Suicide Hotspot: “A Long Way Down”

A Hornby’s novel, published in 2005. 

On the night of the 31th December four people, apparently with nothing in common, find themselves involved in a strange and unusual adventure. They met for the first time on the top of “The House of Suicide”, a skyscraper in London, where they went up with the intention of committing suicide. The protagonists are: Maureen, a lonely woman taking care of a seriously disabled son named Matt; Martin, a journalist who spent a period in jail after having a sexual intercourse with a 15 years old girl, and, after this fact, lost his family, friends and job; Jess, a problematic adolescent girl, with a tragic history in her past and JJ, an American pizza-boy, who was a musician in his country, but his band dissolved and he broke up with his girlfriend. All these people have different tragic past  stories and live in difficult conditions, but, when they start talking on the roof of the skyscraper and sharing their problems, they decide not to commit suicide in that moment. They start a strange friendship, and, in an unusual way, they help each other, talking with honesty, frankness and true empathy. They start to meet periodically, and everytime they postpone the decision about suicide, sharing and comparing their life problems. On the 14th February they decide to go up on the skyscraper “House of suicide”, where they find a man. They try to talk to him, but he commits suicide in front of their eyes. After that, they understand they don’t really want to end their life, and, likewise, they need to stay together, and through their particular friendship, they start to look in a different way to their life and start giving themselves a chance. They go on with a new point of view: although life is not always beautiful and easy, they try to face it step by step, and continue postponing the decision of suicide, never saying “I’ll never do that”, but just waiting for taking this decision, and, in this way, they continue with their life and friendship.

To know more about suicide hotspot visit our post about it!

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Movie of the Month (June 2018)

In May 2018 we chose a movie for you:

Girl on the Brige

Directed by: Patrice Leconte
Starring: Daniel Auteuil, Vanessa Paradis
Year: 2000
Running time: 90 minutes

Plot: the movie is about Gabor and a girl named Adèle, who intends to kill herself by jumping from a bridge in Paris. Gabor intervenes to prevent her to suicide, taking interests in her. Subsequently, the movie describes their relationship during a trip around Europe: staying and working together will help both of them to develop personal resources; unexpectedly at the end, roles are inverted, and Adele will try to help Gabor in a very difficult moment.



Suicide Hotspot

The hotspot is also known as “iconic site” or “suicide magnet”. It is “A specific, usually public, site which is frequently used as a location for suicide and which provides either means or opportunity for suicide”. It is almost always a jumping site; examples are the Golden Gate Bridge, the Eiffel Tower, and Niagara Falls” (National Institute for Mental Health In England, 2006). They also receive a disproportionate amount of media attention.

The “Guidance on action to be taken at suicide hotspots” (2006), developed by the National Institute for Mental Health in England, on the Suicide Prevention Resource Center Website, qualifies the suicide hotspot as follow:

“The term ‘suicide hotspot’ has two possible meanings. It is frequently used to refer to both: a) a geographical area with a relatively high rate of suicide among its resident population (e.g. a town, borough, county or country), and b) a specific, usually public, site which is frequently used as a location for suicide and which provides either means or opportunity for suicide (e.g. a particular bridge from which individuals frequently jump to their deaths)”.

The Guidance reports examples of prevention methods that may be applied to hotspots with proven efficacy: physical barriers, telephone hotlines also encouraged by placing telephones nearby the hotspot, increasing the possibility of intervention by a third party, suicide patrols or trained staff of non-health agencies working at or near hotspots, finally,  paying attention to media reporting (e.g. media guideline).

In 2013 BMC Public Health published a systematic review about suicide hotspots that highlighted quite the same methods to prevent suicide in these areas as those indicated in the Guidance (1). In the same year a meta analysis about the effectiveness of structural interventions at suicide hotspots concluded that structural interventions at ‘hotspots’ avert suicides in these sites: “Some increases in suicide are evident at neighbouring sites, but there is an overall gain in terms of a reduction in all suicides by jumping” (2).

Developing suicide prevention strategies in these places requires complex questions of ownership, responsibility and resources.

On the Center for suicide prevention website there is an interesting editorial about the topic: “Jumping and Suicide Prevention”. It talks about suicide by jumping from heights and arguments for and against barriers.

