Categoriearchief: zelfdoding

Zelfdoding en internet onder jongeren

In Bridgend in Zuid-Wales hebben het afgelopen jaar zeventien jongeren zelfmoord gepleegd. Dinsdag werd het laatste slachtoffer ontdekt: een meisje dat zich had opgehangen aan een boom. Vorige week stierf de 15-jarige Nathaniel Pritchard uit Bridgend nadat hij zich had geprobeerd te verhangen en vervolgens twee dagen in coma had gelegen. Zijn twintigjarige nicht Kelly Stephenson maakte een paar dagen later een einde aan haar leven toen ze over Nathaniels zelfmoord had gehoord.
Internationaal wordt met afschuw op de zelfmoorden gereageerd, vooral omdat onduidelijk is wat de oorzaken zijn: is er sprake van ‘besmetting’? Hitsten de jongeren elkaar via internet op? De inwoners van Bridgend, politie, onderwijzers en welzijnswerkers zijn zenuwachtig op zoek naar mogelijke redenen. Er is gespeculeerd over een zelfmoordpact op internet, maar dat is woensdag door de politie krachtig ontkend. ,,Absolute onzin”, zei woordvoerster Carwyn Jones van de politie hierover tijdens een persconferentie.
De politie ontkende ook dat de slachtoffers beïnvloed zouden zijn door websites waarop zelfmoord wordt verheerlijkt. Op de profielsite Bebo, vergelijkbaar met Hyves, zou sprake zijn van een groei van ‘herinneringsmuren’ voor degenen die zelfmoord pleegden, en waar honderden jongeren lovende woorden aan de overledenen wijdden. Het wekt de indruk dat als je er niet meer bent, je als held voortleeft op internet. Deze ‘romantisering’ van zelfmoord zou jongeren op zelfmoordgedachten brengen. Maar volgens de politie is ook deze relatie niet te leggen.

Beïnvloeding
Terwijl de politie onderzoek doet, neemt de bezorgdheid over de invloed van internet op zelfmoordgedachten onder jongeren wel toe. Terecht, denkt Gwendolyn Portzki, coördinator van de eenheid voor zelfmoordonderzoek aan de Universiteit van Gent. ,,Er zijn uiterst gevaarlijke sites die een onrealistisch en romantisch beeld van zelfmoord ventileren. Je wordt er op het idee gebracht dat zelfmoord een goede oplossing voor problemen is.”

Portzki heeft de sites zelf nooit gezien, maar weet dat ze er zijn. Overigens zijn stabiele en gezonde jongeren volgens haar niet gevoelig voor deze sites. ,,Ze zijn alleen gevaarlijk voor jongeren die al kwetsbaar zijn en problemen hebben.”

Informatie over zelfmoord die via internet wordt verstrekt, is voor jongeren wel gevaarlijker dan voor volwassenen, denkt de onderzoekster. ,,Adolescenten zijn gevoelig voor beïnvloeding op welk gebied dan ook. Verkeerde informatie via kranten, televisie en internet kan daardoor invloed hebben. Bovendien is de puberfase altijd een moeilijke tijd. Je zou dus kunnen zeggen dat jongeren tot een kwetsbare groep behoren. Ze zijn cognitief nog niet sterk genoeg om nep altijd van echt te onderscheiden en om te relativeren.”

Veel zorgvuldiger dan dat nu gebeurt, moeten de risico’s van het internet ook wat betreft de beïnvloeding bij zelfmoordgedachten worden gevolgd, denkt Erik Jan de Wilde, werkzaam bij het Nederlands Jeugd Instituut en deskundige op het gebied van zelfmoord. ,,We laten jongeren maar een beetje surfen omdat we denken dat we er toch geen grip op krijgen. Maar dat kan wel via bijvoorbeeld waarschuwingspagina’s die gekoppeld worden aan sites met risicovolle informatie. Er zijn dergelijke experimenten bekend bij risicovolle pagina’s over anorexia. Bezoekers van zo’n pagina lezen eerst dat de informatie die ze onder ogen gaan krijgen, gevaarlijk is. Als ze willen, kunnen ze daarna alsnog de pagina bezoeken.” Of als gevolg van internet zelfmoord onder jongeren toeneemt, weet De Wilde niet. ,,Het aantal zelfmoorden in Nederland onder jongeren is al jaren constant.”

