Kujiua : Tofauti kati ya masahihisho

Suicide
	Mwainisho na taarifa za nje
Specialty	Psychiatry, Elimunafsia
ICD-10	X60.–X84.
ICD-9	E950
MedlinePlus	001554
eMedicine	article/288598
MeSH	F01.145.126.980.875

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Pitio la 17:45, 28 Novemba 2013

Kujiua (Kilatini suicidium, kutokana na sui caedere, "kujiua") ni kitendo cha kusababisha kifo cha mtu binafsi kimakusudi. Mara nyingi, watu hujiua kufuatia kukata tamaa. Mara nyingi kujiua husababishwa na tatizo la kiakili kama vile mfadhaiko, maradhi ya hisia mseto, skizofrenia,ulevi au kutumia dawa za kulevya.^[1] Vipengele vya dhiki kama vile matatizo ya kifedha au matatizo ya mahusiano ya kijamii huchangia sana. Juhudi za kuzuia kujiua hujumuisha kupunguza uwezo wa kufikia bunduki, kutibu magonjwa ya akili na matumizi mabaya ya dawa na kuboresha maendeleo ya kiuchumi.

Mbinu inayotumika zaidi ya kujiua hutofautiana katika nchi mbalimbali na huhusishwa kwa kiasi na mbinu zinazopatikana. Mbinu zinazotumika mara nyingi hujumuisha: kujinyonga, kunywa sumu na kutumia bunduki. Takriban watu 800,000 hadi milioni 1 hufa kwa kujiua kila mwaka. Kujiua ni kisababishi cha 10 kikuu zaidi cha vifo kote ulimwenguni.^[1]^[2] Viwango vya wanaume kujiua ni zaidi ya vya wanawake huku wanaume wakiwa na uwezekano wa mara 3-4 wa kujiua kuliko wanawake.^[3] Imekadiriwa kuwa kuna majaribio ya kujiua yasiyo hatari milioni 10 hadi 20 kila mwaka.^[4] Majaribio haya mara nyingi huwa ya watu wachanga na wa jinsia ya kike.

Mitazamo ya kujiua imeshawishiwa na mada kuu za kimaisha kama vile dini, heshima na dhamani ya maisha. Kitamaduni, dini za Kiibrahimu zilichukulia kujiua kuwa kumkosea Mungu kwa sababu ya imani yao ya utakatifu wa maisha. Katika enzi za samurai nchini Japan, seppuku iliheshimiwa kama mbinu ya kulipia kosa la kushindwa au njia ya utetezi. Sati wa mazishi ya Kihindi, ambao sasa umeharamishwa, ulimhitaji mjane kujitoa kafara kwa kujichoma katika kimbwi cha mazishi ya mumewe, kwa hiari au kwa kushinikizwa na familia na jamii.^[5]

Ingawa kosa la kujiua au kujaribu kujiua lilichangia adhabu ya kisheria hapo awali katika mataifa ya magharibi, kwa sasa haliadhibiwi. Kosa hili limesalia kuwa hatia katika mataifa mengi ya Kiislamu. Katika karne ya 20 na 21, kujiua kwa mbinu ya kujitoa kafara kumetumika kama mbinu ya utetezi, na kamikaze na kujiua kwa bomu kama harakati za kijeshi au kigaidi.^[6]

Fasili

Kujiua, kwa neno lingine kujiua kikamilifu, ni kitendo cha "kujitoa uhai".^[7] Kujaribu kujiua au hatua isiyochangia kujiua ni kitendo cha kujidhuru kwa lengo la kujiangamiza, bila kufanikiwa kujiua.^[8] Usaidizi wa kujiua ni pale mtu anapomsaidia mwingine kujiua kwa njia isiyo ya moja kwa moja; kupitia ushauri au mbinu za kujiua.^[9] Hii ni kinyume na utanazia ambapo mtu mwingine huusika zaidi katika kusababisha kifo cha mtu.^[9] Mawazo ya kujiua ni kuwaza jinsi ya kujiangamiza.^[8]

Vipengele vya hatari

Vipengele vinavyoathiri hatari ya kujiua hujumuisha matatizo ya kisaikiatria, matumizi mabaya ya dawa, hali ya kisaikolojia, kitamaduni, familia na vitengo vya kijamii na jenetikia.^[11] ugonjwa wa akili na matumizi mabaya ya dawa mara nyingi hutokea kwa pamoja.^[12] Vipengele vingine vya hatari ni pamoja na jaribio la kujiua la hapo awali,^[13] uwepo wa mbinu za kujiua, historia ya kujiua katika familia au uwepo wa jeraha kuu la ubongo.^[14] Kwa mfano, viwango vya kujiua vimetambulika kuwa vya juu katika familia zilizo na bunduki kuliko zisizo nazo.^[15] Vipengele vya kijamii na kiuchumi, kama vile ukosefu wa ajira, umaskini, kukosa makazi na ubaguzi vinaweza kusababisha fikira za kutaka kujiua.^[16] Takriban 15-40% ya watu huacha ujumbe wa kujiua.^[17] Jenetikia huonekana kuhusika kwa kati ya 38% na 55% ya mitindo ya kujiua.^[18] Wakongwe wa vita wana hatari zaidi ya kujiua kufuatia viwango vya juu vya magonjwa ya akili na matatizo ya kiafya yanayohusishwa na vita.^[19]

Matatizo ya akili

Matatizo ya akili mara nyingi huwepo wakati wa kujiua, huku kadirio zikiwa kati ya 27%^[20] hadi zaidi ya 90%.^[13] Katika wagonjwa waliolazwa katika kitengo cha magonjwa ya akili, hatari yao ya kujiua kikamilifu katika maisha yao yote huwa takriban 8.6%^[13] Nusu ya watu wote wanaofariki kutokana na kujiua wanaweza kuwa na tatizo kuu la mfadhaiko; uwepo wa hali hii au mojawapo ya matatizo ya kihisia, kama vile maradhi ya hisia mseto huongeza hatari ya kujiua kwa mara 20.^[21] Hali zingine zinazochangia kujiua ni pamoja na skizofrenia (14%), matatizo ya nafsi (14%), ^[22] maradhi ya hisia mseto,^[21] na tatizo la dhiki baada ya kiwewe.^[13] Takriban 5% ya watu wenye skizofrenia hufa kutokana na kujiua.^[23] Matatizo ya kula ni hali nyingine yenye hatari ya juu.^[24]

