Abstract
Historically, a number of terms have been used to differentiate indirect self-destructive behaviours (ISDBs) from overt acts of suicide such as partial, focal and chronic suicide, sub-intentional death, deliberate self-harm and silent suicide. Each of these terms encompasses a wide range of behaviours such as: refusing to drink or eat, medication mismanagement, self-mutilation, self-neglect, and medical noncompliance. These behaviours all describe deleterious, life-threatening actions that ultimately undermine the health of the individual and lead to premature death. ISDBs are life threatening and commonly occurring, but poorly understood, behaviours that can mask suicidal intent. While many psychological, behavioural, and biological risk factors for completed suicide have been identified, the etiology, role, and clinical correlates of ISDBs have not been satisfactorily examined. In an attempt to reach common ground in describing subtypes of indirect self-destructive behaviour, the National Institute of Mental Health Mental (NIMH) convened 22 experts who defined an ISDB as “…an act of omission or commission that causes self-harm leading indirectly, over time, to the patient’s death”. Reports issued by the Institute of Medicine and by the NIMH of the Aging Research Branch noted that ISDBs are of major concern because they are highly prevalent and result in greater morbidity and mortality than more easily recognized overt suicidal behaviours. These reports recommended that a standardized method to ascertain the extent and nature of ISDBs be developed to examine the etiology and clinical correlates of these behaviours. This chapter reviews the existing literature on ISDBs and offers research, clinical, and policy recommendations.
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References
Alexopoulos, G. S., Meyers, B. S., Young, R. C., Kakuma, T., Feder, M., Einhorn, A., & Rosendahl, E. (1996). Recovery in geriatric depression. Archives of General Psychiatry, 53(4), 305–312.
Alphs, L., Brashear, H. R., Chappell, P., Conwell, Y., Dubrava, S., Khin, N. A., … Schindler, R. J. (2016). Considerations for the assessment of suicidal ideation and behaviour in older adults with cognitive decline and dementia. Alzheimer’s & Dementia: Translational Research & Clinical Interventions, 2(1), 48–59.
Awata, S., Seki, T., Koizumi, Y., Sato, S., Hozawa, A., Omori, K., … Matsuoka, H. (2005). Factors associated with suicidal ideation in an elderly urban Japanese population: A community‐based, cross‐sectional study. Psychiatry and clinical neurosciences, 59(3), 327–336.
Baetens, I., Claes, L., Willem, L., Muehlenkamp, J., & Bijttebier, P. (2011). The relationship between non-suicidal self-injury and temperament in male and female adolescents based on child- and parent-report. Personality and Individual Differences, 50(4), 527–530.
Barraclough, B. (1971). Suicide in the elderly. British Journal of Psychiatry, 6(suppl), 87–97.
Beck, A. T., Steer, R. A., Beck, J. S., & Newman, C. F. (1993). Hopelessness, depression, suicidal ideation, and clinical diagnosis of depression. Suicide and Life-Threatening Behaviour, 23(2), 139–145.
Brown, L. M., Bongar, B., & Cleary, K. M. (2004). A profile of psychologists’ views of critical risk factors for completed suicide in older adults. Professional Psychology: Research and Practice, 35(1), 90–96.
Butler, R., Lewis, M., & Sunderland, T. (1982). Aging and mental health: Positive psychosocial and biomedical approaches (3rd ed., p. 269). St. Louis: Mosby.
Carney, S. S., Rich, C. L., Burke, P. A., & Fowler, R. C. (1994). Suicide over 60: The San Diego study. Journal of the American Geriatics Society, 42(2), 174–180.
Cattell, H., & Jolley, D. J. (1995). One hundred cases of suicide in elderly people. The British Journal of Psychiatry, 166(4), 451–457.
Chan, J., Draper, B., & Banerjee, S. (2007). Deliberate self-harm in older adults: A review of the literature from 1995 to 2004. International Journal of Geriatric Psychiatry, 22(8), 720–732.
Claes, L., Houben, A., Vandereycken, W., Bijttebier, P., & Muehlenkamp, J. (2010). Brief report: The association between non-suicidal self-injury, self-concept and acquaintance with self-injurious peers in a sample of adolescents. Journal of Adolescence, 33(5), 775–778.