Saillant detail hierbij levert Ad Kerkhof, hoogleraar klinische psychologie en suïcidepreventie aan de Vrije Universiteit. Kerkhof doet al jaren onderzoek naar zelfmoord en recent ontdekte een student van hem dat er in het Nederlands geen prosuïcidewebsites bestaan, waarop zelfmoord wordt geromantiseerd en verheerlijkt. ,,Hij heeft ze in ieder geval niet gevonden”, zegt Kerkhof. ,,Het zou best kunnen dat jongeren elkaar via internet opjuinen en aanzetten tot zelfmoord. Dergelijke websites zijn er in andere landen wel. Het effect ervan is door ons echter nooit onderzocht.”

Lang proces
Het is toch al ingewikkeld om de invloed van internet op zelfmoordgedachten bij jongeren precies te duiden, denkt Age Niels Holstein, secretaris van de Ivonne van de Ven-stichting, die zelfmoord als maatschappelijk probleem onder de aandacht wil brengen. ,,Iemand besluit meestal niet opeens zelfmoord te plegen, daar gaat vaak een lang proces aan vooraf. Dat proces noemen wij het suïcidale proces. Daarin komt een poging tot zelfmoord soms aan de oppervlakte en soms ook niet. Er zijn verschillende routes naar zelfmoord. In die routes zijn er risicofactoren en bekend is dat blootstelling aan de media daar een van is.”
Holstein zegt dat wat mensen uit de media oppikken, een rol kan spelen bij hoe het suïcidale gedrag zich ontwikkelt. ,,Daarom is er in Nederland ook een mediarichtlijn vastgesteld waarbij de afspraak is dat media terughoudend zijn bij hun berichtgeving over zelfmoord. Uitgangspunt hierbij is dat wetenschappelijk is aangetoond dat een zelfmoord een andere zelfmoord kan uitlokken.”
Ook al is de invloed van internet op zelfmoordgedachten moeilijk te onderzoeken, Holstein gelooft wel degelijk in het digitale gevaar. ,,Mensen die aan zelfmoord denken, willen eigenlijk niet eens zozeer dood. Ze willen een einde aan hun problemen maken, maar zien geen mogelijkheid daartoe. Als je op internet voortdurend leest dat zelfmoord een oplossing kan zijn, dan kun je daarvoor vallen.”
Verkeerde informatie over zelfmoord op het internet kan een risico zijn omdat internet zo’n laagdrempelig medium is, denkt Holstein. ,,Mensen praten niet snel over zelfmoordgedachten, maar op internet doen ze dat wel.” Dat benadrukt ook Marjolijn Antheunis, die onderzoek doet naar sociale netwerken op internet. Dankzij internet is het gemakkelijker dan vroeger om met gelijkgezinden over allerhande onderwerpen te praten, zegt de promovendus. Vroeger wist je niet wie er óók met zelfmoordgedachten rondliep, tenzij je elkaar kende. Nu kun je via internet gedachten hierover heel gemakkelijk en anoniem met anderen delen.” Politie Wales legt geen link, maar deskundigen waarschuwen voor digitale gevaren

[NB 23-2-2008, Reiny de Fijter]

Veelgestelde vragen over suïcide

What should you do if someone tells you they are thinking about suicide?
If someone tells you they are thinking about suicide, you should take their distress seriously, listen nonjudgmentally, and help them get to a professional for evaluation and treatment. People consider suicide when they are hopeless and unable to see alternative solutions to problems.? Suicidal behavior is most often related to a mental disorder (depression) or to alcohol or other substance abuse. Suicidal behavior is also more likely to occur when people experience stressful events (major losses, incarceration). If someone is in imminent danger of harming himself or herself, do not leave the person alone. You may need to take emergency steps to get help, such as calling 911. When someone is in a suicidal crisis, it is important to limit access to firearms or other lethal means?of committing suicide.

