Suicide, Risk Evaluation
Basics
Description
Description
- Intentionally taking one's own life
- Suicidal ideation:
- Passive: A conscious desire not to live
- Active: Intention to take one's life, 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 medical and not behavioral complaints
- Improved suicide screening practices may be needed to capture this population
Etiology
Etiology
- 42,826 suicides in the U.S. in 2014 (CDC 2014)
- 12–25 attempts per completed suicide
- 20.7 completed suicides per 100,000 males (CDC 2014)
- 5.8 completed suicides per 100,000 females (CDC 2014)
- 13.4 completed suicides per 100,000 general population (CDC 2014)
- 21,386 deaths per 100,000
- Suffocation (11,407 deaths per 100,000)
- Poisoning (6,808 deaths per 100,000)
- Others: Hanging, jumping
Epidemiologic Risk Factors
- Gender:
- Women 3× more likely to attempt suicide
- Men 3× more likely to complete suicide
- Age
- Ethnicity: White or Native American
- Marital status: Widowed or divorced
- Living alone: No children in the home
- Employment: Unemployed, work-related access to lethal means (e.g., physicians)
- Access to firearms
Diagnoses Associated with Completed Suicide
- >90% of patients who commit suicide have a psychiatric diagnosis and >50% are depressed at the time of the attempt
- Depression (especially depression with psychotic features or bipolar depression)
- Anxiety disorders (especially panic disorder)
- Substance use disorders (especially alcohol)
- Schizophrenia
- Chronic medical illness (especially traumatic brain injuries, epilepsy, multiple sclerosis, Huntington disease, Parkinson disease, cancer, HIV/AIDS)
Others at Risk for Completing Suicide
- Recent discharge from psychiatric facility
- Recent medical visit to general practitioner or PCP
- History of suicidal ideation or suicide attempt
- Family history of suicide attempt/completion
- History of incarceration
- Marginalized individuals (e.g., homeless, unemployed, socially isolated)
- Victims of violence/abuse
Interventions That Lower Risk
- Enhancing a well-defined support network including wrap-around care teams of PCP, behavioral health, social services, and case management
- 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
- Emerging research suggests ketamine may reduce suicidality but further research is needed
- 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 (e.g., religion, employment, volunteering)
- Good coping and problem-solving skills
- Positive values and beliefs
- Ability to seek and access help
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Citation
Schaider, Jeffrey J., et al., editors. "Suicide, Risk Evaluation." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307410/all/Suicide__Risk_Evaluation.
Suicide, Risk Evaluation. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307410/all/Suicide__Risk_Evaluation. Accessed November 7, 2024.
Suicide, Risk Evaluation. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307410/all/Suicide__Risk_Evaluation
Suicide, Risk Evaluation [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 November 07]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307410/all/Suicide__Risk_Evaluation.
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