Claes, L., Vandereycken, W., & Vertommen, H. (2005). Self-care versus self-harm: Piercing, tattooing, and self-injuring in eating disorders. European Eating Disorders Review, 13(1), 11–18.
Conn, D. K., Herrmann, N., Kaye, A., Rewilak, D., & Schogt, B. (2007). Practical psychiatry in the long-term care home: A handbook for staff. Lewiston: Hogrefe Publishing.
Conwell, Y., Duberstein, P. R., & Caine, E. D. (2002). Risk factors for suicide in later life. Biological Psychiatry, 52(3), 193–204.
Conwell, Y., Pearson, J., & DeRenzo, E. G. (1996). Indirect self-descrutive behaviour among elderly patients in nursing homes: A research agenda. The American Journal of Geriatric Psychiatry, 4(2), 152–163.
Cox, C. (1996). Relationship of age and Axis I diagnoses in victims of completed suicide: A psychological autopsy study. American Journal of Psychiatry, 153, 1001–1008.
Draper, B. (2010). Suicidal behaviour. In M. Abou-Saleh, C. Katona, & A. Kumar (Eds.), Principles and practice of geriatric psychiatry (3rd ed., pp. 559–564). Chichester: Wiley-Blackwell.
Draper, B., Brodaty, H., & Low, L.-F. (2002). Types of nursing home residents with self-destructive behaviours: Analysis of the harmful behaviour scale. International Journal of Geriatric Psychiatry, 17(7), 670–675.
Ekramzadeh, S., Javadpour, A., Draper, B., Mani, A., Withall, A., & Sahraian, A. (2012). Prevalence and correlates of suicidal thought and self-destructive behaviour among an elderly hospital population in Iran. International Psychogeriatrics, 24(9), 1402–1408.
Esposito-Smythers, C., Goldstein, T., Birmaher, B., Goldstein, B., Hunt, J., Ryan, N., … Keller, M. (2010). Clinical and psychosocial correlates of non-suicidal self-injury within a sample of children and adolescents with bipolar disorder. Journal of Affective Disorders, 125(1–3), 89–97.
Farberow, N. L. (1986). Negative and positive compliance in relation to indirect and direct suicide. Journal of Compliance in Health Care, 1(1), 91–101.
Fliege, H., Lee, J.-R., Grimm, A., & Klapp, B. F. (2009). Risk factors and correlates of deliberate self-harm behaviour: A systematic review. Journal of Psychosomatic Research, 66(6), 477–493.
Florio, E. R., Hendryx, M. S., Jensen, J. E., Rockwood, T. H., Raschko, R., & Dyck, D. G. (1997). A comparison of suicidal and nonsuicidal elders referred to a community mental health center program. Suicide and Life-Threatening Behaviour, 27(2), 182–193.
Gerber, K. E., Nehemkis, A. M., Farberow, N. L., & Williams, J. (1981). Indirect self-destructive behaviour in chronic hemodialysis patients. Suicide and Life-Threatening Behaviour, 11(1), 31–42.
Glassman, L. H., Weierich, M. R., Hooley, J. M., Deliberto, T. L., & Nock, M. K. (2007). Child maltreatment, non-suicidal self-injury, and the mediating role of self-criticism. Behaviour Research and Therapy, 45(10), 2483–2490.
Glenn, C. R., & Klonsky, E. D. (2009). Social context during non-suicidal self-injury indicates suicide risk. Personality and Individual Differences, 46(1), 25–29.
Glenn, C. R., & Klonsky, E. D. (2011). Prospective prediction of nonsuicidal self-injury: A 1-year longitudinal study in young adults. Behaviour therapy, 42(4), 751–762.
Gostin, L. O. (1997). Deciding life and death in the courtroom: From Quinlan to Cruzan, Glucksberg, and Vacco—A brief history and analysis of constitutional protection of the ‘Right to Die’. JAMA, 278(18), 1523–1528.
Gratz, K. L. (2001). Measurement of deliberate self-harm: Preliminary data on the deliberate self-harm inventory. Journal of Psychopathology and Behavioural Assessment, 23(4), 253–263.