It is known that barriers and other prevention methods may not stop an individual that wants to commit suicide, but multiple efforts should be performed to prevent the event, because, as reported in the editorial:

“A barrier or another prevention measure should not be up for debate. If suicides have occurred previously in the location… it is worth the expense.
Even one suicide is too many”.

  1. Interventions to reduce suicides at suicide hotspots: a systematic review
  2. The effectiveness of structural interventions at suicide hotspots: a meta-analysis.
  3. “Jumping” and Suicide Prevention

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Scientific News and Reading Suggestions #20

Suicide is a global public health concern: human activities and rapid urbanisation influence the environments in which people live, and this may impact on health, including mental health. In particular, a recent article published on The Lancet Planetary Health by M.Helbich and colleagues, focuses on the association between natural environments and population suicide risk. Authors studied how green or blue spaces may influence suicide rate in association with many socio-economic factors and provide references on previous studies about how  suicide-methods access may contribute to suicidal behaviors.

LINK: Natural environments and suicide

Moreover, “suicide hotspots” should be considered among the environmental factors that may influence suicide rate in a specific context. Several articles have been published about this topic in different countries: on PloS One, in 2017, it was published a Swiss study that compares different suicide prevention measures in jumping hotspots; an Austrian study (2017) focuses on railway suicide, studying clustering phenomena, and particular events occuring in proximity to psychiatric institutions in order to help further prevention strategies.  

LINK: Comparing Different Suicide Prevention Measures at Bridges and Buildings: Lessons We Have Learned from a National Survey in Switzerland

LINK: Suicides on the Austrian railway network: hotspot analysis and effect of proximity to psychiatric institutions.

If you want to know more about suicide hotspots you can visit our post about it! 

Natural environments and suicide. Chang, Shu-Sen et al.
The Lancet Planetary Health , Volume 2 , Issue 3 , e109 – e110

Hemmer A, Meier P, Reisch T (2017) Comparing Different Suicide Prevention Measures at Bridges and Buildings: Lessons We Have Learned from a National Survey in Switzerland.
PLoS ONE 12(1): e0169625. doi:10.1371/journal. pone.0169625

Strauss MJ, Klimek P, Sonneck G, Niederkrotenthaler T. Suicides on the Austrian railway network: hotspot analysis and effect of proximity to psychiatric institutions. Royal Society Open Science. 2017;4(3):160711. doi:10.1098/rsos.160711.

Looking forward to sharing with you
the next scientific news and reading suggestions!

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Thirteen reasons why: new episodes, debate still ongoing

Since 18th May 2018, new episodes of the TV series “Thirteen reasons why” are available on Netflix. Anna Baker’s story has divided the scientific community about suicide and how this difficult topic should be discussed by and through the media.

Different scientific papers have been published about this topic. On “Health communication” it has recently been published the article “#13ReasonsWhy Health Professionals and Educators are Tweeting: A Systematic Analysis of Uses and Perceptions of Show Content and Learning Outcomes” that analyses more than 700 health professionals’ and educators’ tweets about the Netflix show. In October 2017, JAMA Internal Medicine published the editorial “A Call for Social Responsibility and Suicide Risk Screening, Prevention, and Early Intervention Following the Release of the Netflix Series 13 Reasons Why” linked to the research letter “Internet Searches for Suicide Following the Release of 13 Reasons Why”. The Authors of the letter reported that suicide-related internet searches increased following the release of the series 13ReasonsWhy, even though it’s impossible to discriminate whether  the internet searches had been performed by scientists, teachers or people contemplating suicide.

On the American Journal of Maternal/Child Nursing, the article “13 Reasons Why: A Trigger for Teen Suicide?” discusses the controversy raised by the Netflix series and expressed by school officials, healthcare providers, and parents. This paper, as many dissemination websites, such as Huffington Post and Washington Post, suggests that the series may romanticize suicide and eventually lead to possible negative effects. On the other hand, hypotheses have been suggested that the series may help specialists and people from the community to discuss about the difficult topic of teenagers’ suicide.

In any case, certainly the series fostered the debate about suicide.

