskenisia) also anxiety, depression, thoughts of suicide etc. Which would better explain the leap.

Psychiatric drugs as you probably know often cause permanent brain damage and physical symptoms that "mimic" what are often thought of as craziness. So I would need to know much more about that particular person and his "madness" to respond thoughtfully about that. Also your suggestion that you need to be "accountable" is as I see it just a judgement about someone's behavior. It is not a universal law. Our demands of accountability vary over time. At one time being homosexual was seen as illness now it is just normal activity. What part of choosing sexual partners is intended and which is not? Same goes for choosing to take drugs or seeing it as "sickness." In my mind these are judgements about behavior very much dependent on current social and personal moral and ethical perspectives. After all we also have divine madness of the Greeks, which was thought to be a positive version. On Madness please see my recently published book Mad Science:http://www.amazon.com/Mad-Science-Psychiatric-Coercion-Diagnosis/dp/1412849764/ref=sr_1_1?ie=UTF8&qid=1384439428&sr=8-1&keywords=mad+science+psychiatric+coercion+diagnosis+and+drugs

A my best.

Tomi

Sultan Salah

Its all in the mindset rather than the diseases and more important thing is some medications leads to suicidal tendency. The answer to the prevention of suicidal thoughts is that one should have high level physical,social,financial,mental health, for these what we need is to practice and preach the good values,deeds,ethics,moral,in the society and the parents, teachers,leaders,mass media etc., play a very important role.

Antosocial personality disorder in comorbidity with substane abuse is also very high risk subgroup. Among the highest.