Suicide - An Overview of Epidemiology and Clinical Considerations

Question 1

Which gender commits more suicides?

Answer 1

Males commit more suicide than females in all age groups

Question 2

What is the average number of suicide deaths per year based on 2012 data?

Answer 2

2400 per year

Question 3

What is the ranking of suicide as a cause of death worldwide?

Answer 3

10th

Question 4

How many suicides are there yearly?

Answer 4

~ 1 million

Question 5

What is the ranking of suicide as a cause of death worldwide in 15 -24 year olds?

Answer 5

3rd

Question 6

What is the ranking of suicide as a cause of death worldwide in 25 - 44 year olds?

Answer 6

5th

Question 7

Where are suicide rates lowest and where are they highest?

Answer 7

Highest for both men and women in eastern europe

Lowest in eastern Mediterranean and central Asia

Question 8

Which professions have/had highest rates of suicides?

Answer 8

Professions with means/knowledge to kill themselves (vets, doctors, dentists, pharmacists, etc) now higher numbers are seen amongst manual occupations

Question 9

What mental conditions are commonly associated with suicides?

Answer 9

Affective disorders such as depression

Schizophrenia

Alcohol dependence

Personality disorder

Drug dependence

Conduct disorder

Psychotic disorders

Question 10

What is the association between narcotic dependence and suicide?

Answer 10

Some data suggests narcotic dependence is associated with 50x more suicides than in the general population.

Question 11

What is the most common suicide methods in the US?

Answer 11

Firearms, hanging, and falls

Question 12

What risk factors increase chance of a suicide?

Answer 12

Mental illness

Substance abuse

Serious or chronic health condition and/or pain

Previous suicide attempts

Bullying, foster care, sexual/emotional abuse in childhood

Question 13

What are some precipitating factors for suicide?

Answer 13

Acutely stressful life events (death, divorce, or job loss)

Prolonged stress - harassment, bullying, relationship problems, and unemployment.

Access to lethal means including firearms and drugs.

Family history of suicide attempt (Contagion)

Media coverage of celebrity suicides.

People often describe method and location of suicide and then carry it out.

Question 14

Association between suicide and suicide sites:

Answer 14

Suicide sites are often hot spots for suicides. (eg Westgate, Golden gate in San Francisco, and Yangtze River Bridge) These are conducted by people committing copycat suicides.

Question 15

Why must understanding of suicide risk by physicians be studied deeply??

Answer 15

It is a process not an event.

25% of suicidal patients deny suicidal ideation when asked.

Patients determined to commit suicide do not want to tell clinicians.

Documentation of suicide risk assessments is important but can not be done using forms.

Question 16

Where can information be taken for potential suicides?

Answer 16

Input should be taken from all team members since they observe and interact with the patient 24/7

Significant others

Question 17

What is the SAD PERSONS suicide risk scale?

Answer 17

Sex (male): 1
Age 15 - 25 or 59+: 1
Depression/hopelessness: 2
Previous suicidal attempts: 1
Excessive ethanol or drug use: 1
Rational thinking loss: 2
Single, widowed or divorced: 1
Organized or serious attempt: 2
No social support: 1
Stated future intent (determined to repeat or ambivalent): 2

Question 18

What do SAD PERSONS assessment risk scale indicate?

Answer 18

0 - 5 may be safe to discharge

6 - 8 requires psychiatric consultation

> 8 requires hospital admission

Question 19

Why was the SADPERSONS scale not adopted?

Answer 19

It was found to miss many patients at risk

Question 20

Why must a comprehensive suicide risk assessment be taken in patients following suicide attempt or psychological crisis?

Answer 20

Fewer than 1/200 commit suicide within the next 6 months and they are 50 times more likely to die by suicide in the following year

Question 21

Why can risk assessments not be effective in detecting potential suicide?

Answer 21

Assessments rely on risk factor or combination of risk factors which are overepresented in people who do commit suicide but absent from those who don’t which is not the case.

Question 22

What does a comprehensive clinical assessment of suicidal behaviour entail?

Answer 22

Full psychiatric history with emphasis on recognized risk factors.

Mental state examination

Collateral information if available from partners, friends, and family

Input of members of MDT (especially nursing staff)

Specialist/2nd opinion if uncertain

Question 23

What are the recognized risk factors for suicide?

Answer 23

Acquiring weapon

Hoarding medication

No plan for the future

Putting affairs in order

Making or changing a will

Giving away personal belongings

Mending grievances

Checking on insurance policies

Withdrawing from people

Loss of a significant relationship or death of a loved one

Diagnosis of a terminal illness

Loss of financial security or livelihood

Loss of home or employment

Abuse, rape or other serious emotional trauma

Question 24

How does suicide impact significant others?

Answer 24

Complicated grief reactions and mental disorders

Future suicides

Guilt, separation, divorce

Blame or scapegoat someone

Deny suicide ever took place and insist it was an accident

Feeling guilty from the relief

feeling stigmatised and shamed by the death

Abandoned by the spouse