Transcript Abnormal Psychology: Suicide And Parasuicide Prof. Craig Jackson Head of Psychology Division BCU [email protected] health.bcu.ac.uk/craigjackson Research limitations • Suicide multi-causal • End-stage of complex process • Attracts emotive reporting in media •

Abnormal Psychology:
Suicide
And
Parasuicide
Prof. Craig Jackson
Head of Psychology Division
BCU
[email protected]
health.bcu.ac.uk/craigjackson
Research limitations
• Suicide multi-causal
• End-stage of complex process
• Attracts emotive reporting in media
• Workplace suicide received little / no academic attention
• Occupational attribution straightforward in many cases
• Workplace factors ascertained by
• Notes
• Recorded trouble at work
• Coincidence with unusual workplace situation / landmarks
• Compounded home-life complications
• Occupational health history
Suicide Media Stories
“A teacher who set herself alight had complained about pressure of
work, an inquest has been told. Janet Dibb, 28, had complained to her
father about overwork.”
20 March 2004
“A family doctor hanged herself because of stress at work, an inquest
has heard. Bury coroners' court was told Dr Dawn Harris, 38, who
worked at the Lever Chambers practice in Bolton, became ‘angry, very
distressed and quite hurt’ by problems at the busy medical practice.”
22 May 2004
1. Over-emotive
2. Blames “extreme stress response”
3. Always best when involving females!
Case 1 – “PT” Bullying
PT (female armed response officer, 37) suicide in 2004
hanged at home
2003 Dismissed from firearms duties - poor proficiency
• One of two female firearms officers in 90-strong unit
• One of first female snipers in UK
Complained of colleagues viewing pornographic video on a residential course
Felt victimised in macho culture of firearms unit.
Fell out with a number of influential male colleagues
Sefton Coroner Christopher Sumner: “Paula Tomlinson killed herself at a time
that she was suffering from stress, a contributory factor of which was work
related.”
IPCC found no evidence of bullying or intimidation
Did acknowledge management failings and an “in-crowd culture”
France Telecom Cases
Privatised in 1998
40,000 jobs gone since 1998
186,000 employees
45% of those outside France
Used to be public sector employer
new working conditions
modernisation
cultural & organisational changes needed
internal job transfers
4.3% fall in profits in 1Q of 2009
182 million customers in 5 continents
France Telecom Cases
France Telecom Cases
Between Feb 2008 – Sep 2009
23 staff committed suicide
• 9th Sept: 49 yr old male employee stabbed himself in meeting – told he
would be undergoing internal job transfer
• 11th Sep: 32 yr old female employee leapt to death from office window
• 14th Sep 53 yr old senior manager overdosed
• 1st Oct: 51yr old male employee jumped from road bridge – note blamed
work “atmosphere”
French suicide rate:
26.4 per 100,000 male deaths
9.2 per 100,000 female deaths
17.8 per 100,000 all deaths
France Telecom’s Defence
France Telecom’s two-point defence:
1) “There were 28 suicides in the company in 2000, so 23 suicides over
17 months is actually an improvement and not evidence of an
epidemic”
2) “Most suicides caused by personal problems not professional ones”
France Telecom Case
Oct 2009
Deputy CEO Louis-Pierre Wenes (second in command) resigns
CEO Didier Lombard – vowed to end the “Spiral of death”
Phone helpline
Counselling
Suspending job transfers
French Labour Minister, Xavier Darcos wants:
2,500 biggest companies to plan “anti-stress” strategies
Plan it with Unions
Govt has 27% stake in FT
Health & Happiness now on “National Agenda” in France
Foxconn and the iPad
Manufacturing giant in China
Renowned for efficiency – 300,000 employees
Laptops, mobiles - Nokia, Apple, Dell HP
13 suicide attempts since Jan 2010 – 10 deaths
Foxconn and the iPad
Foxconn and the iPad
Compensation for families in poverty
Working conditions – long shifts, rigid,
Oppressive, poor pay
Company asked workers to sign a letter promising not to kill themselves
(now withdrawn)
Building giant safety net to prevent jumpers from Dorms and Workshops
Hiring counsellors and Buddhist monks
Case – “TB” Overwork / Depression
TB (male engineer, 28) suicide in 2002 – hanged at home
Been working for 1 year in Singapore
Had party celebrating end of contract
2 suicide notes:
First addressed work colleagues “unfortunately the game has got the
better of me – give my apologies to all the lads”
Second addressed his parents “I have been depressed for a while now
– pressure of work has turned my mind into a ticking time bomb”
Cardiff Coroner – Mary Hassell: “It is hard to understand why someone
described as happy-go-lucky should choose to end their own life over pressure
in work.”