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Image from Pixabay

Movie of the Month (May 2018)

In May 2018 we chose a movie for you:

“The Perks of Being a Wallflower”

Directed by: Stephen Chbosky
Starring: Logan Lerman, Emma Watson, Ezra Miller…
Year: 2012
Running time: 103 minutes

Plot:  This movie is an adaptation of an epistolary novel, written and directed by the novel’s author Stephen Chbosky. A young student, Charlie, has been suffering from clinical depression and has recently been discharged from a mental health care institution to begin his adaptation to a normal lifestyle as a young high school student.

When he starts attending school, he meets Sam and Patrick, who invite him to join several social activities. Charlie discloses to Sam that the year before his best friend committed suicide. The story is about the friendship among Sam, Patrick and Charlie, adolescence-related problems and difficulties facing topics such as bullying, friendship and love. After the release of film, Chbosky began to speak more openly concerning mental health care aspects. Producers are the same of Ghost World and Juno, which are both movies about struggling teenagers.

Stephen Chbosky, in a interview from the Guardian,
about mental health issues and why it’s important to talk about these topics:

“Before they are diagnosed, they are told these things. Even though there might not be stigma, they have been told to get over it for so long that they feel there must be something wrong with them. There is nothing wrong with them. They just have an illness that they need to treat, just like anyone would treat allergies or a cold.
It’s more complicated than that, obviously”.


Scientific News and Reading Suggestions #19

Recently, on the Journal of Medical Internet and Research (IF: 5,175), an English research group published a systematic review about self-harm, suicidal behaviours and cyberbullying, in people younger than 25 years. Many research studies are available about the association between electronic bullying and suicidal behaviors in this population at risk, and the review tries to systematize the existing literature about this topic. Briefly, victims of cyberbullying seem to be at a greater risk of self-harm and suicidal behaviors.

LINK: Self-Harm, Suicidal Behaviours, and Cyberbullying in Children and Young People: Systematic Review

Young people suffering from mental illness are at higher risk for suicide than their healthy peers. A recent study published on JAMA Psychiatry, performed by a group of researchers from Hong Kong University, reports about the impact of an Early Intervention Service on  suicide rate. While it is widely acknowledged that early interventions improve short-term outcomes in schizophrenia, this study is specifically focused on suicide reduction in the long term (12 years follow up) and main risk factors for early and late suicide.

LINK: Association of an Early Intervention Service for Psychosis With Suicide Rate Among Patients With First-Episode Schizophrenia-Spectrum Disorders

John A, Glendenning AC, Marchant A, Montgomery P, Stewart A, Wood S, Lloyd K, Hawton K. Self-Harm, Suicidal Behaviours, and Cyberbullying in Children and Young People: Systematic Review. J Med Internet Res 2018;20(4):e129. DOI: 10.2196/jmir.9044

Chan SKW, Chan SWY, Pang HH, et al. Association of an Early Intervention Service for Psychosis With Suicide Rate Among Patients With First-Episode Schizophrenia-Spectrum Disorders. JAMA Psychiatry.2018;75(5):458–464. doi:10.1001/jamapsychiatry.2018.0185

 Image From Pixabay

Looking forward to sharing with you
the next scientific news and reading suggestions!

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Bulgakov’s Morphine: substance use disorders and suicide

Morphine is a story written by Michail Bulgakov, published for the first time in 1927 on the magazine “The Medical Worker”.

The book, written in form of diary, is focused on the personal history of young doctor Polijakov, describing feelings and consequences of substance use disorder, until the extreme one: suicide. Polijakov has his first contact with morphine during a crisis of abdominal pain. From this moment, Polijakov’s life falls into a spiral of decadence and addiction: recruitment and research of the substance become the young doctor’s only concerns, and as a consequence he eventually neglects his work and personal relationships. Moreover, the abuse of morphine causes him physical consumption and psychiatric symptoms, with the onset of hallucinations and distress which lead the young doctor into a voluntary hospitalization in a detox clinic. This attempt fails: he escapes from the clinic and restarts abusing. Exasperated by his situation, for which he sees no way out, Polijakov writes a letter to ask for help to a university classmate, but after sending the letter, hopeless and full of remorse, he impulsively decides to take his own life; his diary is then delivered to the colleague to whom he had asked for help, who decides to publish and share Polijakov’s memories (to know more about the topic read our new reading suggestion at this link).

