The impact of suicide on the family

Little research has examined the consequences of a suicide for social or family networks. Because suicide occurs within families, the focus on the aftermath of suicide within families is an important next step to determine exactly how to help survivors. In this article, we review and summarize the research on the impact of suicide on individuals within families and on family and social networks. We begin with a discussion of family changes following suicide. Next, we discuss the effects of suicide on social networks overall and responses of children and the elderly to a suicide in the family. Finally, we identify key issues that remain to be resolved in family survivor research and make recommendations for future studies.     

The pattern of suicide in Pakistan

There is paucity of information on suicide from Pakistan, an Islamic country in which data collection poses formidable challenges. A variety of social, legal, and religious factors make reporting and diagnosing suicide difficult. Paradoxically, incidents of suicide are regularly reported in newspapers in Pakistan. In the absence of other means these reports serve a useful, though basic information source for suicidal deaths. A 2-year analysis of all such reports in a major newspaper in Pakistan showed 306 suicides reported from 35 cities. Men (n = 208) outnumbered women by 2:1. While there were more single than married men, the trend was reversed in women. The majority of subjects were under 30 years of age and "domestic problems" was the most common reason stated. More than half the subjects used organophosphate insecticides, while psychotropics and analgesics were used infrequently. The study challenges the widely held belief that suicide is a rare phenomena in an Islamic country like Pakistan, and underscores the need for more culture specific research on this important public health problem.     

Suicide to harass others: clues from mythology to understanding suicide bombing attacks

Suicide by revenge, the Samsonic suicide, and the suicide by devotio, all described in classical mythology and also reported in the ethnographic literature, belong to the same class of suicidal behaviors as kamikaze suicide and the suicide bombing attack: suicide to harass and burden others or suicide with a hostile intent. The lack of a social dimension to share in a positive manner may lead an individual to integrate him/herself in another social structure, e.g., a military organization, which allows the individual to express his/her desires and personal identity only by destroying others and themselves. The dynamics of these forms of suicide are also likely to work in other displays of life-threatening behavior, such as family annihilation, mass murder, and spree killing. A more thorough investigation of the dynamics operating in suicide bombing attacks could, therefore, contribute to preventative strategies against violence at large.     

Suicide in developing countries (2): risk factors

The majority of studies on risk factors for suicide have been conducted in developed countries, and less work has been done to systematically profile risk factors in developing countries. The current paper presents a selective review of sociodemographic, clinical, and environmental/situational risk factors in developing countries. Taken together, the evidence suggests that the profiles of risk factors in developing countries demonstrate some differences from those in developed countries. In some developing countries, at least, being female, living in a rural area, and holding religious beliefs that sanction suicide may be of more relevance to suicide risk than these factors are in developed countries. Conversely, being single or having a history of mental illness may be of less relevance. Risk factors that appear to be universal include youth or old age, low socioeconomic standing, substance use, and previous suicide attempts. Recent stressful life events play a role in both developing and developed countries, although their nature may differ (e.g., social change may have more of an influence in the former). Likewise, access to means heightens risk in both, but the specific means may vary (e.g., access to pesticides is of more relevance in developing countries). These findings have clear implications for suicide prevention, suggesting that preventive efforts that have shown promise in developed countries may need to be tailored differently to address the risk factor profile of developing countries.     

Beyond risk theory: suicidal behavior in its social and epidemiological context

The effect of exposure to risk factors for suicidal behavior varies from place to place and from period to period. This may be due to contextual influences, which arise if individuals' suicide risk depends not only on their personal exposure to risk or protective factors, but also on how these are distributed in their social, cultural, economic, or even physical environments. There has been relatively little explicit attention in suicide research for such contextual influences even though they are an important component of the cross-level bias, which can arise when aggregate level associations are assumed to also apply in individuals and vice versa. Contextual effects are conceptually related to the issues of social selection vs. causation, population density, and network effects. Because of a lack of prospective multilevel research, it is unclear exactly which mechanisms underlie the phenomenon that the distribution of risk factors in an individual's context may affect their suicide risk above and beyond their personal exposure. A number of mechanisms, like deviancy amplification, formalization of restraints, and buffering effects of social support are proposed. Contextual effects may result in a concentration of suicide risk in persons when the risk factors they are exposed to become rare--whether spontaneously or through focused prevention. This has important but mostly overlooked implications for population-based prevention strategies.     

