Suicide Prevention
Jezer-Bon S. Luy,RPm, LPT
Psychometrician
caro.doh.gov.
ph
●Suicide – self-inflicted death w/ evidence
(either explicit or implicit) that person
wishes to die
●Suicide attempt – self-injurious behavior
Definiti w/ a nonfatal outcome accompanied by
evidence that the person wishes to die
on of ●Parasuicidal – patients who injure
themselves by self-mutilation (eg. cutting
Terms skin) but usually do not wish to die
●Suicidal ideation – thoughts of wanting to
die; may vary in seriousness depending on
specificity of suicide plans and degree of
suicide intent
●Suicidal intent – subjective expectation &
desire to end one’s life
●Lethality of suicidal behavior – objective
Republic of the
Department
Philippines of
Health
danger to life associated with a suicide
2
Center for Health
caro.doh.gov.
Development-CAR method or action (eg. hanging versus
● Every year, almost 1 million people
die from suicide, w/ global mortality
rate of 16 per 100,000
Suicide ● In the last 45 years, suicide rates
have increased by 60% worldwide
Situatio ● Leading cause of death in those
aged 15-44 in some countries
n ● Rates among young people have
been increasing so they are now the
highest risk group
Republic of the
Department
Philippines of
Health 3
Center for Health
caro.doh.gov.
Development-CAR
● Mental disorders (particularly depression &
alcohol use disorders) are a major risk for
suicide in Europe & North America; in Asian
countries, impulsiveness plays an important
Facts role
● Suicide is complex w/ psychological, social,
on
biological, cultural, & environmental factors
involved
● Restriction of access to common methods of
Suicide suicide prove effective in reducing rates
● Up to 90% of patients w/ suicidal intent have
a major psychiatric illness
● Some patients become suicidal or commit
suicide with relatively little warning.
● Others have communicated their intent to a
caregiver or significant other.
● Up to 70% saw a physician within 30 days
prior to their death, and nearly 50% had seen
Republic of the
Department
Philippines of
Health a physician in the preceding week 4
Center for Health
caro.doh.gov.
Development-CAR (Barraclough et al., 1974)
Robins and colleagues (1959) reported
that only 18% of suicidal patients
communicated their intent to helping
professionals, while 69% communicated
Facts their intent to an average of three close
relatives or associates, 73% within 12
on months of their suicide (Robins et al.,
A World Health Organization study found
1959).
Suicide that approximately two‐thirds of
individuals with suicidal ideation never
make a suicide attempt2, and a
population‐based study found that only 7%
of individuals with suicidal ideation
attempted suicide during the subsequent
two years.
Republic of the
Department
Philippines of
Health 5
Center for Health
caro.doh.gov.
Development-CAR
The IPTS provides separate explanations for
the development of suicidal ideation and the
Interperso progression from suicidal ideation to suicide
nal Theory attempts. Specifically, the IPTS suggests that
suicidal desire is caused by thwarted
of Suicide belongingness and perceived
burdensomeness, whereas progression from
suicidal desire to suicide attempts occurs
when one has acquired the capability to
make a suicide attempt.
Republic of the
Department
Philippines of
Health 6
Center for Health
caro.doh.gov.
Development-CAR
The 3ST suggests that:
a) suicidal ideation is caused by the
combination of unbearable pain (usually
psychological) and hopelessness,
Three‐ b) b) suicidal ideation is strong when one’s
Step
pain exceeds or overwhelms one's
connectedness (to valued people,
Theory of communities, or sources of purpose and
meaning), and
Suicide c) c) transition from strong suicidal
ideation to potentially lethal suicide
(3ST) attempts is facilitated by dispositional,
acquired and practical contributors to
capability for suicide.
NOTE: Thus, the 3ST is a concise theory
that explains suicide in terms of just four
Republic of the
Department
Philippines of
Health variables: pain, hopelessness, 7
Center for Health
caro.doh.gov.
Development-CAR connectedness, and suicide
Variable High Risk Low Risk
Age Over 45 Below 45
Suicide
Sex Male Female
Marital status Divorced or Married
widowed
Risk
Employment Unemployed Employed
Interpersonal rel’p Conflictual Stable
Family background Chaotic or Stable
Factors Physical health
conflictual
Chronic illness,
Good health
Feels healthy
hypochondriac, Low substance
Excessive use
substance intake
Republic of the
Department
Philippines of
Health 8
Center for Health
caro.doh.gov.
