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cw: suicide, suicidal ideation, depression, death

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Suicide and Physician-Assisted Death in Neurological Disorders

Brandi St. Romain ℅ ‘22 | NSC 312

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Purpose and intentions

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Suicide Statistics (US) Risk Factors

10th leading cause of death
Men die by suicide 3.5x more often than women
¼ adults has thought about or attempted suicide

Depression or history of mental disorder
Feelings of hopelessness/isolation
History of alcohol/substance abuse
Physical/mental impairments
Loss (relational, social, work, financial)
Family history of suicide
Cultural/religious beliefs

per 100,00 deaths

2018

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Perceptions about access to support

⅓ say seeing a mental health professional is something people can’t afford

⅓ say it’s hard to find a professional

¼ say it’s not accessible for most people

Main reasons people may not seek help: lack of hope, embarrassment, not knowing where to get help, affordability, sign of weakness, last resort, lack of social support, fear of disappointing others, fear of losing job

Where Groups May Turn If Experiencing Suicidal Ideation

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Suicide and Neurological Disorders - Denmark

15% of total suicides were people living with a neurological disorder (ND)
Almost double incidence rate for people with ND
Highest risk - 5x higher - in people with ALS and Huntington’s Disease
Lowest risk - Alzheimer’s and other dementias
Other ND implicated -- head injuries, stroke, MS, epilepsy
Time as a risk factor

Increased risk (3x more likely) within the first 3 months after diagnosis
1.5x more likely after 10+ years

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Physician-assisted death

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Physician-Assisted Death (PAD) and ND

Oregon, 2018

n=168 overall

ALS - 8.9%

Other - 6%

Vermont, 2013-2019

n=87 overall

ALS - 13%

PD or HD - 3%

California, 2019

n=378 overall

ALS - 3.7%

PD - 2.9%

Other - 4.2%

F - 48.2% M - 51.8%

White - 97%

Asian - 1.2%

Biracial - 0.6%

Other - 0.6%

F - 44.7% M - 55.3%

White - 87.2% Other - .5%

Asian - 6.4% Multi - .5%

Hispanic - 4%

Black - 1.2%

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Why patients choose PAD/suicide

Unable to do enjoyable things in life
Outliving their need
Not being neurotypical
Valuing independence: loss of bodily autonomy
Viewing risk factors and/or diagnoses as inherent instead of mitigated by social factors
Being a burden to family/friends: physical, financial, emotional

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Medical vs. Social Model of Disability

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Strategies and Solutions

Integrate suicide prevention strategies into treatment and associated therapies of people with ND like ALS, PD, Huntington’s
Disability studies in school curriculums
Awareness about the risk factors/signs of illnesses, early diagnosis
More research about people's' perceptions of a ND vs. others (i.e. cardiovascular) that may be thought to be more “controllable” through diet/exercise/lifestyle
Enjoying life in different forms, diversify the “norm”, what’s valuable?

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Resources for suicide, suicidal ideation, depression

Self

Don’t be afraid to ask for help
Know you are not alone
Remember that depressing feelings can be overcome
Evaluate the relationships in your life; build a support network
Make a safety plan
Evaluate the relationships in your life
Find a therapist/support group
Find an activity you enjoy
Write in a journal

Someone else

Take the person seriously
Accept their feelings
Research/know the risk factors
Listen with empathy and provide support
Learn the warning signs
Don’t keep it a secret

Crisis Text Line - Text HOME to 741741 to connect with a counselor

https://suicidepreventionlifeline.org/

www.helpguide.org/articles/suicide-prevention/suicide-prevention.htm

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Thank you!

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Sources

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Public Perception of Mental Health and Suicide Prevention Survey Results, The Harris Poll, August 2020

Slide 3:

Erlangsen A, Stenager E, Conwell Y, et al. Association Between Neurological Disorders and Death by Suicide in Denmark. JAMA. 2020;323(5):444–454. doi:10.1001/jama.2019.21834

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