Historia ya jaribio la awali la kujiua ni ishara kuu ya kujiua kikamilifu baadaye.^[13] Takriban 20% ya visa vya kujiua hutanguliwa na jaribio la kujiua. 1% ya watu waliojaribu kujiua hufaulu kujiua katika mwaka mmoja^[13], na zaidi ya 5% hufaulu kujiua baada ya miaka 10 .^[24] Ingawa vitendo vya kujidhuru havichukuliwi kama majaribio ya kujiua, kuwepo kwa mtindo wa kujidhuru huhusishwa na hatari zaidi ya kujiua.^[25]

Kwa takriban 80% ya visa vya kujiua kikamilifu, mwathiriwa huwa amemtembelea daktari katika mwaka huo kabla ya kujiua,^[26] ikijumuisha 45% ya visa katika mwezi uliotangulia.^[27] Takriban 25%-40% ya watu wanaojiua huwa wamepokea huduma ya afya ya kiakili katika mwaka uliotangulia. ^[20]^[26]

Matumizi ya vileo

Kutumia vileo ni kipengele cha hatari cha pili kikuu kinachopelekea kujiua, baada ya mfadhaiko mkuu na maradhi ya nafsi mseto.^[28] Ulevi wa muda mrefu na ulevi wa muda mfupi huhusishwa na kujiua.^[12]^[29] Ikiwa hali hii itaambatana na masikitiko ya kibinafsi, kama vile kufiwa, hatari huongezeka zaidi.^[29] Hali kadhalika, kutumia dawa za kulevya huhusishwa na matatizo ya afya ya kiakili.^[12]

Watu wengi huwa wameathiriwa na dawa za kutuliza na kuwezesha usingizi (kama vile pombe au benzodiazepines) wakati wa kujiua ^[30],huku ulevi ukiwepo katika 15%-61% ya visa.^[12] Nchi zilizo na viwango vya juu vya ulevi wa pombe na idadi kubwa ya baa pia huwa na viwango vya juu vya kujiua^[31]. Uhusiano huu huhusishwa hasa na matumizi ya vinywaji vikali vilivyotoneshwa kuliko pombe kamili.^[12] Takriban 2.2-3.4% ya watu waliotibiwa kutokana na ulevi katika wakati fulani maishani mwao hufa kwa kujiua.^[31] Walevi wanaojaribu kujiua kwa kawaida huwa wanaume wazee na ambao wamejaribu kujiua hapo awali.^[12]Kati ya 3% na 35% ya vifo vya watu wanaotumia heroini hutokana na kujiua (takriban mara 14 zaidi ya wale wasiotumia).^[32]

Matumizi mabaya ya kokeini na methamphetamine huhusiana pakubwa na kujiua.^[12]^[33]Katika watumizi wa kokeini, hatari huwa ya juu zaidi katika awamu ya kusitisha.^[34] Waliotumia vileo vya kuvuta pia huwa katika hatari, na takriban 20% yao hujaribu kujiua katika wakati fulani, huku zaidi ya 65% wakikusudia kujiua.^[12] uvutaji sigara huhusishwa na hatari ya kujiua.^[35] Kuna ushahidi mdogo kuhusu kuwepo kwa uhusiano huu; hata hivyo, imedhaniwa kuwa watu waliohatarishwa kwa moshi pia huhatarishwa kwa kujiua. Uvutaji husababisha matatizo ya afya yanayomfanya mtu kutaka kujiua. Pia, uvutaji huathiri kemia ya ubongo na kusababisha uwezekano wa kujiua.^[35] Hata hivyo, bangi haitambuliki kuongeza hatari ikitumika pekee.^[12]

Kubahatishia matatizo

Kubahatishia matatizo huhusishwa na ongezeko la mawazo ya kujiua na majaribio ikilinganishwa na watu wa kawaida. ^[36] Kati ya 12% na 14% ya wabahatishi wa kipatholojia hujaribu kujiua.^[37] Kiwango cha kujiua cha wake zao huwa mara tatu zaidi ya kile cha umma.^[37] Vipengele vingine vinavyoongeza hatari kwa wanaobahatishia matatizo hujumuisha ugonjwa wa akili, ulevi wa pombe na dawa.^[38]

Hali za kimatibabu

Kuna uhusiano kati ya uwezekano wa kujiua na matatizo ya afya, ikijumuisha:^[24]maumivu ya muda mrefu,^[39] jeraha la ubongo lenye kiwewe,^[40] saratani,^[41] watu wanaofanyiwa hemodialisi, wenye VVU, erithematosasi ya kitaratibu ya lupusi miongini mwa hali zingine.^[24] Utambuzi wa saratani huongeza hatari ya kujiua baadaye kwa takriban mara mbili.^[41] Ukithiri wa ongezeko la uwezekano wa kujiua ulijikita hata baada ya kurekebishwa kutokana na maradhi ya mfadhaiko na ulevi. Hatari katika watu wenye hali nyingi za kimatibabu huwa juu zaidi. Matatizo ya afya nchini Japan yanaorodheshwa kama sababu kuu ya kujiua.^[42]

Masumbufu ya usingizi kama vile insomnia^[43] na apnea ya usingizi ni vipengele vya hatari vya mfadhaiko na kujiua. Wakati mwingine, masumbufu ya usingizi yanaweza kuwa vipengele vya hatari ya kujiua bila kutegemea mfadhaiko.^[44] Hali nyingine za kimatibabu zinaweza kuwepo, huku zikiwa na dalili sawa na matatizo ya kihisia, ikiwa ni pamoja na:hipouthiroidi, Alzheimer, tyuma ya ubongo, erithematosasi ya kitaratibu ya lupusi na madhara ya dawa (kama vile viziba beta na steroidi).^[13]

Hali za kimawazo na kijamii

Baadhi ya hali za kimawazo na kijamii huongeza hatari ya kujiua, ikujumuisha: kukosa matumaini, kupoteza furaha katika maisha, mfadhaiko na wasiwasi.^[21] Uwezo duni wa kusuluhisha matatizo, ukosefu wa uwezo aliokua nao mtu na udhibiti duni wa hisia pia unaweza kuchangia kujiua.^[21]^[45]Katika watu wazima, wazo la kuwa mzigo kwa watu wengine ni kipengele kikuu.^[46]^[46]

Dhiki za awali, kama vile kifo cha jamaa au rafiki, kupoteza kazi au kujitenga na jamii (kama vile kuishi pekee) huongeza hatari.^[21] Watu ambao hawajawai kuoa pia wana hatari ya juu zaidi.^[13] Kujihusisha na dini kunaweza kupunguza hatari ya kujiua .^[47] Hali hii imehusishwa na msimamo hasi wa dini dhidi ya kujiua, na uhusiano mkuu ulioko katika dini.^[47] Waislamu, wakilingashwa na watu wa dini zingine, huwa na kiwango cha chini zaidi cha kujiua.^[48]

