Suicide
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Introduction
Suicidality reveals the extent of desparation.
affects more males than females (3:1 for completed suicide).
Rates increase after age 14; suicide is the second-most common cause of death for ages 15-24. However, rates are highest in people over 65 years old.
In Nova Scotia, about 11/100,000
There is a lot of varation among countries; apparently
There is a lot of overlap between deliberate self-harm and suicide
There are approximately 120 suicide attempts for every successful suicide.
Causes and Risk Factors
Risk factors include:
- male
- white/aboriginals
- widowed or divorced
- alone, with no children under 18 in the house
- stressful life events
- access to firearms
- psychiatric disorders: depression, bipolar, panic, schizophrenia, substance aboce, eating disorders, adjustment disorder, conduct disorder, personality disorders (especially borderline, antisocial)
Sex: male
Age: older
Depressed, often an undignosed first episode
Previous attempts
Ethanol (15%)
Recent losses: widowed, divorced
Sickness (schizophrenia, cancer, AIDS, peptic ulcer disease, others)
Organized plan
No supports
Suicide in Family (4x increased risk)
Other factors:
- social isolation, loneliness, unemployment, drop in SES, firearm access
- highest in spring and early summer (April, May, June)
- psychological dimensions: hoplessness, psychic pain/anxiety, psychological turmoil, decreased self-esteem, fragile narcissism and perfectionism
- behavioural dimensions: impulsivity, aggression, others...
Family history of suicide, or past history of suicide attempt, is a substantial risk factor.
Warning Signs
preoccupation with death or threatening to commit suicide
history of past attempts: 100x increase in the next year
- "the best predictor of past behaviour is future behaviour"
significant/deep depression
Symptoms associated with suicide include:
- hopelessness
- anhedonia
- insomnia
- severe anxiety or panic attacks
- impaired concentration
- psychomotor agitation
Suicide Assessment
- watch for risk factors, protective factors
- attempt to modify
- ask about suicide, ask
Specific Suicide Inquiry
- do you ever think about doing yourself in?
- have you ever thought about how you might do this?
- do you have a plan?
- have you imagined your funeral, and how people might react to your death?
- have you changed your will or life insurance policy, or given away possessions?
Protective Factors
- children at home, except
Prevention
Education
school based educational programs (equivocal success)
general community education
peer counselling
Decreased Access to Means
put as many barriers in the way:
car catalytic converters decrease carbon monoxide production
benzo's are much less lethal than barbiturates
firearm controls
making buildings/bridges safer
making OTC analgesics with sublethal doses per packet
Crisis Lines
Secondary Prevention
- problem-solving therapy
- cognitive behaviour therapy
- emergency access card
Media Guidelines
reduce sensationalist guidelines
- details of method/location
- interviews with the bereaved
include a bit about getting help
Resources and References
Stovall J, Domino FJ. 2003. Approaching the Suicidal Patient. Am Fam Physician. 68:1814-8.
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