Suicide - An Overview of Epidemiology and Clinical Considerations Flashcards
Which gender commits more suicides?
Males commit more suicide than females in all age groups
What is the average number of suicide deaths per year based on 2012 data?
2400 per year
What is the ranking of suicide as a cause of death worldwide?
10th
How many suicides are there yearly?
~ 1 million
What is the ranking of suicide as a cause of death worldwide in 15 -24 year olds?
3rd
What is the ranking of suicide as a cause of death worldwide in 25 - 44 year olds?
5th
Where are suicide rates lowest and where are they highest?
Highest for both men and women in eastern europe
Lowest in eastern Mediterranean and central Asia
Which professions have/had highest rates of suicides?
Professions with means/knowledge to kill themselves (vets, doctors, dentists, pharmacists, etc) now higher numbers are seen amongst manual occupations
What mental conditions are commonly associated with suicides?
Affective disorders such as depression
Schizophrenia
Alcohol dependence
Personality disorder
Drug dependence
Conduct disorder
Psychotic disorders
What is the association between narcotic dependence and suicide?
Some data suggests narcotic dependence is associated with 50x more suicides than in the general population.
What is the most common suicide methods in the US?
Firearms, hanging, and falls
What risk factors increase chance of a suicide?
Mental illness
Substance abuse
Serious or chronic health condition and/or pain
Previous suicide attempts
Bullying, foster care, sexual/emotional abuse in childhood
What are some precipitating factors for suicide?
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.
Association between suicide and suicide sites:
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.
Why must understanding of suicide risk by physicians be studied deeply??
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.
Where can information be taken for potential suicides?
Input should be taken from all team members since they observe and interact with the patient 24/7
Significant others
What is the SAD PERSONS suicide risk scale?
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
What do SAD PERSONS assessment risk scale indicate?
0 - 5 may be safe to discharge
6 - 8 requires psychiatric consultation
> 8 requires hospital admission
Why was the SADPERSONS scale not adopted?
It was found to miss many patients at risk
Why must a comprehensive suicide risk assessment be taken in patients following suicide attempt or psychological crisis?
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
Why can risk assessments not be effective in detecting potential suicide?
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.
What does a comprehensive clinical assessment of suicidal behaviour entail?
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
What are the recognized risk factors for suicide?
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
How does suicide impact significant others?
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
