Suicidality in TBI Flashcards
What is the definition of suicide?
Any death caused by self-injurious behavior performed with any intent to die as result of that behavior
What is the definition of a suicide attempt?
Any non-fatal self-inflicted behavior performed with intent to die as a result of that behavior
What is the definition of suicidal inent?
Clinical determination via past or present evidence, either implicit or explicit, that a person wishes to die, intends to kill himself or herself, and understands the probable consequenceof his/her actions or potential actions
What are suicidal ideations?
Thoughts of engaging in suicidal behavior whre the individual has thoughts of suicide
- without a suicidal intent
- with an undetermined degree of suicidal intent
- with some suicidal intent
What are gender differences with regard to suicide (attempts) in the general population and the TBI population?
In general population:
- women are more likely to attempt suicide
- men are more likely to commit suicide
In TBI population:
- equal proportion of suicide attempts of men and women
- higer rate of death by suicide in women than in men
-> Gender-related patterns of suicidal behavior observed in the general population may not apply to patients with TBI
Why is it important to know about the timing of suicide in relation to TBI?
Because knowledge of high risk periods could assist in prevention.
However: prediction of the time period in which suicide is most likely to occur following TBI is difficult.
Teasedale & Engberg (2001): risk is relatively constant following injury for at least 15 years
Name 4 risk factors for suicidality in TBI patients
- Depression (especially symptom of hopelessness)
- Substance abuse
- Impulsivity and aggressiveness
- Severity of TBI
Name 3 aspects on which TBI has an effect that could increase the rate of depression in TBI patients
- Brain functioning
- Psychological impact of the accident
- Psychosocial problems
What can be an explanation for the fact that depression is significantly more frequent in patients with TBI than in patients without brain injury but with similar baseline characteristics who underwent similar levels of stress? (Jorge et al. 2004)
Neuropathological processes associated with TBI act as predisposition in the development of depression.
Neurbiological basis might explain depression subsequent to TBI:
- deactivation of lateral and dorsal prefrontal cortices and increased activation of ventral limbic and paralimbic structures, including the amygdala
- abnormalities in the serotonergic system
What can be an explanation for the fact that there, next to TBI patients, also an elevated risk of suicide in patients with mild injuries (e.g. concussion) but do not suffer the same long-term effects?
Assumption:
- association not the consequence of injury per se, but:
- association arises from pre-morbid or concominant characteristics
Name 4 protective factors for those with a history of TBI/suicidality
- Social support
- Having a sense of purpose/hope
- Religion/spirituality
- Mental health care (acces, possibilities)
What is the definition f a warning sign with regard to suicidality?
Rudd et al. (2006):
The earliest detectable sign that indicates heightened risk for suicide in the near-term (i.e. within minutes, hours or days)
-> immediate intervention needed!
What are the 3 warning signs (not specific to TBI) indicating need for immediate intervention? (American Association for Suicidology)
- Threatening to hurt or kill oneself
- Looking for ways to kill oneself uch as seeking access to pills, weapons, or other means
- Talking or writing about death, dying, or suicide
What are warning signs (not specific to TBI) indicating the need for mental health treatment but NOT necessarily immediately (American Association for Suicidology)
- hopelessness
- rage, anger, or revenge-seeking behavior
- acting reckless or engaging in risky activities, seemingly without thinking
- feeling trapped
- increasing acohol or drug use
- withdrawing from friends, family or society
- anxiety, agitation, inability to sleep, or sleeping all the time
- dramatic changes in mood
- no reason for living or no sense of purpose in life
What is an example of an assessment tool for suicide risk?
Columbia Suicide Severity Rating Scale (C-SSRS)
