Lecture 48: Suicide

Question 1

What is the public health approach (5 step approach) to suicide prevention?

Answer 1

1. Define the problem; surveillance
2. Identify causes (risk and protective factors)
3. Develop and test interventions
4. Community implementation
5. Dissemination; Program evaluation

Question 2

How many suicides occur every year in the US?

Answer 2

38,000 per year
Completed suicide…Men:women ratio 4:1
Attempted suicide….women > men…3:1

Question 3

What is the highest risk group for suicide?

Answer 3

White men ages 75+

Asian women?

Question 4

What is the leading cause of death in 15-34 age group?

Answer 4

Unintential injury (car injury)

Question 5

What is the second leading cause of death in 25-34 age group?

Answer 5

Suicide

Question 6

What is the best way to prevent suicide?

Answer 6

Interventions
Only RCT trial done in 2000 showed that patients who received intervention (getting a letter from hospital) had less incidence of suicide than those who did not receive intervention over a 2 year period!
However, over 5 years, results not significant

Question 7

What are the risk factors for suicide?

Answer 7

1. Suicide attempts
2. Hopelessness
3. Impulsivity and aggression
4. Psychiatric Diagnoses
   -MDD
   Bipolar disorders
   Schizophrenia
   Substance use disorders

Question 8

How heritable is risk of suicide?

Answer 8

Contribution of genetic factors is estimated to be 30-50%
2-4 times greater risk of suicide in relatives of those who die by suicide, een after adjusting for psychiatric disorder
Genes not identified…5-HT2A gene? Serotonin 2A receptors
SEROTONERGIC system

Question 9

What system is implicated in suicide?

Answer 9

Serotonergic system

Question 10

Why is it hard to do suicide research?

Answer 10

Such few patients to conduct a RCT on!

Question 11

What is the stress diathesis model?

Answer 11

Most patients with psychiatric disorders do not commit suicide
HOWEVER
At risk patients have a vulnerability or predisposition to suicide in the context of psychiatric disorder

Question 12

What is diathesis?

Answer 12

A tendency to suffer from a particular condition

Question 13

When sending an intervention postcard or letter, what do you want to avoid?

Answer 13

You want to avoid being demanding…

Sending postcards/mail and calling all showed an ability to reduce rate of suicide

Question 14

What is dialectal behavior therapy (DBT) for borderline personality disorder?

Answer 14

-weekly individual psychotherapy
-weekly group skills training
-telephone consultation as needed
-weekly therapist consultation
1 year duration

Question 15

What are the goals of DBT?

Answer 15

Decrease
	-life-threatening behaviors
	-therapy-interfering behaviors
	-severe quality of life interfering behaviors
Increase
	-mindfulness
	-interpersonal effectiveness
	-emotion regulation
	-distress tolerance/self-management

Question 16

What are the conceptual underpinnings of cognitive therapy intervention?

Answer 16

A. Suicidal behavior is viewed as a problematic COPING behavior
B. Suicidal behavior is viewed as the PRIMARY problem rather than a symptom of a disorder
C. Treatment is brief and focused (10 sessions)

Question 17

What is the safety plan intervention?

Answer 17

-prioritized written list of coping suicides for use during a suicidal crisis
-collaborative process between provider and patient
-brief, easy to read format and uses the patient’s own words
-involves a commitment to treatment process
Safety plan is NOT a no suicide contract…just teaching them skills

Question 18

What are the 6 steps of the safety plan for cognitive therapy?

Answer 18

1. Recognizing warning signs from the patient’s story
2. Employing internal coping strategies without needing to contact another person
3. Socializing with family members or others who may offer support as well as distraction from the crisis
4. Contacting family members or friends who may help resolve a crisis
5. Contacting mental health professionals or agencies
   
   • discuss treatment expectaitons
   • discuss barriers to care
6. Reducing the potential for use of lethal means

Question 19

What is the purpose of a “timeline” of patients path to suicide attempt?

Answer 19

It assists in developing the cognitive case conceptualization of the suicidal crisis as well as in IDing points in time when interventions or coping strategies can be used to prevent a future crisis

Question 20

What is the hope kit?

Answer 20

A memory aid consisting of a collection of meaningful items that remind patients of reason to live and that can be reviewed during times of crisis

Question 21

What is a coping card?

Answer 21

Small, preferably LAMINATED cards that contain useful reminders from therapy for dealing with distress that has the potential to be associated with hopelessness and suicide ideation
Example….automatic thought = theres no way out of this
Response: things are tough now but that doesn’t mean theres no way out…solutions

Question 22

What is the relapse prevention protocol?

Answer 22

A set of guided imagery exercises in which patients imagine suicidal crises and systematically describe the manner in which they would cope with suicide relevant thoughts
Three steps:
1. Imagine chain of events, thoughts, behaviors and feelings leading to attempt
2. Imagine chain of events and respond to maladaptive thoughts
3. Imagine future scenario likely to trigger suicidal reaction

Question 23

What is scientific evidence for cognitive intervention?

Answer 23

Penn found that cognitive therapy decreases suicide

• decreases depression
• decreases hopelessness