Suicide Flashcards
what gives an increased risk of suicide for:
- age
- behavior
- sex
- race
- social status
- religion
- health
- occupation
- economic condition
higher risk if:
- older adults
- chronic substance abuse/dependence, with history of race/violent behavior
- white males
- socially isolated, unmarried
- Jewish or Protestant
- chronic illness
- professional occupation with low job satisfaction in a recession/depression
what are some behavioral science symptom precursors to suicide?
- anxiety, agitation, panic attacks, insomnia, restlessness
- irritability, hostility, aggressiveness, impulsivity
- hypomania and mania
- hopelessness and helplessness
what is the risk triad of suicide?
- ideation (thinking)
- intention (wanting)
- plan (doing)
explain the epidemiology of suicide
12/100,000 (increasing in adolescents, decreasing in teens)
- > 30,000 successful out of >600,000 attempts a year
- symptom/complication of many psychiatric disorders, and treatment may increase risk
- almost always due to mental illness (usually depression)
- 11th cause of death in US, and “average” for international rates
- -higher: Scandinavia, Japan, Switzerland, Germany, Austria, Eastern Europe
- -lower: Spain, Italy, Ireland, Egypt, Netherlands
age and suicide
children: rare before puberty
adolescents: 3rd leading cause of death (1-2 million/year)
adults: rare increases substantially after 55 yo
elderly: decreases for women, increases for men
- -attempt suicide less often than younger, but usually more successful
- -elderly are 10% of population, but 25% of suicides
gender and suicide
- women attempt 4x as much as men, but using less lethal means (overdose), so unsuccessful
- men are successful 3x as much as women by using more violent means (firearms, hanging, jumping)
ethnicity and suicide
- African Americans have lower rates than White or Native Americans
- -race gap narrows among male adolescents (esp. if with gun)
- immigrants have higher rates of suicide (both here and in native countries) due to life transition
marital status and suicide
- lowest if married, especially if young children at home
- higher rate if separated, divorced, or widowed
- -divorced men are 3x as likely to commit suicide than divorced women
- higher especially if loss of partner occurred in recent past
what is an “anniversary suicide”?
person commits suicide on the day a member of their family did
religion and suicide
- lower in Catholic and Islamic religions (specifically prohibit in teachings and practice)
- highest in Protestant
- may depend on degree of orthodoxy rather than religion itself
occupations and suicide
- of employed persons, rate is higher in professionals than non-professionals
- -due to access to means (drugs, guns)
- fall in social status also increases risk
- higher if unemployed
suicide in physicians
- higher in female physicians (highest risk for females)
- -41/100000
- physicians who commit suicide usually have mental disorder, usually depression and/or substance abuse
- usually occurs by substance overdose, due to drug availability and knowledge about toxicity
- psychiatrists are at greatest risk, followed by ophthalmologists and anesthesiologists
substance abuse and suicide
- both chronic and acute use
- decrease inhibitions against risk-taking behavior
genetics and suicide
- monozygotic > dizygotic twins
- FH is relevant b/c death of a parent by suicide or when child was younger than 11 yo
- -increased risk if loss of parents by divorce in adolescence
- short allele for serotonin transporter (reuptake pump) to convey poor resilence, increased MDD, and suicide risk when faced with stress
- -long allele provides protective resilience
climate and suicide
increase slightly in spring and fall, but not during December/holiday periods
what is Werther syndrome?
copy cat suicides
depression and suicide
~80% of suicide
- especially patients with holelessness (conditions will never improve)
- increased risk after patient is put on antidepressants or in the initial stages of recovery from depression
- -increased energy and clear thinking improve before lifting of depressed mood gives patient capacity to attempt
schizophrenia and suicide
~10% of suicides
-50% attempt suicide, 5% lifetime prevalence
physical health and suicide
approx 1/3 of people who commit suicide have had medical attention within 6 mo of death
- many visit the PCP within 1 month
- must differentiate between normal desire to avoid pain and abnormal mental state of major depression (both can be risky)
victim-precipitated homicide
using others (ex or police) to kill onself -places the blame on others while killing two birds with one stone)
murder-suicide
can occur as part of a pact (usually made by females or elderly couples)
- sometimes may NOT be a pact, but a homicide or coercion
- increasingly common for someone to rampage, then kill oneself
suicidal treatment
- interview about triad (ideation, intent, plans)
- take good history about risk factors
- greatest predictor may be past violence
- despite good technique, predicting who will commit suicide is statistically poor outcome - ask about protective things that keep them alive
- use least restrictive approach
- add medication to quickly lower anxiety, insomnia, etc.
- add slower acting antidepressants or psychotherapy
- increase support (family, more appointments, social supports) to increase connectivity, purpose, and to decrease helplessness, hopelessness - send to hospital in dire cases
hospitalizing a suicidal patient
- if a patient is high risk and doesn’t want to be hospitalized, can be detained for 1-63 days (exact duration depends on state law)
- can’t force patients to take medications once inpatient - can extend length of detainment if court involvement
- physicians can be legally responsible if they don’t recognize a suicidal patient or if they give a patient medicine that is later used in a suicide attempt
what should psychiatric notes comment on?
- lethality risk being low, moderate, or high
- plan to mitigate symptom
especially if making suicidal comments
antisuicidal Rx?
- Electroconvulsive therapy
- ketamine IV or IN is experimental
- lithium
- clozapine
- antidepressants may protect OR increase risks
- FDA boxed warning for ages up to 24 yo
- long-term international data
