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New blog about suicide and physical health by SBRL member Sarah Eschle

posted Feb 29, 2016, 3:27 AM by SBRL Glasgow   [ updated Apr 1, 2016, 3:51 AM by Glasgow Wellbeing ]
Suicide Risk and Physical Health Conditions

I recently read about Former Arts Council chief, freelance business consultant and blog writer Frances Medley and her decision to end her own life in 2013. According to reports, the mental and physical exhaustion Frances felt following 8 years of living with multiple sclerosis (MS) contributed to Frances ending her life. As Frances described it in her blog “the prospect of further rapid deterioration was both terrifying and not one I wanted to entertain.” This lack of hope for the future as a result of her degenerative condition, as well as the lack of support in dealing with MS from the NHS, chronicled in her blog, appear to have contributed to her decision to end her life. This story prompted me to read more about physical health conditions and suicide, and thus to write this blog about the current research on this area. The Think-tank Demos conducted a study ‘The Truth about Suicide’ and noted that at least 10% of suicides are linked to chronic or terminal illnesses in Britain. That translates into at least one person with a physical health condition dying by suicide every day in the UK. As in Frances Medley’s case, people are sadly ending their lives at younger ages to avoid future pain and deterioration. What, then, can we say about suicide risk and physical health conditions?

Given this statistic, understanding the elevated suicide risk in physical health conditions warrants further research. The symptoms associated with physical health conditions and their impact on a person’s life may be contributing to an increased suicide risk, for example, co-morbid mental health diagnoses, social isolation, hopelessness and unemployment, among others are all likely to play a role in increasing risk. There is a dearth of research in this area of suicide research, as with many others, but given the statistics reported in ‘The Truth about Suicide’ paper, that over 400 people per year with a physical health condition die by suicide, it is surely an area which requires further investigation.

We need to better appreciate how different risk factors may be associated with the increased suicide risk in those with a physical health condition.  A systematic review by Pompili et al (2012)  noted that in most of the 12 studies included, there was an increased suicide rate in patients with multiple sclerosis, in comparison to the general population. Several risk factors were identified in this review including severity of depression, social isolation and younger age. These risk factors would suggest that it is not the physical condition in and of itself that contributes to an elevated suicide risk, but the consequences of the condition and the individual’s ability to deal with it. Cao et al (2014) noted, for example, that counter-intuitively those with the most severe spinal cord injuries were actually at a lower risk of suicide than other, less severe spinal cord injury groups. This would indicate that it is important to tease apart the specific risk factors due to an illness, that actually increase suicide risk, as opposed to assuming it is the diagnosis itself that increases risk.

From the Pompili et al (2012) review it appears to be factors such as a lack of social contact, more severe depression and being younger at time of diagnosis that can increase an individual’s risk of suicide. Examining these factors could suggest that, for example, young age at time of diagnosis may lead to feelings of hopelessness, with the knowledge of many years of dealing with a health condition ahead of them. As already noted from ‘The Truth about suicide’ study, increasingly it is those who are younger who choose to take their own life, and indeed, Frances Medley was only 44 when she died. Furthermore, a lack of social contact may increase suicide risk if a person has “too much” to deal with on their own, or feels a lack of social activity in comparison to life pre-diagnosis. With support from health – including mental health – and social services, quality of life can be maximised and those who are most vulnerable may be better able to live with their condition, derive enjoyment in their lives, instead of taking their lives?

Some issues that have already been examined in suicide research are particularly applicable to those with a physical health condition. For example, Kanzler et al (2012) examined a risk factor for suicidality already established in the general population that is particularly pertinent in the present context – perceived burdensomeness. Perceived burdensomeness is the belief that you are a burden to others, and that you do not contribute to other’s lives and is a core feature of Joiner’s Interpersonal Theory of Suicide (Joiner, 2005). This factor is also included within the Integrated Motivational-Volitional Model of suicidal behaviour (O’Connor, 2011) wherein it is believed to increase the likelihood that if someone feels trapped that they will become suicidal.  In Kanzler’s study of participants who experience chronic pain, perceived burdensomeness was the sole predictor of suicidal ideation, when other potential risk factors such as age, gender, depression and pain severity were controlled for.  This highlights the consequences of a physical health condition on wellbeing, in particular on how feeling a burden may increase the risk of suicidal ideation and behaviour. It also suggests an avenue for further exploration and ultimately intervention. Alleviating perceived burdensomeness should be a treatment target.

What can we conclude from this research, then? Physical health problems may increase the risk of suicidal ideation and behaviour. I’d like to emphasise the word ‘may’ here, as there are plenty of people living with their health condition who have never experienced any suicidal ideation or behaviour. However, in those that have, it is important to investigate the factors underpinning this increased risk and not attributing it to the diagnosis itself. No two people’s experiences of a health condition are the same, so it is vital that we tailor treatments to maximise each individual’s wellbeing. 

We need to look beyond the label. We need more research into the underlying risk factors for suicidality that are attributable to physical illness. Mental health problems can go hand in hand with physical health conditions, but this is often overlooked by the professionals (Doherty and Gaughran, 2014), partly due to lack of time with patients and funding concerns. But research also provides us with hope. If we can establish the factors that increase a person’s risk of suicide following diagnosis with a physical health condition, we can try to intervene to help reduce their risk. We can provide social support and counselling, facilitate employment for those with disabilities, and treat mental health conditions. Frances Medley was a talented young woman with many years ahead of her, and with important contributions to make to society, but she lost her life to suicide. Ultimately, more research into specific physical health risk factors for suicidality is required, not just for the good of those with the conditions, but for the good of society.

Sarah Eschle   


References

BBC. (2014) Frances Medley ended life over multiple sclerosis pain, inquest told.  Retrieved from http://www.bbc.co.uk/news/uk-wales-south-east-wales-25721163

Cao, Y., Massaro, J.F., Krause, J.S, Chen, Y., Devivo, M.J. (2014) Suicide Mortality after Spinal Cord Injury in the United States: Injury Cohorts Analysis. Archives of Physical Medicine and Rehabilitation, 95, 230-235. http://dx.doi.org/10.1016/j.apmr.2013.10.007

DEMOS (2011) ‘The Truth about Suicide’ Retrieved from http://www.demos.co.uk/files/Suicide_-_web.pdf?1314370102

Doherty, A.M., Gaughran, F. (2014) The interface of physical and mental health. Social Psychiatry and Psychiatric Epidemiology, 49(5), 673-682. http://dx.doi.org.ezproxy.lib.gla.ac.uk/10.1007/s00127-014-0847-7

Joiner, T.E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.

Kanzler, K.E., Bryan, C.J., McGeary, D.D., and Morrow, C.E. (2012) Suicidal Ideation and Perceived Burdensomeness in Patients with Chronic Pain, Pain Practice, 12(8), 602-609. doi: 10.1111/j.1533-2500.2012.00542.x  

O’Connor, R.C. (2011). Towards an Integrated Motivational-Volitional Model of Suicidal Behaviour (pp.181-198).  In O’Connor, R.C. Platt, S. & Gordon, J. (Eds.). International Handbook of Suicide Prevention: Research, Policy & Practice. Chichester: Wiley-Blackwell

Pompili, M., Forte, A., Palermo, M., Stefani, H., Lamis, D.A., Serafini, G., Amore, M., Girardi, P. (2012) Suicide risk in multiple sclerosis: A systematic review of current literature. Journal of Psychomatic Research, 73(6), 411-417. doi:10.1016/j.jpsychores.2012.09.011

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