Suicide Flashcards
In 2015 how many people took their own lives?
2500+, 8 people per day
How many people attempt suicide every day?
200
What is the ratio of males to females?
76% males
What age group for males are most likely to suicide?
18-24, then males over 65
What is the ratio for aboriginal suicides?
2-3 times higher than that of non-aboriginal australians
What are the most common methods of suicide?
Firearms, hanging, carbon monoxide and poisoning (incl. medical overdose)
What are a cause of unknown suicides?
Deaths in motor vehicles
When have there been peaks for suicides?
During the great depression, peak for males but not for females as it was the males that went to work
but a drop during wars
What are suicide clusters?
5% of suicides occur in clusters, mostly adolescents
How to intervene with suicide clusters?
Remove the child from the environment
Take the child out of the school if there are more than 1 suicides in close succession
Counsel for the other children in the group- critical incidence stress debriefing (continuing to talk about it however may induce PTSD)
Risk factors for depression
Previous attempt (25-50% of people who kill themselves have previously attempted to do so)
Alcohol use (alcohol dependence increases liklihood, more likely to attempt when drunk)
Recent loss (of a family or friend)
Social support lacking
Organised plan to harm and/or kill themselves
Sickness (i.e. schizophrenia, bipolar, bulimia nervosa, borderline)
or a chronic illness
DSM for non-suicidal self injury
A. In the last year, the individual has, on 5 or more days, engaged in intentional self-inflicted damage to the surface of his or her body.
B. The individual engages in the self-injurious behaviour with one or more of the following expectations:
(1) to obtain relief from a negative feeling or cognitive state,(2) to resolve an interpersonal difficulty,(3) to induce a positive feeling state. Note: The desired relief or response is experienced during or shortly after the self-injury, and the individual may display patterns of behaviour suggesting a dependence on repeatedly engaging in it.
C. The intentional self-injury is associated with at least one of the following:
(1) interpersonal difficulties or negative feelings or thoughts, such as depression, anxiety, tension, anger, generalized distress, or self-criticism, occurring in the period immediately prior to the self-injurious act,
(2) prior to engaging in the act, a period of preoccupation with the intended behaviour that is difficult to control,
(3) thinking about self-injury that occurs frequently, even when it is not acted upon.
D. The behaviour is not socially sanctioned (e.g., body piercing, tattooing, part of a religious or cultural ritual) and is not restricted to picking a scab or nail biting
E. The behaviour or its consequences cause clinically significant distress or interference in interpersonal, academic, or other important areas of functioning.
F. The behaviour does not occur exclusively during psychotic episodes, delirium, substance intoxication, or substance withdrawal.
DSM for suicide behaviour
A. Within the last 24 months, the individual has made a suicide attempt.
B. The act does not meet criteria for nonsuicidal self –injury.
The biggest difference is that suicidal behaviour has the intent to kill
C. The diagnosis is not applied to suicidal ideation or preparatory acts
Technically, can’t make a diagnosis if they have put everything in place, but haven’t acted on it
D. The act was not initiated during delirium or confusion.
E. The act was not undertaken solely for a political or religious objective.
Outline the steps for a suicidal assessment interview
Evaluating for depression
Depression is implicated in most suicides
Have to assess for this
Work with treating their depression
when evaluating depression assess for belief that future is hopeless
Exploring suicidal ideation and hopelessness
Inquire directly about suicidal thoughts
Common fear that asking directly about suicide will put ideas into the person’s head
no clinical evidence to suggest this occurs
if admit to suicide ideation, the frequency, duration and intensity should be explored
problem with ideation is that it goes up and down during the day, always ask over a period of time
Assessing suicide plans
Attempted in past?
the greater lethality of previous attempt, the higher the present risk
Assess for (SLAP):
1) Specificity of plan
Have they thought of how they would do it?
2) Lethality of method
3) Availability of proposed method
Assessing patient self-control
Determine level of impulsivity
Assessing intent
Involves determining whether person is talking and acting in ways that suggest that he or she intends to commit suicide (can use 1-10 scale)
What are the risk factors for a person self harming/suiciding?
Depression, hopelessness, lack of meaningful friendships, alcohol addiction
What are some on-the-spot interventions for suicide?
Remove the means Don't leave them alone Be empathetic, acknowledge their pain Identify ambivalence (if they're not sure) Help identify solutions
What are some longer term interventions for suicide?
Establish a system of safety (remove medications, find a support network)
Paracetamol is the most commonly used medication to overdose-remove it from the home
Most suicidal people are also depressed- so address the depression (medication?)
Problem solving; suicide as an option is generally because that person can’t see an alternative solution.Using the stress diathesis model, help improve their problem solving skills.
Look at a persons attitude to solve the problem; do they believe they have the ability?
Reframe problems as a normal part of life
Teach them how to define problems
Teach difference between fact and assumption
Teach them how to generate solutions
How to improve how the system responds to self harm
Respond with a follow up appointming within 24-48 hours, and defiantely within a week
Give them a card (adam used a green card), that tells them the time of the next appointment, an invitation to return to the emergency department and crisis contacts
What were the findings from Adams ‘Green card’ system?
Follow-up should be immediate.
A ‘Green Card’ referral system aids compliance.
Appointment times should be as convenient as possible.
Presentations for depression or loss in adolescents should be assessed for suicidal ideation.
Storage of household medication should be considered as a public health issue.
