Presentation Transcript

1. Suicide, Trauma, the Hemispheres and Empathy

   April 2014 Offered by Sarah Peyton
2. Before we begin… a word about resonant empathy
3. Important events that are not held with resonance remain in waiting in our brains…
4. With complex events, we need to be held over and over again, from many angles and by many people…
5. Coming toward our subject…
6. Pausing for Empathy
7. Our plan for this evening The Brain Picture and Statistics Empathy Causes and Contributing Factors Empathy Danger Signs and Prevention Empathy Questions and Check-Out
8. The Brain Picture
9. Our brain has a left and a right hemisphere 9
10. Impairment of the Left Prefrontal Area
11. Logical Linear Literal Practical language Making sense Social self Spoken/lived narrative Detail monitoring Analytic problem-solving Fact accumulation Chalkboard of the mind/ Working memory Adding to regulation Handling familiar Moderate levels of stress Attunement Voice quality/eye gaze Touch and gesture Circuits of attachment Integrated map of body Affective experience Experience of self Beginning of regulation Empathic resonance Implicit Memory Felt autobiographical narrative Intuition/Morality Metaphorical language Rapid processing of novelty Severe levels of stress Left and Right Hemispheres
12. Suicide as the ultimate short-sighted decision…
13. Epigenetics But suicide-completion-type changes in the brain show up even at the level of the genome Such methylation changes occur in response to early-life trauma
14. This is your DNA – the Recipe for You
15. It is wrapped in a protein sheath
16. Unwrapping bits of the protein sleeve lets the DNA be read
17. Then, that part of the DNA blueprint can be acted upon, allowing the gene to be “expressed”
18. Different substances attach to the outer surface of the opened DNA
19. Methyl groups are one substance that activate or silence genes
20. Epigenetic changes in response to early childhood experiences can help us or harm us Helpful Harmful Decreased health Autoimmune diseases Cancer Decreased effectiveness of HPA axis Decreased effectiveness of cognitive processes Changes in the cells of the hippocampus Decreased production of GABA A tendency toward suicide Improved health Improved HPA axis regulation for stress Cancer remission
21. The Big Picture (Statistics) As the tenth leading cause of death in 2009, the most recently compiled year for national suicide statistics, suicide resulted in 36,909 deaths (Kochanek, Jiaquan, Murphy, Minino, & Hsiang-Ching, 2011). When accounting for the age at death, suicide becomes the fifth leading cause of years of potential life lost in the US (Centers for Disease Control and Prevention [CDC], 2013). Nonfatal forms of self-inflicted violence further burden the nation with mounting emergency department visits; 472,000 visits were seen in 2007 alone (Niska, Bhuiya, & Xu, 2010).
22. More statistics Suicide affects everyone, but some groups are at higher risk than others. Men are 4 times likelier to commit suicide than women. The prevalence of suicidal thoughts, suicide planning, and suicide attempts is significantly higher among young adults aged 18-29 years than it is among adults aged ≥30 years. Other groups with higher rates of suicidal behavior include American Indian and Alaska Natives, rural populations, and active or retired military personnel.
23. Ideators vs Attemptors Most people who consider suicide do not go on to make a suicide attempt. For example, in a large population-based study, only 7.4% of those with baseline suicidal ideation reported a suicide attempt over the subsequent 2 years (ten Have et al., 2009). Overall, lifetime rates of suicide ideation are many times higher than lifetime rates of attempts (Fergusson, Beautrais, & Horwood, 2003; Kessler, Borges, & Walters, 1999). Specifically, oft-cited risk factors for suicide are, in actuality, risk factors for suicide ideation, and not for progression from suicide ideation to attempts.
24. Multiple attempts Multiple attempters were younger, not married, more severe in psychopathology (e.g., psychiatric disorder, personality disorder, lower function, and suicide family history) and suicidality (e.g., repetitive/ severe/ continuous suicide ideation), and lower in psychiatric resources (e.g., interpersonal stress/conflict, conflicting interpersonal relationship, socially isolated, lower personal achievement, and lower ability to control emotion) than first attempters. Suicide ideation severity and conflicting interpersonal relationships predicted multiple suicide attempts. Past year's highest global functioning score and age over 45 protected against multiple suicide attempts.
25. Trauma hits us hard… Perceived burdensomeness and low belongingness combine to create suicidal desire. The capability to act on desire is acquired over time through exposure to painful and provocative events (Van Orden et al., 2010).
26. The blows that lead to suicide attempts…
27. Desire to Die, or Diminished Desire to Live? Implicit suicide-related cognition appears to reflect a gradual diminishing of the desire to live, rather than a desire to die.