Development-CAR
Variable High Risk Low Risk
Suicidal ideation Frequent, intense, Infrequent, low intensity,
prolonged transient
Suicide attempt Multiple attempts First attempt
Planned Impulsive
Suicide Rescue unlikely
Unambiguous wish to die
Communication inter-
Rescue inevitable
Primary wish for change
Communication externa-
Risk
nalized (self-blame) lized (anger)
Method lethal & available Method of low lethality
or not available
Factors Personal resources Poor achievement
Poor insight
Good achievement
Insightful
Affect unavailable or Affect available &
poorly controlled approp controlled
Poor rapport Good rapport
Socially isolated Socially integrated
Unresponsive family Concerned family
Republic of the
Department
Philippines of
Health 9
Center for Health
caro.doh.gov.
Development-CAR
Variable High Risk Low Risk
Social resources Poor rapport Good rapport
Socially isolated Socially integrated
Unresponsive family Concerned family
Suicide
Risk
Factors
Republic of the
Department
Philippines of
Health 10
Center for Health
caro.doh.gov.
Development-CAR
How to spot ● Expressing in words or actions
a person ● Withdrawal from friends, family, and
who is society
● Loss of interest from previous activities
feeling ● Describing selves as a burden to others
suicidal?
RED FLAGS
● Looking for ways to kill themselves
● Unexpected jokes about death or suicide
● Setting matters in order
● Life threatening behavior
Republic of the
Department
Philippines of
Health 11
Center for Health
caro.doh.gov.
Development-CAR
How to spot OTHER SIGNS
a person ●Rage, anger, seeking revenge
who is ●Anxiety
feeling ●Agitation
suicidal? ●Sleep disturbances
●Starting/increasing smoking,
alcohol, or drug use
●Significant change in level of
religious interest in afterlife
●Any dramatic change in mood,
appearance, or behavior
Republic of the
Department
Philippines of
Health 12
Center for Health
caro.doh.gov.
Development-CAR
● Ask about suicidal ideas, especially plans
to harm oneself. Asking about suicide
does not plant the idea.
● Do not hesitate to ask patients if “they
Managi want to die”. A straightforward approach
is the most effective.
ng ● Conduct the interview in a safe place.
Patients have been known to throw
Suicidal themselves out of a window.
● Do not offer false reassurance. Eg. “Most
Client people think about killing themselves at
some time.”
● Always ask about past suicide attempts
which can be related to future attempts.
● Always ask about access to firearms or
other means of suicide.
Republic of the
Department
Philippines of
Health 13
Center for Health
caro.doh.gov.
Development-CAR
Dos and
Don’ts
Republic of the
Department
Philippines of
Health 14
Center for Health
caro.doh.gov.
Development-CAR
- used for viewing the life experiences of
Pagdadal the Filipino and a tool to help the Filipino
in difficult times.
a Model: - Filipino is described as committed to
Suicide
their tasks, responsibilities and
relationships, taking these to their
First Aid destinations, crawling on hands and
knees if needed.
- Gain meaning from a sense of
belonging to a community of co-burden
bearers. (Decenteo 1999)
Republic of the
Department
Philippines of
Health 15
Center for Health
caro.doh.gov.
Development-CAR
Pa
tu
(D tun
es
ti n g u h
ati an
on
)
PAGDADALA MODEL
Nagdadala
(Burden Bearer)
Dinadala
(Burden)
Pagdadaanan
(Way)
Pa
tu
(D tun
PAGDADALA MODEL
es
ti n g u h
ati an
on
)
Nagdadala
(Burden Bearer)
Pagdadala
(Manner of Carrying)
Dinadala
(Burden)
Pagdadaanan
(Way)
Pa
tu
(D tun
es
ti n g u h
ati an
on
)
PAGDADALA MODEL
Nagdadala rin
Nagdadala (Co-burden Bearer)
(Burden Bearer)
Pagdadala
(Manner of Carrying)
Dinadala
(Burden)
Pagdadaanan
(Way)
Pa
tu
PAGDADALA MODEL
(D tun
es
ti n g u h
ati an
on
)
Pagdadaanan
(Way)
Dinadala
Patutunguha
Pag-asa
n
Katulong Pagdadaanan
Kalakasan
(Desai, 2016)
Dinadala
Identify roles, responsibilities, relationships, and
experiences brought by the situation.
