Suicide and Risk Assessment Flashcards
What is suicide?
A fatal act of self-harm initiated with the intention of ending one’s own life.
What is attempted suicide?
The act of intentionally trying to take one’s own life with the primary aim of dying, but failing to succeed in this endeavour.
Give examples of protective factors for suicide
- Children at home
- Pregnancy
- Strong religious beliefs or spiritual belief that suicide is immoral
- Strong social support
- Positive coping skills
- Positive therapeutic relationship
- Supportive living arrangements
- Life satisfaction
- Fear of the physical act of suicide
- Fear of disapproval by society
- Responsibility for others
- Hope for the future
With regards to the leading causes of death, where does suicide fall?
Suicide is the 13th leading cause of death worldwide.
How common is suicide?
About 1 million deaths every year due to self-inflicted violence.
In 2012, in the UK there were 18.2 ♂ suicides per 100 000 population and 5.2 ♀ suicides per 100 000 population.
What are the most common methods of suicide?
The most common methods of suicide are hanging, strangulation and suffocation (58% of ♂ suicides and 36% of ♀ suicides), followed by poisoning (43% of ♀ suicides and 20% of ♂ suicides).
What are the clinical risk factors for suicide?
- History of DSH or attempted suicide
- The rate of suicide in people who have self-harmed increases and is 50– 100 times greater than in the general population
- Psychiatric illness
- Including depression, schizophrenia, substance misuse, alcohol abuse and personality disorder
- Childhood abuse
- History of childhood sexual or physical abuse
- Family history
- Family history of suicide or suicide attempt in first-degree relatives increases the risk
- Medical illness
- Physically disabling, painful or terminal illness
What are the socio-demographic risk factors for suicide?
- Male gender
- Males are 3x more likely than females
- Male suicide attempts are more likely to be violent and therefore successful
- Age
- Highest in the age group 40 to 44 in men
- Employment and financial status
- Those unemployed and who have low socioeconomic status are at higher risk
- Occupation
- Vets, doctors, nurses and farmers are at higher risk of suicide
- Access of lethal means
- The most lethal means of suicide are firearms, followed by hanging, strangling and suffocation
- Social support
- Low social support living alone and institutionalized e.g. prisons, soldiers
- Marital status
- Those that are single, widowed, seperated or divorced
- Recent life crisis
- Bereavement and family breakdown
How does suicide present?
Individuals who are suicidal usually have a number of characteristics, including the following:
- Preoccupation with death: thoughts, fantasies, ruminations and preoccupations with death and particularly self-inflicted death
- Sense of isolation and withdrawal from society
- Emotional distance from others
- Distraction and lack of pleasure: often are ‘in their own world’ and suffer from anhedonia
- Focus on the past: they dwell on past losses and defeats and anticipate no future; they voice the notion of Beck’s cognitive triad that the world would be better off without them
- Feelings of hopelessness and helplessness
What’s important to ask in order to determine the risk of suicide following DSH?
Note: Planned Attempts Are Very Frightening
- Note left behind: usually written
- Planned attempt of suicide
- Attempts to avoid discovery
- Afterwards help was not sought
- Violent method
- Final acts: sorting out finances, writing a will
What investigations should be ordered for suicide?
Medical investigations according to the method e.g. drug levels.
Questionnaires: Tool for Assessment of Suicide Risk (TASR), Beck Suicide Intent Scale.
Suicide can be confirmed by post-mortem.
Briefly differentiate between suicide and self-harm
Suicide
- More common in males
- Risk increases with age
- Act may be planned meticulously
- Act is more often violent
- Physical and psychiatric illness is common
Self-harm
- More common in females
- More common in young people
- Act is impulsive
- Usually in form of overdose or cutting
- Physical and psychiatric illness is less common
Briefly describe the 7 steps required for a risk assessment in an OSCE
- Exploring suicidal ideation
- Exploring suicide intent
- Exploring risk factors
- Perform a mental state examination
- Explore protective factors
- Explore risk to others (including children) and risk from others
- Formulate management plan
When should a patient be referred to secondard care if suicide risk?
Note: SUSPicious
Is usually considered if:
- Suicidal ideation clearly stated
- Underlying psychiatric illness is severe
- Social support (lack of)
- Presentation change for an individual who has repeatedly self-harmed
Briefly describe the general principles of treating suicide
Ensure safety: immediate action should include removing means for suicide and ensuring the safety of the patient and others.
Patients who have attempted suicide and failed, should be medically stabilised e.g. management of drug overdose or treatment of physical injury.
Risk assessment: the risk of further suicide should then be assessed. People with a high degree of suicidal intent, specific plans, or chosen methods (particularly if lethal) should be assigned a higher level of risk.
Admission to hospital (or observation in a safe place) is generally indicated if individuals pose a high and immediate risk of suicide. The Mental Health Act might be required if the patient refuses help and there is evidence of a mental illness.
Psychiatric treatment: depression or psychosis should be detected and treated accordingly. Involvement of the Crisis Resolution and Home Treatment team to provide support immediately following discharge can be instrumental.
Outpatient and community treatment may be more suitable for patients with chronic suicidal ideation but no history of previous significant suicide attempts. For this to succeed, a strong support network and easy access to outpatient and community facilities are required.
