Suicide

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Suicide

Amal Benchakroun
Suicide
• 10th leading cause of death in the US – 2015

• Suicidal ideation prevalence 2% per year and 9% in


lifetime

• Suicide attempt are common. 30 attempts for every


death
Risk factors
• Acute/Dynamic
• Chronic/static

• Past attempts
• Substance use
• Depression
• family/Peer suicide • Hopelessness
• Loss of support system
• Psychiatric illness • Change in therapeutic
alliance
• Chronic/ Terminal • Suicide plan/ intent
illness/ Pain • Ease of access to lethal
methods
• Doom/gloom delusions.
• Gender Existential qs
Risk Factors.
• Previous suicide attempt
o Strongest single factor predictive of suicide.
o 1% of people that attempt suicide die within 1 year of attempt.
Risk 100 x greater than general population.

• Psychiatric disorder
o Psychiatric illness (severity) is a strong predictor of suicide
o >90% attempt suicide have a psychiatric disorder and 95% who
successfully commit suicide have a psychiatric diagnosis
o Inpatient hospitalization
o Depression, bipolar disorder, alcoholism or other substance
abuse, schizophrenia, personality disorders, anxiety disorders
including panic disorder, PTSD, and delirium
o Combination of more than one the above increase the risk 2-3x
Risk Factors.
• Age: Female more attempts, Male more completion.
• Hopelessness: suicidal ideation and attempts
• Marital status: Single
• Sexual minority: 2x > heterosexual. Bisexual>homosexual
• Occupation: >unskilled occupation (labors vs managers)
except: Physicians and nurses
• General medical illness and chronic pain
• Fam hx, genetics, child abuse
• Firearms
• Rural residence
• Low income, unemployment
• Antidepressant 18-24yr old in the first 2 mo
Methods
• Firearms: Leading methods. 50% of deaths
o meta-analysis of 10 observational studies found that the risk of completed
suicide was three times greater among adults with access to firearms,
compared with individuals without available firearms

• Suffocation: eg. Hanging 25%

• Poisoning: eg. Drug overdose 15%


Methods
Adult suicide safety plan
Evaluation
• Many seek help. Directly or indirectly.

• Assess for ideation, method, plan, and intent.

• Can’t predict who would and wouldn’t die by


suicide.
• No empirically supported method for incorporating
risk and protective variables – Clinical Judgment
• Some advances have been made in the long-term
prediction of suicidal behavior but no study has
been able to predict the short-term of suicide risk
Warning Signs
• Recent threats or action to hurt/kill self

• Focusing, talking, writing about suicide or death

• Hopelessness or trapped

• Reckless behavior

• Increased substance use

• Anxiety and/or sleep problems

• Significant change in mood or behavior


Cutting
Self injury - Cutting
• Form of self harm where patient hurts themselves to
help deal with emotions or distress.
o Teenagers

• Why?
o Deal with negative emotions – seen as positive action to express
feelings and feel in control
• Depression, rage, guilt, emptiness or self hatred
• Distraction from difficult life event
• Relief from guilt as a form of self punishement
• A way to feel more alive

o Non suicidal self injury


Cutting – Risk Factors
• Life issues: Many with child abuse in some way. Sexual,
physical or emotional, or a case of neglect.

• Teenagers: More likely to cut themselves. Self-harm


often begins in the early teen years due to emotional
ups and downs, peer pressure, loneliness and conflicts
with authority figures.
• Mental Health: Negative emotions. Cutters tend to be
more impulsive and have poor cognitive skills.
• Mental disorders: borderline personality disorder,
depression, anxiety disorder, PTSD and eating disorders
are at a higher risk of cutting.
• Substance Abuse: drugs and EtOH
The end

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