Hall, R., Hall, R., & Chapman, M. (2006). Effects of terrorist attacks on the elderly-Part II: Posttraumatic stress, acute stress, and affective disorders. Clinical Geriatrics, 14(9), 17–24.
Hawton, K., Witt, K. G., Taylor Salisbury, T. L., Arensman, E., Gunnell, D., Hazell, P., … Van Heeringen, K.(2015). Pharmacological interventions for self-harm in adults (Review). Cochrane Database of Systematic Reviews, 7. doi:10.1002/14651858.CD011777.
Heilbron, N., & Prinstein, M. J. (2008). Peer influence and adolescent nonsuicidal self-injury: A theoretical review of mechanisms and moderators. Applied and Preventive Psychology, 12(4), 169–177.
Hendin, H. (1996). Suicide, assisted suicide, and euthanasia. Crisis, 17(2), 90–93.
Himes, C. L. (2002). Elderly Americans. Population Bulletin, 56(4), 3–40.
Kastenbaum, R., & Mishara, B. L. (1971). Premature death and self-injurious behaviour in old age. Geriatrics, 26(7), 71–81.
Kennedy, G. J., Metz, H., & Lowinger, R. (1996). Epidemiology and inferences regarding the etiology of late-life suicide. In G. J. Kennedy (Ed.), Suicide and depression in late life: Critical issues in treatment, research and public policy (pp. 03–22). Oxford, England: Wiley.
Kiriakidis, S. P. (2015). Elderly suicide: Risk factors and preventive strategies. Annals of Gerontology and Geriatric Research, 2(2), 1028–1033.
Kochanek, K. D., & Smith, B. L. (2001). Deaths: Preliminary data for 1999. National Vital Statistics Reports, 49(3), 1–48.
Laye-Gindhu, A., & Schonert-Reichl, K. A. (2005). Nonsuicidal self-harm among community adolescents: Understanding the ‘Whats’ and ‘Whys’ of self-harm. Journal of Youth and Adolescence, 34(5), 447–457.
Lester, D. (1994). Are there unique features of suicide in adults of different ages and developmental stages? OMEGA-Journal of Death and Dying, 29(4), 337–348.
Linehan, M. M. (1993). Skills training manual for treating borderline personality disorder. New York: Guilford Press.
Lloyd-Richardson, E. E., Perrine, N., Dierker, L., & Kelley, M. L. (2007). Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychological Medicine, 37(8), 1183–1192.
MacKinnon, D. R., & Farberow, N. L. (1976). An assessment of the utility of suicide prediction. Suicide and Life-Threatening Behaviour, 6(2), 86–91.
MacLaren, V. V., & Best, L. A. (2010). Nonsuicidal self-injury, potentially addictive behaviours, and the five factor model in undergraduates. Personality and Individual Differences, 49(5), 521–525.
Maris, R. W. (1992). How are suicides different? In R. W. Maris, A. L. Berman, J. T. Maltsberger, & R. I. Yufit (Eds.), Assessment and prediction of suicide (pp. 65–87). New York, NY: Guilford Press.
Masters, J. L. (1998). The prevalence of indirect self-destructive behaviours in older adult females. (58), ProQuest Information & Learning, US. Retrieved from https://paloaltou.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=1998-95009-114.
McIntosh, J. L. (1992). Older adults: The next suicide epidemic? Suicide and Life-Threatening Behaviour, 22(3), 322–332.
McIntosh, J. L., & Hubbard, R. W. (1988). Indirect self-destructive behaviour among the elderly: A review with case examples. Journal of Gerontological Social Work, 13(1–2), 37–48.
Meisekothen, L. M. (1993). Noncompliance in the elderly: A pathway to suicide. Journal of the American Academy of Nurse Practitioners, 5(2), 67–72.
Mikolajczak, M., Petrides, K. V., & Hurry, J. (2009). Adolescents choosing self-harm as an emotion regulation strategy: The protective role of trait emotional intelligence. British Journal of Clinical Psychology, 48(2), 181–193.
Miller, A. L., & Smith, H. L. (2008). Adolescent non-suicidal self-injurious behaviour: The latest epidemic to assess and treat. Applied and Preventive Psychology, 12(4), 178–188.
Moody, H. R. (1985). The ethics of suicide in old age. Frontiers in Aging Series, 4, 84–97.
