New insights into suicide and associated risk factors by Prof. Ella Arensman

New insights into suicide and associated

risk factors

Prof. Ella Arensman

National Suicide Research Foundation,

Department of Epidemiology and Public Health,

University College Cork

28th November 2013

3

Suicide is a devastating event for individuals, families, and

communities. People who experience such a loss, the wider public,

and health professionals, often struggle to understand this complex

behaviour

Limited information on specific risk factors associated with suicide in

Ireland

Unclear to what extent the increase in suicide in Ireland in recent

years is linked to the economic recession

Background

Suicide

Approx.

550

Deliberate

self harm

medically treated

Approx. 12,000

“

“Hidden” cases of

Deliberate self harm

Approx. 60,000

Suicide and Medically Treated Self Harm:

‘The tip of the iceberg’

New insights through the

Suicide Support and

Information System

Trends in rates of suicide per 100,000 for men, women and the total population in Ireland, 2001-2011

0

5

10

15

20

25

Rate

per

100,0

00

Ireland Female Male

Percentage increase in suicide since 2007: 14.6%

SSIS objectives in line with Reach Out Action 25.2

Gaps in Knowledge - Challenges Need for more timely access to

information on suicide deaths (delay CSO data 2-3 years)

Need for increased accuracy of suicide mortality figures

Need for more information on psychosocial and psychiatric risk factors associated with suicide

Objectives of the SSIS

Obtain real-time data on suicide cases through accessing Coroner’s records

In addition to confirmed suicides conduct screening of open verdicts

Obtain information on a wide range of demographic, psychosocial and psychiatric risk factors accessing multiple sources

Why was the Suicide and Information System

(SSIS) developed?

Innovative aspects of the SSIS methodology: Obtaining a complete picture of suicide cases and open

verdicts by accessing multiple sources

Coroners' verdict records & Post mortem reports (Response Rate: 100%)

Close family members/ friends (Response Rate: 66.0%)

GP/Psychiatrist/

Psychologist (Response Rate: 77.1%)

• Period and area covered:

Sept. 2008-June 2012, City and County Cork • Number of consecutive

cases: 275 suicide cases + 32 open verdicts meeting screening criteria. Total N=307

Key outcomes

• Proactive facilitation: Among those who had no bereavement support,

83.0% took up help following facilitation

• Overrepresentation of men (80.1%)

• Relatively high proportion were unemployed at time of death (33.1%)

• Relatively high proportion had worked in the construction/production

sector (40.6%)

• Nearly two thirds had a history of self-harm (65.2%); 69.1% were

diagnosed with depression, and alcohol/and or drug abuse was present

among 60.7%

Key outcomes

Subgroups among People who died by Suicide:

• Men vs. Women

• Men aged < 40 years vs. Men aged > 40 years

• People who were Unemployed vs. People who were Employed

• People with a History of Self-Harm vs. People without a History of

Self-Harm

• People diagnosed with Depression vs. People without a Depression

Diagnosis

Men aged <40 years versus Men aged > 40 years

0 50 100

Unemployed

History of alcoholand drug abuse

Alcohol in toxicology

Benzodiazepines intoxicology

Opiates in toxicology

Marital status: Single

Cause of death:Hanging

Aged < 40 years

0 20 40 60 80 100

Diagnosed withdepression

Diagnosed with aphysical illness

In paid employment

Antidepressants intoxicology

Marital status:Married/Co-habiting

Drugs in toxicology

Living with family oforigin

Cause of death: Hanging

History of alcohol onlyabuse

Aged > 40 years

People who were unemployed versus those employed

0 20 40 60 80


Antidepressants intoxicology

Living withpartner/children

Married/Co-habiting


Employed

0 20 40 60 80

History of self-harm

Opiates in toxicology

History of alcoholand/or drug abuse

Benzodiazepines intoxicology

Drugs in toxicology

Construction/Production sector


Unemployed

People who had engaged in self-harm versus those who had not

0 20 40 60 80


Family or close frienddied by suicide

Married/Co/habiting

In paid employment


History of self-harm

0 20 40 60 80


Construction/production sector

Treated as psychiatricout-patient

Unemployed


Psychiatric diagnosis

Drugs in toxicology


No history of self-harm

Required actions arising from the information

Improved access to health care services for people who have engaged

in self-harm, people at high risk of suicide and people with multiple

mental health problems

The association between the impact of the recession and suicide

underlines that suicide prevention programmes should be prioritised

during times of economic recession

National strategies to increase awareness of the risks involved in

alcohol misuse should be intensified, starting at pre-adolescent age

Pro-active facilitation of bereavement support would be the

recommended approach for services working with families bereaved

by suicide

SSIS

Health Services

Community Services

National Office for Suicide

Prevention

General

Public

World Health Organisation

Academia

Government

Impact of SSIS information on a wide

range of agencies

“People who attempt suicide never want to die, what they want is a different life” (R. Wieg, 2003)

Thank you!

Prof. Ella Arensman

National Suicide Research Foundation

Department of Epidemiology and Public Health

University College Cork

Ireland

T: 00353 214205551

E-mail: [email protected]

www.nsrf.ie

New insights into suicide and associated risk factors by Prof. Ella Arensman

Health & Medicine

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