Suicide

Aka: Suicide, Suicide Risk, Suicidality, Suicidal Ideation

1. See Also
   1. Major Depression
2. Risk factors: Suicide
   1. Current mental status
      1. Agitation
      2. Anxiety
      3. Insomnia
   2. Biologic factors
      1. Age 20 to 24 and over age 65 years
      2. Native American or native alaskan
      3. Caucasian
      4. Male gender (especially elderly male)
   3. Psychiatric factors
      1. Psychotic symptoms
      2. Previous Suicide attempt within last 2 years
      3. Family History of completed Suicide
      4. Major Depression symptoms
         1. Anhedonia
         2. Hopelessness
         3. Insomnia
         4. Irritability
      5. Comorbid mental illness
         1. Substance Abuse
         2. Major Depression
         3. Severe Anxiety Disorder (including PTSD)
         4. Bipolar Disorder
         5. Schizophrenia
         6. Borderline Personality disorder
   4. Social factors
      1. Solitary lifestyle or limited social support (e.g. divorced or widowed patient)
      2. Available means to carry out a Suicide plan (e.g. weapons in home)
      3. Stressful life event
   5. Comorbid medical conditions
      1. Associated chronic medical condition
      2. Seizure disorder (3 fold higher risk)
      3. Medications associated with increased Suicidal Ideation
         1. See Suicidality Associated with Medications
3. Screening
   1. Be alert for depressed mood in all patients
   2. Inquire about suicidal thoughts in depression
      1. Asking about Suicide does not increase its risk
      2. Guns
      3. Poisoning
      4. Hanging
4. Evaluation
   1. Avoid confrontational approach
      1. Obtain patient comfort and trust first
      2. Maintain culturally sensitive approach
      3. Maintain good eye contact
   2. Sample questioning method:
      1. Have there been recent CHANGES with family, friends, home or work?
      2. What are your plans for the FUTURE?
      3. Do you ever lose HOPE with your current situation?
      4. What do you THINK ABOUT when feeling down?
      5. Do you ever consider Running AWAY from your problems?
      6. Have you had DEPRESSION, ANXIETY or OTHER mental illness in the past?
      7. Have you ever thought of HURTING yourself?
      8. Have you ever thought of KILLING yourself?
      9. How have you PLANNED to kill yourself?
      10. Have you PREPARED to do this?
      11. Has any FAMILY MEMBER attempted Suicide in the past?
      12. Are you CURRENTLY thinking about death or harming yourself?
      13. Do you use Alcohol or DRUGS?
      14. Do you make IMPULSIVE decisions or actions?
      15. Do you have WEAPONS, POISONS in PILLS at home you would use to harm yourself?
      16. Have you shared your self-harm thoughts with OTHERS?
      17. Do you have FRIENDS or FAMILY with whom you are close?
      18. What would happen to your FAMILY without you?
      19. What has PREVENTED you from committing Suicide?
   3. References
      1. Norris (2012) Am Fam Physician 85(6): 602-5
      2. Stovall (2003) Am Fam Physician 68(9):1814-8
5. Management
   1. Evaluate patient safety
      1. Hospitalize imminently suicidal patients
      2. Remove all weapons in the home
      3. Family and friend involvement is critical
   2. Treat underlying psychiatric illness
      1. See Depression Management
      2. Treat Substance Abuse
      3. Initiate psychological counseling
6. Resources
   1. American Foundation for Suicide Prevention
      1. http://www.afsp.org
   2. National Suicide Prevention Lifeline
      1. http://www.suicidepreventionlifeline.org
      2. Phone: 800-273-TALK
   3. Suicide Prevention Resource Center
      1. http://www.sprc.org
7. References
   1. Hamilton (2000) Postgrad Med 108(6):81-7
   2. Hirschfeld (1997) N Engl J Med 337(13): 910-5
   3. Maris (2002) Lancet 360(9329):319-26
   4. (2004) Ann Intern Med 140(10): 820-1
   5. Norris (2012) Am Fam Physician 85(6): 602-5
   6. Stovall (2003) Am Fam Physician 68(9):1814-8