Muehlenkamp, J. J., Engel, S. G., Wadeson, A., Crosby, R. D., Wonderlich, S. A., Simonich, H., & Mitchell, J. E. (2009). Emotional states preceding and following acts of non-suicidal self-injury in bulimia nervosa patients. Behaviour Research and Therapy, 47(1), 83–87.
Murphy, G. E., Wetzel, R. D., Robins, E., & McEvoy, L. (1992). Multiple risk factors predict suicide in alcoholism. Archives of General Psychiatry, 49(6), 459–463.
Nelson, F. L., & Farberow, N. L. (1980). Indirect self-destructive behaviour in the elderly nursing home patient. Journal of Gerontology, 35(6), 949–957.
Nock, M. K., Joiner, T. E., Jr., Gordon, K. H., Lloyd-Richardson, E., & Prinstein, M. J. (2006). Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts. Psychiatry Research, 144(1), 65–72.
Osgood, N. J. (1982). Suicide in the elderly: Are we heeding the warnings? Postgraduate Medicine, 72(2), 123–130.
Osgood, N. J., & Thielman, S. (1990). Geriatric suicidal behaviour: Assessment and treatment.
Patterson, R. D., Abrahams, R., & Baker, F. (1974). Preventing self-destructive behaviour. Geriatrics, 29(11), 115–121.
Plener, P. L., Libal, G., Keller, F., Fegert, J. M., & Muehlenkamp, J. J. (2009). An international comparison of adolescent non-suicidal self-injury (NSSI) and suicide attempts: Germany and the USA. Psychological Medicine, 39(9), 1549–1558.
Reiss, N. S., & Tishler, C. L. (2008). Suicidality in nursing home residents: Part I. Prevalence, risk factors, methods, assessment, and management. Professional Psychology: Research and Practice, 39(3), 264–270.
Rosowsky, E. (1993). Suicidal behaviour in the nursing home and a postsuicide intervention. American Journal of Psychotherapy, 47(1), 127–142.
Ross, S., & Heath, N. (2002). A study of the frequency of self-mutilation in a community sample of adolescents. Journal of Youth and Adolescence, 31(1), 67–77.
Sainsbury, P. (1955). Suicide in London: An ecological study. Published for the Institute of Psychiatry by Chapman & Hall.
Santa Mina, E. E., & Gallop, R. M. (1998). Childhood sexual and physical abuse and adult self-harm and suicidal behaviour: A literature review. The Canadian Journal of Psychiatry/La Revue canadienne de psychiatrie, 43(8), 793–800.
Seligman, M. E. P. (1975). Helplessness: On depression, development, and death. New York, NY, US: W H Freeman/Times Books/ Henry Holt & Co.
St. Germain, S. A., & Hooley, J. M. (2012). Direct and indirect forms of non-suicidal self-injury: Evidence for a distinction. Psychiatry Research, 197(1–2), 78–84.
Suyemoto, K. L. (1998). The functions of self-mutilation. Clinical Psychology Review, 18(5), 531–554.
Szanto, K., Gildengers, A., Mulsant, B. H., Brown, G., Alexopoulos, G. S., & Reynolds, C. F. I. (2002). Identification of suicidal ideation and prevention of suicidal behaviour in the elderly. Drugs and Aging, 19(1), 11–24.
Waltzer, H. (1981). The many faces of suicide (book review). American Journal of Psychotherapy, 35(2), 293.
Yates, T. M., Tracy, A. J., & Luthar, S. S. (2008). Nonsuicidal self-injury among ‘privileged’ youths: Longitudinal and cross-sectional approaches to developmental process. Journal of Consulting and Clinical Psychology, 76(1), 52–62.
Yip, P. S., Chi, I., Chiu, H., Chi Wai, K., Conwell, Y., & Caine, E. (2003). A prevalence study of suicide ideation among older adults in Hong Kong SAR. International Journal of Geriatric Psychiatry, 18(11), 1056–1062.
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Hosseini, C., Walsh, J., Brown, L.M. (2017). Indirect Self-destructive Behaviour Across the Lifespan. In: Kumar, U. (eds) Handbook of Suicidal Behaviour. Springer, Singapore. https://doi.org/10.1007/978-981-10-4816-6_13
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