Abnormal Psychology: Suicide And Parasuicide Prof. Craig Jackson Head of Psychology Division BCU

1. Abnormal Psychology: Suicide And Parasuicide Prof. Craig Jackson Head of Psychology Division BCU craig.jackson@bcu.ac.uk health.bcu.ac.uk/craigjackson

2. Research limitations • Suicide multi-causal • End-stage of complex process • Attracts emotive reporting in media • Workplace suicide received little / no academic attention • Occupational attribution straightforward in many cases • Workplace factors ascertained by • Notes • Recorded trouble at work • Coincidence with unusual workplace situation / landmarks • Compounded home-life complications • Occupational health history

3. Suicide Media Stories “A teacher who set herself alight had complained about pressure of work, an inquest has been told. Janet Dibb, 28, had complained to her father about overwork.” 20 March 2004 “A family doctor hanged herself because of stress at work, an inquest has heard. Bury coroners' court was told Dr Dawn Harris, 38, who worked at the Lever Chambers practice in Bolton, became ‘angry, very distressed and quite hurt’ by problems at the busy medical practice.” 22 May 2004 1. Over-emotive 2. Blames “extreme stress response” 3. Always best when involving females!

4. Case 1 – “PT” Bullying • PT (female armed response officer, 37) suicide in 2004 • hanged at home • 2003 Dismissed from firearms duties - poor proficiency • One of two female firearms officers in 90-strong unit • One of first female snipers in UK • Complained of colleagues viewing pornographic video on a residential course • Felt victimised in macho culture of firearms unit. • Fell out with a number of influential male colleagues • Sefton Coroner Christopher Sumner: “Paula Tomlinson killed herself at a time that she was suffering from stress, a contributory factor of which was work related.” • IPCC found no evidence of bullying or intimidation • Did acknowledge management failings and an “in-crowd culture”

6. France Telecom Cases Privatised in 1998 40,000 jobs gone since 1998 186,000 employees 45% of those outside France Used to be public sector employer new working conditions modernisation cultural & organisational changes needed internal job transfers 4.3% fall in profits in 1Q of 2009 182 million customers in 5 continents

7. France Telecom Cases

8. France Telecom Cases • Between Feb 2008 – Sep 2009 • 23 staff committed suicide • 9th Sept: 49 yr old male employee stabbed himself in meeting – told he would be undergoing internal job transfer • 11th Sep: 32 yr old female employee leapt to death from office window • 14th Sep 53 yr old senior manager overdosed • 1st Oct: 51yr old male employee jumped from road bridge – note blamed work “atmosphere” • French suicide rate: 26.4 per 100,000 male deaths • 9.2 per 100,000 female deaths • 17.8 per 100,000 all deaths

9. France Telecom’s Defence • France Telecom’s two-point defence: • “There were 28 suicides in the company in 2000, so 23 suicides over 17 months is actually an improvement and not evidence of an epidemic” • 2) “Most suicides caused by personal problems not professional ones”

10. France Telecom Case Oct 2009 Deputy CEO Louis-Pierre Wenes (second in command) resigns CEO Didier Lombard – vowed to end the “Spiral of death” Phone helpline Counselling Suspending job transfers French Labour Minister, Xavier Darcos wants: 2,500 biggest companies to plan “anti-stress” strategies Plan it with Unions Govt has 27% stake in FT Health & Happiness now on “National Agenda” in France

11. Foxconn and the iPad Manufacturing giant in China Renowned for efficiency – 300,000 employees Laptops, mobiles - Nokia, Apple, Dell HP 13 suicide attempts since Jan 2010 – 10 deaths

12. Foxconn and the iPad

14. Foxconn and the iPad Compensation for families in poverty Working conditions – long shifts, rigid, Oppressive, poor pay Company asked workers to sign a letter promising not to kill themselves (now withdrawn) Building giant safety net to prevent jumpers from Dorms and Workshops Hiring counsellors and Buddhist monks

15. Case – “TB” Overwork / Depression TB (male engineer, 28) suicide in 2002 – hanged at home Been working for 1 year in Singapore Had party celebrating end of contract 2 suicide notes: First addressed work colleagues “unfortunately the game has got the better of me – give my apologies to all the lads” Second addressed his parents “I have been depressed for a while now – pressure of work has turned my mind into a ticking time bomb” Cardiff Coroner – Mary Hassell: “It is hard to understand why someone described as happy-go-lucky should choose to end their own life over pressure in work.”

