Oxford Textbook of Suicidology and Suicide Prevention

851 Pages·2021·79.091 MB·English

by  Danuta Wasserman (editor)

Oxford Textbook of
Suicidology and
Suicide Prevention
OXFORD TEXTBOOKS IN PSYCHIATRY
Oxford Textbook of Suicidology and Suicide Prevention 2nd edition
Edited by Danuta Wasserman
Oxford Textbook of Migrant Psychiatry
Edited by Dinesh Bhugra
Oxford Textbook of Old Age Psychiatry 2nd edition
Edited by Tom Dening, Alan Thomas, Robert Stewart, and John- Paul Taylor
Oxford Textbook of Neuropsychiatry
Edited by Niruj Agrawal, Rafey A. Faruqui, and Mayur Bodani
Oxford Textbook of Psychiatry of Intellectual Disability
Edited by Sabyasachi Bhaumik and Regi Alexander
Oxford Textbook of Inpatient Psychiatry
Alvaro Barrera, Caroline Attard, Rob Chaplin
Oxford Textbook of Attention Deficit Hyperactivity Disorder
Edited by Tobias Banaschewski, David Coghill, and Alessandro Zuddas
Oxford Textbook of Correctional Psychiatry
Edited by Robert Trestman, Kenneth Appelbaum, and Jeffrey Metzner
Oxford Textbook of Community Mental Health
Edited by Graham Thornicroft, George Szmukler, Kim T Mueser, and Robert E. Drake
Oxford Textbook of Women and Mental Health
Edited by Dora Kohen
Oxford Textbook of 
Suicidology
and Suicide
Prevention
SECOND EDITION
EDITED BY
Danuta Wasserman
Professor of Psychiatry and Suicidology at Karolinska Insitutet (KI) Stockholm, Sweden; Founder and Head
of the National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP) Stockholm,
Sweden; Director of the World Health Organization (WHO) Collaborating Centre for Research, Methods
Development, and Training in Suicide Prevention at KI; Chair of the Committee on Ethics of the
European Psychiatric Association (EPA), Honorary President of the Estonian- Swedish Mental Health and
Suicidology Institute (ERSI); Principal Investigator for the Genetic Studies of Suicide and Attempted Suicide
(GISS); Leader of the Saving and Empowering Young Lives in Europe (SEYLE) mental health promoting
programme, and other European Union projects; Former President of the International Association of
Suicide Research (IASR) and of the EPA; President-Elect for the World Psychiatric Association (WPA)
Special mention to
Camilla Wasserman
Medicine and Health Sciences and MA in Anthropology. Co- editor of the first edition, and current editor of the
chapters on Religion, Art, Film, Media, and Suicide
1
3
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To my late husband, Jerzy Wasserman, Professor in Immunology.

Foreword
Every year a million people kill themselves and at least ten times methods that help in the recognition of suicidal risks and in the
as many attempt to do so, frequently ending up disabled by the prevention of suicide. The strategies of the healthcare system, and
psychological, physical, and social consequences of their attempts. the ways in which health services can make a contribution to the
A large proportion of this loss of human life could be prevented, but prevention of suicide and to the alleviation of the consequences of
this does not happen. One of the reasons for this is that the informa- suicidal behaviour, are examined critically. The impact of suicide on
tion about the magnitude of the problem and about ways to reduce those who are left behind, and an estimation of the economic cost
it, as well as the results of research done to explore the causes and of suicide to society, are discussed along with the arguments for ac-
consequences of suicidal behaviour, are not sufficiently well known. tion that can be successful, as examples from many countries clearly
It is easy to understand this. The prevention of suicide requires demonstrate.
access and use of many sources of information. The media, schools, The large number of contributors to the volume is a witness to
health services, social services, authorities dealing with labour and the size and excellence of the network that Professor Wasserman
many others who should be involved in the prevention of suicide, and her colleagues working in the field of suicide have estab-
and in the evaluation of methods used to do this, are distant from lished: more importantly, however, it demonstrates that suicide and
one another and belong to different worlds. There is little or no its consequences are a global problem that is likely to become even
sharing of information among them. Data remain in the parts of more important in the future for a variety of reasons, ranging from
the society in which they were produced. Highly interesting positive changes of the demographic structure and the growing prevalence
and negative experiences obtained in programmes of suicide pre- of chronic mental and physical disorders (often occurring together,
vention by one social agency or one country are often not published thus worsening the prognosis of both types of disorders), to the in-
in widely read journals, neither in the country in which they were crease of alcohol consumption and of other risk factors for suicide,
obtained nor in other countries. and the many forms of social disruption leading to the reduction of
What is true for the difficulties in obtaining information is even sources of support in times of stress and destructive anomie.
more disturbing when it comes to collaboration between agencies I wish to be the first among the many who will wish to express
and countries in programmes of suicide prevention. Declarations thanks to the editors of this work. They give us a volume that is
of intent to work together are numerous and recommendations to unique in its coverage of the field—b oth in geographical and in
do so even more frequent: yet in most countries there is no serious epistemological terms— and remarkable because of the excellence
and lasting intersectoral collaboration on any topic— including the of its many contributors who give us hope that the major public
prevention of suicide. The same problem is a major hurdle to any health problems created by suicidal behaviour can be reduced by
programme aiming to help those who have attempted suicide but concerted action. They show us that this can be done by describing
did not complete it. successful programmes, which give us information that is often dif-
This magnum opus thoroughly updated and expanded that ficult to access, yet can be of great importance for the understanding
Danuta and Camilla Wasserman and their colleagues originally pub- of suicidal behaviour and for the development of programmes to
lished in 2009, attempts to deal with the first of these two problems. prevent suicide and its consequences. It is to be hoped that the book
It brings together information about suicide in different cultures will be read by many and that the information that has been so skil-
and at different stages of life; about the relevance and role of reli- fully presented will be used in developing programmes against sui-
gion in the prevention of suicide; about political and socioeconomic cide: in that lies the usefulness of this effort and, in that, would be
determinants of suicide; about the psychiatric and somatic diseases the greatest reward for the editors and the contributors to this extra-
and their relationship with suicidal behaviour. The volume explores ordinarily valuable book.
the theories of suicidal behaviour and provides a cogent review of Professor N. Sartorius, MD, PhD