Terrorism,Signaling, and Suicide Attack

This article examines the strategic utility of suicide terrorism. Suicide terrorism, we suggest, can be thought of as a form of strategic "signaling." We define terrorism as a signaling game in which terrorist attacks are used to communicate a group's character and objectives to a set of target audiences. This is followed by an examination of the utility of suicide attacks as a signaling tactic. The relative effectiveness of suicide operations is evaluated in relation to other tactical options that are traditionally available to terrorist organizations. We go on to examine the institutional and social context of suicide terrorism, concluding with an examination of the evolutionary use of suicide attacks by Palestinian terrorist organizations and the Liberation Tigers of Tamil Eelam.‐     

Adolescent suicide myths in the United States

In the United States, teen suicide rates tripled over several decades, but have declined slightly since the mid-1990s. Suicide, by its nature, is a complex problem. Many myths have developed about individuals who complete suicide, suicide risk factors, current prevention programs, and the treatment of at-risk youth. The purpose of this article is to address these myths, to separate fact from fiction, and offer recommendations for future suicide prevention programs. Myth #1: Suicide attempters and completers are similar Myth #2: Current prevention programs work. Myth #3: Teenagers have the highest suicide rate. Myth #4: Suicide is caused by family and social stress. Myth #5: Suicide is not inherited genetically. Myth #6: Teen suicide represents treatment failure. Psychiatric illnesses are often viewed differently from other medical problems. Research should precede any public health effort, so that suicide prevention programs can be designed, implemented, and evaluated appropriately. Too often suicide prevention programs do not use evidence-based research or practice methodologies. More funding is warranted to continue evidence-based studies. We propose that suicide be studied like any medical illness, and that future prevention efforts are evidence-based, with appropriate outcome measures.     

Harsh State Repression as a Cause of Suicide Bombing: The Case of the Palestinian–Israeli Conflict

Although students of social movements have established that state repression strongly affects protesters’ choice of tactics, this finding has been ignored by most analysts of suicide bombing. Based on data collected from various sources, including 88 interviews the author conducted in 2006 with senior leaders of six Palestinian political organizations and close relatives and friends of Palestinian suicide bombers, this article argues that harsh state repression is a major cause of suicide bombing. It shows that understanding the effect of state repression is crucial to clarifying many of the unsolved puzzles concerning the rationales of organizations that employ suicide bombing, the motivations of individual suicide bombers, and the reasons why this tactic has become popular in some societies. The article concludes that there are three types of organizational rationales underlying the use of suicide bombing. Suicide bombing may be an extreme reaction to extreme state repression, a combined reactive and strategic action, or a purely strategic action. Different contexts and organizations typify these organizational rationales.     

The Making of a Martyr: Chechen Suicide Terrorism

Beginning in June of 2000 Chechen terrorists have carried out twenty-eight acts of suicide terrorism acts including two mass hostage taking operations combined with suicide terrorism (Beslan and Nord Ost). This paper reports the findings from psychological autopsies (interviews with close family members and friends) of thirty-four (out of 112 total) of these human bombers as well as augmenting them with material from hostage interviews from Beslan and Nord-Ost. The authors analyze the phenomena on the levels of the organization, individual, society and in terms of ideology and compare findings from other arenas also involving suicide terrorism. The main findings are that a lethal mix occurs when individuals in Chechnya are vulnerable to self recruitment into suicide terrorism due to traumatic experiences and feeling a duty to revenge and this vulnerability is combined with exposure to groups that recruit and equip suicide terrorists with both an ideology and the means to explode themselves. The ideology supporting Chechen suicide terrorism is very similar to the global jihadist ideology but remains more nationalist in its goals. It functions for the bombers much like short lived psychological first aid—answering their posttraumatic concerns in a way that shortly leads to their deaths. Unlike the Palestinian case, there is little social support for suicide terrorism in Chechnya.     

The phenomenon of suicide bombing: a review of psychological and nonpsychological factors

This article reviews the literature on the phenomenon of suicide bombing. It addresses the question of just how much a psychological understanding of the individuals involved can aid in prevention. The article looks at historical, epidemiological, and cultural perspectives and compares the nonpsychological and psychological approaches to suicide bombing. On the basis of the material available it seems that social processes such as group-dynamic indoctrination and political factors are decisive in analyzing this problem. Cultural, nationalistic, and religious factors are important. The conclusion is that in suicidal bombing, suicide is instrumental in the context of war, not in the context of psychopathology. Suicide bombing is instrumental in realizing fatalities, and it is only one of many weapons. The act of killing in warfare is more important to understanding suicidal terrorism than the act of suicide. This explains why psychological profiling of suicidal terrorists has to date not been successful.     