Baadhi ya watu wanaweza kujiua ili kuepuka ukatili au ubaguzi.^[49] Historia ya dhuluma za kimapenzi dhidi ya watoto u^[50] na muda aliokaa mtu kwenye utunzaji wa walezi pia huwa vipengele vya hatari.^[51] Dhuluma za kimapenzi huaminika kuchangia hadi takriban 20% ya hatari ya kijumla.^[18]

Maelezo ya ya mageuko kuhusu kujiua ni kwamba kunaweza kuboresha uwezo wa kimalezi. Hii inaweza kutokea iwapo mtu anayejiua hawezi kupata watoto wengine na anaendelea kutumia raslimali za jamii kwa kuendelea kuishi. Pingamizi ni kuwa vifo vya watu waliobaleghe wenye afya mara nyingi haviongezi uwezo wa kimalezi. Utohozi katika mazingira tofauti na aliyozaliwa mtu unaweza kupelekea marekebisho mabaya katika mazingira anayoishi mtu kwa sasa.^[45]^[52]

Umaskini huhusishwa na hatari ya kujiua.^[53]Ongezeko la hali ya umaskini ikilinganishwa na watu walio karibu huongeza hatari ya kujiua .^[54] Zaidi ya wakulima 200,000 nchini India wametekeleza kujiua kuanzia 1997 kwa sababu ya deni .^[55] Nchini China, uwezo wa kujiua ni mara tatu zaidi katika maeneo ya mashambani kuliko mijini, kufuatia matatizo ya kifedha katika maeneo hayo.^[56]

Vyombo vya habari

Vyombo vya habari, ikiwa ni pamoja na mtandao, huchangia pakubwa.^[11] Jinsi vyombo hivi vinavyowasilisha kujiua inaweza kuwa na athari mbaya, huku habari zilizotiliwa mkazo, kusisitizwa na kurudiwa huku zikisifia matukio ya kujiua zikiwa na athari kuu zaidi.^[57] Mbinu moja ya kujiua inapoangaziwa kwa kina, umaarufu wake unaweza kuongezeka kwenye umma.^[58]

Kichochezi cha kusambaza hisia za kujiua au uigaji kujiua hujulikana kama athari ya Werther. Kichochezi hiki kilipewa jina kutokana na mhusika mkuu katika kitabu cha Goethe kijulikanacho kama The Sorrows of Young Werther aliyejiua.^[59]Hatari hii ni kubwa zaidi katika vijana wanaosifia kifo.^[60] Inaonakana kuwa, ingawa vyombo vya habari vina ushawishi mkubwa, ushawishi wa vyombo vya burudani ni wa kupotosha.^[61] Kinyume cha athari ya Werther ni ile inayoitwa athari ya Papageno, ambapo kuwasilisha habari kuhusu mbinu mwafaka za ukabilianaji kunaweza kupelekea matokeo bora ya kinga. Neno hili linatokana na mhusika katika tamthilia ya [[Wolfgang Amadeus Mozart|Mozart] iitwayo The Magic Flute. Mhusika huyu alitaka kujiua kwa kuogopa kumtopeza mpenzi wake hadi marafiki zake wakamshawishi asijiue. ^[59] Hatari ya kujiua inaweza kupungua iwapo vyombo vya habari vitafuatilia miongozo inayofaa ya kuripoti.^[57] Inaweza kuwa vigumu kupata uwajibikaji wa wataalam wa mawasiliano, hasa katika muda mrefu wa usoni.^[57]

Kirazini

Kujiua kirazini ni kujiua baada ya kufanya uamuzi wa busara, ^[62] ingawa baadhi ya watu husema kuwa kujiua hakuwezi kuwa jambo la busara.^[62]Kitendo cha kujiua ili kuwanufaisha watu wengine hujulikana kama kujiua kiutu.^[63] Mfano wa aina hii ni mzee akijiua ili kuwaachia watoto wake mali nyingi katika jamii.^[63] Katika baadhi ya tamaduni za Eskimo, hatua ya kujiua kiutu imeonekana kama kitendo cha heshima, ujasiri au hekima.^[64]

Shambulio la kujiua ni kitendo cha kisiasa ambapo mshambulizi huwavamia watu wengine akifahamu kuwa kitendo hicho kitapelekea kifo chake. ^[65] Baadhi ya watu wanaojiua kwa bomu hufanya hivyo ili kupata umaarufu wa ufiadini.^[19] Mashambulizi ya Kamikaze yalitekelezwa kama wito mkuu au wajibu wa kimaadili.^[64] Kujiua baada ya mauaji ni kitendo cha uuaji wa binadamu kinachofuatiwa punde na mtu aliyetekeleza mauaji hayo kujiua mwenyewe.^[66] Mauaji ya halaiki mara nyingi hutekelezwa chini ya ushawishi wa kijamii ambapo washirika humpa kiongozi mamlaka ya kuwafanyia atakavyo.^[67] Mauwaji ya watu wengi yanaweza kutekelezwa na hata watu wawili tu, maarufu kama mkataba wa kujiua.^[68]

Katika hali za kujaribu kuhalalisha, ambapo kuendelea kuishi kutapelekea mateso, watu wengi hutumia kujiua kama mbinu ya kuepuka. ^[69] Baadhi ya wafungwa katika Nazi kambi za mkusanyiko waliripotiwa kujiua kimakusidi kwa kugusa ua za umeme.^[70]

Mbinu

Faili:KujiuaCFR.png

Uchunguzi Maalum Kima cha vifo kwa kujiua nchini Marekani.^[15]

Mbinu maarufu ya kujiua hutofautiana katika nchi mbalimbali. Mbinu inayoongoza katika maeneo tofauti ni pamoja na kunyonga, kunywa sumu na kujiua kwa bunduki.^[71] Tofauti hizi zinaaminika kusababishwa na upatikanaji wa mbinu mbalimbali kulingana na kila eneo.^[58] Mapitio ya nchi 56 yalionyesha kuwa mbinu ya kujinyonga ilikuwa maarufu zaidi katika idadi kubwa ya nchi hizi, ^[72] ikihasibia 53% ya visa vya kujiua kwa wanaume na 39% katika wanawake. ^[73]

