Özel Gruplarda (Gaziler, Mülteciler, Mahkumlar) İntihar
Özet
Özel gruplarda (gaziler, göçmen/mülteciler ve mahkumlar) intihar risklerini ve dinamiklerini ele alan bu çalışma, intiharın küresel bir halk sağlığı sorunu olduğunu ve bu kırılgan popülasyonlarda intihar oranlarının genel nüfusa kıyasla çok daha yüksek seyrettiğini vurgulamaktadır. Gazilerde intihar davranışı; sivil hayata uyum süreçlerinde yaşanan sosyoekonomik zorluklar, askeri kimliğin kaybı, silahlara aşinalık, travma sonrası stres bozukluğu (TSSB) ve "ahlaki incinme" gibi faktörlerle açıklanmakta, İntiharın Kişilerarası Psikolojik Kuramı ve Üç Basamaklı İntihar Teorisi ile temellendirilmektedir. Göçmen ve mültecilerde ise göç öncesi yaşanan savaş ve şiddet travmalarına, göç sonrasında dil bariyeri, yoksulluk, dışlanma ve yeni bir kültüre uyum sürecinin getirdiği akültüratif stres eşlik etmekte; bu durum yetişkinlerin yanı sıra çocukların da ruh sağlığını ve intihar eğilimlerini doğrudan olumsuz etkilemektedir. Kapalı ve izole bir ortam olan cezaevlerindeki mahkumlar için ise toplumsal bütünleşmenin kaybı, yoksunluk, hücrede yalnız kalma gibi çevresel faktörlerin yanı sıra majör psikiyatrik bozukluklar ve geçmiş intihar öyküsü riski kritik düzeyde artırmaktadır. Çalışma, tüm bu özel gruplarda intiharı önlemek için veri kayıt sistemlerinin iyileştirilmesini, erken tanısal taramaları, kriz hatlarını ve hem klinik hem de toplum odaklı müdahaleleri birleştiren multidisipliner bir halk sağlığı stratejisinin uygulanmasını önermektedir.
Suicide in special groups (veterans, immigrants/refugees, and prisoners), addressing suicide risks and dynamics, emphasizes that suicide is a global public health problem and that suicide rates in these vulnerable populations are substantially higher compared to the general population. Suicidal behavior in veterans is explained by socioeconomic challenges in transitioning to civilian life, loss of military identity, familiarity with firearms, post-traumatic stress disorder (PTSD), and "moral injury," grounded in the Interpersonal-Psychological Theory of Suicide and the Three-Step Suicide Theory. In immigrants and refugees, pre-migration traumas from war and violence are compounded post-migration by language barriers, poverty, social exclusion, and acculturative stress from adapting to a new culture; this directly and adversely affects the mental health and suicidal tendencies of both adults and children. For prisoners in closed and isolated environments, environmental factors such as loss of social integration, deprivation, and being alone in a cell, alongside major psychiatric disorders and a history of past suicide attempts, critically escalate the risk. The study proposes improving data registration systems, early diagnostic screenings, crisis hotlines, and adopting a multidisciplinary public health strategy combining clinical and community-focused interventions to prevent suicide in these special groups.
Referanslar
U.S. Department of Veterans Affairs. National veteran suicide prevention annual report 2021. Washington, DC: Veterans Health Administration, Office of Mental Health and Suicide Prevention. (12.07.2022 tarihinde https://www.mentalhealth.va.gov/docs/data-sheets/2021/2021-National-Veteran-Suicide-Prevention-Annual-Report-FINAL-9-8-21.pdf adresinden ulaşılmıştır.)
Türkiye İstatistik Kurumu. Ölüm İstatistikleri 2018 (13.07.2022 tarihinde https://data.tuik.gov.tr/Bulten/Index?p=Olum-Istatistikleri-2018-30701 adresinden ulaşılmıştır.)