Epidemiology of World Suicide
• 1 million suicide deaths per year worldwide
• 10 – 20 million attempts (huge variation)
• Suicide ideation / rumination even higher
• WS comprises 3.5% of workplace fatalities worldwide (Pegula 2004)
• Nearly 50% of first-time attempts fail
• Those with history of repeated attempts X 23 likely to die by suicide
World Wide Attitudes
Epidemiology of Suicide
Epidemiology of Suicide in the UK
Males
Females
30 suicides per 10 suicides per
100,000 deaths in Scotland
22 suicides per 6 suicides per
100,000 deaths in Wales
18 suicides per 5.6 suicides per
100,000 deaths in Northern Ireland
16 suicides per 5.4 suicides per
100,000 deaths in England
Ages 15-44 have highest suicide rate in males
Ages 75+ have highest suicide rate in females
Epidemiology of Suicide in the UK
Slow decrease in UK suicide rates since 1990s
75% of suicidal deaths are Male
Sex split been same since 1991 – but may just reflect methods used
2006
5554 suicides in adults (15 or over)
2007
5377 suicides in adults (15 or over)
2008
5706 suicides in adults (15 or over)
Epidemiology of Suicide in the UK
Epidemiology of Suicide in the Midlands
1998-2004
Wolves
22.1 per 100,000 deaths 146 cases
#101
Birmingham
19.3 per 100,000 deaths 541 cases
#172
Dudley
18.0 per 100,000 deaths 147 cases
#215
Coventry
17.3 per 100,000 deaths 146 cases
#245
Sandwell
16.6 per 100,000 deaths 125 cases
#268
Walsall
15.9 per 100,000 deaths 105 cases
#294
Solihull
13.8 per 100,000 deaths 74 cases
#363
Can we pin any of this to industry, ethnicity, decline, deprivation ????
Demographics of Suicide
Case – “TC” Chronic Ill-health / Depression
TC (male mechanic, 37) suicide in 2002
1996 right ear severed in accident at work IBC Vehicles Luton
Prolonged tinnitus, headache, severe depression
2005 TCs widow at High Court for £750,000
IBC accepts liability for accident – not suicide. Awarded £82,520
Court of Appeal overturned award – Lord Justice Sedley claimed there to be
no other cause. TC had previously been a
“rational man. . . The suicide was proved to have been a function of the
depression and so formed part of the damage for which IBC were liable. . . To
treat TC as responsible for his own death was an unjustified exception to
modern views on the links between accidents and their causes”.
Job Specific Factors
Vets and Farmers
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Functional use of euthanasia
Facilitate a “Good death”
Long working hours
Rural isolation
Client dependence
Social isolation
Not adapting to change / flux
Attitudes to suicide and (non) help-seeing behaviour
This may serve to make suicide seem like a plausible solution to problems
Jobs with “Gallows Humour” Police, Nursing, Military, Fire, Ambulance ?
Complexity
• Emotive reporting of WRS suicides
• Coroner’s & Inquests often too narrow in scope
• Wrongly suggests WRS is “final remedy” for workplace problems e.g. stress
• Suicide is complex final stage behaviour with many antecedents
Socio-demographics
Childhood experiences
Psychiatric morbidity / history
Recent stressful life events
Social interactions / supports
Complexity of Background
Beautrais (2001)
Following are all common to suicide & attempts:
1.
2.
3.
4.
5.
6.
7.
current mood disorder
previous suicide attempts
prior outpatient psychiatric treatment
admission to psychiatric hospital within the previous year
low income
absence of educational qualifications
recent stressful interpersonal, legal & work-related life events.
