Psych - Suicide Flashcards
Epidemiology
36,000 suicides a year
11/100,000 people
11 attempts for every 1 completed suicide
Not without consequences – brain trauma, liver damage, hospitalizations, stress, loss of relationships, etc!
3 peaks of suicide risk –> ADOLESCENCE, MIDDLE AGE, OLD AGE
Elderly OVER 65 have a rate 6x over the national average!!!
FEMALES attempt more, but MALES complete more suicides
Suicide Attempt vs. Suicide Completion
Attempts –> females, young people, Native Americans, financial difficulty, social isolation, recent adverse events
Completion –> ELDERLY, Caucasians, MALES, financial difficulty, social isolation, recent adverse events
Risk Factors
Depression, substance related disorders and other mental disorders are present in 90% of people who die from suicide
There are TREATMENTS for these - just goes to show how preventable this public health crisis can be!
Chronic Illness
Prior attempts
Family history (of mental disorders, substance abuse or attempts)
Availability of Firearms
EXPOSURE to others who attempt or have attempted, besides just family –> Copycat suicides :(
Neurobiological risk factors too (decreased 5HT could lead to impulsivity and aggression)
Bipolar Disorder
Risk of suicide jumps to 400-1400/100,000 annually
This rate is SO MUCH HIGHER (1000x) and FAR MORE ARE COMPLETED
Highest risk in younger BPD patients who are frustrated with their illness
Associated with the depressive/mixed state (agitation and depression) of BPD
LITHIUM has been shown to DECREASE SUICIDE RISK –> use it more!
Research Methods to Identify Risk Factors
Vital Statistics – data collected from autopsies. Determination of suicide is complex – evidence is vague and the cause and manner may be wrongfully classified as incidental or undetermined, rather than suicide, which could lead to under-reporting
Psychological Autopsies – detailed interviews with loved ones and friends of the deceased to collect information about the psychiatric diagnosis and to construct a retrospective suicide risk
Follow up of clinical samples – prospective observation of those with high-risk behavior for suicide and then associating other risk factors to suicide
Risk Assessment is very important, but difficult
Patient may be motivated to mislead the physicians or family members
Consider symptoms, demographics and psychosocial factors
Impulsivity, aggression and access to weapons must be considered
Physicians need to face their own biases and discomforts in dealing with suicide, as well as acknowledge the inherent difference between their goal to prevent suicide and the patient’s goal to eliminate pain through suicide –> ERR ON THE SIDE OF AUTION
Conducting Risk Assessment
Observation and active listening
Look for DEPRESSION
Look for substance abuse/dependence
Be aware of the link to chronic pain – 17% admitted that pain was a precipitant for attempting suicide
DIRECTLY ASK ABOUT SUICIDE
Preventing Suicide
Treatment of MENTAL DISORDERS and SUBSTANCE ABUSE is first line!
Modifiable risk factors to be addressed –> symptoms such as anxiety, agitation, hopelessness, hallucinations, or insomnia should be treated aggressively
Protective factors such as social supports need to be strengthened
Access to weapons should be addressed
Remove expired or unused medications
CBT reduces the rate of repeated attempts by 50% during a year of follow-up by providing patients with alternative thoughts
BETTER OUTREACH TO MEN, and ESPECIALLY BETTER PRIMARY CARE RECOGNITION!!!! 45% of elderly who committed suicide saw a primary care doctor a month prior!!! 19% saw a mental health provider!
Myths about suicide
Talking about it will NOT give the patient ideas - it will provide the patient with relief and the chance to talk about their problems
It is assumed that people who talk about suicide will not follow through while, in reality, 69% of people who eventually complete suicide COMMUNICATED IT WITHIN THE LAST YEAR!!!! So, ANY MENTION needs to be taken seriously!
Prior attempts are a HUGE RISK FACTOR (just because they weren’t successful once does NOT mean they won’t try again)
It is NOT NORMAL in mental disorders to want to commit suicide – these people do still want to live way more often than not!
How many people are affected by each suicide?
On average, 6 other people are affected..at least
Grief, shame, blame, anger, guilt – all affect these people
YOUTHS are affected strongly by suicide, particularly if it’s a parent – they are then at risk for behavioral issues themselves