16. Epidemiology of World Suicide • 1 million suicide deaths per year worldwide • 10 – 20 million attempts (huge variation) • Suicide ideation / rumination even higher • WS comprises 3.5% of workplace fatalities worldwide (Pegula 2004) • Nearly 50% of first-time attempts fail • Those with history of repeated attempts X 23 likely to die by suicide

17. World Wide Attitudes

20. Epidemiology of Suicide

21. Epidemiology of Suicide in the UK Males Females 30 suicides per 10 suicides per 100,000 deaths in Scotland 22 suicides per 6 suicides per 100,000 deaths in Wales 18 suicides per 5.6 suicides per 100,000 deaths in Northern Ireland 16 suicides per 5.4 suicides per 100,000 deaths in England Ages 15-44 have highest suicide rate in males Ages 75+ have highest suicide rate in females

22. Epidemiology of Suicide in the UK Slow decrease in UK suicide rates since 1990s 75% of suicidal deaths are Male Sex split been same since 1991 – but may just reflect methods used 2006 5554 suicides in adults (15 or over) 2007 5377 suicides in adults (15 or over) 2008 5706 suicides in adults (15 or over)

23. Epidemiology of Suicide in the UK

24. Epidemiology of Suicide in the Midlands 1998-2004 Wolves 22.1 per 100,000 deaths 146 cases #101 Birmingham 19.3 per 100,000 deaths 541 cases #172 Dudley 18.0 per 100,000 deaths 147 cases #215 Coventry 17.3 per 100,000 deaths 146 cases #245 Sandwell 16.6 per 100,000 deaths 125 cases #268 Walsall 15.9 per 100,000 deaths 105 cases #294 Solihull 13.8 per 100,000 deaths 74 cases #363 Can we pin any of this to industry, ethnicity, decline, deprivation ????

25. Demographics of Suicide

26. Case – “TC” Chronic Ill-health / Depression TC (male mechanic, 37) suicide in 2002 1996 right ear severed in accident at work IBC Vehicles Luton Prolonged tinnitus, headache, severe depression 2005 TCs widow at High Court for £750,000 IBC accepts liability for accident – not suicide. Awarded £82,520 Court of Appeal overturned award – Lord Justice Sedley claimed there to be no other cause. TC had previously been a “rational man. . . The suicide was proved to have been a function of the depression and so formed part of the damage for which IBC were liable. . . To treat TC as responsible for his own death was an unjustified exception to modern views on the links between accidents and their causes”.

27. Job Specific Factors • Vets and Farmers • Functional use of euthanasia • Facilitate a “Good death” • Long working hours • Rural isolation • Client dependence • Social isolation • Not adapting to change / flux • Attitudes to suicide and (non) help-seeing behaviour • This may serve to make suicide seem like a plausible solution to problems • Jobs with “Gallows Humour” Police, Nursing, Military, Fire, Ambulance ?

28. Complexity • Emotive reporting of WRS suicides • Coroner’s & Inquests often too narrow in scope • Wrongly suggests WRS is “final remedy” for workplace problems e.g. stress • Suicide is complex final stage behaviour with many antecedents • Socio-demographics • Childhood experiences • Psychiatric morbidity / history • Recent stressful life events • Social interactions / supports

29. Complexity of Background • Beautrais (2001) • Following are all common to suicide & attempts: • current mood disorder • previous suicide attempts • prior outpatient psychiatric treatment • admission to psychiatric hospital within the previous year • low income • absence of educational qualifications • recent stressful interpersonal, legal & work-related life events. • Many suicidents do not fit this profile

30. Suicides and Recession – Japanese Data Suicides risen since 1989 and financial decline Climbed higher in 1997 recession Seems a natural end-point considering over-work and working hours Joins UN Financial boom Recession