What are the most common methods of suicide?
Firearms are the most commonly used method of suicide for men and women, accounting for 60 percent of all suicides. Nearly 80 percent of all firearm suicides are committed by white males. The second most common method for men is hanging; for women, the second most common method is self-poisoning including drug overdose. The presence of a firearm in the home has been found to be an independent, additional risk factor for suicide. Thus, when a family member or health care provider is faced with?an individual at risk for suicide, they should make sure that firearms are removed from the home.??

Why do men commit suicide more often than women do?     
More than four times as many men as women die by suicide; but women attempt suicide more often during their lives than do men, and women report higher rates of depression. Several explanations have been offered: a) Completed suicide is associated with aggressive behavior that is more common in men, and which may in turn be related to some of the? biological differences identified in suicidality. b) Men and women use different suicide methods. Women in all countries are more likely to ingest poisons than men. In countries where the poisons are highly lethal and/or where treatment resources scarce, rescue is rare and hence female suicides outnumber males. More research is needed on the social-cultural factors that may protect women from completing suicide, and how to encourage men to recognize and seek treatment for their distress, instead of resorting to suicide.

Who is at highest risk for suicide in the U.S.?
There is a common perception that suicide rates are highest among the young. However, it is the elderly, particularly older white males that have the highest rates. And among white males 65 and older, risk goes up with age. White men 85 and older have a suicide rate that is six times that of the overall national rate.

Why are rates so high for this group?
White males are more deliberate in their suicide intentions; they use more lethal methods (firearms), and are less likely to talk about their plans.? It may also be that older persons are less likely to survive attempts because they are less likely to recuperate. Over 70 percent of older suicide victims have been to their primary care physician within the month of their death, many with a depressive illness that was not detected. ?This has led to research efforts to determine how to best improve? physicians’ abilities to detect and treat depression in older adults.

Do school-based suicide awareness programs prevent youth suicide?
Despite good intentions and extensive efforts to develop suicide awareness and prevention programs for youth in schools, few programs have been evaluated to see if they work. Many of these programs are designed to reduce the stigma of talking about suicide and encourage distressed youth to seek help. Of the programs that were evaluated, none has proven to be ?effective. In fact, some programs have had unintended negative effects by making at-risk youth more distressed and less likely to seek help. By describing suicide and its risk factors, some curricula may have the unintended effect of suggesting that suicide is an option for many young people who have some of the risk factors and in that sense “normalize” it—just the opposite message intended. Prevention efforts must be carefully planned, implemented and scientifically tested. Because of the? tremendous effort and cost involved in starting and maintaining programs, we should be certain that they are safe and effective before they are further used or promoted.?? There are number of prevention approaches that are less likely to have negative effects, and have broader positive outcomes in addition to reducing suicide. One approach is to promote overall mental health among school-aged children by reducing early risk factors for depression, substance abuse and aggressive behaviors. In addition to the potential for saving lives, many more youth benefit from overall enhancement of academic performance and reduction in peer and family conflict. A second? approach is to detect youth most likely to be suicidal by confidentially screening for depression, substance abuse, and suicidal ideation. If a youth reports any of these, further evaluation of the youth takes place by professionals, followed by referral for treatment as needed. Adequate treatment of mental disorder among youth, whether they are suicidal or not, has important academic, peer and family relationship benefits.??Are gay and lesbian youth at high risk for suicide???With regard to completed suicide, there are no national statistics for suicide rates among gay, lesbian or bisexual (GLB) persons. Sexual orientation is not a question on the death certificate, and to determine whether rates are higher for GLB persons, we would need to know the proportion of the U.S. population that considers themselves gay, lesbian or bisexual. Sexual orientation is a personal characteristic that people can, and often do choose to hide, so that in psychological autopsy studies of suicide victims where risk factors are examined, it is difficult to know for certain the victim’s sexual orientation. This is particularly a problem when considering GLB youth who may be less certain of their sexual?orientation and less open. In the few studies examining risk factors for suicide where sexual orientation was assessed, the risk for gay or lesbian persons did not appear any greater than among heterosexuals, once mental and substance abuse disorders were taken into account.??With regard to suicide attempts, several state and national studies have reported that high school students who report to be homosexually and bisexually active have higher rates of suicide thoughts and attempts in the past year compared to youth with heterosexual experience. Experts have not been in complete agreement about the best way to measure reports?of adolescent suicide attempts, or sexual orientation, so the data are subject to question. But they do agree that efforts should focus on how to help GLB youth grow up to be healthy and successful despite the obstacles that they face. Because school based suicide awareness programs have not proven effective for youth in general, and in some cases have caused increased distress in vulnerable youth, they are not likely to be helpful for GLB youth either. Because young people should not be exposed ?to programs that do not work, and certainly not to programs that increase risk, more research is needed to develop safe and effective programs.