Preface
The subject of suicide is old, yet still suicide prevention remains an social conditions. Consequently, it was already decided in the first
uncharted territory. Only in the last decades has the World Health edition by my co- editor, PhD in Medicine and Health Sciences and
Organization (WHO) recognized suicide as a serious problem not suf- MA in Anthropology Camilla Wasserman, to open the reading of
ficiently addressed by the clinical and public health sectors. Emerging this textbook with chapters examining religious expressions and
research and knowledge about the predicaments surrounding suicide practices across the world, so allowing the reader to contemplate
calls for action on all continents. Conventionally, much research on people’s attitudes to and representations of suicide. The chapters
suicide has been geographically and culturally confined to Europe, discussing representations of suicide in film and other media give
North America, Australia, and New Zealand; however, in recent times, room for unbound associations and new initiatives on how pre-
suicidology and suicide prevention in Africa, Asia, and Latin America ventive efforts can be tailored. In the final sections, descriptions
has emerged on the international scene, and consequently this text- of the major actors and organizations in the field are given. These
book reflects a large range of research across all continents. chapters provide the readers with resources and options for fu-
According to the WHO, each year, approximately 850,000 people ture developments of suicide preventive activities. The content of
across the world commit suicide and up to 20 times more attempt the chapters and references have been updated until the very last
to do so. Estimates indicate that these numbers will increase if pre- submission before publishing: consequently they contain the most
ventive and treatment efforts will not be forcefully supported by le- up- to- date clinical psychiatric perspectives, including all aspects
gislative and economic measures. of pharmacological, psychotherapeutic, and other treatment
Understanding risk and protective factors on the individual, family, methods, as well as public health perspectives with all existing
structural, and sociocultural levels is necessary in order to tailor sui- strategies described extensively.
cide preventive actions. Suicidal behaviours vary widely across the Notwithstanding the fact that treatment of suicidal people and
lifespan. One example is the ratio of suicide attempts to completed prevention of suicide is a difficult task, this book is filled with evi-
suicides which is around 20 or even 30 to 1 in young people and 3 dence showing that such efforts are in fact effective. Therefore, it is
or less to 1 in the elderly. Risk factors for suicide are only partly de- important to try to continue to decrease suicide’s toll.
pendent on psychiatric diagnosis and even if illness is an important Before commencing your journey into this book, please reflect
component in suicide, it is a challenge to understand what makes a on a saying:
minority of people who have suicidal thoughts within any given diag- To save one life is as if you have saved the world.
nostic category, suicidal. The underlying causes of attempted and
completed suicide are extremely complex and the body of research
presented in this textbook shows that the recognition of the problem,
appropriate intervention, and prevention is not an easy task. Yet they
are possible. Prevention is superior and preferable therefore a focus
on prevention and early recognition of suicidal behaviours should
direct its attention to much earlier stages of the suicidal process.
This textbook is written by the foremost international scholars in
suicidology, presenting the latest developments in the field, while n
e
d
allowing for an extension into fields closely related to suicidology we
S
and suicide prevention. The book offers a comprehensive review m,
and synthesis of data regarding suicidal behaviour and suicide hol
k
prevention across the lifespan as well as in different countries, oc
St
encompassing both healthcare and public health perspectives on n,
mli
all continents. Thus, all references have been carefully selected by Gi
the authors with such objectives in mind. The textbook is intended vid
a
for researchers but also for clinical and public healthcare practi- D
y
b
tioners. The two major approaches in suicide prevention, through o
ot
general healthcare and public health, are described against the h
P
background of the sufferings and the cost of suicide as well as sav- Danuta Wasserman
ings when implementing suicide- prevention strategies. Across the Karolinska Institutet
world, suicide is deeply tied up with human beings’ existential and Stockholm, Sweden, 2020