Suicide
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Contents |
More Specific Terms
Etiology
- Risk factors for completed suicide
- male gender
- > 60 years of age [5]
- widowed or divorced
- Caucasian or native American
- availability of firearms
- firearms are the most common method used
- life stressors
- death of spouse
- economic woes, loss of job
- chronic or terminal illness
- major depression [3]
- Risk factors for attempted suicide
- female gender
- < 30 years of age
- substance abuse
- drug ingestion is the most common method used
- mental disorders [6]
- nightmares?
- prior suicide attempts
- disrupted family situation
Epidemiology
- 33% of people have suicidal ideation during their lifetime
- 9th leading cause of death
- 3rd leading cause of death in adolescents (age 15-24)
- males > 85 years of age have highest rate
- rates in elderly tend to be underestimated because they are easily confused with medical complications
- 20 cases per 100,000 in > 65 age group vs 12 per 100,000 in younger population
- deteriorating physical health is more important than psychiatric illness in predicting self-harm in the elderly [7]
Pathology
- reduced brain serotonin or 5-hydroxy indoleacetic acid ( 5-HIAA) levels
Diagnostic-criteria
- screen for suicidal ideation
- asking does not precipitate suicidal thoughts
- 75% of suicidal patient seek physician help within 6 months of committing suicide
- most patients are reluctant to discuss suicidal thoughts without encouragement
- assess risk
- current stressors
- presence of depression
- drug (including alcohol) abuse
- socioeconomic risks
- gender
- age
- imminent risk
- suicidal ideation
- reasonable plan
- lethal method
- co-existing psychiatric disease
- lack of social support
Management
- Intervention:
- imminent risk
- don't leave the patient alone
- immediate psychiatric hospitalization
- short term
- involve family or close friends
- remove access to methods
- close follow-up & counseling
- suicide awareness education
- school & community support programs
- peer support programs
- hospital & police programs to support victims of violence & at risk groups
- crisis intervention
- fellow students after successful suicide
- firearm restrictions & safeguards
- early detection & screening programs
- routine communication helpful [4]
- Pharmacology
- only 2 pharmaceutical agents shown to lower suicidal behavior; neither reaches therapeutic levels immediately
- anxiolytics ( benzodiazepines), sedative/ hypnotics & short-acting antipsychotics may be indicated to reduce suicidal behaviors
More General Terms
Additional Terms
References
- Contributions from Linda Kuribayashi MD, Dept of Medicine, UCSF Fresno
- Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- Carter GL, Clover K, Whyte IM, Dawson AH, D'Este C. Postcards from the EDge project: randomised controlled trial of an intervention using postcards to reduce repetition of hospital treated deliberate self poisoning. BMJ. 2005 Oct 8;331(7520):805. Epub 2005 Sep 23. PMID: [1]
- Eddleston M, Dissanayake M, Sheriff MH, Warrell DA, Gunnell D. Physical vulnerability and fatal self-harm in the elderly. Br J Psychiatry. 2006 Sep;189:278-9. PMID: [2]
- Bolton JM and Robinson J. Population-attributable fractions of axis I and axis II mental disorders for suicide attempts: Findings from a representative sample of the adult, noninstitutionalized US population. Am J Public Health 2010 Dec; 100:2473. PMID: [3]
- Oude Voshaar RC et al First episode of self-harm in older age: A report from the 10-year prospective Manchester Self-Harm project. J Clin Psychiatry 2011 Jun; 72:737. PMID: [4]
- NIH Institute and Center Resources [5]
- National Guideline Clearinghouse
- Assessment and care of adults at risk for suicidal ideation and behavior. Registered Nurses' Association of Ontario (RNAO). ngc-guideline: [6]
