Suicide

Question 1

Does talking about suicide increase feelings of depression and potentiate suicidal behavior?

Answer 1

No- there is a sense of relief for the empathy and caring

Question 2

Is it true that only low-functioning or crazy people attempt suicide?

Answer 2

No

Question 3

Is there a relationship between media coverage of high profile suicides and rates of suicidal behavior in the US?

Answer 3

YES! - esp in the month following the celebrity death

Question 4

What season/month has the highest suicide rate in the US?

Answer 4

April

Question 5

What are 2 potential explanations for increased risk of suicide-related deaths among physicians?

Answer 5

1. potential barriers to adequate mental health care because of professional attitudes that discourage admission
2. physicians are more likely to have a job-related stressor compare to non-physicians

Question 6

Define suicide attempt vs. suicide.

Answer 6

Suicide attempt = self-inflicted, potentially injurious behavior with a non-fatal outcome where there was evidence the person wanted to die [explicit or implicit]

Suicide = fatality

Question 7

What is suicidal ideation?

Answer 7

Thoughts of causing one’s own death that can exist on a spectrum of:

• specificity
• frequency
• intensity
• intent

Question 8

What is suicidal intent?

Answer 8

Death is the intended result of one’s actions.

It does NOT include medical lethality [taking a bunch of meds that can’t kill you]

Question 9

What is non-suicidal self-directed violence?

Answer 9

Self-inflicted personal injury where the intent is not to kill himself/herself, but rather to garner attention

Question 10

What is the relationship between gender and suicide?

Answer 10

Women are more likely to attempt suicide but men are 4x more likely to complete suicide

Question 11

What are high risk groups for suicide?

Answer 11

1. lesbian, gay, bisexual youth
2. returning veterans [although freq has decreased]
3. old, lonely white men

Question 12

What race/ethnicity is most likely to commit suicide?

Answer 12

Caucasians are greater than 90% of suicides in the country

US American Indians and Alaskans have the highest suicide rates [but because their total population is small, whites still have the highest frequency]

Question 13

What acute risk factors increase the chances of intentional self-harm in a suicidal person?

Answer 13

1. current ideation, intent, plan, access to means
2. recent suicide attempt
3. recent self-harm behavior
4. hopelessness- presence, duration, severity
5. recent discharge from an inpatient psychiatric unit

• increased alcohol/substance abuse
• impulsivity and poor self control
• intense psychological pain

Question 14

What 3 factors decrease the risk of intentional self harm in a suicidal person?

Answer 14

1. positive social support
2. spirituality- religious beliefs prohibit it
3. children at home/pregnancy

• responsibility to family
• life satisfaction
• intact reality testing [no psychosis, paranoia, delusion]
• positive coping skills

Question 15

What 5 patient groups should be screened routinely for for suicide risk?

Answer 15

1. symptoms of depression or mania
   - ask about suicide risk
2. history of mental illness
3. warning signs
4. active-duty military returned from combat
5. released recently from psychiatric facility

Question 16

When should a patient be referred for outpatient evaluation by a mental health care provider?

Answer 16

1. hopeless
2. rage, anger, revenge seeking
3. reckless/risky behavior
4. increased alcohol/drugs
5. withdraw from friends, family, coworkers
6. anxious, agitated, insomnia or excessive sleep
7. changes in mood
8. unable to articulate reason for living

Question 17

When is a patient determined to be at imminent risk for suicide?
What immediate action should be taken?

Answer 17

1. verbal threats to hurt or kill themselves
2. looking for ways to kill themselves
   - access to weapons, pills, etc
3. preoccupied with death, dying, suicide

Action Steps:

1. do not leave the person alone [1:1 monitoring]
2. request psychiatric eval
3. involve family/friends [SAFETY> confidentiality]
4. limit access to means of suicide [have family clear out their residence of weapons, pills etc]

Question 18

What 2 actions are crucial when responding to a suicidal crisis?

Answer 18

1. assure the patient’s immediate safety
   - 1:1, psychiatric eval, involve family, limit access to means
2. Determine appropriate treatment setting
   - call police to escort patient to emergency psych eval
   - Refer patient for psych eval and assure followup is made
   - increase contact and commit to help through the crisis

Question 19

How does age affect suicide?

Answer 19

Increased # under 30 attempt suicide
Increased # over 45 complete suicide

Rate of suicide for adults over 75 is higher than general population

Question 20

What is the effect of psychiatric illness on suicide?

Answer 20

90% of suicide victims have a psychiatric disorder

• bipolar
• schizophrenia
• borderline personality disorder, MDD
• depression
• alcohol/drug abuse

Question 21

What is the correlation btw antidepressant use and suicide?

Answer 21

Black box warning that medication increases suicide ideation and behavior in children, adolescents and young adults but not 24-65 age group

Question 22

What are the perpetuating risk factors for suicide that are permanent and non-modifiable?

Answer 22

1. age and gender
2. history of attempts
3. prior ideation
4. history of self-directed violence
5. trauma/abuse
6. psychiatric hospitalization
7. separation, divorce, marital conflict

Question 23

What are Major Axis I psychiatric disorders?

Answer 23

1. mood disorders
2. schizophrenia
3. anxiety disorders
4. substance use disorders
5. body dysmorphic disorder

Question 24

What are the Axis II personality disorders?

Answer 24

Cluster B - borderline personality, antisocial, narcissistic, histrionic

Question 25

What 3 illnesses have increased suicide risk?

Answer 25

1. HIV/AIDS
2. cancer of lung head, neck
3. MS

Question 26

What medical conditions are associated with an “unclear” risk of suicide?

Answer 26

1. Parkinson’s

2. spinal cord injuries

Question 27

What medical condition has a decreased risk of suicide?

Answer 27

pregnancy