Kote ulimwenguni, 30% ya visa vya kujiua hutokana na kunywa sumu. Visa vya kutumia mbinu hii, hata hivyo ni tofauti sana, kutoka 4% bara Uropa hadi zaidi ya 50% katika eneo la Pasifiki. ^[74] Mbinu hii pia ni maarufu Marekani Kusini kwa sababu ya hali rahisi ya kupatikana kwa sumu za ukulima. ^[58] Katika nchi nyingi, kuzidisha kipimo cha dawa husababisha takriban 60% ya visa vya kujiua miongoni mwa wanawake na 30% katika wanaume.^[75] Idadi kubwa ya vifo hivi hutokea bila mpango, na hutokea katika kipindi kikali cha mashaka.^[58] Kiasi cha vifo hutofautiana na mbinu iliyotumika; bunduki: 80-90%, kuzama: 65-80%, kujinyonga: 60-85%, mivuke ya gari: 40-60%, kujirusha: 35-60%, kuchoma makaa: 40-50%, sumu ya kuua wadudu: 6-75%, kuzidisha kiasi cha dawa: 1.5-4%.^[58] Mbinu za kujiua zilizojaribiwa zaidi hutofautiana na mbinu kuu zaidi, huku kukiwa na 85% ya majaribio ya kuzidisha kiasi cha dawa katika mataifa yaliyostawi.^[24]

Nchini Marekani, 57% ya visa vya kujiua vimehusisha kutumia bunduki, huku mbinu hii ikitumiwa zaidi na wanaume kuliko wanawake. ^[13] Mbinu iliyofuatia kwa umaarufu ni kujinyonga katika wanaume na kunywa sumu katika wanawake.^[13] Mbinu hizi kwa pamoja zilichangia 40% ya visa vya kujiua nchini Marekani. ^[76] Nchini Uswisi, ambapo takriban kila mtu humiliki bunduki, idadi kubwa zaidi ya visa vya kujiua ni kwa kujinyonga. ^[77] Visa vya kujiua ni maarufu nchini Hong kong na Singapore huku vikiwa 50% na 80% mtawalia. ^[58] Nchini Uchina, mbinu kuu zaidi ni kunywa sumu. ^[78] Nchini Japani, kujitoa matumbo, yaani seppuku au hara-kiri, bado hutokea, ^[78]ingawa kujinyonga ndiyo njia kuu zaidi. ^[79]

Pathofisiolojia

Hakuna Pathofisiolojia ya kujiua au mfadhaiko iliyo bayana, unganishi na ya kimsingi. ^[13] Hata hivyo, kujiua huaminika kutokana na mwingilianao wa vipengele vya kimtindo, kimazingira na kijamii na magonjwa ya akili. ^[58]

Viwango vya chini vya kipengele cha neurotrofiki zitokanazo na ubongo (KNZU) huhusishwa moja kwa moja na kujiua ^[80] na pasipo moja kwa moja jinsi vinavyochangia mfadhaiko mkuu, matatizo ya baada ya kiwewe, skizofrenia na matatizo ya ung’ang’anizi shurutishi.^[81] Uchunguzi wa Uchunguzi maiti umetambua viwango vya chini vya KNZU katika hipokampasi na koteksi ya mbele kwa watu walio au wasio na hali za ugonjwa wa akili. ^[82] Serotonini, ambayo ni niurotransmita ya ubongo, huanimika kuwa katika kiwango cha chini katika watu wanaojiua. Hii ni kwa kimsingi wa kupatikana kwa viwango vya juu vya kipokezi cha 5- HT2A vinavyopatikana baada ya kufa. ^[83] Ushahidi mwingine ni pamoja na viwango vya chini vya asidi ya hidroksindoletisia-5, zao linalopatikana baada ya serotonini kumeng’enywa, katika kiowevu cha uti wa mgongo.^[84] Hata hivyo, ushahidi wa moja kwa moja ni mgumu kupata. ^[83] Epigenetikia, somo la mabadiliko ya udhihirisho wa kijeni katika kuitikia vipengele vya kimazingira visivyobadilisha DNA, pia inaaminika kuchangia katika kubaini hatari ya kujiua.^[85]

Kinga

Kama mpango wa kuzuia visa vya kujiua, picha hii inahamsisha kuhusu simu maalum kwenye Daraja la Golden Gate iliyounganishwa na simu ya dharura ya ushauri.

Kuzuia kujiua ni neno linalotumika kumaanisha juhudi za pamoja za kupunguza matukio ya kujiua kupitia hatua za kuzuia. Kupunguza ufikiaji mbinu fulani za kujiua, kama vile bunduki au sumu, hupunguza hatari hii. ^[58]^[86] Hatua zingine ni pamoja na kupunguza ufikiaji makaa na kuweka vizuizi kwenye madaraja na reli za chini ya ardhi. ^[58] Matibabu dhidi ya uraibu wa dawa za kulevya na pombe, mfadhaiko na majaribio ya kujiua pia yanaweza kuwa mwafaka. ^[86] Baadhi ya wataalam wamependekeza ufikiaji pombe kama mkakati wa kuzuia (kama vile kupunguza idadi za baa.) ^[12] Ingawa simu ya dharura ya ushauri hutumika sana, ushahidi uliopo ni mdogo wa kuunga mkono au kupinga ufanisi wake. ^[87]^[88] Katika vijana ambao awali wamekusudia kujiua, matibabu ya kubadilisha mawazo yametambulika kuboresha matokeo. ^[89] Ukuaji wa uchumi unaweza kupunguza viwango vya visa vya kujiua kupitia uwezo wake wa kupunguza umaskini. ^[53] Juhudi za kuongeza mahusiano ya kijamii, hasa katika wanaume wazee zinaweza kuwa mwafaka. ^[90]

Uchunguzi wa kimatibabu

Takwimu zilizopo hazitoshi kuelezea matokeo ya uchunguzi wa kimatibabu kwa umma na viwango vya hatima vya viwango vya kujiua. ^[91] Kwa kuwa kuna watu wengi wasio katika hatari ya kujiua wanaopata matokeo chanya kupitia mbinu hii, kuna wasiwasi kuwa uchunguzi unaweza kuongeza kwa kiasi kikubwa utumiaji wa raslimali za huduma ya afya. ^[92] Hata hivyo, inapendekezwa kuwachunguza watu walio katika hatari kuu ya kujiua. ^[13] Kuuliza kuhusu uwezo wa kujiua hakuonekani kuongeza hatari hii.^[13]

