WCS43 Suicide And Drug Overdose: Risk Factors And Assessment Flashcards
HK suicide rate
13 per 100,000
Definition of terms
Suicide / Committed suicide:
- Self-inflicted death with evidence (explicit / implicit) that the person intended to die
Suicide attempt:
- Self-injurious behaviour with a ***non-fatal outcome accompanied by evidence (explicit / implicit) that the person intended to die
Deliberate self-harm:
- Willful self-inflicting of painful, destructive, injurious acts ***without intent to die
Diathesis-Stress model of suicidal behaviour
Stress (~ 進攻)
- acute intrinsic psychiatric illness
- acute family and social stresses
- acute medical illness
- acute substance abuse
Diathesis (~ 防守)
- generic predisposition
- early life experiences
- personality characteristics
- chronic illness
- chronic substance abuse
Categories of suicidal behaviour
- True suicidal acts (Most dangerous)
- likely with underlying psychiatric Dx esp. depression
- characterised by intense melancholia + despair
- wish for relief from emotional pain
- highest risk of completed suicide (likelihood of careful planning)
- ONLY category with ***persistent intent to die - Retributive rage
- characterised by ***impulsiveness, vengefulness
- constricted capacity to see other immediate options - “Parasuicidal” gesturing (一哭二鬧三上吊)
- often repetitive, tinged with strong dependency needs
- appears to be a form of communication
- ***extract a response from a significant other - Self-mutilation / Deliberate self harm
- serves the purpose of ***relieving dysphoria
- a form of “indirect self-destructive behaviour”
Suicidal risk assessment
Psychiatrist cannot predict who will commit suicide
—> but CAN reduce / eliminate suicide risk
Purpose:
1. Identify and treat acute risk factors
2. Identify + mobilise protective factors in management
***Framework in assessment of suicidal risk
“Past”
1. Demographic factors (harder to modify)
—> Gender (male>female)
—> Age (>=65 yo)
—> Marital status (divorced)
—> Social class, Employment (lower social class)
- Previous history of attempts
- 25-50% completed suicide have tried before
- 1% attempters will die by suicide within 12 months of index attempt, 3-4% die of suicide eventually
“Present”
1. Current psychiatric / physical symptoms
- >80% suicide cases have >=1 psychiatric diagnosis (<50% never in contact with psychiatric services)
- eating disorders
- major depression
- sedative abuse
- schizophrenia
- AIDS
- alcohol abuse
- cannabis abuse
- brain injury
- Assessment on the extent of lethality of recent suicidal attempt / thoughts
“Future”
1. Is there anything going to change?
Gender
Women:
- More suicidal attempts + depressive illness
- BUT lower suicide mortality rate
Men:
- Higher suicide mortality rate
Age
Elderly
- Depressive disorder
- Physical illness
- Functional impairment
- Social isolation
Marital status
***Divorced > Widowers > Never married > Married
Also depends on quality of relationship
Social class, Employment
Lower socioeconomic level (***Social class 5) (Social class 1: highest)
Certain occupations
- dentists
- doctors
- nurses
- social workers
- lawyers
—> Stress
—> Accessibility to methods of suicide (e.g. drugs)
Depressive disorders
- Period of high risk: ***When mood is improving, around discharge
- 15% suicide
- 50% suicide patients suffer from depression
Schizophrenia
- life-time prevalence of completed suicide: 10%
- attempted suicide: 25-50%
- could be ***secondary to active psychotic symptoms e.g. command hallucinations, prosecutory delusions
- High risk:
—> **first few years after diagnosis
—> **higher cognitive ability, during remission, awareness of loss of function (e.g. Post-schizophrenic depression)
—> difficulty accepting decline in socioeconomic status
***Assessment on the extent of lethality of recent suicidal attempt / thoughts
- Belief about intent
- purpose of attempt
- expectation of dying
- lethality of means - Preparation (for act + for things after death)
- saving up pills for overdose
- saying goodbye
- planning
- settling of own properties / savings to others - Concealment
- attempt to avoid discovery: timing so no one will find soon, choosing an isolated place
- attempt to delay being rescued - Communication
- suicide note
- telling others, directly / indirectly about suicidal thinking
Suicidal ideation is a key risk factor
Probability of transitioning from suicidal ideation to suicidal plan: 34%
Probability of transitioning from a plan to attempt: 72%
Passive ideation can ***quickly become active
Is there anything going to change?
Modifiable + Treatable risk factors:
- Depression
- Anxiety
- Panic attacks
- Sleep disorders
- Substance abuse
- Impulsivity
- Agitation
- Physical illness + symptoms (e.g. pain)
- Situation (e.g. family, work)
- Lethal means (e.g. guns, drugs)
- Drug effects (e.g. akathisia)
Possible protective factors (could be the other way round!!!):
- Children at home
- Sense of responsibility to family
- Pregnancy
- Religiosity
- Life satisfaction
- Positive coping skills
- Positive problem-solving skills
- Positive social support
- Positive therapeutic relationship
