Too easy to blame the internet for suicides in Wales

Photo by Guillermo Esteves (Flickr)

This is the text of my article in The Evening Herald on 20th February 2008:

The spate of teenage deaths by suicide in Wales has spurred speculation that the internet – especially tributes on social networking websites – has played a role in what has been going on.

The speculation has been rejected by the police. “They were all young people with big issues,” a police spokesman said. “There are a constellation of factors influencing these young people.”

So where has speculation about internet suicide pacts come from? Partly it comes from the belief that suicide pacts do exist and that the internet plays a role in these in some parts of the world.

Deaths arising from suicide pacts are a major source of concern in Japan where this phenomenon has been most reported. There, even complete strangers have taken their own lives as part of pacts made over the internet.

Closer to home, last summer saw the death of two young irish men who made a suicide pact over the internet.

Research in Britain suggests that about 12 couples a year take their lives in what might be called a suicide pact but this is not confined to teenagers and can be a response to depression or incurable illness.

But such pacts have existed since before the internet came along. So have copycat suicides. When singer Kurt Cobain took his own life in 1994, some fans also committed suicide. In 1994, hardly anybody used the internet, most people didn’t know what it was and social networking sites such as Bebo and My Space had not even been imagined.

There have been claims that tributes on the networking sites to those who killed themselves have led others to do the same. The theory sounds plausible until you consider that such tributes are only a part, indeed a small part, of the mourning that surrounds a death.

If you attend the funeral of somebody who has committed suicide, you will hear the same tributes that are heard at funerals for other people. There may be an underlying, unspoken sense of anger at the person who has destroyed the life of his or her family by committing this stupid act but a desperate attempt is made to act as though this is a normal funeral.

Such funerals are, needless to say, very emotional especially if a young person has died. I would suggest that they are far more emotional than a website tribute can be – yet I am unaware of any evidence that they lead to copycat deaths.

Similarly are we to say that the loving death notices placed in newspapers lead other people to think of suicide, even when we know that this is how the person died?

To work out whether the suicides in Wales are linked, we need to know whether these represent a rise in such deaths compared to previous periods or whether we are seeing a statistical cluster of largely unrelated deaths.

Suicides among young men in England and Wales are at their lowest level for three decades and among young women they are at their lowest level since 1968. This makes the deaths in Wales stand out even more.

The internet is open in the sense that suicide pacts made online are fairly easy for the police to uncover forensically . It is likely that such pacts, if behind the deaths in Wales, would have been discovered by now.

Following a death by suicide the question that haunts family and friends for years afterwards is, Why did he or she do it? Could we have prevented it? Usually there will never be a satisfactory answer to the question and families have to accept this fact before they can move on.

In the long run I suspect that there will never be a satisfactory explanation for these pointless deaths in Wales either.

Fall in the suicide rate for young men in the UK - but more young women use dangerous methods

When I read the headline on the BBC website about the fall in suicide among young men in the UK I thought I had come across a reason to hope that in one society, at least, a way had been found to tackle this painful problem.

Well, it has and it hasn't. The suicide rate for young men in England and Wales is at its lowest level for 30 years, the report says. But this isn't due to a change in attitudes. "One key factor has been a cut in toxins in vehicle exhaust fumes because of catalytic converters - making it harder for people to kill themselves," it says.

Still, it's a good outcome but how long will it be before young men turn to more dangerous alternatives? Young women seem to be doing this already, with a dramatic rise in hanging. Could this, I wonder, be an unintended consequence of measures that made it more difficult to put together a large supply of paracetamol? Nevertheless, suicide rates among young women are at their lowest level since 1968.

Suicide is an extraordinarily complicated issue but the UK figures suggest that in Ireland we can hope to get the figures down by a variety of measures - even if those measures and their possible consequences are far from straightforward.

(This is the complete post. Ignore "Continue reading" link below.)

The grim reality behind that rural retreat

Photo by Jasmic (Flickr)

This is the text of my article in The Evening Herald on 15th February 2008:

The rural retreat, complete with green fields, clear streams and singing birds seems idyllic when you’re stuck in urban traffic in the rain – but behind the pretty picture is a grimmer reality, judging by the latest comments from Dr Moosajee Bhamjee.

The Clare psychiatrist and former Labour Party TD has pointed to the demise of the rural pub and of other social facilities as a factor in suicide in country areas. The close-knit rural community of legend has, for too many people, become a thing of the past.

The link between the demise of the rural pub, depression and suicide is not necessarily to do with alcohol - it is to do with social contact. For men living alone, in particular, the pub provided a nightly or almost nightly immersion the affairs of the parish. It kept them connected. Drinking at home on your own is no substitute.