31. Suicides and Recession Prof Natalie Jeremiienko – Bureau of Inverse Technology Engineering Created "Despondency Index" - correlating the Dow Jones Industrial Average with number of jumpers Detected by "Suicide Boxes" containing motion-detecting cameras, under the bridge. Boxes recorded 17 jumps in three months

32. High Risk Occupations US Data from 10,000 suicides and 135,000 deaths 15 occupations with higher / lower risk than the general pop. Reduced to 8 after adjustment for socio-demographics Dentists (X 5.4) Doctors (X 2.3) Scientists (X 1.5) Nurses (X 1.5) Social workers (X 1.5) Artists (X 1.2) Farm workers (X 0.69) Admin staff (X 0.85) UK picture different – suggests Farm workers & Veterinary have one of highest rates (Mellanby, 2005)

33. Suicide Space • Access to lethal means • Opportunity for solitude • Freedom of movement • Location away from assistance

34. Behavioural Yellow Flags • Observable in 75% of decedents in few weeks before death • Previous suicide attempts • History of suicide in family • Begin “tidying up” affairs • Person acting completely out of character • Symptoms of depression • Hopelessness about the future • Periods of difficulty and change – holiday periods, prior to disciplinary hearings

35. More Behavioural Yellow Flags • recent bereavement or other life-altering loss • recent break-up of a close relationship • major disappointment (failed exams or missed job promotion) • major change in circumstance (retirement, redundancy, children leaving) • physical illness • mental illness • substance misuse / addiction • deliberate self-harm, (particularly in women) • previous suicide attempts • loss of close friend / relative by suicidal means • loss of status • feelings of hopelessness, powerlessness and worthlessness • declining performance in work and other (sometimes this can be reversed) • declining interest in friends, sex, or previous activities • Neglect of personal welfare and hygiene • Alterations in sleeping habits (either direction) or eating habits

36. References Etzersdorfer, E., L. Vijayakumar, W. Schöny, A. Grausgruber and G. Sonneck (1998). Attitudes towards suicide among medical students: comparison between Madras (India) and Vienna (Austria). Social Psychiatry and Psychiatric Epidemiology. 33. 3. 104-110. Gibb, B. E., M. S. Andover and S. R. Beach (2006). Suicidal ideation and attitudes toward suicide. Suicide & Life-Threatening Behavior. 36. 1. 12-8. Hawton, K and van Heeringen, K (eds). (2000). The International Handbook of Suicide and Attempted Suicide. Chichester, Wiley. Jackson CA. (2008) Work-Related Suicide. Management of Health Risks. 126: 2-8. Karasek, R. and T. Theorell (1990). Healthy work: stress, productivity, and the reconstruction of working life. New York, Basic Books.

37. References Karasek, R. A. (1979). Job demands, job decision latitude and mental strain: implications for job design. Administrative Science Quarterley. 24. 285-308. Mellanby, R. J. (2005). Incidence of suicide in the veterinary profession in England and Wales. Veterinary Record. 157. 14. 415-7. Sawyer, D. and J. Sobal (1987). Public Attitudes Toward Suicide Demographic and Ideological Correlates. The Public Opinion Quarterly. 51. 1. 92-101. Siegrist, J. (1996). Adverse health effects of high-effort/low-reward conditions. Journal of Occupational Health Psychology. 1. 27-41. Stack, S. (2001). Occupation and Suicide. Social Science Quarterly (Blackwell Publishing Limited) 82. 2. 384.

38. References Stansfeld, S., R. Fuhrer, M. Shipley and M. Marmot (2002). Psychological distress as a risk factor for coronary heart disease in the Whitehall II Study. International Journal of Epidemiology 31. 248-255. Stansfeld, S. A., R. Fuhrer, J. Head, J. Ferrie and M. Shipley (1997). Work and psychiatric disorder in the Whitehall II Study. Journal of Psychosomatic Research. 43. 1. 73-81. Vilhjalmsson, R., E. Sveinbjarnardottir and G. Kristjansdottir (1998). Factors associated with suicide ideation in adults. Social Psychiatry and Psychiatric Epidemiology. 33. 3. 97-103.