Maradhi ya akili

Katika watu walio na matatizo ya akili, aina kadhaa za matibabu zinaweza kupunguza hatari ya kujiua. Watu walio na hisia za kujiua wanaweza kulazwa katika kituo cha utunzaji wa kiakili, kwa hiari au bila hiari yao. ^[13] Kwa kawaida, vifaa anavyoweza kutumia mtu kujiumiza huondolewa. ^[24] Baadhi ya madaktari huwaagiza wagonjwa kutia saini mkataba wa kuzuia kujiua ambapo wanaahidi kutojiumiza iwapo wataachiliwa. ^[13] Hata hivyo, ushahidi hauonyeshi matokeo mengi ya hatua hii. ^[13] Iwapo mtu yuko katika kiasi kidogo cha hatari, matibabu ya mgonjwa wa nje yanaweza kupangiwa. ^[24] Kulazwa kwa muda mfupi hospitalini hakujatambulika kuwa na ufanisi zaidi ya utunzaji wa kijamii ili kunufaisha matokeo kwa wale walio na tatizo la nafsi hafifu, ambao huwa na hisia za muda mrefu za kujiua. ^[93]^[94]

Kuna ushahidi wa kutosha kuonyesha kuwa matibabu ya kisaikolojia, hasa matibabu ya kitabia ya upembuzi, hupunguza uwezo wa kujiua katika vijana baleghe ^[95] pamoja na wale walio na tatizo la nafsi hafifu.^[96] Hata hivyo, ushahidi haujapata upungufu katika visa kamilifu vya kujiua. ^[95]

Kuna utata kuhusu manufaa ya matibabu ya mfadhaiko, ikilinganishwa na madhara yake. ^[11] Katika vijana, matibabu mapya zaidi, kama vile KCUS huaminiwa kuongeza hatari ya kujiua kutoka watu 25 hadi 40 kwa kila 1000. ^[97] Hata hivyo, katika watu wazee,matibabu haya yanawaweza kupunguza hatari ya kujiua.^[13] Lithiamu huaminika kuwa mwafaka katika kupunguza hatari katika watu walio na maradhi ya hisia mseto na maradhi ya mfadhaiko mkuu hadi kufikia viwango sawa na watu wengine wa kawaida. ^[98]^[99]

Epidemologia

Takriban 0.5% hadi 1.4% ya watu hufikia kifo kwa kujiua. ^[2]^[13] Kote ulimwenguni kufikia mwaka wa 2008/2009, kujiua ni kisababishi cha kumi kikuu ^[1], huku takriban watu 800,000 hadi milioni moja wakifa kila mwaka, ikipelekea kima cha vifo cha watu 11.6 kwa kila 100,00 kwa mwaka. ^[2] Kima cha vifo kimeongezeka hadi 60% kutoka miaka ya 1960 hadi 2012, ^[86] huku ongezeko hili likitambulika hasa katika mataifa yanayostawi.^[1] Kwa kila kisa cha kujiua, kuna majaribio mengine 10 hadi 14 ya kujiua. ^[13]

Viwango vya kujiua hutofautiana pakubwa kati ya nchi na wakati. ^[2] Takwimu kwa asilimia ya vifo mwaka wa 2008 zilikuwa: Afrika 0.5%, Kusini Mashariki mwa Asia 1.9%, Marekani 1.2 na Uropa 1.4%. ^[2] Viwango kwa kila watu 100,00 vilikuwa: Australia 8.6, Canada 11.1, Uchina 12.7, India 23.2, Uingereza 7.6, Marekani 11.4. ^[101] Kujiua kumerodheshwa katika nafasi ya 10 kama kisababishi cha kifo kinachoongoza nchini Marekani mwaka wa 2009, ikiwa ni takriban visa 36,000 kila mwaka. ^[102] Takriban watu 650,000 hupatikana katika idara ya dharura kila mwaka kutokana na majaribio ya kujiua. ^[13] Nchi za Lithuania, Japani na Hangeria zina viwango vikubwa zaidi vya aina za kujiua. ^[2] Nchi zilizo na idadi kuu zaidi ya visa vya kujiua ni Uchina na India, zikihasibia zaidi ya nusu yaidadi yote ^[2] Nchini Uchina, kujiua ni kisababishi cha 5 kikuu cha kifo. ^[103]

Jinsia

Suicide rate per 100,000 males (left) and female (right) (data from 1978–2008).

no data < 1 1–5 5–5.8

5.8–8.5 8.5–12 12–19 19–22.5

22.5–26 26–29.5 29.5–33 33–36.5

>36.5

Katika mataifa ya magharibi, wanaume hufa mara 3 hadi 4 zaidi kutokana na kujiua kuliko wanawake, ingawa wanawake hujaribu kujiua mara 4 zaidi. ^[2]^[13] Hali hii imesababishwa na wanaume kutumia mbinu kali zaidi za kujiua. ^[104] Tofauti hii inadhihirika zaidi katika watu wa umri wa zaidi ya miaka 65, huku visa vya kujiua kwa wanaume vikiwa zaidi ya vya wanawake kwa hadi mara 10. ^[104] Uchina kuna mojawapo ya viwango vikuu zaidi vya kujiua kwa wanawake duniani, na ndiyo nchi pekee ambapo viwango vya kujiua kwa wanawake ni zaidi ya wanaume (uwiano wa 0.9). ^[2]^[103] Katika Masharariki mwa Mediterranean, viwango vya kujiua ni karibu sawa baina ya wanaume na wanawake. ^[2] Katika wanawake, viwango vikubwa vya visa vya kujiua vinapatikana Korea Kusini, ikiwa ni watu 22 kwa watu 100,000, huku kukiwa na viwango vya juu Asia ya Kusini Mashariki na Magharibi mwa Pasifiki kwa kijumla.^[2]