Are Suicide Bombers Suicidal?

Recent work by Ariel Merari argues that, while certain contextual factors increase the probability of suicide attacks, they do not explain why particular individuals become suicide bombers. Merari seeks to demonstrate that suicide bombers are motivated by an unusually high prevalence of depression and suicidal tendencies. This article questions the representativeness of Merari's sample. It raises the possibility that interviewer and contextual effects contaminated his findings. Finally, it presents evidence that challenges Merari's conclusions. This evidence is drawn from interviews with immediate family members and close friends of a 25 percent random sample of Palestinian suicide bombers who conducted attacks between 2000 and 2005. Based on their analysis, the authors question the value of a psychological approach to the study of suicide bombers and assert the importance of focusing on the political and social roots of the phenomenon.     

Social and economic burden of suicides in Hong Kong SAR: a year of life lost perspective

The paper proposes to use the years-of-life-lost method (YLL) in assessing the social and economic burden of suicides in Hong Kong SAR. The YLL from suicide by age group in 1981-2002 is calculated based on the standard set by World Health Organization (WHO). It shows that the middle age group (25-39) contributed most to the burden of disease in Hong Kong. The proportion of older adults' suicides is about 25% of the total number of suicides but its disease burden is less than 6% in terms of the YLL. Though the group aged 25-39 contributed disproportionately to the total YLL from suicide, the prevention effort for this particular group has been very much neglected and needs to be strengthened. It illustrates that use of YLL could provide a new viewpoint for setting up public health policies.     

Party,State, and Socialism in Guinea-Bissau

Suicide is generally regarded as an anti-social behavior. It is, perhaps, for this reason that sociologists and psychologists, among other experts, have been interested in studying the incidence of suicide in many societies. Most modern theories on suicide, however, do not emphasize the idea of “heroic suicide.” Epitomizing this “genre” of suicide are the high profile, politically motivated suicides in early colonial Ibadan examined here. This article suggests that the key to understanding these suicide cases is to be found not only in these people’s multilayered pasts — the general Yoruba past and Ibadan’s nineteenth-century military heritage — but also in their conception of honor and in their social norms. The ideals of honor thus carried over into the twentieth century were so strong that they survived the first three decades of colonial rule despite the intrigue-laced nature of Ibadan chieftaincy politics and the official interference of the colonial authorities. This article concludes that politically motivated suicide, though self destructive was actually meant to serve an honorable purpose such that those involved became heroes even in death. There is therefore the need for suicide theorists to highlight exceptions like these.     

Remarks by Mary McAleese, President of Ireland made at the International Association of Suicide Prevention XXIV Biennial Conference, August 31, 2007, Irish National Events Centre, Killarney, Co. Kerry, Ireland

Reducing suicide rates requires a collective, concerted effort from all groups in society: health, social services, other professionals, communities and community leaders, voluntary and statutory agencies and organizations, parents, friends, neighbors, and individuals. It also requires the careful nurturing of a culture in which people in psychological distress don't hesitate to seek help from family, friends, health professionals and community leaders, a culture that recognizes the signs and signals of distress and is willing to help, and that focuses early in life on developing good coping skills and avoiding harmful practices; in short, a sensitive culture that cherishes human courtesy and takes responsibility for our own mental health and the mental health of others. Suicide occurs in many diverse contexts but there are recurring patterns and elements that research is revealing to us. The more we are learning, the better we are able to devise strategies and take action. We already know, for example, that alcohol abuse plays a very significant role in suicide and features prominently in youth suicide. Research has also established that cannabis increases the risk of depression and psychosis and that it reduces normal inhibitions against suicide. Since marijuana is the illegal drug most used by those under25 years of age, a critical factor in suicide prevention must be to inform young people as to its danger and counter the erroneous impression that it is a benign substance. We know that bullying sometimes features in the story of suicide. Our young people need to know just how damaging, just how unacceptable, bullying is. Education and access to support structures - whether at work, school, or home - are an essential part of protecting the victim of bullying not just from the bully but from their own downward spiral into suicidal thoughts. A less discussed but nonetheless important issue worth raising is the issue of dealing with sexual identity. Although Ireland is making considerable progress in developing a culture of genuine equality, recognition, and acceptance of gay men and women, there is still an undercurrent of both bias and hostility which young gay people must find deeply hurtful and inhibiting. For them, homosexuality is a discovery, not a decision, and for many it is a discovery which is made against a backdrop where, within their immediate circle of family and friends as well as the wider society, they have long encountered antigay attitudes which will do little to help them deal openly and healthily with their own sexuality.     

