Suicide

Question 1

Epidemiology

Answer 1

• Suicide rate is 10-13/100,000 ppl in US
• Overall, 10th most common cause of death in US
• Highest among older adults (65+)
• Males > females (women make more attempts but do not use lethal means/guns as often)
• White >black
• Most common means = firearm

Question 2

Long Term Risk Factors (6)

Answer 2

• Suicide attempt hx
• Psych dx
• Family hx suicide
• Male, isolated, poor
• Violent/aggressive/impulsive
• Medical conditions - neuro, cancer, HIV, renal, cardiovascular disease, epilepsy

Question 3

Short Term Risk Factors (7)

Answer 3

• Suicidal ideation (sensitive but not specific)
  
  • Plan or attempt?
  • Current symptoms of hopelessness, shame, anxiety
  • Current psych dx
  • Desperate
  • Communication breakdown
  • Recent d/c or discontinuation of meds

Question 4

Neurobiology

Answer 4

Likely due to disrupted serotonin function

Question 5

What to do as a physician?

Answer 5

• Screen
• Assess current risk - work up gradually to tough questions, normalize it, do not use jargon
• ID protective behaviors
• Determine level of risk
  
  • If acute - admit to inpatient psych
  • If less acute - make safety plan and talk w/ family
• Document all findings