28. Pausing for Empathy
29. Causes and Contributing Factors
30. Economics of Suicide
31. Job Loss
32. The Social Environment
33. Suicide and the Honor Culture
34. Gun Ownership
35. Rate of Firearm Deaths
36. Risk Factors Risk factors for suicide include: • Previous suicide attempt(s) • History of depression or other mental illness • Alcohol or drug abuse • Family history of suicide or violence • Physical illness • Feeling alone
37. 4+ ACEs and Personal violence predict suicide attempts
38. Juvenile Detention
39. Inmate-to-Inmate Violence Suicide is the leading cause of preventable death in U.S. jails, comprising 29% or more of all deaths (Way et. al, 2005, Clarke, n.d.). In fact, suicide rates in correctional facilities are three to nine times higher than outside of them (Hall & Gabor, 2004; Hayes, 1997; Tartaro & Lester, 2005), and local jails often have higher rates of suicide than large jails and state or federal prisons (Clarke, n.d.; Mumola, 2005; Tartaro & Lester, 2005; Tripoti & Bender, 2007).
40. Being a Vet
41. White male suicide rates by profession (x normal rate) Physicians 1.87 Dentists 1.67 Veterinarians 1.54 Finance workers 1.51 Chiropractors 1.50 Heavy construction operators 1.46 Urban planners 1.43 Hand molders 1.39 Realtors 1.38 Assemblers of electrical equipments 1.36 Lawyers 1.33 Lathe operators 1.33 Farm managers 1.32 Operators of heat treating equipments 1.32 Electricians 1.31 Precision woodworkers 1.3 Pharmacists 1.29 Natural scientists 1.28
42. Suicide rates by profession for women White women Physicians – 2.78 Sales – 2.43 Law enforcement – 2.03 Black women Protective svc – 2.78 Sales – 2 Packaging svc – 1.96
43. Veterinarians
44. Depression and Exposure
45. Suicide Contagion
46. Suicide Contagion is Real ........between 1984 and 1987, journalists in Vienna covered the deaths of individuals who jumped in front of trains in the subway system. The coverage was extensive and dramatic. In 1987, a campaign alerted reporters to the possible negative effects of such reporting, and suggested alternate strategies for coverage. In the first six months after the campaign began, subway suicides and non-fatal attempts dropped by more than 80%. The total number of suicides in Vienna declined as well.
47. Research finds an increase in suicide by readers or viewers when: • The number of stories about individual suicides increases • A particular death is reported at length or in many stories • The story of an individual death by suicide is placed on the front page or at the beginning of a broadcast • The headlines about specific suicide deaths are dramatic (A recent example: "Boy, 10, Kills Himself Over Poor Grades")
48. Recommendations Questions to ask: Had the victim ever received treatment for depression or any other mental disorder? Did the victim have a problem with substance abuse? Angles to pursue: Conveying that effective treatments for most of these conditions are available (but underutilized) may encourage those with such problems to seek help. Acknowledging the deceased person’s problems and struggles as well as the positive aspects of his/her life or character contributes to a more balanced picture.
49. Internet-based contagion
50. Insomnia
51. Mental Pain
52. Bullying
53. Cyberbullying
54. Suicide and gender Men are about four times more likely than women to die from suicide. However, women are more likely to have suicidal thought than men. Adolescent males jump from high places about 10% more often than females
55. Traumatic Brain Injury Suicide Risk Factors For the first 6 years after the occurrence of a traumatic brain injury, suicide attempt probability is 18.4% Post-injury of TBI, patients with emotional/psychiatric disorders and substance use problems were 21 times more likely to have a history of post-injury suicide attempts In comparison to the general population, people with TBI have a fourfold higher risk of death by suicide Patients who had made both a pre-injury and post-injury suicide attempt were found to have a stronger intent to die at the time of post-injury attempt Findings indicate an increased risk of death by suicide, a higher frequency of attempts, and clinically significant suicidal ideation in 21% to 22% of those suffering from TBI7
56. Sexual Minorities
57. Families matter…
58. Pausing for Empathy
59. Danger Signs and Prevention
60. Here’s an Easy-to-Remember Mnemonic: IS PATH WARM? Ideation Substance Abuse   Purposelessness Anxiety Trapped Hopelessness   Withdrawal Anger Recklessness Mood Changes
61. Preventive Measures When these warning signs appear, quickly connecting the person to supportive services is critical. Promoting opportunities and settings that strengthen connections among people, families, and communities is another suicide prevention goal.
62. Pausing for Empathy