This tale describes drug addiction from the point of view of an addicted, depicting young doctor’s thoughts. We sew the first contact with the substance, the excuses that Polijakov gives himself to continue in the abuse of morphine, the intense craving and, when he becomes conscious of his problem and the sense of fail and hopelessness related to the awareness that he is not able to stop morphine abuse; the shame for his condition finally leads him to the extreme gesture. This book also contains many autobiographical references; the author himself has suffered from morphine addiction during his life.

We choose this book as reading suggestion for this month because substance use disorder is one of risk factors for suicide; moreover, recent review highlights the frequency of self-harm and suicide between medical doctors. Perhaps not everyone knows that Michail Bulgakov, besides being a famous writer, was a medical doctor. After graduation he worked as a physician at the Kiev Military Hospital and then, during the First World War, as a volunteer in the Red Cross to the front. Then he worked as a surgeon and was eventually appointed provincial physician.

To know more about suicide among people with substance use disorders contact us for our Flyers about the argument (to know more visit our page about Flyers).

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  • “Morphine” text by Mikhail Bulgakov
  • Wikipedia:
  • Psychosocial job stressors and suicidality: a meta-analysis and systematic review. Milner A, Witt K, LaMontagne AD, Niedhammer I, Occup Environ Med. 2018 Apr;75(4):245-253. doi: 10.1136/oemed-2017-104531. Epub 2017 Aug 29.

Image from Pixabay

Robin Williams’ death and copycat suicides

In a previous article we reported about celebrities, as Chris Cornell and Chester Bennington, who committed suicide (Click HERE to read the article). It is widely acknowledged that a celebrity suicide may influence population health, in particular suicides rate may increase in the next weeks due to copycat and Werther effect (Click HERE to know more about Werther Effect), and this may have a varying impact in different populations and cultures.

The role of media communicating the news is very important: the World Health Organization recently published an update in the guidelines “Preventing suicide: a resource for media professionals”, where there is a specific section named “Apply particular caution when reporting celebrity suicides” (Click HERE for the Guidelines).

Many articles about the topic were published after Robin Williams’ death, occurred in 2014: this is a good example in order to explain the topic. Robin Williams was a famous actor, with a 35-year career on screen, playing lead roles in different famous films (es: Dead Poets Society, Mrs. Doubtfire…). The day Williams died, the National Suicide Prevention Lifeline received the highest number phone calls ever.

A recent open access study published on PLOS One investigates suicides following the death of the actor Robin Williams: using a time-series analysis, researchers reported that suicides observed exceeded expected ones; this was observed across gender and age groups.  

LINK to articleIncrease in suicides the months after the death of Robin Williams in the US

Moreover, on Health Communication Young it was published an article about a survey on how his death influenced searches for information concerning depression, suicide, and mental health. They found, for example, that respondents who sought information about the suicide reported changes in their thoughts about suicide, most often dealing with the difficulty in spotting warning signs and the idea that “it can happen to anyone.”

LINK to the articleTweeting celebrity suicides: Users’ reaction to prominent suicide deaths on Twitter and subsequent increases in actual suicides.

Finally, the relationships between guidelines and news about suicide were assessed in a study performed at the Mental Health University Institute in Quebec by Creed and Whitley. In Canada guidelines and best practice have been recently published to help journalists writing about mental health and suicide. Creed and Whitley tried to relate these norms to the pieces written about Robin Williams’ suicide from major Canadian newspapers: they observed that articles generally followed the evidence-based guidelines when reporting about Williams’ suicide.

LINK to the article: Assessing Fidelity to Suicide Reporting Guidelines in Canadian News Media: The Death of Robin Williams

In conclusion, as described in the WHO guidelines, celebrity suicides are particularly likely to induce copycat suicides: “the effect of a report about a suicide on subsequent suicides is greater when the person described in the story is a celebrity and is held in high regard by the reader or viewer. Particular subgroups in the population (such as young people, people suffering from mental illness, persons with a history of suicidal behaviour or those bereaved by suicide) are particularly vulnerable to engaging in imitative suicidal behaviour”.

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Image from Pixabay

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