Griffith J, Vaitkus M. Perspectives on suicide in the Army National Guard. Armed Forces & Society. 2013; 39: 628–653. https://doi.org/10.1177/0095327X12471333
Joiner TE, Jr. Van Orden KA, Witte TK, et al. Main predictions of the interpersonal–psychological theory of suicidal behavior: Empirical tests in two samples of young adults. Journal of Abnormal Psychology, 2009; 118: 634–646. https://doi.org/10.1037/a0016500
Rudd MD. Fluid vulnerability theory: A cognitive approach to understanding the process of acute and chronic suicide risk. Ellis TE (Ed.), Cognition and suicide: Theory, research, and therapy içinde. Washington, DC: American Psychological Association; 2006. p. 355–368
Wolfe-Clark AL, Bryan CJ. Integrating two theoretical models to understand and prevent military and veteran suicide. Armed Forces & Society, 2017; 43(3), 478-499. https://doi.org/10.1177/0095327X16646645
Klonsky ED, May AM. The three-step theory (3ST): a new theory of suicide rooted in the “ideation-to-action” framework. International Journal of Cognitive Therapy. 2015; 8 (2), 114–129. https://doi.org/10.1521/ijct.2015.8.2.114
Zoli C, Maury R, Fay D. Missing Perspectives: Servicemembers’ Transition from Service to Civilian Life — Data-Driven Research to Enact the Promise of the Post-9/11 GI Bill. Institute for Veterans & Military Families, Syracuse University. (13.07.2022 tarihinde https://surface.syr.edu/cgi/viewcontent.cgi?article=1006&context=ivmf adresinden ulaşılmıştır.)
Ahern J, Worthen M, Masters J, et al. The challenges of Afghanistan and Iraq veterans’ transition from military to civilian life and approaches to reconnection. PLoS ONE 2015; 10 (7), e0128599. https://doi.org/ 10.1371/journal.pone.0128599.
Sokol Y, Eisenheim E. The relationship between continuous identity disturbances, negative mood, and suicidal ideation. The primary care companion for CNS disorders, 2016; 18(1), 26150. https://doi.org/10.4088/PCC.15m01824.
Sokol Y, Serper M. Temporal self appraisal and continuous identity: associations with depression and hopelessness. Journal of Affective Disorders. 2017; 208: 503–511. https://doi.org/ 10.1016/j.jad.2016.10.033.
Selby EA, Anestis MD, Bender TW, et al. Overcoming the fear of lethal injury: evaluating suicidal behavior in the military through the lens of the interpersonal-psychological theory of suicide. Clinical Psychology Review. 2010; 30 (3): 298–307.
Lee DJ, Kearns JC, Wisco BE, et al. A longitudinal study of risk factors for suicide attempts among Operation Enduring Freedom and Operation Iraqi Freedom veterans. Depression and anxiety. 2018; 35(7): 609-618. https://doi.org/10.1002/da.22736
McCarthy JF, Bossarte RM, Katz IR, et al. Predictive modeling and concentration of the risk of suicide: Implications for preventive interventions in the US Department of Veterans Affairs. American Journal of Public Health. 2015; 105:1935–1942.
Monteith LL, Wendleton L, Bahraini NH, et al. Together With Veterans: VA national atrategy alignment and lessons learned from community-based suicide prevention for rural veterans. Suicide and Life Threatening Behavior. 2020; 50:588–600. https://doi.org/10.1111/sltb.12613
Wood DS, Wood BM, Watson A, et al. Veteran suicide risk factors: a national sample of nonveteran and veteran men who died by suicide. Health & social work, 2020; 45(1): 23-30. https://doi.org/10.1093/hsw/hlz037
Halimi R, Halimi H. Risk among combat veterans with post-traumatic stress disorder: The impact of psychosocial factors on the escalation of suicidal risk. Nöro Psikiyatri Arşivi. 2015; 52(3), 263. https://doi.org/10.5152/npa.2015.7592
Verger P, Dab W, Lamping DL, et al. The psychological impact of terrorism: An epidemio- logic study of post traumatic stress disorder and associated factors in victims of the 1995-1996 bombings in France. Amrican Journal of Psychiatry. 2004;161:1384-1389 https://doi.org/10.1176/appi.ajp.161.8.1384
Güloğlu B, Karaırmak Ö. Güneydoğu gazilerinde travma sonrası stres bozukluğu gelişimi. Anatolian Journal of Psychiatry/Anadolu Psikiyatri Dergisi. 2013; 14(3):237-244. https://doi.org/10.5455/apd.36696
Mantri S, Lawson JM, Wang Z, et al. Identifying Moral Injury in Healthcare Professionals: The Moral Injury Symptom Scale-HP. Journal of Religion and Health. 2020; 59, 2323–2340. https://doi.org/10.1007/s10943-020-01065-w
Bryan CJ, Morrow CE, Etienne N, et al: Guilt, shame, and suicidal ideation in a military outpatient clinical sample. Depress & Anxiety. 2013; 30(1): 55–60 https://doi.org/10.1002/da.22002
Bryan AO, Bryan CJ, Morrow CE, et al: Moral injury, suicidal ideation, and suicide attempts in a military sample. Traumatology. 2014; 20(3): 154–161. https://doi.org/10.1037/h0099852
Ames D, Erickson Z, Youssef NA, et al. Moral injury, religiosity, and suicide risk in US veterans and active duty military with PTSD symptoms. Military medicine, 2019;184(3-4): e271-e278 https://doi.org/10.1093/milmed/usy148
Carroll D, Kearney LK, Miller MA. Addressing suicide in the veteran population: engaging a public health approach. Frontiers in psychiatry. 2020; 11: 569069. https://doi.org/10.3389/fpsyt.2020.569069
Bogic M, Njoku A, Priebe S. Long-term mental health of war-refugees: a systematic literature review. BMC international health and human rights. 2015;15(1): 1-41.
