116. Suicide

Question 1

Suicide Epidemiology

• what leading cause of death
• trends over time
• women vs. men
• race

Answer 1

10th leading cause of death for all ages
Major contributor to premature mortality
45k die in US annually by suicide
Rates increased 35% since 1999
Women 3x likely to attempt suicide (OD/suffocation) highest age 45-65
Men 4x likely to complete suicide (firearm) highest age 75+
Higher suicides among american indians/white men

Question 2

What are the modifiable and unmodifiable risk factors for suicide?

Answer 2

Unmodifiable

• Prior attempt (biggest predictor)
• +FamHx of suicide, childhood mistreatment
• +Hx of aggression/impulsivity
• recent interpersonal loss
• cultural/religious beliefs

Modifiable

• Mental Illness (depression/addition): biggest modifiable RF
• Physical Illness (chronic, terminal)
• Feelings of Personal Isolation
• Feelings of Hopelessness
• Barriers to Mental Health Tx
• Access to Lethal Means
• Local Suicide “epidemics”

Question 3

How is lethality assessed?
What is an impulsive suicide attempt?
Why are prior suicide attempts a risk factor?
What is parasuicidal behavior?

Answer 3

Lethality: highest risk and lowest chance of rescue
Impulsive: occurs without SI, assoc w/ alcohol use disorder and adverse life events
Prior attempts: 60% complete on 1st attempt, 80% of suicides after first attempt occur within ONE YEAR

Parasuicidal Behavior: suicidal behavior with less risk of death (higher rescue, lower lethality); difficult to distinguish b/w failed true attempt and manipulative gesture, used to solve interpersonal crises or communicate dysphoric affect, at higher risk of eventual suicide

Question 4

Mental Illness in completed suicide
Social RF for suicide
Protective Factors against suicide

Answer 4

Mental Illness: Depression, Alcohol use disorder, PDs, Psychotic Disorders
Social RF: Acute life event (illness, breakup, job loss), or chronic (social isolation, traumatic family background, poor health, poverty)
Protective Factors: Social support, access to tx, personal sense of family responsibility, religious/culture sanctions against suicide, good insight, skills in problem-solving

Question 5

What is the optimal practice to assess for suicide?
Public Health Strategies for Suicide
Healthcare Strategies for Suicide
- what meds are known to decrease SI?

Answer 5

Ask MORE than 1 question on current state for individuals at higher risk for suicide
Public Health Strategies: less access to lethal means, media guidelines to decrease risk of suicide, more access to psych care, promote social connectedness, more economic opportunity (more SDoH)

Healthcare Strategies: hospitalize pts at acute high risk, routine ongoing monitoring of sx status beyond reported suicidality, tx of pysch illness (clozapine, Li, antidepressants, CBT/DBT all decrease SI)
tx of substance use disorders
Address modifiable suicide RFs