Suicide
Def'n: self-inflicted and they intended to kill themselves
Risk factors useful for ID'ing at-risk groups but less so for at-risk INDIVIDUALS
Suicidal behavior = extreme form of emotional avoidance (gaining some kind of control)
Myths/Truths
"people that talk about it don't commit it." (1/3 visit doctors in the week before)
suicide happens in mood disorders, schizophrenia, personality disorders and medical illness (not "just a single disease")
no correlation w/ holidays - peak in May and June - most between 7 am and 4 pm (in hospitals, between 5-7 am - shift change) - decrease in seasonality due to modernization
no specific factors to foretell or correct intervention
rise in incidence by 24% from 1999-2014
10th cause of death in US
Montana #1 for suicides per capita; NY #50 (access to services probably accounts for this)
Stats
Native American highest risk
older white males are next (whites have 2x risk of non-whites)
2nd cause of death in age 15-24
rates rise significantly after age 65 - possibly due to undiagnosed depression?
females attempt more, males complete more (4 M:1 F completion, 3 F:1 M attempt)
Risk factors
mental illness
depression (60% of completed suicides)
bipolar
previous suicide attempt greatest single risk factor
mixed states - dangerously increase risk - energy and impulsivity to negative thoughts/perceptions
suicidality in context of hopelessness/negative feelings
schizophrenia
impulsivity/aggression
increased substance use
recent stressors/family crisis
Parasuicidal behavior
cutting/burning/scratching: usually no suicidal intent - anger toward self or others - understand context
Biology
decreased serotonin (increased impulsivity)
orbitofrontal cortex
Metholds
50% of suicides committed with firearms
poisoning method of choice among women (chance of rescue)
hanging #1 method worldwide
Treatment - lethality eval
ideation or attempt?
circumstances
planned or impulsive? notes?
if attempt, how serious?
guns in the home?
HOSPITALIZE - even if they don't agree - start appropriate meds
when starting SSRIs - careful! may have increased suicidality - may have energy with negative thoughts
no-suicide contracts don't work - give docs false sense of security
media: avoid repetitive/excessive reporting, avoid simplistic language, how-to descriptions
Prevention: screen for depression/mania, ask about suicide/other self-injury, drugs and alcohol, stressors
minimize firearms or make them safer
high risk in military