3.02 Suicide Assessment and Prevention Flashcards
Primary psychiatric emergency that is a fatal act that represents the person’s wish to die. It is almost always the result of?
Suicide
-Primary psychiatric emergency that is a fatal act that represents the person’s wish to die. It is almost always the result of MENTAL ILLNESS, USUALLY DEPRESSION. This is amenable to psychological and pharmacological tx.
- Thought of serving as the agent of one’s own death.
- Subjective expection and desire for a destructive act to end in death.
- Self-injurious behavior with a non-fatal outcome
- “Successful” suicide
- Stopped the attempt before physical damage occurred
- Willful self-inflicting of pain, destructive, or injurious acts without intent to die
- Objective danger to life associated with a suicide method or action
- Suicidal Ideation
- Suicidal Intent
- Suicidal Attempt
- Completed Suicide
- Aborted Suicide Attempt
- Deliberate Self-Harm
- Lethality of Suicidal Behavior
Suicide
>~804k suicide deaths worldwide
> (1) leading cause of death in 15- to 29-year-olds
> WHO estimates that 1.53 M will die of suicide: 1 death every 20s, 1 attempt every 2s.
2nd
3 Main Risk Factors for Suicide?
- Which among them is the best indicator that a patient is at increased risk of suicide?
3 Main Risk Factors for Suicide:
- Previous suicide attempt
- Mental illness
- Demographic Data
Which among them is the best indicator that a patient is at increased risk of suicide? Previous suicide attempt. Studies show that 40% of depressed px who commit suicide have previous attempt.
The risk of a second suicide attempt is highest when?
Within 3 months of the first attempt
Risk Factor for Suicide: Mental Illness
- Almost __% of all persons who commit or attempt suicide have a diagnosed mental d/o.
- Which d/os account for #1?
- 95%
2. Depressive disorder (80%), Schizophrenia (10%), Delirium or Dementia (5%)
Risk Factor for Suicide: Demographics
- Gender which commits suicide four times more than the other?
- Gender which attempts suicide three times more often than the other?
- Expound on 1 and 2.
- Marital status: Married vs. Single, never-married vs. Divorce vs. Widows/widowers
- Socially isolated individuals
- Family hx (attempted or real)
- Homosexuality
- Male
- Female
- Disparity for #1 and 2 unclear but may be related to the methods used. Men are more likely than women to commit suicide using firearms, hanging, or jumping from high placed. Women, on the other hand, more commonly take an overdose of psychoactive substances or poison. The use of firearms among women, however, is increasing. In states w/ gun control laws, the use of firearms had dec as a method of suicide.
- Marital status:
- Marriage lessens risk of suicide significantly esp if there are children in the home.
- Single, never-married persons have an overall rate nearly double of married people.
- Divorce increases suicide risk. Divorced men three times more likely to kill themselves than divorced women.
- Widows and widowers have high suicide rates. - Suicide more often occurs
- Suicide more frequent than usual
- Homosexual indivs have higher rates of suicide than hetero
Globally, what is the most common method of suicide?
Hanging
Suicide on the day a member of their family did
Anniversary suicide
Risk Factors:
- Religion
- Protestant and Jews vs. Catholics vs. Muslims - Social status
- Employment
- Physical health and illness (i.e. previous medical care)
- Drugs (i.e. reserpine, corticosteroids, anti-HPN, some anti-cancer)
- Alcohol
- Religion
- Protestants and Jews in US have higher suicide rates then Catholics. Muslims have much lower rates. Degree of orthodoxy and integration may be a more accurate measure of risk in this category than simple insti religious affiliation. - Higher social status, greater risk. However, a drop in social status also increases the risk.
- Work in general protects against suicide. Suicide is higher among unemployed. Suicide rates increase during economic recession and depression and decrease during times high employment and during wars.
- Among occupational rankings, professionals particularly physicians, have traditionally been considered to be at great risk. Other high-risk occupations: law enforcements, dentists, artists, mechanics, lawyers, and insurance agents. - Previous medical care appears to be a positively correlated risk indicator of suicide. About ⅓ of all persons who commit suicide have had medical attention w/in 6 months of death, and a physical illness is estimated to be an important contributing factor in about half of all suicides. Factors assoc w/ illness that contribute to both suicide and attempts are: loss of mobility especially when physical activity is important to occupation or recreation.
- Certain drugs can produce depression which may lead to suicide in some cases. Among these drugs are: reserpine, CS, anti-HPN, some anti-cancer.
- ROH-related illness such as cirrhosis are associated with higher suicide rates.
The first major contribution to the study of the social and cultural influences on suicide was made at the end of the 19th century by the French sociologist: Emile Durkheim. In an attempt to explain statistical patterns, Durkheim divided suicides into 3 social categories which are?
Egoistic
- applies to those not strongly integrated into any social group
- explains higher suicide rates in unmarried people and protestants (less cohesive religion than Catholicism) and less in couples with children as well as in rural communities
Altruistic
- applies to those susceptible to suicide stemming from excessive integration into a group
- e.g. JP soldiers who sacrifice their life in battle
Anomic
- applies to persons whose integration into society is disturbed so that they cannot follow customary norms of behavior.
- explains why a drastic change in economic situation makes people more vulnerable than before change in fortune
- anomie also refers here to social instability and a general breakdown of society’s standards and values
Other theories
1. Offered the 1st important psychological insight into suicide. Described only 1 px who made a suicide attempt but saw many depressed px. In his paper “Mourning and Melancholia”, he stated his belief that suicide represents aggression turned inward against an introjected, ambivalently cathected love object. He doubted that there would be a suicide w/o an earlier repressed desire to kill someone else.
- Built on #1, in “Man Against Himself”, conceived of suicide as inverted homicide because of a patient’s anger towards another person. This retroflexed murder is either turned inward or used as an excuse for punishment. Also described a self-directed death instinct (#1’s concept of Thanatos) plus 3 components of hostility in suicide which are wish to kill, wish to be killed, or wish to die.
- W/c NT and NT metabolite has been shown to play a role in suicidal behavior as it is diminished.
- Sigmund Freud
- Karl Menninger
- Central serotonin and its metabolite, 5-hydroxyindoleacetic acid (5-HIAA)
Note: Recent studies also report some changes in the noradrenergic system of suicide victims.
Suicide Risk
- Previous attempt or fantasized suicide
- Anxiety, depression, or exhaustion
- Availability of means of suicide
- Concern for effect of suicide on family members
- Verbalized suicidal ideation
- Preparation of will, resignation, after agitated depression
- Proximal life crisis (mourning, surgery)
- Family hx of suicide
- Pervasive pessimism or hopelessness
Indications for hospitalization
ISP (Indications Pasok Siya)
1. Absence of strong Social support system
- Suicidal Plan of action
- History of Impulsive behavior
Suicide Prevention: Your presence is critical.
Never leave the person alone. Remain calm. Listen more than you speak. Act with confidence. Don’t argue.
Limit questions to gathering relevant information, not gossip.
Use supportive and encouraging comments
-“Concerned ako sa kalagayan mo”, “Di kita pababayaang saktan ang sarili mo”, “I’m here for you”
Stay non-judgmental.
Allow the person to express feelings and reasons.
