自杀定义
自杀是有意夺走生命的行为。但是,该定义已扩展,以描述以某种方式考虑自杀的个人所表现出的思想和行为的范围。自杀念头涉及有自杀或死亡的想法。自杀意图涉及制定如何自杀和打算执行该计划的计划。自杀行为是一个广义术语,包括与自杀有关的所有行动(即本段中的所有术语),但还包括此处列出的其他术语未捕获的某些行为,包括与自杀有关的行为,这些行为没有导致尝试导致尝试,例如收集一瓶药丸(无需服用)或绑住绞索(不使用它)。当一个人打算夺走自己的生活,采取这种意图,但不会死亡时,就会发生自杀企图。当一个人打算夺走自己的生命并导致死亡时,就会发生自杀。
One way to understand suicidal behavior is to think of it as a continuum with ideation at the far left and completion to the far right: In this way, behaviors toward the left of the continuum are relatively less severe and behaviors to the right are relatively more severe because of their differing proximities to suicide completions. This continuum view has not been empirically validated (e.g., it is possible that suicidal ideation differs from suicide attempt in kind rather than just in degree), and in any event, all suicidal behaviors are serious and warrant assessment by a mental health professional.
Importance and Context of Suicide
Suicide is a serious health problem worldwide, including in the United States. In 2002, it is estimated that 31,655 individuals died by suicide, making suicide the 11th leading cause of death (homicide ranks 14th). Although rates vary somewhat year to year, approximately 30,000 people in the United States, and almost a million people die by suicide each year worldwide. On one hand, 30,000 U.S. deaths per year—one every 18 minutes or so—is a lot. On the other hand, suicide is a rare cause of death compared with other causes of death in the United States. For example, given that a person has died, the chance that the cause was heart disease or cancer is 52%. Given that someone has died, the chance that the cause of death was suicide is a little over 1%. However, the number of deaths by suicide (i.e., the number of suicide completions), though an accurate representation of the fact that death by suicide is rare, also greatly underestimates the magnitude of the problem: For every death by suicide, there are as many as 25 nonfatal attempts. Suicidal ideation is even more common than attempts: Estimates suggest that approximately 13% of individuals in the United States will experience substantial suicidal ideation at some point in their lifetime. Thus, suicide completions are relatively rare in the United States, but attempts are more common, and ideation is even more common.
自杀行为的患病率(即它的普遍性)在男女方面有所不同。男性比女性更频繁地自杀,但女性比男性更频繁地自杀。更具体地说,男性的可能性是女性死于自杀的可能性约4倍。妇女尝试自杀的可能性大约是男性的三倍。可以通过研究表明,总的来说,男性比女性更暴力的行为来解释这种模式。妇女的自杀企图平均使用较少暴力的方法,因此致命的可能性较小。例如,美国3名男性自杀受害者中有2名死于枪支,而美国3名女性自杀受害者中有1名死于枪支。女性受害者最常见的方法是过量服药或中毒。
Suicide Measurement
尽管可以通过医疗记录进行尝试和完成,但自杀的其他方面(即构想和意图)不能以这种直接的方式进行衡量。一种常用的措施是贝克自杀量表,这是一个有21个问题的自我报告措施。对于每个问题,受访者都选择了三个最能描述他或她感觉如何的陈述之一。每个语句的评分为0,1,2,严重程度增加。例如,表明自杀念头的项目之一如下:“我不想自杀(0分反应),“我渴望杀死自己(1分反应),并且“我有一个中等的强烈渴望杀死自己(2分反应)。贝克自杀量表的得分较高,表明更严重的自杀念头或意图。
自杀理论
自杀理论家之一是埃德温·史内德曼(Edwin Shneidman)。他的理论指出,自杀是由于他称之为心理痛苦的无可生度的心理痛苦而导致的。另一位自杀研究者亚伦·贝克(Aaron Beck)理论认为,我们的思想(即认知)在自杀行为的发展中起因果作用。该理论提出,自杀是由涉及绝望的认知引起的,这使人们相信将来情况不会变得更好。罗伊·鲍梅斯特(Roy Baumeister)提出,自杀是由于渴望摆脱因期望和实际事件之间差异而产生的痛苦自我意识的愿望。托马斯·乔纳(Thomas Joiner)提出了一个最新的理论。该理论指出,自杀是由三个因素的结合而产生的:挫败的归属感,感知到负担的负担(即,一个人认为一个是对他人的负担),以及获得致命自我伤害的获得的能力。该理论的最后一个成分是获得的能力,涉及这样的想法,即很难克服所有人(自我保护)最基本的本能,并且个人通过痛苦和挑衅的事件获得了这种能力。通过这些经验,个人习惯了自我伤害的痛苦,变得越来越害怕自我伤害,并建立了促进自我伤害的知识。
自杀风险评估
Suicide risk assessment is a process conducted by a mental health professional to determine if an individual is at risk for engaging in suicidal behavior. Two main questions guide suicide risk assessment: Is the individual being assessed a danger to himself or herself and is the danger both immediate and severe? The answer to these questions can come from the use of standardized assessment measures (such as the Beck Suicide Scale) as well as clinical interviews. A thorough risk assessment for suicide gathers information from the individual on both present suicidal symptoms as well as past suicidal behavior, current stressors, and other psychological symptoms (e.g., hopelessness). For example, individuals who suffer psychiatric disorders are at higher risk for suicide. A disorder with one of the highest rates is major depressive disorder. One of the strongest predictors of completed suicide is a prior attempt; thus, considering presenting symptoms is not sufficient for thorough risk assessment.
If risk is deemed to be immediate or severe, emergency mental health services are used, most often involving hospitalization until the individual is no longer at imminent risk for suicide. If risk is not deemed immediate or severe, alternatives to emergency mental health can be used. For example, with the help of a trained mental health professional, individuals may be helped to create a coping card that lists concrete steps to take in the event that suicidal symptoms intensify.
Suicide Warning Signs
美国自杀学协会的成员是研究和治疗自杀行为的研究人员和临床医生。该小组设计了自杀的警告标志清单,表明自杀的严重风险。这些警告信号是为朋友,家人和任何其他可能与自杀人接触的人设计的。警告迹象指示,如果一个人见证,听到或看到以下任何一个或多个,则应立即获得帮助:
- Someone threatening to hurt or kill himself or herself
- Someone looking for ways to kill himself or herself by seeking access to pills, weapons, or other means
- Someone talking or writing about death, dying, or suicide
The warning signs also instruct that should seek immediate help if one witnesses, hears, or sees someone exhibiting any one or more of the following:
- 绝望
- Rage, anger, seeking revenge
- Acting reckless or engaging in risky activities, seemingly without thinking
- Feeling trapped—like there’s no way out
- Increasing alcohol or drug use
- Withdrawing from friends, family, or society
- Anxiety, agitation, unable to sleep or sleeping all the time
- 心情的戏剧性变化
- No reason for living
- No sense of purpose in life
References:
- American Association of Suicidology. (n.d.). http://www.suicidology.org/
- Joiner, T. E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.