Umri

Visa vingi vya kujiua katika nchi nyingi hutokea katika watu wa umri wa makamo^[105] au wazee.^[58] Hata hivyo, idadi kamili ya visa vya kujiua ni vingi katika watu wa umri wa kati ya miaka 15 na 29, kwa sababu ya idadi ya watu iliyopo katika kikundi hiki.^[2] Nchini Merikani, visa hivi hutokea kwa wingi katika kizungu, hasa wa umri wa zaidi ya miaka 80, ingawa watu wa umri wa chini hujaribu kujiua mara nyingi.^[13] Kujiua ni kisababishi cha pili kikuu cha vifo katika umri wa balegheHitilafu ya kutaja: Closing </ref> missing for <ref> tag Katika Ugiriki ya Kale na Roma, njia ya kujiua ilikubaliwa kama njia ya kuonyesha kushindwa vitani ^[106]. Ingawa kujiua kulikubalika mwanzoni katika Roma ya kale, baadaye kuliharamishwa kama kosa dhidi ya serikali kwa sababu ya gharama za kiuchumi.^[107] Amri ya uhalifu iliyotolewa na Louis XIV wa Ufaransa mwaka wa 1670 ilitoa adhabu kali zaidi: maiti ya mtu aliyejiua ilibururwa mitaani huku kichwa kikielekezwa chini, kisha kuninginishwa au kutupwa kenye biwi la takataka. Vile vile, mali yote ya mshukiwa ilichukuliwa.^[108]^[109]. Katika historia ya Ukristo, watu waliojaribu kujiua walikuwa wakitengwa, huku waliokufa kufuatia kujiua wakizikwa nje ya eneo takatifu la makaburi.^[110] Katika miaka ya mwishoni mwa karne ya 19 nchini Uingereza, jaribio la kujiua lilifananishwa na jaribio la kuua na adhabu yake ilikuwa kunyongwa.^[110] Katika karne ya 19 barani Uropa, mtazamo wa kujiua ulibadilishwa kutoka mtazamo kuwa kulisababishwa na dhambi, hadi kuwa kulisababiswa na wazimu.^[109].

Jamii na Utamaduni

Sheria

A *tantō* Kisu kilichotayarishwia *seppuku*.

Katika mataifa mengi ya Ulaya, kujiua hakuchukuliwi kama hatia tena,^[111] ingawa mtazamo huo ulikuwa katika mataifa mengi ya Uropa kuanzia Enzi za Kati hadi angalau miaka ya 1800.^[112] Mataifa mengi ya Kiislamu huchukulia kujiua kama hatia.^[48]

Nchini Australia, kujiua si hatia.^[113]Hata hivyo, ni hatia kumshauri, kumchochea, au kumsadia na kumshawishi mtu kujaribu kujiua. Sheria inamruhusu kikamilifu mtu yeyote kutumia "kiwango chochote cha nguvu kama itakavyohitajika" ili kumzuia mwingine asijiue.^[114] Milki ya Kaskazini mwa Australia iliruhusu, kwa muda mfupi, kifo halali cha kusaidiwa na daktari kutoka 1996 hadi 1997.^[115]

Barani Uropa, hakuna taifa lolote linalochukulia kitendo au jaribio la kujiua kama hatia kwa sasa.^[110] Uingereza na Wales waliondoa sheria iliyoharamisha kujiua kupitia Sheria ya kijiua ya 1961, nayo Jamhuri ya Ayalandi ikifuatia mwaka wa 1993. ^[110] Neno "kutenda" ilitumika kurejelea uharamu wa kujiua. Hata hivyo, mashirika mengi yamekoma kulitumia kwa sababu ya mtazamo mbaya ya neno hili.^[116]^[117]

Nchini India, kujiua ni hatia, na jamii ya mwathiriwa inaweza kushtakiwa.^[118] Nchini Ujerumani, utanazia ni haramu na mtu anayeshuhudia mwingine akijiua anaweza kuhukumiwa kwa kukosa kutoa usaidizi wakati wa dharura.^[119] Uswisi hivi majuzi imepiga hatua katika kuruhusu usaidizi wa kujiua kwa watu walio na ugonjwa wa muda mrefu wa akili. Mahakama kuu ya Lausanne, katika hukumu moja mwaka wa 2006, ilimpa mtu ambaye hakutajwa jina, mwenye tatizo la kiakili la muda mrefu idhini ya kujiua.^[120]

Nchini Merikani, kujiua si hatia, ingawa watu wanaojaribu kujiua wanaweza kuadhibiwa.^[110] Kujiua kwa kusaidiwa na daktari ni halali katika jimbo la Oregon^[121] na Washington.^[122]

Mtazamo wa kidini

Faili:Mjane wa Hindoo akijichoma pamoja na maiti ya mumewe.jpg

A Mhindu Mjane akijichoma pamoja na maiti ya mumewe, miaka ya 1820.

Katika dhehebu nyingi za Ukristo, kujiua huchukuliwa kama dhambi, kwa msingi wa maandishi ya Wakristo wasomi wenye ushawishi mkuu wa Enzi za Kati kama vile Mtakatifu Agostino na Mtakatifu Thomas Aquinas. Hata hivyo, kujiua hakukuchuliwa kama dhambi katika kanuni za Kijustina za Milki ya Bizantiamu, kwa mfano.^[123]^[124] Katika kanuni za Kikatoliki, mswada wa kujiua uko kwenye msingi wa amri "Usiue" (iliyoidhinishwa katika Agano Jipya na Yesu katika Mathayo 19:18), pamoja na dhana kuwa uhai ni karama kutoka kwa Mungu, hivyo haufai kudhalilishwa. Vile vile, kuua ni kinyume na "amri asilia", hivyo huathiri mpango mkuu wa Mungu hapa Duniani.^[125]

Hata hivyo, inaaminiwa kuwa ugonjwa wa akili au woga mkuu wa kuteseka hupunguza wajibu wa mtu anayejiua.^[126] Miswada pinzani ni pamoja na ifuatayo: kuwa Amri ya sita imefasiliwa kifasaha kama "usitekeleze mauaji", ambayo hailengi moja kwa moja mtu binafsi ; yaani Mungu amempa uhuru kila binadamu kujichagulia; ya kuwa mtu akijiua hajavunja Sheria za Mungu, sawa na kuponya ugonjwa; na kuwa visa vingi vya wafuasi wa Mungu waliojiua vimenakiliwa katika Bibilia bila kuambatana na laana yoyote.^[127]

Desturi za Kiyahudi huzingatia umuhimu wa kudhamini maisha yaliyopo, hivyo kujiua huchukuliwa kuwa sawa na mtu kujinyima wema wa Mungu duniani. Licha ya hayo, katika hali mbaya ambapo hakuna chaguo lingine ila kuuawa au kulazimishwa kuisaliti dini yao, Wayahudi walijiua kibinafsi au kujiua kwa umati (tazama Masada, Mateso ya kwanza ya Wayahudi nchini Ufaransa, na York Castle, kwa mifano). Kwa ukumbusho wa tahadhari, kuna sala katika liturujia ya Kiyahudi ya "kisu kiwapo kooni" kwa watu wanaokufa "kulitukuza jina la Mungu "(tazama Ufiadini). Matendo haya yamepokelewa kwa njia mbalimbali na watawala wa Kiyahudi, huku yakichukuliwa na baadhi ya watu kama mfano bora wa wafiadini mashujaa, huku wengine wakiyachukulia kama hatia kwa watu kujiua kwa kutazamia ufiadini.^[128]

