Risk Factors For Suicide

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Suicide is among the leading causes of death and, among teenagers, the leading causes of death in many Asian countries. In recent years there has been growing concern regarding the increasing rate of suicidal behaviors, including suicidal ideation and attempted suicide among Malaysian youth. Suicide is the second leading cause of death among youth between the aged of 18-25. The World Health Organization (WHO) promotes a broad definition of suicide: “suicide is the act of deliberately killing oneself. Risk factors for suicide include mental disorder (such as depression, personality disorder, alcohol dependence, or schizophrenia), and some physical illnesses, such as neurological disorders, cancer, and HIV infection”. It is obvious that in any defination of suicide, the intention to die is a key element. However, unless the deceased have made clear statements before their death about their intentions or left a suicide note, it is extremely difficult to reconstruct the thoughts of people who commited suicide. According to the report from World Health Organization this epidemic of suicide among young people has accounted for a greater part of the world’s suicides.

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In Malaysia, there is an increasing frequency of suicide among young people. It was found that almost 7% of the adolescents experienced suicide ideation and more than half of them turned their thoughts into action. The suicide rate in Malaysia, according to the National Statistics Department was as low as 1 per 100,000 suicides per year in 2003, however, National Suicide Registry Malaysia (NSRM) reported that there were 1.28 suicide per 100000, in a population estimated at 27.73 million for 2008. The most recent report from NSRM (Average of 60 suicides, February 10, 2011) computed that there were an estimated total of 425 suicide cases between January and August last year as reported on the web-based registration system. It was averaging 60 cases per month and 2 cases each day. Due to difficulties in identifying a death as suicide and other issues such as claiming of insurance and dealing with family shame, the above figures could be under reporting. In actual suicide rate in Malaysia should be much higher. Factors associated with attempted suicide among youth have not been studied extensively in Malaysia, though a review of existing research points to a number of potentioal risk factors. In response to these concerns, there has been a growing research interest in the risk factors and predictors of young peoples’ suicidal behaviors. An increasing number of studies have examined the extent to which social, family, personal, and environmental factors contribute to suicide risks in young people. Few studies of suicide have simultaneously examined the individual and combined effects of psychosocial and psychiatric risk factors. For example, Hassali, Khan, Sulaiman (2011) a descriptive study based on retrospective evaluations of the medical records at the psychiatric Out Patient Department, public hospital Penang. A total of 410 cases were registered during this time frame, of which 298 cases had a confirmed diagnosis of depressive disorders. SPSS was used to analyze the satistic figures for frequency count and Chi-square was used to assess the association among variables. Odds ratios were calculated. Multiple logistic regression was applied to identify the predictors for suicidal behavior. The findings show that Chinese females were found at higher risk of suicidal ideation, as were smokers and alcohol users. The elderly aged 50 and over were also at a higher risk, followed by adolescents and youths aged 15-24 years. Comorbid medical complications and social problems were other factors that may contribute to suicidal ideation among the patients with depressive disorders. Another research (Chan, Maniam, Shamsul, 2011) found that seventy-five subjects were diagnosed with a depressive disorder according to the Structured Clinical Interview for DSM-IV Axis I Disorders-Clinical Version (SCID-CV). Data on suicide attempts, suicidal ideation (Scale for Suicidal Ideation, SSI), depression severity (Beck’s Depression Inventory, BDI), recent life-event changes (Social Readjustment Rating Scale, SRRS), sociodemographic and other relevant clinical factors were collected. A third of the subjects presented after a current suicide attempt. Significant factors for a current suicide attempt were race, religion, recent life-event changes, suicidal ideation, and alcohol use disorder. Independent predictive risk factors for a current suicide attempt were Chinese race, recent marital separation, major mortgage or loans, and being newly diagnosed with depression. Any recent change in personal habits was shown to be a protective factor against current suicide attempt. Age and gender were nonsignificant factors. The findings are generally consistent with existing studies and highlight the role of psychosocial risk factors. Most studies which examined the associations between measures of social disadvantage and suicide or suicide attempts have reported an increased risk of suicidal behavior among individuals from socially disadvantaged back- grounds characterized by low socioeconomic status (SES), limited educational achievement, low income, and poverty. Considerable research has focused on the extent to which exposure to adverse, dysfunctional or abusive family and/or childhood circumstances is associated with an increased risk of suicidal behavior in Malaysia youth. This research has identified a range of risk factors related to family functioning and parent-child relationships during childhood and adolescence that have been found to predict later suicidal behavior. These factors include: parental disharmony, separation or divorce; parental psychopathology such as substance abuse; a family history of suicidal behavior; impaired parent-child relations, poor attachment, and bonding; and exposure to physical and sexual abuse. In general, these findings suggest that young people exposed to adverse, dysfunctional or abusive childhood environments are at a significantly greater risk for subsequent suicidal behavior. This evidence suggests that a wide array of adverse social and family factors appear to be associated with an increased risk of adolescent suicidal behavior. This has usually been interpreted as evidence of a causal process in which exposure to childhood and family adversity increases an individual’s vulnerability to later psychopathology and adjustment difficulties, with this in turn reflected in increased rates of suicidal behavior.

