Suicide, Risk Evaluation
Suicide, Risk Evaluation is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
Description
- The intentional taking of one's own life
- Suicidal ideation:
- Passive: A conscious desire not to live
- Active: Intention to die with or without a plan
- Parasuicidal behavior: Self-injury not intended to cause death (e.g., superficial cutting, cigarette burns, head banging)
- Reckless behavior: Not taking prescribed medications, taking too much of prescribed medications, running into traffic
- Risk-to-rescue ratio—lethality of plan compared with likelihood of rescue:
- High risk-to-rescue ratio indicates increased severity of attempt.
- Occult presentation:
- Many individuals at risk for suicidal behavior seek care in the ED for nonbehavioral complaints
- Improved suicide screening practices may be needed to capture this population.
Etiology
Etiology
- 36,891 suicides in US (CDC 2009)
- 12–25 attempts per every completed suicide
- 25.4 per 100,000 males (CDC 2009)
- 7.4 per 100,000 females
- 11.1 per 100,000 general population
- 2 peaks in age group most at risk for suicide:
- Age 15–24 yr (3rd leading cause of death in this age group)
- Age >60 yr (highest rates of any age group, increasing incidence with age)
Risk Factors for Suicidal Behavior
- Depression (bipolar or unipolar)
- Alcohol or drug abuse
- History of physical or sexual abuse
- Unemployment
- Incarceration
- History of head injury or neurologic disorder
- Firearms in the home
- Cigarette smoking
- Positive family history of suicide attempt
- Psychiatric or medical comorbidities
- Gender:
- Women 3 times more likely to attempt suicide.
- Men 3 times more likely to complete suicide.
- Psychological:
- Impulsivity/aggression
- Depression
- Anxiety
- Hopelessness
- Self-consciousness/social disengagement
- Poor problem-solving abilities
- Lack of social supports
- Widowed
- Divorced
- Separated
- Lack of social supports
- Recent loss of relationship
- Anniversary of loss
- Environmental
- Rural areas:
- Access to firearms
- Poverty
- Unemployment
Risk Factors for Completed Suicide
- Male
- Age >60 yr
- White or Native American
- Widowed/divorced
- Living alone
- Unemployment/poverty
- Past suicide attempt
Methods of Suicide (CDC 2009)
- Firearms (most common among men and 2nd most common in women)
- Overdose (Most common among women); most common means of suicide attempt (70% of failed attempts are by overdose)
- Hanging
- Suffocation
Populations at Highest Risk for Completing Suicide
- >90% of patients who commit suicide have a psychiatric diagnosis.
- Depression—especially psychotic depression
- Anxiety and panic disorder
- Alcohol or drug intoxication
- Schizophrenia
- Adolescents
Others at Risk for Completing Suicide
- Recent discharge from psychiatric facility
- History of suicidal ideation or suicide attempt
- Serious physical illness present in up to 70% of all suicides, particularly in elderly patients.
- History of incarceration
- Physicians
- Victims of violence/abuse
Interventions that Lower Risk
- Patients with mood disorders (major depression and bipolar disorder) treated with lithium
- Patient with major depression treated with electroconvulsive therapy
- Patients with schizophrenia treated with clozapine
- NOT shown to decrease suicide rates: Treatment with selective serotonin reuptake inhibitors (SSRIs) for major depression
Protective factors
- Strong social supports
- Family cohesion
- Peer group affiliation
- Good coping and problem-solving skills
- Positive values and beliefs
- Ability to seek and access help
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Citation
Rosen, Peter, et al., editors. "Suicide, Risk Evaluation." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307410/all/Suicide__Risk_Evaluation.
Suicide, Risk Evaluation. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307410/all/Suicide__Risk_Evaluation. Accessed December 9, 2019.
Suicide, Risk Evaluation. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307410/all/Suicide__Risk_Evaluation
Suicide, Risk Evaluation [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 December 09]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307410/all/Suicide__Risk_Evaluation.
* Article titles in AMA citation format should be in sentence-case
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