The concept of loneliness is one we are used to in the cities and towns. A city flat can be a very lonely place. So can a home in an urban housing estate where everybody else is at work all day. But at least in cities and towns you can go for a walk to the shops or to the post office and you can hope to meet somebody with whom you are at least on a nodding acquaintance. And if all else fails you can find a pub to go to at night.

There are still parts of rural Ireland in which there is a closeness between people that you will not find in cities and towns. Everybody living along a stretch of road knows each other; they have known each other for years and they look out for each other.

But if you live on the wrong road, if your nearest neighbours have gone, if you are unable to travel due to disability or if your local pub has shut down you can be utterly isolated in the countryside.

In any event, there is something wrong with the rural dream of the past. City people think of Clare as the quintessential rural county. In many respects I think it fair to say we were encouraged to think of the county of the De Valeras as more "real" than the cities. It was the home of traditional Irish music, of unforgettable sessions in the pubs, of poety, of wonderful natural scenery and of wonderful people.

Perhaps that was true and perhaps it is still true. Yet 17 people are thought to have taken their lives in Clare last year and two thirds of these lived in rural areas. Suicides in Clare outnumbered deaths from road accidents last year.

Six of these deaths were among men in their twenties and three were men in their thirties, forties and fifties. This suggests that suicide in Clare is not predominantly affecting elderly people. It is more likely that isolated, elderly people are prey to depression than to suicide.

More importantly, all of this suggests that the answer to rural depression involves social rather than medical measures. For example, there are roads in rural Ireland which a bus has never ever, ever passed down. If each rural area had an easily-accessible bus service even a couple of times a day the difference to the physical and mental health of rural dwellers would be enormous.

It seems highly unlikely that services like this can be run on a commercial basis. They would have to be subsidised out of taxes and, as far as I am concerned, it would be money well spent.

Meanwhile,though, I am for city and town living. The field and the stream may be attractive -but the lonely country road with the bus once a week definitely is not.

Rural suicide figures suggest urban life not as unhealthy as we assume

We often think of life in cities and towns as unpleasant, hurried, stressful and therefore unhealthy - but the latest suicide figures from Co Clare suggest we may be wrong.

Last year, according to Gordon Deegan's story (premium content) in The Irish Times, 17 people (16 male) took their own lives in the county. This exceeds the number of deaths (12) from road accidents.

Of the 17 suicides, 11 took place in rural areas and 10 during the summer months. This is puzzling because we also expect a stronger sense of community in rural areas than in cities and towns - and community protects against depression.

Does anyone have an explanation?

(This is the complete post. Ignore "Continue reading" link below.)

Separation and unemployment contribute to suicide, report suggests

Photo by Bethany L King (Flickr)

New Irish report on suicide

Connections with other people constitute an under-valued source of psychological well-being. As we become more individualised - not knowing who our next-door-neighbour is, spending more time in our own rooms with our own technology and so on - we ignore, at our peril, evidence of the links between isolation and mental ill-health. Further evidence for that link was reported in The Irish Times on Tuesday 27th November by Barry O'Keeffe.

"Separated men and women have high suicide rates, far higher than married people, according to new figures published last night," O'Keeffe wrote. "The figures also show that unemployed men are four times more likely to take their own lives than men in employment.

"The suicide rate of women who were unemployed was five times higher than that of women in employment. Women who were 'engaged in home duties' had a similar suicide rate to the employed.

"The report, which was launched last night in Dublin by Dr Jimmy Devins, Minister of State for Disability and Mental Health, was compiled by the National Suicide Research Foundation. Commissioned by the HSE National Office for Suicide Prevention, it examined deaths which occurred in the Republic in 2002. Of the 1,800 deaths into which an inquest was held, 495 were recorded as deaths by suicide.

New data
"The researchers were given access to what is known as form 104 for the first time. This is a form which gardaí complete for coroners' inquests to determine the cause of death, when such deaths are thought not to be through natural causes.

"'It is the first time that Irish data has shown separated people to be a high risk group,' said Dr Paul Corcoran, deputy director of the National Suicide Research Foundation. 'It is worth looking into, in terms of suicide prevention as the number of separated people in Ireland is increasing.'

"Dr Corcoran said the study of inquested deaths was the first time such data had been separated out from general data collected by the Central Statistics Office (CSO)."

Highest rates are in young men
As in traffic deaths, overall, the study found that the highest rates of suicide were among young men, according to the report.

In general, two-thirds of men who died by suicide did so by hanging, whereas for women, the most common forms of death by suicide were hanging, drowning and drug overdoses.

On the issue of whether alcohol was involved, Dr Corcoran said the data was not reliable, as it seemed at odds with generally accepted data on suicide, ie alcohol dependence seemed to be underestimated as a factor.

The report found that an above-average number of deaths happened on Sundays and Mondays. It said accidental deaths peaked on Sundays, whereas suicide deaths peaked on Mondays.