Are African American youth at great risk for suicide?
Historically, African Americans have had much lower rates of suicides compared to white Americans. However, beginning in the 1980s, the rates for African American male youth began to rise at a much faster rate than their white counterparts. The most recent trends suggest a decrease in suicide across all gender and racial groups, but health policy experts remain concerned about the increase in suicide by firearms for all young males. Whether African American male youth are more likely to engage in “victim-precipitated homicide” by deliberately getting in the line of fire of either gang or law enforcement activity, remains an important research question, as such deaths are not typically classified as suicides.

Is suicide related to impulsiveness?
Impulsiveness is the tendency to act without thinking through a plan or its consequences. It is a symptom of a number of mental disorders, and therefore, it has been linked to suicidal behavior usually through its association with mental disorders and/or substance abuse. The mental disorders with impulsiveness most linked to suicide include borderline personality disorder among young females, conduct disorder among young males and antisocial behavior in adult males, and alcohol and substance ?abuse among young and middle-aged males. Impulsiveness appears to have a lesser role in older adult suicides. Attention deficit hyperactivity disorder that has impulsiveness as a characteristic is not a strong risk factor for suicide by itself. Impulsiveness has been linked with aggressive and violent behaviors including homicide and suicide. However, impulsiveness without aggression or violence present has also been found? to contribute to risk for suicide.

Is there such a thing as “rational” suicide?
Some right-to-die advocacy groups promote the idea that suicide, including assisted suicide, can be a rational decision. Others have argued that suicide is never a rational decision and that it is the result of depression, anxiety and fear of being dependent or a burden. Surveys of terminally ill persons indicate that very few consider taking their own life, and when they do, it is in the context of depression. Attitude surveys suggest that assisted suicide is more acceptable by the public and health providers for the old who are ill or disabled, compared to the young who are ill or disabled. At this time, there is limited research on the frequency with which persons with terminal illness have depression and suicidal ideation, whether they would consider assisted suicide, the characteristics of such persons, and the context of their depression and suicidal thoughts, such as family stress, or availability of palliative care. Neither is it yet clear what effect other factors such as the availability of social support, access to care, and pain relief may have on end-of-life preferences. This public debate will be better informed after such research is conducted.??What biological factors increase risk for suicide? ??Researchers believe that both depression and suicidal behavior can be linked to decreased serotonin in the brain. Low levels of a serotonin metabolite, 5-HIAA, have been detected in cerebral spinal fluid in persons who have attempted suicide, as well as by postmortem studies examining certain brain regions of suicide victims. One of the goals of understanding the biology of suicidal behavior is to improve treatments. ?Scientists have learned that serotonin receptors in the brain increase their activity in persons with major depression and suicidality, which explains why medications that desensitize or down-regulate these receptors (such as the serotonin reuptake inhibitors, or SSRIs) have been found effective in treating depression. Currently, studies are underway to examine to what extent medications like SSRIs can reduce suicidal behavior.