Many suicidents do not fit this profile
Suicides and Recession – Japanese Data
Suicides risen since 1989 and financial decline
Climbed higher in 1997 recession
Seems a natural end-point considering over-work and working hours
Joins UN
Financial boom
Recession
Suicides and Recession
Prof Natalie Jeremiienko – Bureau of Inverse Technology Engineering
Created "Despondency Index" - correlating the Dow Jones Industrial
Average with number of jumpers
Detected by "Suicide Boxes" containing motion-detecting cameras,
under the bridge.
Boxes recorded 17 jumps in three months
High Risk Occupations
US Data from 10,000 suicides and 135,000 deaths
15 occupations with higher / lower risk than the general pop.
Reduced to 8 after adjustment for socio-demographics
Dentists (X 5.4)
Nurses (X 1.5)
Doctors (X 2.3)
Social workers (X 1.5)
Farm workers (X 0.69)
Admin staff (X 0.85)
Scientists (X 1.5)
Artists (X 1.2)
UK picture different – suggests Farm workers & Veterinary have one of highest
rates (Mellanby, 2005)
Suicide Space
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Access to lethal means
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Opportunity for solitude
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Freedom of movement
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Location away from assistance
Behavioural Yellow Flags
Observable in 75% of decedents in few weeks before death
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Previous suicide attempts
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History of suicide in family
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Begin “tidying up” affairs
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Person acting completely out of character
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Symptoms of depression
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Hopelessness about the future
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Periods of difficulty and change – holiday periods, prior to disciplinary
hearings
More Behavioural Yellow Flags
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recent bereavement or other life-altering loss
recent break-up of a close relationship
major disappointment (failed exams or missed job promotion)
major change in circumstance (retirement, redundancy, children leaving)
physical illness
mental illness
substance misuse / addiction
deliberate self-harm, (particularly in women)
previous suicide attempts
loss of close friend / relative by suicidal means
loss of status
feelings of hopelessness, powerlessness and worthlessness
declining performance in work and other (sometimes this can be reversed)
declining interest in friends, sex, or previous activities
Neglect of personal welfare and hygiene
Alterations in sleeping habits (either direction) or eating habits
References
Etzersdorfer, E., L. Vijayakumar, W. Schöny, A. Grausgruber and G.
Sonneck (1998). Attitudes towards suicide among medical students:
comparison between Madras (India) and Vienna (Austria). Social Psychiatry
and Psychiatric Epidemiology. 33. 3. 104-110.
Gibb, B. E., M. S. Andover and S. R. Beach (2006). Suicidal ideation and
attitudes toward suicide. Suicide & Life-Threatening Behavior. 36. 1. 12-8.
Hawton, K and van Heeringen, K (eds). (2000). The International Handbook
of Suicide and Attempted Suicide. Chichester, Wiley.
Jackson CA. (2008) Work-Related Suicide. Management of Health Risks.
126: 2-8.
Karasek, R. and T. Theorell (1990). Healthy work: stress, productivity, and
the reconstruction of working life. New York, Basic Books.
References
Karasek, R. A. (1979). Job demands, job decision latitude and mental strain:
implications for job design. Administrative Science Quarterley. 24. 285-308.
Mellanby, R. J. (2005). Incidence of suicide in the veterinary profession in
England and Wales. Veterinary Record. 157. 14. 415-7.
Sawyer, D. and J. Sobal (1987). Public Attitudes Toward Suicide Demographic
and Ideological Correlates. The Public Opinion Quarterly. 51. 1. 92-101.
Siegrist, J. (1996). Adverse health effects of high-effort/low-reward conditions.
Journal of Occupational Health Psychology. 1. 27-41.
Stack, S. (2001). Occupation and Suicide. Social Science Quarterly (Blackwell
Publishing Limited) 82. 2. 384.
References
Stansfeld, S., R. Fuhrer, M. Shipley and M. Marmot (2002). Psychological
distress as a risk factor for coronary heart disease in the Whitehall II Study.
International Journal of Epidemiology 31. 248-255.
Stansfeld, S. A., R. Fuhrer, J. Head, J. Ferrie and M. Shipley (1997). Work
and psychiatric disorder in the Whitehall II Study. Journal of Psychosomatic
Research. 43. 1. 73-81.
Vilhjalmsson, R., E. Sveinbjarnardottir and G. Kristjansdottir (1998). Factors
associated with suicide ideation in adults. Social Psychiatry and Psychiatric
Epidemiology. 33. 3. 97-103.