For each of these categories, the rate was at least 20 per cent higher than average on these days. Suicide deaths were least common on Wednesdays and Thursdays, with 17 per cent fewer deaths than average.

Link to spring and summer
The data demonstrated that suicides peak in late spring and early summer (April to June). Dr Corcoran said people would expect such deaths to occur more in winter, but these findings bore out similar studies around the world. It also found that about half of suicide deaths occurred around the home of the deceased, compared with 26-30 per cent of the accidents and homicides.

"The data indicated that a final communication - generally in the form of a written note - was made in 30 per cent of suicide deaths.

Dr Corcoran said the data was limited in respect of occupation of the deceased. However, he said, there seemed to be a high rate of suicide among semi-skilled and unskilled workers, including builders' labourers, assembly line workers, security guards and bar staff.

He cited Australia where a major initiative had been launched to target young men in the building industry, where it was thought that issues such as bullying had led to suicides. "We should consider launching similar initiatives here," he said.

Forms not satisfactory
The data was based on the 104 forms, which are completed by gardaí for inquests, giving details about the deceased and the facts surrounding the death.

Dr Corcoran said it was not the fault of the gardaí, but these forms were not always satisfactory. The report recommends that some changes be made in these forms to provide more accurate information.

In addition, Dr Corcoran said some different mechanism needed to be developed to collect more in-depth information on the medical and other contributory factors associated with suicide.

23 schoolgoing children died by suicide last year

Twenty-three suicides by children were reported to the National Educational Psychological Service (NEPS) in the last school year, according to figures presented at a meeting of the service last week.

ireland.com - The Irish Times - Fri, Oct 19, 2007 - 23 schoolgoing children died by suicide last year

(This is the complete post. Ignore "Continue reading" link below.)

Off Topic: Residents call a halt to assisted suicide in Swiss housing block

I'm in favour of making assisted suicide available to people who are suffering great pain in terminal illnesses. In Europe, many people go to Dignitas in Zurich to die. But what if you lived in the same apartment block in which Dignitas, er, facilitates suicide? Read this remarkable article from The Guardian to get a flavour of what it's like.....
(This is the complete post. Ignore "Continue reading" link below.)

Breast implants: higher suicide rate suggests cosmetic surgery not the answer to life's ills

If cosmetic surgery brought happiness, I guess we'd all be doing it. But evidence that this is far from the case comes in a disturbing new study of Swedish women reported in this story on irishhealth.com. Women with breast implants are three times more likely to commit suicide or to die from drug or alcohol-related causes than other women, a new study has indicated, says the story.

Researchers at the International Epidemiology Institute in Maryland and the Vanderbilt University Medical Center in Tennessee, in a detailed follow-up of an earlier study, looked at data on 3,527 Swedish women who underwent cosmetic breast implantation from 1965 to 1994 at an average age of 32.

After an average 18.7 years of follow-up, there were 175 deaths among the women with implants. This was a 30% higher than the expected all-cause mortality rate.

Suicide was three times more common among women with implants than the rate in the general population. Deaths related to mental disorders were also higher among women with breast implants

Does this mean, I wonder, that these women had looked to breast implants to resolve life's normal problems and that they despaired when their problems returned? Or were breast implants just one of many options they had tried unsuccessfully?

It suggests to me that women or men who are thinking of plastic surgery should see it as something they use to deal with a specific physical issue but not as something that will resolve wider problems.....

More than 80 per cent of suicides in Derry study were male

Over 83% of 60 suicides in the Derry area in the five years to the end of 2005 were male, according to a University of Ulster study reported in this story on irishhealth.com.

A peak in the number of suicides was recorded in the month of July.

The authors, Drs Amanda Burns and Tara Moore, said an increased incidence of suicides by young men had alse been recorded in the Republic of Ireland, Portugal, Spain and Greece. They attributed the phenomenon to the changed social role of young men compounded by other stress factors such as broken relationships, increased substance abuse and unemployment.

The Derry research revealed that in almost half the cases reported on, the person who took their own life was unemployed.

In almost 42% of the cases examined, the victim has been previously diagnosed with depression and there was a possible history of mental health problems in 11.7% of cases.

Forty per cent of Northen Ireland suicides are younger men, says report

More than 40 per cent of those who took their own lives in Northern Ireland between 2000 and 2004 were men under 35 years of age, according to a report from the Department of Health, Social Services and Public Safety (press release here; full report here in pdf format).

Main findings:

• People in Northern Ireland report higher happiness levels than in many parts of Europe and further afield, yet this sits alongside high levels of unhappiness and psychological distress.
• Conflict related trauma can have long term physical and mental consequences, and suicide rates have been associated with immediate and longer term consequences of conflict.
• Research shows that people who live in an area heavily affected by violence tend to have very high rates of depression.
• The troubles affected the way suicide was reported and recorded, and limited public recognition of suicide and self-harming as serious public issues.
• During the transition to peace, people are more willing to report depression etc.