Uislamu haukubali kujiua.^[48] Katika Uhindu kwa kijumla, kujiua hakukubaliwi, hivyo huchukuliwa kuwa dhambi sawa na kumuua mtu mwingine katika jamiii ya kisasa ya Kihindu. Maandiko ya Kihindu yanasema kuwa mtu anayejiua huingia katika ulimwengu wa mapepo, akitangatanga duniani hadi wakati ambapo angekufa iwapo hangejiua.^[129] Hata hivyo, Uhindu hukubali haki ya kujiua kupitia njia isiyo na dhuluma ya kujinyima chakula hadi kufa, inayojulikana kama Prayopavesa.^[130] Hata hivyo, Prayopavesa hukubalika tu kwa watu wasiokuwa na hamu au matarajio, wala majukumu maishani.^[131] Ujaini una desturi sawa na hii, iitwayo Santhara. Desturi ya Sati, au kujitoa kama kafara kwa wajane ilikuwepo katika Enzi za Kati.

Filosopfia

Faili:Njia ya kutokea.jpg

Njia ya kutokea, au Dhana za kujiua: George Grie, 2007.

Maswali mengi yameulizwa katika filosofia ya kujiua, ikiwa ni pamoja na fasili ya kujiua, ikiwa kujiua ni chaguo la busara au la, na kuruhusika kimaadili kujiua.^[132] Miswada ya kifilosofia inayohusu kuruhusu au kutoruhusu kujiua kama jambo linaloweza kukubalika kimaadili hutofautiana kutoka upinzani, (kwa kuchukulia kujiua kama mwiko) hadi kuchukulia kujiua kama haki ya kimiungu kwa mtu yeyote (hata mtu mchanga mwenye afya njema) anayeamini kwamba amefikia, kwa busara na dhamiri, uamuzi wa kukatisha maisha yake.

Wapinzani wa kujiua ni pamoja wanafilosofia Wakristo kama vile Agostino wa Hippo na Mtakatifu Thomas Aquinas,^[132] Immanuel Kant^[133] na, kwa njia moja John Stuart Mill – malengo ya Mill kuhusu umuhimu wa uhuru na kujitawala yalipelekea yeye kupinga chaguo ambazo zingemzuia mtu kufanya uamuzi wa kibinafsi katika siku za usoni.^[134] Watu wengine huchukulia kujiua kama jambo halali la kujichagulia kibinafsi. Waafiki wa dhana hii husisitiza kuwa mtu yeyote hafai kushurutishwa kuteseka kinyume na mapenzi yake, hasa kutokana na hali kama vile ugonjwa usiotibika, ugonjwa wa akili na uzee usiokuwa na uwezekano wa kuimarika. Waafiki hawa hupinga imani ya kwamba, kila wakati, kujiua ni jambo lisilo la busara, badala yake wakihimiza kuwa linaweza kuwa chaguo halali la mwisho, kwa watu wanopitia maumivu makali au dhiki.^[135] Dhana nyingine yenye msimamo mkali inahimiza kuwa watu wanapaswa kuruhusiwa wajichagulie kufa bila kuzingatia iwapo wanateseka au la. Waafiki mashuhuri wa dhana hii ni pamoja na Mskoti mwana falsafa David Hume^[132] na Mmarekani mwana bayojilia na maadili Jacob Appel.^[120]^[136]

Utetezi

Utetezi wa kujiua umetokea katika tamaduni nyingi na vijitamaduni. Jeshi la Japani, katika Vita vya II vya Dunia, liliruhusu na kutukuza mashambulizi ya kamikaze. Haya yalikuwa mashambulizi ya kujiua yaliyotekelezwa na wanajeshi wanahewa wa Milki ya Japani dhidi ya vyombo vya majini vya Majeshi ya Muungano katika awamu za mwisho za uhamasisho wa Pasifikia wa Vita vya II vya Dunia. Jamii ya Japani kwa jumla imechukuliwa kama " inayoruhusu" kujiua^[138] (tazama Kujiua nchini Japan).

Pekuzi mtandaoni kuhusu kijiua hutoa kurasa za mtandao ambazo huruhusu au kuwezesha majaribio ya kujiua kwa kiwango cha 10-30%. Kuna maoni kuwa kurasa kama hizo zinaweza kuchochea watu walio hatarini hadi wakajiua.Baadhi ya watu hutia mkataba wa kujiua mtandaoni, wakiwa na marafiki waliokuwa wakijuana mbeleni au waliopatana katika vyumba vya majadiliano au majojpo ya habari. Hata hivyo, mtandao pia unaweza kusaidia kuzuia kujiua kupitia vikundi vya mahusiano kwa watu waliotengwa.^[139]

Maeneo

Baadhi ya maeneo yamekuwa maarufu kwa visa vingi vya majaribio ya kujiua.^[140] Haya ni pamoja na Daraja la Golden Gate, Jimbo la San Francisco; msitu wa Aokigahara, Japani;^[141] Beachy Head, Uingereza;^[140] na Bloor Street Viaduct, jijini Toronto.^[142]

Kufikia mwaka wa 2010, Daraja la Golden Gate limekuwa na zaidi ya visa 1300 vya kujiua kwa kuruka tangu daraja hilo kujengwa mnamo 1937.^[143] Maeneo mengi ambapo visa vingi vya kujiua hutokea yana vizuizi vilivyojengwa ili kuzuia visa hivi.^[144] Maeneo haya ni pamoja na Luminous Veil jijini Toronto,^[142]na vizuizi katika mnara wa Eiffel jijini Paris na Jengo la Empire State jijini New York.^[144] Tangu mwaka wa 2001, kizuizi kinaendelea kujengwa katika daraja la Golden Gate ^[145] Vizuizi vimeonekana kuwa mwafaka sana.

