Suicide

Question 1

Basic Epidemiology of Suicide

Answer 1

Over 32,000/yr in US
Over 800,000/year world-wide

4th leading cause of death (3rd for ages 15-24)

Majority of people not under psychiatric care
3/4 had contact with PCP in previous year
2/3 had contact with PCP in previous month

Question 2

Suicide Risk Factors with Psych Illness

Answer 2

90% of suicide victims have a psychiatric illness

Affective disorders with highest risk
Risk increased by psychosis and/or substance use

45-75% have mood DO
2.4% lifetime risk of suicide for any mood DO
1-3% lifetime risk with depression
15% lifetime risk with severe depression requiring hospitalization

Tx Hx: psych hospitalization, treatment, or recent discharge

Question 3

“Static” risk factors for completed suicide

Answer 3

1) Previous Attempts
2) Male (female more attempts, men more completions)
3) Single, divorced, or widowed
4) Age > 65
5) Caucasian
6) Unemployment / financial stress
7) Major medical illness / Worsening health
8) Abuse / Trauma
9) Family Hx of suicide

Question 4

“Dynamic” risk factors for suicide (modifiable)

Answer 4

1) Access to firearms
2) Substance misuse/dependence
3) Severe anxiety, agitation, insomnia
4) Impulsivity
5) Psychosis
6) Hopelessness
7) Physical Pain
8) Polarized thinking (black/white), constricted thinking (no other options)
9) Lack of social supports

Question 5

Protective Factors against suicide

Answer 5

1) Beliefs (moral, religious, needs of family)
2) Positive, supportive relationships
3) Having something to live for