VIII - Mood Disorders II (Suicide)

Question 1

Suicide as the endpoint of a disease

Answer 1

Some think of suicide as an endpoint of severe form of disease. Debate over whether desire to die necessarily means that you are ill.

Question 2

Suicide spectrum

Answer 2

Not that you are suicidal or not - there is a continuum.

Question 3

Impact on Therapist/Patient Dynamic of Hospitalization

Answer 3

Therapist must assess, but there is uncertainty. If hospitalize w/o actual intent, must restore trust. If death, process loss individually and systemically. What to do in case of hospitalization

Question 4

SAFE-T

Answer 4

Suicide Assessment Five-Step Evaluation and Triage

Question 5

Mood disorders and suicide

Answer 5

Risk of suicide significant factor in mood disorder - estimated 50-90% during depressive or recovery. Est. 90% of people attempt or commit suicide w/ some psychiatric disorder at the time.

Question 6

Suicide demographics

Answer 6

Among 10th leading causes in most Western countries. Most common: 18-24 years (prev. 25-44). 3-4x more likely in divorced/separated individuals. Completed most common in elderly 65+. Women more likely to attempt, men more likely to complete (method), though bipolar is exception. Elevated rates in certain groups like health professionals, composers, business people, artists. Very rare among children

Question 7

Suicide in children

Answer 7

Very low but seems to be increasing. Esp. rare in under 10. 10-14 rare, but 4th leading cause for age group (don’t die as much). Risk factors: loss of parent, abuse, depression, antisocial behavior, high impulsivity

Question 8

Suicide in adolescents, young adults

Answer 8

Rates 3x in 15-24 between mid 1950s and mid-1980s. 3rd leading cause in 15-19 years. Risk factors: mood disorders, conduct disorder, substance abuse. Very slight increase in suicidal ideation w/ anti-depressants.

Question 9

Suicide psychosocial factors

Answer 9

Impulsivity, aggression, pessimism, negative affect, negative events, family psychopathology or instability

Question 10

Suicide biological causal factors

Answer 10

Genetic factors may play a role; reduced serotonergic activity associated w/ more risk

Question 11

Suicidal attempt vs. completion prevalence

Answer 11

7-10% of those who have made attempt will eventually die by suicide

Question 12

Distinct groups of suicidal individuals

Answer 12

• Those who don’t want to die but have dramatic message about distress (nonlethal, intervention likely)
• Those intent on dying (little or no warning of intent, different means)
• Those ambivalent about dying (methods dangerous but slower acting - if I die ok, if I am saved that is what was meant to happen)

Question 13

Communication of intent

Answer 13

40% of people who committed suicide indicated intent. Another 30% talked about death and dying in preceding weeks/months. Most often to friends or family members. Only 20% under care of mental health professional at time of death.

Question 14

Suicide notes

Answer 14

Only 15-25% left. Some for love/concern; others hostile. Many short and straightforward.

Question 15

Suicide prevention and intervention

Answer 15

• Treatment of mental disorder(s)
• Crisis intervention (ask whether want to die or escape, maintain support, recognize acute distress, instill hope)
• Working with high-risk groups