Suicide in the Ukraine

The suicide rates of the 24 provinces (oblasts) of the Ukraine were found to be strongly associated with indices of social disintegration (such as divorce and illegitimacy rates), with the Western provinces incorporated in the USSR later than other Ukrainian territories having lower suicide rates and lower levels of social disintegration.     

The prevention of suicide in India and the developing world: the need for population-based strategies

Very high rates of suicide have been reported from India and the developing world. However, much of the debate on suicide prevention focuses on individuals, methods, site-specific solutions, or particular suicide prevention strategies. This article argues for population based approaches that focus on improving the general health of populations (e.g., macroeconomic policies that aim for social justice, schemes to meet basic human needs, organizing local support groups within vulnerable sections of society, developing and implementing an essential pesticide list, addressing gender issues, and increasing public awareness through the mass media) rather than medical, psychiatric, and other strategies that target individuals (e.g., treatment of mental illness, counseling, etc.) in order to reduce high suicide rates in India and developing countries. Individual approaches will help people in distress and prevent individuals from committing suicide, but will not reduce population suicide rates.     

The lived experience of adults bereaved by suicide: a phenomenological study

In recent years, a plethora of research studies have attempted to delineate the grief experiences associated with suicide from those of other sudden traumatic deaths. The emerging consensus suggests that bereavement through suicide is more similar than different to other bereavements, but is characterized by the reactions of shame, stigma, and self-blame. The causal nature of these reactions has yet to be fully understood. This study reports on the lived experiences of eight adults bereaved by suicides, which were obtained through in-depth interviews. Data were analyzed using interpretative phenomenological analysis. Four main themes dominated the relatives' grief experiences. First, the early months were checkered by attempts to "control the impact of the death." The second theme was the overwhelming need to "make sense of the death" and this was coupled with a third theme, a marked "social uneasiness." Finally, participants had an eventual realization of a sense of "purposefulness" in their lives following the suicide death. Overall, the findings suggest that suicide bereavement is molded and shaped by the bereaved individual's life experiences with the deceased and their perceptions following social interactions after the event. The findings from this study suggest that "meaning making" may be an important variable in furthering our understanding of the nuances in suicide bereavement.     

Suicide rates and mental health services in modern China

Suicide rates in China have in the past been reported to be very low for a variety of historical and political reasons. In recent years, however, the reported suicide rates in China have increased alarmingly among certain age groups. This article reviews reports of the national rural suicide rates in China for 1992, gathered from the Annal of Chinese Public Health, which has previously never been reported publicly. The highest suicide rates occur in the rural areas and among young women and men over 60 years. These data reveal that suicide in China may have some unique characteristic associated with a variety of socio-cultural variables, such as traditional culture, social class, economic status, health care levels, and interpersonal problems. The author shows that lack of mental health services in rural areas in China may be considered one of associated reasons to the high rural suicide rate in China.     

Some problems of research on the association between blood types and suicide mortality: comment on Lester (2004)

This is a comment on the ecological finding of a negative association of national suicide rate and national proportion of people with Type O blood (Lester, 2004). Current knowledge on this topic is reviewed and several problems, limitations, and discrepancies within this research line are noted. Specifically, it is suggested that (1) this association appears to have been subject to attenuation recently; (2) available ecological evidence on this association is contradictory to both individual-level findings on the same topic and similar ecological-level findings pertaining to personality-related risk factors and antecedents of suicide; (3) a negative association of one of the four ABO phenotypes with suicide mortality does not help single out phenotypes with possibly increased suicide risk; and (4) genetic suicide risk factors may well be associated with other ABO phenotypes than Type O and may further coincide with other blood polymorphisms than the ABO system.