Spishi zingine

Baadhi ya watu hudhani kuwa kujiua hakuwezi kutokea katika viumbe wengine wasiokuwa na utu, kwa sababu kujiua huhitaji jaribio la hiari la kufa.^[106] Mitindo inayohusishwa na kujiua imetambulika katika salmonela zinazojitahidi kushindana na bakteria kwa kuchochea mfumo wa kingamwili dhidi ya bakteria hizi.^[146] Hatua za kujikinga kwa kujiua zimetambulika katika aina ya mchwa wa Brazil, Forelius pusillus, ambapo kikundi kidogo cha mchwa huacha usalama wa kiota kila usiku, baada ya kufunga milango wakiwa nje. ^[147]

Afidi ya choroko, anapotishwa na mbawakawa, anaweza kujilipua na kutapakaa ili kuwakinga wengine, na hata wakati mwingine anaweza kuwaua mbawakawa hao.^[148] Baadhi ya spishi za mchwa wana walinzi wanaojilipua hivyo kuwafunika adui zao na michozo inayoshikamanisha.^[149]^[150]

Kumekuwa na ripoti zisizotegemewa za mbwa, farasi na pomboo wanaojiua, ingawa ushahidi uliopo ni mdogo na hauaminiki.^[151] Kumekuwa na utafiti mdogo wa kisayansi kuhusu kujiua kwa wanyama.^[152]

Visa maarufu

Mfano wa kujiua kwa halaiki ni kujiua kwa kidhehebu mwaka wa 1978 mjini "Jonestown", ambapo wanachama 918 wa Peoples Temple, wa dhehebu la Kimarekani, wakiongozwa naye Jim Jones, walijiua kwa kunywa Flavor Aid ya zabibu iliyochanganywa na sianidi. ]].^[153]^[154]^[155] Mwaka wa 1944, zaidi ya Wajapani 10,000 walijiua katika siku za mwisho za Vita vya Saipan, baadhi yao wakiruka kutoka "Suicide Cliff" na "Banzai Cliff".^[156]

Mgomo wa kususia chakula wa 1981, ulioongozwa na Bobby Sands, ulisababisha vifo vya watu 10. Kisababishi cha vifo hivi kilirekodiwa na coroner kama "njaa ya kujitakia," badala ya kujiua. Kisababishi hiki kilibadilishwa na kuwa "njaa" kwenye vyeti vya kifo baada ya familia za waathiriwa kulalamika.^[157] Katika Vita vya II vya Dunia Erwin Rommel aligunduliwa kufahamu mbeleni kuhusu Njama ya Julai 20 kuhusu maisha ya Hitle, hivyo akatishwa kwa hukumu ya umma, kuuawa na jeshi na pia familia yake kulipiziwa kisasi iwapo hatajuia.^[158]

Vidokezo

↑ ^1.0 ^1.1 ^1.2 ^1.3 Hawton K, van Heeringen K (April 2009). "Suicide". Lancet 373 (9672): 1372–81. PMID 19376453. doi:10.1016/S0140-6736(09)60372-X. Check date values in: |date= (help)
↑ ^2.00 ^2.01 ^2.02 ^2.03 ^2.04 ^2.05 ^2.06 ^2.07 ^2.08 ^2.09 ^2.10 ^2.11 Värnik, P (2012 Mar). "Suicide in the world.". International journal of environmental research and public health 9 (3): 760–71. PMC 3367275. PMID 22690161. doi:10.3390/ijerph9030760. Check date values in: |date= (help)
↑ Meier, Marshall B. Clinard, Robert F. (2008). Sociology of deviant behavior (toleo la 14th ed.). Belmont, CA: Wadsworth Cengage Learning. uk. 169. ISBN 978-0-495-81167-1.
↑ Bertolote JM, Fleischmann A (October 2002). "Suicide and psychiatric diagnosis: a worldwide perspective". World Psychiatry 1 (3): 181–5. PMC 1489848. PMID 16946849. Check date values in: |date= (help)
↑ "Indian woman commits sati suicide". Bbc.co.uk. 2002-08-07. Iliwekwa mnamo 2010-08-26.
↑ Aggarwal, N (2009). "Rethinking suicide bombing.". Crisis 30 (2): 94–7. PMID 19525169. doi:10.1027/0227-5910.30.2.94.
↑ Stedman's medical dictionary (toleo la 28th ed.). Philadelphia: Lippincott Williams & Wilkins. 2006. ISBN 978-0-7817-3390-8.
↑ ^8.0 ^8.1 Krug, Etienne (2002). World Report on Violence and Health (Vol. 1). Genève: World Health Organization. uk. 185. ISBN 978-92-4-154561-7.
↑ ^9.0 ^9.1 Gullota, edited by Thomas P.; Bloom, Martin (2002). The encyclopedia of primary prevention and health promotion. New York: Kluwer Academic/Plenum. uk. 1112. ISBN 978-0-306-47296-1.
↑ Karch, DL; Logan, J; Patel, N; Centers for Disease Control and Prevention, (CDC) (2011 Aug 26). "Surveillance for violent deaths—National Violent Death Reporting System, 16 states, 2008.". Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002) 60 (10): 1–49. PMID 21866088. Check date values in: |date= (help)
↑ ^11.0 ^11.1 ^11.2 Hitilafu ya kutaja: Invalid <ref> tag; no text was provided for refs named Hawton2012
↑ ^12.00 ^12.01 ^12.02 ^12.03 ^12.04 ^12.05 ^12.06 ^12.07 ^12.08 ^12.09 Vijayakumar, L; Kumar, MS; Vijayakumar, V (2011 May). "Substance use and suicide.". Current opinion in psychiatry 24 (3): 197–202. PMID 21430536. doi:10.1097/YCO.0b013e3283459242. Check date values in: |date= (help)
↑ ^13.00 ^13.01 ^13.02 ^13.03 ^13.04 ^13.05 ^13.06 ^13.07 ^13.08 ^13.09 ^13.10 ^13.11 ^13.12 ^13.13 ^13.14 ^13.15 ^13.16 ^13.17 ^13.18 ^13.19 ^13.20 ^13.21 Chang, B; Gitlin, D; Patel, R (2011 Sep). "The depressed patient and suicidal patient in the emergency department: evidence-based management and treatment strategies.". Emergency medicine practice 13 (9): 1–23; quiz 23–4. PMID 22164363. Check date values in: |date= (help)
↑ Simpson, G; Tate, R (2007 Dec). "Suicidality in people surviving a traumatic brain injury: prevalence, risk factors and implications for clinical management.". Brain injury : [BI] 21 (13–14): 1335–51. PMID 18066936. doi:10.1080/02699050701785542. Check date values in: |date= (help)
↑ ^15.0 ^15.1 Miller, M; Azrael, D; Barber, C (2012 Apr). "Suicide mortality in the United States: the importance of attending to method in understanding population-level disparities in the burden of suicide.". Annual review of public health 33: 393–408. PMID 22224886. doi:10.1146/annurev-publhealth-031811-124636. Check date values in: |date= (help)
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↑ Hitilafu ya kutaja: Invalid <ref> tag; no text was provided for refs named Kihindu
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