The suicide rate for men aged 25-34 in Northern Ireland doubled between 1995 and 2000. For those aged 15-24, it rose by 35 per cent and for those aged 55-64 by 70 per cent. For the 75+ age group the rate actually fell by 75 per cent.

For women the suicide rate more than trebled for the 25-34 year old group but fell for those aged 55 and over.

The number of suicides resulting directly from the interrogation and
punishment practices of loyalist and republican armed groups has not
been established, it says.....

Self immolation on the rise among Afghan women

An increasing number of young Afghan women decide that suicide is their only way of escaping violence and forced marriages, according to this item on BBC Radio 4's Woman's Hour. Self-immolation – setting fire to oneself – is the most common method. Human rights organisations say that the number of reported cases have doubled in some parts of Afghanistan over the past year. The main causes of this disturbing phenomenon are domestic violence and forced child marriages (picture of 11 year old child bride, above right, with 55 year old groom. New York Times magazine).

According to this statement from medica mondiale, self-immolation is very frequently employed by young women and girls as a way of escaping violence in their families – even if this means death. Media mondiale is an NGO advocating for the rights of women who have suffered sexual violence in conflict situations. The statement says that:

• Suicide occurs in all provinces, amongst both men and women (hanging, shooting, drowning in wells or rivers, taking rat poison or tablets, poisoning etc.).
• Self-immolation is the most common method in the province, with especially frequent occurrences in the west in the Herat area.
• Self-immolation is particularly frequent among women and girls in the 10-40 age group, although men also self-immolate.
• Decisive factors amongst women and girls include profound psychological and physical violence (beatings, psychological torture, etc.) over extended periods of time, the still widespread custom of families exchanging girls as brides, for example in order to obtain money or goods, or to “pay off” debts or crimes, marriages of couples without their consent etc.
  
• All these practices, which are rooted in archaic traditions and increasingly go hand-in-hand with rising levels of general poverty since the end of the war, are manifestations of the use of violence against the women and girls concerned and determine how they live their lives.
• 85 per cent of the women who die as a result of their burns die because they are not taken to hospital, or are taken there too late, or because the hospitals have neither the medicines they need, nor skilled specialist healthcare staff.
• An extreme social taboo surrounds self-immolation and it is kept quiet as much as possible, in order to spare the family of the victim from the “shame”. For survivors that means social isolation and exclusion.
  

Quiklink: Dating violence and sexual assault associated with suicide attempts among urban teens

Dating violence and sexual assault associated with suicide attempts among urban teens says this report on male and female teen suicide attempts in Science Daily.

Men more likely than women to use cutting to self harm

Cutting is used significantly more often by men than by women as a means of self harm, according to new figures from Ireland's National Registry of Deliberate Self-Harm, says this report in The Irish Medical News. "In terms of method, drug overdose was the commonest method of self-harm involved in 76 per cent of all acts registered in 2005 and self-cutting was the second commonest method of self-harm, used in one-in-five cases, and significantly more often by men (25 per cent) than women (17 per cent)," the IMN report says.

The provisional figure for suicides in 2005 was 431 and the level of youth suicide is currently fifth highest in Europe. Men under 35 years account for 40 per cent of all suicide.

For self-harm figures for earlier years see this report from the National Documentation Centre on Drug Use.

Prosperity brings 400 per cent increase in young male suicides

Ireland's prosperity has brought a rise in youth suicide, especially among adolescent males, according to an Irish Times (premium content) story by Olivia Kelly."

Since 1990 there has been a 400 per cent increase in the number of suicides among young males between the ages of 15 and 24. This has happened at a time of significant social and cultural change and there is a significant relationship between the two factors," Dr Caroline Smyth of RehabCare told a National Children's Office conference. "Celtic Tiger Ireland" had failed to replace the "traditional Irish values" from which it was moving away, she said. "We have seen a move towards a more liberal, consumer based society. People are defined not by who they are but by what they own."

"There are very few role models left. There used to be the church or the guards . . . I'm not proposing returning to that era, but their loss has created a vacuum that needs to be filled.

"Teenage boys and young men seemed to feel the cultural loss more than girls, she said, according to the Irish Times report. In 2003, 444 Irish people died by suicide, of which 358 were male. Some 92 of those males were between the ages of 15 and 24."It's harder than ever before to be a young man in Ireland. The 'ladette' culture has meant that more young women are adopting traditional male roles and young men are experiencing an inability to deal with this cultural change."Young men also cite "helplessness" more often than young women as a factor that makes suicide an "understandable" option, the report says. Traditional research into the subject has failed to take into account the contextual issues of Irish society and treatment has been focused almost exclusively on medication, rather than the provision of support services.

"We need to put suicide prevention programmes into schools and the community not only to target high risk groups but all young people."