Fındık OTP, Ceri V, Ünver H, et al. Mental health need and psychiatric service utilization patterns of refugee children in Turkey: A comparative study. Children and youth services review. 2021;124:105970. https://doi.org/10.1016/j.childyouth.2021.105970
Mucci N, Traversini V, Giorgi G, et al. Migrant workers and psychological health: A systematic review. Sustainability. 2019; 12(1):120. https://doi.org/10.3390/su12010120
Ide N, Kolves K, Cassaniti M, et al. Suicide of first-generation immigrants in Australia, 1974–2006. Social Psychiatry and Psychiatric Epidemiology. 2012; 47(12): 1917–1927.
Hollander AC, Pitman A, Sjöqvist H, et al. Suicide risk among refugees compared with non-refugee migrants and the Swedish-born majority population. The British Journal of Psychiatry. 2020; 217(6): 686-692.
Staehr MA, Munk-Andersen E. Suicide and suicidal behavior among asylum seekers in Denmark during the period 2001-2003. A retrospective study. Ugeskrift for laeger. 2006; 168(17): 1650-1653.
Forte A, Trobia F, Gualtieri F, et al. Suicide Risk among Immigrants and Ethnic Minorities: A Literature Overview. International Journal of Environmental Research and Public Health, 2018; 15(7), 1438. https://doi.org/10.3390/ijerph15071438
Saunders NR, Chiu M, Lebenbaum M, et al. Suicide and self-harm in recent immigrants in Ontario, Canada: a population-based study. The Canadian Journal of Psychiatry, 2019;64(11), 777-788. https://doi.org/10.1177/0706743719856851
Yako RM, Biswas B. “ We came to this country for the future of our children . We have no future”: Acculturative stress among Iraqi refugees in the United States. International Journal of Intercultural Relations. 2014; 38: 133–141. https://doi.org/10.1016/j.ijintrel.2013.08.003
Hovey JD, King CA. Acculturative stress, depression, and suicidal ideation among immigrant and second-generation Latino adolescents. Journal of the American academy of child & adolescent psychiatry. 1996; 35(9): 1183-1192. https://doi.org/10.1097/00004583-199609000-00016
Ratkowska KA, De Leo, D. Suicide in immigrants: An overview. Open Journal of Medical Psychology.2013; 2:124-133. https://doi.org/ 10.4236/ojmp.2013.23019
Ünlü G, Aksoy Z, Ersan EE. İntihar girişiminde bulunan çocuk ve ergenlerin değerlendirilmesi. Pamukkale Tıp Dergisi. 2014; 7(3): 176-183.
Aydın D, Şahin N, Akay B. Göç olayının çocuk sağlığı üzerine etkileri. İzmir Dr. Behçet Uz Çocuk Hastalıkları Dergisi. 2017; 7(1):8-14. https://doi.org/10.5222/buchd.2017.008
Çeri V, Beşer C, Perdahlı Fiş N, et al. İstanbul’daki Mülteci Çocuklara Bakım Vermek Üzere Özelleşmiş Bir Çocuk Psikiyatri Ünitesinden Bulgular. Klinik Psikiyatri Dergisi, 2018; 21(2): 113-121. https://doi.org/10.5505/kpd.2018.57070
Husain SA, Nair J, Holcomb W, et al. Stress reactions of children and adolescents in war and siege conditions. American Journal of Psychiatry, 1998; 155(12): 1718-1719. https://doi.org/10.1176/ajp.155.12.1718
Işık E, Ertuğrul F. Mülteci Ruh Sağılığında Güncel Yaklaşımlar. Sağlık Bilimlerinde Değer, 2022; 12(1): 180-187. https://doi.org/10.33631/sabd.1055671
Alkan N. Cezaevi Ölümleri, İstanbul Barosu Dergisi, 2007; 81:2007-2014.
