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Flashcards in Psych - Suicide Deck (10):
1

Epidemiology

36,000 suicides a year

11/100,000 people

11 attempts for every 1 completed suicide
Not without consequences -- brain trauma, liver damage, hospitalizations, stress, loss of relationships, etc!

3 peaks of suicide risk --> ADOLESCENCE, MIDDLE AGE, OLD AGE

Elderly OVER 65 have a rate 6x over the national average!!!

FEMALES attempt more, but MALES complete more suicides

2

Suicide Attempt vs. Suicide Completion

Attempts --> females, young people, Native Americans, financial difficulty, social isolation, recent adverse events

Completion --> ELDERLY, Caucasians, MALES, financial difficulty, social isolation, recent adverse events

3

Risk Factors

Depression, substance related disorders and other mental disorders are present in 90% of people who die from suicide

There are TREATMENTS for these - just goes to show how preventable this public health crisis can be!

Chronic Illness
Prior attempts
Family history (of mental disorders, substance abuse or attempts)
Availability of Firearms

EXPOSURE to others who attempt or have attempted, besides just family --> Copycat suicides :(

Neurobiological risk factors too (decreased 5HT could lead to impulsivity and aggression)

4

Bipolar Disorder

Risk of suicide jumps to 400-1400/100,000 annually

This rate is SO MUCH HIGHER (1000x) and FAR MORE ARE COMPLETED

Highest risk in younger BPD patients who are frustrated with their illness

Associated with the depressive/mixed state (agitation and depression) of BPD

LITHIUM has been shown to DECREASE SUICIDE RISK --> use it more!

5

Research Methods to Identify Risk Factors

Vital Statistics -- data collected from autopsies. Determination of suicide is complex -- evidence is vague and the cause and manner may be wrongfully classified as incidental or undetermined, rather than suicide, which could lead to under-reporting

Psychological Autopsies -- detailed interviews with loved ones and friends of the deceased to collect information about the psychiatric diagnosis and to construct a retrospective suicide risk

Follow up of clinical samples -- prospective observation of those with high-risk behavior for suicide and then associating other risk factors to suicide

6

Risk Assessment is very important, but difficult

Patient may be motivated to mislead the physicians or family members

Consider symptoms, demographics and psychosocial factors

Impulsivity, aggression and access to weapons must be considered

Physicians need to face their own biases and discomforts in dealing with suicide, as well as acknowledge the inherent difference between their goal to prevent suicide and the patient's goal to eliminate pain through suicide --> ERR ON THE SIDE OF AUTION

7

Conducting Risk Assessment

Observation and active listening

Look for DEPRESSION

Look for substance abuse/dependence

Be aware of the link to chronic pain -- 17% admitted that pain was a precipitant for attempting suicide

DIRECTLY ASK ABOUT SUICIDE

8

Preventing Suicide

Treatment of MENTAL DISORDERS and SUBSTANCE ABUSE is first line!

Modifiable risk factors to be addressed --> symptoms such as anxiety, agitation, hopelessness, hallucinations, or insomnia should be treated aggressively

Protective factors such as social supports need to be strengthened

Access to weapons should be addressed

Remove expired or unused medications

CBT reduces the rate of repeated attempts by 50% during a year of follow-up by providing patients with alternative thoughts

BETTER OUTREACH TO MEN, and ESPECIALLY BETTER PRIMARY CARE RECOGNITION!!!! 45% of elderly who committed suicide saw a primary care doctor a month prior!!! 19% saw a mental health provider!

9

Myths about suicide

Talking about it will NOT give the patient ideas - it will provide the patient with relief and the chance to talk about their problems

It is assumed that people who talk about suicide will not follow through while, in reality, 69% of people who eventually complete suicide COMMUNICATED IT WITHIN THE LAST YEAR!!!! So, ANY MENTION needs to be taken seriously!

Prior attempts are a HUGE RISK FACTOR (just because they weren't successful once does NOT mean they won't try again)

It is NOT NORMAL in mental disorders to want to commit suicide -- these people do still want to live way more often than not!

10

How many people are affected by each suicide?

On average, 6 other people are affected..at least

Grief, shame, blame, anger, guilt -- all affect these people

YOUTHS are affected strongly by suicide, particularly if it's a parent -- they are then at risk for behavioral issues themselves