Can the risk for suicide be inherited?
There is growing evidence that familial and genetic factors contribute to the risk for suicidal behavior. Major psychiatric illnesses, including bipolar disorder, major depression, schizophrenia, alcoholism and substance abuse, and certain personality disorders, which run in families, increase the risk for suicidal behavior. This does not mean that suicidal behavior is inevitable for individuals with this family history; it simply means that such persons may be more vulnerable and should take steps to reduce their risk, such as getting evaluation and treatment at the first sign of mental illness.

Does alcohol and other drug abuse increase the risk for suicide?
A number of recent national surveys have helped shed light on the relationship between alcohol and other drug use and suicidal behavior. A review of minimum-age drinking laws and suicides among youths age 18 to 20 found that lower minimum-age drinking laws was associated with higher youth suicide rates. In a large study following adults who drink alcohol, suicide ideation was reported among persons with depression. In another survey, persons who reported that they had made a suicide attempt during their lifetime were more likely to have had a depressive disorder, and many also had an alcohol and/or substance abuse disorder. In a study of all nontraffic injury deaths associated with alcohol intoxication, over 20 percent were suicides.??In studies that examine risk factors among people who have completed suicide, substance use and abuse occurs more frequently among youth and adults, compared to older persons. For particular groups at risk, such as American Indians and Alaskan Natives, depression and alcohol use and abuse are the most common risk factors for completed suicide. Alcohol and substance abuse problems contribute to suicidal behavior in several ways.? Persons who are dependent on substances often have a number of other risk factors for suicide. In addition to being depressed, they are also likely to have social and financial problems. Substance use and abuse can be common among persons prone to be impulsive, and among persons who engage in many types of high risk behaviors that result in self-harm.?Fortunately, there are a number of effective prevention efforts that reduce risk for substance abuse in youth, and there are effective treatments for alcohol and substance use problems. Researchers are currently testing treatments specifically for persons with substance abuse problems who are also suicidal, or have attempted suicide in the past.

What does “suicide contagion” mean, and what can be done to prevent it?
Suicide contagion is the exposure to suicide or suicidal behaviors within one’s family, one’s peer group, or through media reports of suicide and can result in an increase in suicide and suicidal behaviors. Direct and indirect exposure to suicidal behavior has been shown to precede an increase in suicidal behavior in persons at risk for suicide, especially in adolescents and young adults.??The risk for suicide contagion as a result of media reporting can be minimized by factual and concise media reports of suicide. Reports of suicide should not be repetitive, as prolonged exposure can increase the likelihood of suicide contagion. Suicide is the result of many complex factors; therefore media coverage should not report oversimplified explanations such as recent negative life events or acute stressors.? Reports should not divulge detailed descriptions of the method used to avoid possible duplication. Reports should not glorify the victim and should not imply that suicide was effective in achieving a personal goal such as gaining media attention. In addition, information such as hotlines or emergency contacts should be provided for those at risk for suicide.?? Following exposure to suicide or suicidal behaviors within one’s family or peer group, suicide risk can be minimized by having family members, friends, peers, and colleagues of the victim evaluated by a mental health professional. Persons deemed at risk for suicide should then be referred for additional mental health services.

Is it possible to predict suicide?
At the current time there is no definitive measure to predict suicide or suicidal behavior. Researchers have identified factors that place individuals at higher risk for suicide, but very few persons with these risk factors will actually commit suicide. Risk factors include mental illness, substance abuse, previous suicide attempts, family history of suicide, history of being sexually abused, and impulsive or aggressive tendencies. Suicide is a relatively rare event and it is therefore difficult to predict which persons with these risk factors will ultimately commit suicide.