There is also clinical interest in the extent to which various personality and tempera- mental factors may influence young people’s susceptibility to suicidal behavior. Although the findings have been somewhat inconsistent, certain personality traits have often been cited as predisposing factors to suicidal behavior. In particular, mood disorders such as depression, have emerged as one of the strongest predictors of suicidal behavior. All adolescents with symptoms of depression should be asked about suicidal ideation, and an estimation of the degree of suicidal intent should be made. Serious depression in adolescents may manifest in several ways. For some adolescents, the symptoms may be similar to those in adults, with signs such as a continually depressed mood, crying spells or the inability to cry, dis- couragement, irritability, a sense of emptiness and meaninglessness, negative expectations of self and the environment, low self-esteem, isolation, a feeling of helplessness, markedly diminished interest or pleasure in most activities, significant weight loss or weight gain, insomnia or hypersomnia, fatigue or loss of energy, feelings of worthlessness, and a diminished ability to think or concentrate. However, it is more common for an adolescent with serious depression to exhibit psychosomatic symptoms or behavioral problems. Such a teenager may seek care for recurrent or persistent complaints such as abdominal pain, chest pain, headache, lethargy, weight loss, dizziness and syncope or other nonspecific symptoms. Behavioral problems that may be manifestations of masked depression include truancy, deterioration in academic performance, running away from home, defiance of authority, self-destructive behavior, vandalism, alcohol and other drug abuse, sexual acting out, and delinquency. Risks of suicidal behavior have also been linked to a range of other disorders including substance abuse, conduct disorder, anxiety disorder, and psychosis. This consensus suggests that suicidal behavior commonly results from a convergence of multiple predis- posing and concurrent risk factors that combine to encourage the development of suicidal behavior. An individual’s coping strategies have also been related to suicide attempts and to suicide ideation. Disengagement coping was identified as a predictor of suicidal ideation in homeless youth as well as past attempts, depressive symptoms, and both internalizing and externalizing behavior patterns. In particular, psychiatrically hospitalized adolescents with clinically elevated scores on the Beck Depression Inventory were more likely to use social withdrawal and blaming others if confronted with the problem and were less likely to use social support and cognitive restructuring than non-depressed inpatients.

The purposes of this study are to identify the rate of suicide attempts, to examine the difference in relevant variables between suicide attempters, i.e. those who attempt suicide and non-attempters, i.e. those who do not attempt suicide, and to investigate possible predictors of suicide attempts among Korean adolescents.

Risk Factors for Suicide and Attempted Suicide Among Malaysian Youths

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References

Hendin, H., Philips, R. M., Vijayakumar, L., Pirkis, J., Wang, H., Yip, P., Wasserman, D., Bertolete, J. M., Fleischmann, A. (2008). Suicide and suicide prevention in Asia. Switzerland: World Health Organization.

Kok, J. K., & Goh, L. Y. (2011). Young people and suicide. Issue International Conference on Humanities, Society and Culture, 20 ,1-5.

Ministry of Health Malaysia, Clinal Research Centre, National Suicide Registry Malaysia (NSRM). (2009). The annual report of national suicide registry malaysia (nsrm) 2008.Retrieved from http://www.nsrm.gov.my/pdf/NSRM_report2008.pdf.

Word Health Organization. (2012). Suicide.Retrieved from http://www.who.int/topics/suicide/en/.

Hassali, M. A., Khan, T. M., & Sulaiman, S. A. S. (2011). Factors associated with suicidal behaviour among depressed patients in Penang, Malaysia. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3460490/.

Chan, L. F., Maniam, T., Shamsul, A.S. (2011) Suicide attempts among depressed inpatients with depressive disorder in a Malaysian sample. Psychosocial and clinical risk factors. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21940256.

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