Pagdadal Ask how they are managing these, at
a Model:
Suicide Patutunguhan
Identify their goals, direction, or situation that
First Aid the nagdadala wants to achieve or be in.
Ask how they will lighten their current load or
burden
Republic of the
Department
Philippines of
Health 21
Center for Health
caro.doh.gov.
Development-CAR
Pagdadaanan
Identify how to help them make a decision to continue
to move forward.
Pagdadal Ask their plans and strategies they will undertake to
a Model: bring their role or responsibility to their desired
direction.
Suicide Kalakasan
Identify available resources or coping
First Aid behaviors.
Ask immediate internal and external resources
that they currently have, these can be
identifying available resources or coping
behaviors.
Republic of the
Department
Philippines of
Health 22
Center for Health
caro.doh.gov.
Development-CAR
Katulong
Identify people who can support them to manage their
resources and emotions.
Pagdadal Ask their personal drive, people who bring them
a Model: ginhawa and spirituality.
Suicide Pag-asa
Towards ending the conversation, highlight their
First Aid strengths and problem solving, instilling
them a sense of hope.
Republic of the
Department
Philippines of
Health 23
Center for Health
caro.doh.gov.
Development-CAR
PAMAMARAAN NG PAGTULONG
Nagdadala rin
Nagdadala (Co-burden Bearer)
(Burden Bearer)
Pagdadala
(Manner of Carrying)
Dinadala
(Burden)
Pagdadaanan
(Way)
Paglilinaw
clarification of the aspects in the
pagdadala model
Nagdadala rin
Nagdadala (Co-burden Bearer)
(Burden Bearer)
Dinadala
(Burden)
Pagdadaanan
(Way)
Pagsasaayos
assist in pagdadala, a burden that is
well arranged is easier to carry
Nagdadala rin Nagdadala
(Co-burden Bearer) (Burden Bearer)
Dinadala
(Burden)
Pagdadala
(Manner of Carrying)
Pagdadaanan
(Way)
Pagaalalay
the co-burden bearer moves with the
burden bearer
Nagdadala
(Burden Bearer)
Nagdadala rin
(Co-burden Bearer)
Pagdadaanan
(Way)
Masasandala
n
both what is leaned on and the burden
bearer are standing still
Nagdadala
(Burden Bearer)
Nagdadala rin
(Co-burden Bearer)
Pagdadaanan
(Way)
Pagpapahing
a
does not think of the dinadala for a
while
Nagdadala
(Burden Bearer)
Nagdadala rin
(Co-burden Bearer)
Dinadala
(Burden)
Pagdadaanan
(Way)
Self-blame Talking alone as if conversing w/
unseen
Common
signs of
Mental Hearing non-existent voices Irrational fearfulness
Illness
Republic of the
Department
Philippines of
Health 30
Center for Health
caro.doh.gov.
Development-CAR
Profound sadness for more Sleep disturbance
than 2 weeks
Common
signs of
Mental
Illness
Stomach pains (medical problem Feeling hopeless
ruled out)
Republic of the
Department
Philippines of
Health 31
Center for Health
caro.doh.gov.
Development-CAR
Mood swings Lack of
energy
Common
signs of
Mental Increased or decreased
talking
Suicide attempts
Illness
Republic of the
Department
Philippines of
Health 32
Center for Health
caro.doh.gov.
Development-CAR
Suicidal Poor
thoughts concentration
Common
signs of
Mental Grandiose Poor grooming & hygiene
Illness
delusions
Republic of the
Department
Philippines of
Health 33
Center for Health
caro.doh.gov.
Development-CAR
Assaultiveness/ Persecutory delusions
violence
Common
signs of
Mental Withdrawing from family &
Illness
friends
Republic of the
Department
Philippines of
Health 34
Center for Health
caro.doh.gov.
Development-CAR
Suicidal Poor
thoughts concentration
Common
signs of
Mental Grandiose Poor grooming & hygiene
Illness
delusions
Republic of the
Department
Philippines of
Health 35
Center for Health
caro.doh.gov.
Development-CAR
Compassion, good listening skills, and some basic knowledge of mental illnesses
are all that are required.
Republic of the
Department
Philippines of
Health
Center for Health
36
caro.doh.gov.
Development-CAR
Maraming Salamat po!
Republic of the
Department
Philippines of
Health
Center for Health
caro.doh.gov.
Development-CAR
ph