Kaya N, Güler Ö, Çilli AS. Konya kapalı cezaevindeki mahkûmlarda psikiyatrik bozuklukların yaygınlığı. Anadolu Psikiyatri Dergisi. 2004; 5:85-91.
Bertolote JM, Fleischmann A. Suicidal behavior prevention: WHO perspectives on research. American Journal of Medical Genetics Part C: Seminars in Medical Genetics içinde. Hoboken: Wiley Subscription Services, Inc., A Wiley Company; 2005. p. 8-12
Fazel S, Grann M, Kling B, et al. Prison suicide in 12 countries: an ecological study of 861 suicides during 2003–2007. Social psychiatry and psychiatric epidemiology, 201; 46(3): 191-195. https://doi.org/10.1007/s00127-010-0184-4
Liebling A. “Vulnerability and prison suicide”. British Journal of Criminology. 1995; 35: 173-187. https://doi.org/10.1093/oxfordjournals.bjc.a048492
Gore SM. Suicide in prisons: reflection of the communities served, or exacerbated risk? British Journal of Psychiatry. 1999; 175:50–55.
Durkheim E. Suicide, A Study in Sociology. London: Routledge; 2002. https://doi.org/10.4324/9780203994320
Tartaro C, Lester D. “An application of Durkheim's theory of suicide to prison suicide rates in the United States”. Death Studies. 2005; 29: 413-422. https://doi.org/10.1080/07481180590932526
Grossmann MG. “Two perspectives on aboriginal female suicides in custody: Special issue: Aboriginal criminal justice in Canada”. Canadian Journal of Criminology. 1992; 34: 403-415
Kennedy DB, Homant RJ. Predicting custodial suicides: Problems with the use of Profiles. Justice Quarterly.2006; 5(3): 441–456. https://doi.org/10.1080/07418828800089811
Hales H, Freeman M, Edmondson A, et al. Witnessing suiciderelated behavior in prison: A qualitative study of young male prisoners in England. Crisis. 2014; 35(1): 10–17. https://doi.org/10.1027/0227-5910/a000223
Beautrais AL. Suicide and serious suicide attempts in youth: A multiple-group comparison study. The American Journal of Psychiatry, 2003; 160: 1093–1099. https://doi.org/10.1176/appi.ajp.160.6.1093
Lekka NP, Argyriou AA, Beratis S. Suicidal ideation in prisoners: risk factors and relevance to suicidal behaviour. A prospective case-control study. Eurepean Archives of Psychiatry and Clinical Neuroscience. 2006; 256:87-92. https://doi.org/10.1007/s00406-005-0606-6
Klonsky ED, May AM. Differentiating suicide attempters from suicide ideators: a critical frontier for suicidology research. Suicide and Life Threatening Behavior 2014; 44(1):1–5. https://doi.org/10.1111/sltb.12068
May AM, Klonsky ED. What distinguishes suicide attempters from suicide ideators? A meta-analysis of potential factors. Clinical Psycholology. 2016; 23(1):5–20 https://doi.org/10.1037/h0101735
Marcus P, Alcabes P. Characteristics of suicides by inmates in an urban jail. Psychiatric Services. 1993; 44(3): 256-261. https://doi.org/10.1176/ps.44.3.256
He XY, Felthous AR, Holzer CE, et al. Factors in prison suicide: one year study in Texas. Journal of Forensic Science. 2001;46(4): 896-901.
Görgülü T, Tutarel-Kışlak Ş. Erkek Hükümlü ve Tutukluların Boyun Eğici Davranışları, Depresyon ve İntihar Olasılıkları. Archives of Neuropsychiatry/Noropsikiatri Arsivi. 2014; 51(1):40-45. https://doi.org/10.4274/npa.y6563
