Suicide

Corie Ferestad, Michael Pretz, Steven Coop

Suicide

World Health Organization

International Statistics5 million suicides

worldwide since 200010-20 times as many

suicide attempts than suicide deaths

In the last 45 years, suicide rates have increased by 60 percent in some countries.

Worldwide, suicide ranks among the three leading causes of death among those aged 15-44 years.

Center for Disease Control and Prevention

National StatisticsSuicides (2009)

36,909 suicides Rate= 12 1.5% of all deaths 2.4% increase from 2008 Highest rate in 15 years

Suicide ranked 10th cause of all deaths

Suicide Attempts (2009) 922,725 annual attempts in

the US 25 attempts for every death

by suicide Between 20 and 50 percent

of people who kill themselves had previously attempted suicide.

2009Firearms- 18,735 (50.8%)Suffocation/Hanging- 9,000 (24.4%)Poisoning- 6,398 (17.3%)Cut/pierce- 669 (1.8%)


Statistics of Methods

Due to a mental illnessRational SuicideEuthanasia and Physician-Assisted Suicide

PassiveActiveVoluntaryInvoluntary

(Gearing & Worchell, 2010)

Types of Suicides

Gender There are four male suicides for every female suicide, but three times as many

females as males attempt suicide. (79% male and 21% female) Rate of male suicide in 2009- 19.2 Rate of female suicide in 2009- 5

Age Suicide is the fourth leading cause of death for adults between the ages of 18 and

65 years in the United States. 5-14 rate .7 – lowest 45-54 rate 19.3- highest

Race European Americans are most likely to commit suicide

32% white (rate- 13.5) 29% native american or alaska native (12.3) 15% asian or pacific islander (6.3) 12% Hispanic (5.3) 12% Black (rate-5.1)

Region Montana rate- 22.5 (219/974,989) District of Columbia rate- 4.8 (29/599,657)


Special Populations and Suicide

Ninety percent of all people who die by suicide have a diagnosable psychiatric disorder at the time of their death. Depression

2/3 who commit suicide are clinically depressed 30% of depressed people attempt suicide

Bi-Polar 25-50% of persons with this illness make at least one suicide attempt The suicide rate in the first year off lithium treatment is 20 times

that during treatment During treatment an estimated 3-20% of persons diagnosed with

bipolar disorder die by suicide Schizophrenia

20-40% of persons with schizophrenia make suicide attempts and 10% of individuals with schizophrenia eventually complete suicide.

Suicide is the number one cause of death for young people with schizophrenia


Mental Disorders and Suicide

Lifetime mortality due to suicide in alcohol dependence is between 2.2% and 18%20-35% of completed suicides are committed

by individuals with alcoholism24% of individuals with alcohol use disorder

have attempted suicideLifetime prevalence for suicide ideation

among heroin users is between 50-60%Approximately 1/3 attempt suicide

(Gearing & Worchel, 2010)

Substance Use and Suicide

Suicide is not a disorder

It is also possible that certain types of suicide are not indicative of a mental disorder


Suicide Assessment

1. Sociodemographic dataAge GenderRaceCultureEthnicity SESLiving situationCurrent and past medical historySubstance use


Assessment

2. Identified problem/symptom historyFrom a diagnosis to a specific problem of living

3. Current suicidalityIdeationIntentPlan/PlanningFeasibilityLethality (help differentiate between parasuicide) TimingImpulsivity/aggressionHopelessness


Assessment

4. Risk FactorsSocialEnvironmentalPsychiatric Individual

5. Protective FactorsSocial EnvironmentalPsychiatric Individual

6. Suicide history7. Family/peer suicide history


Assessment

Employment- unemployed and retired persons Marital Status- being single or divorced Religion- Protestants are at higher risk Family History- increases risk even beyond mental disorder Living Alone- Isolation Gun Ownership Physical Disease Feelings of Hopelessness Recent Mental Hospitalization- first few days after release Financial Difficulty Heaving Gambling Losses Talking about suicide Suicide of Others Prior Suicide Attempt

(Morrison, 2007)

Individual Factors That Increase Risk of Suicide

Reasons for livingSocial support and connectednessLimited access to firearms Marital statusReligious affiliationEthnicity


Protective Factors

Warning SignsIS PATH WARM

I-IdeationS-Substance AbuseP- PurposelessnessA-AnxietyT-TrappedH-HopelessnessW-WithdrawalA-AngerR-RecklessnessM-Mood Changes

Fifty to 75 percent of all suicides give some warning of their intentions to a friend or family member

AFSP.ORG

Suicide Ideation

Lt. Colonel Frank Slade:• Retired Army Officer• Complete Visual Impairment• Noticeable Alcohol use• Suicide Ideation

Disclaimer: The video clips you are about to view contain foul language necessary to depict a realistic life event involving suicidal ideations.

Case Study

1. Absences of risk – Treatment based on clinical presentation and issues present

2. Low Risk – Outpatient referral may be acceptable3. Moderate – Outpatient referral can be reasonable

and psychopharmacological treatment may be needed to supplement outpatient psychotherapy

4. High Risk – Observation for up to 72 hours at the ER

5. Severe Risk – Admission to a psychiatric hospital is typically required


Level of Risk

Lt. Coronel Frank Slade:RetiredSingleIsolatedGun ownershipVisually impairedHopelessTalks about suicideAlcoholicMajor depressive disorder

Risk Factors

More than 90 percent of people who kill themselves are suffering from one or more psychiatric disorders, including:

Major depression (especially when combined with alcohol and/or drug abuse)

Bipolar depressionAlcohol abuse and dependenceDrug abuse and dependenceSchizophreniaPost Traumatic Stress Disorder (PTSD)Eating disordersPersonality disorders


Treatment Considerations:

(Anil et al., 1999)

Treatment Algorithm for Patients with Suicidal Ideations

Three Options:Hospitalization

Psychotherapy

Prescription Medications

(Demyttenaere , 2001)

Treatment Options

HospitalizationTreatment for an Acute Suicidal Crisis

Take the person to an emergency room or walk-in clinic at a psychiatric hospital.

If a psychiatric facility is unavailable, go to your nearest hospital or clinic.

If the above options are unavailable, call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

(Brown et al., 2005)

Treatment Options

Psychotherapy Research shows that when it comes to treating depression, all

therapy is NOT created equal.

Study shows applying correct techniques reduce suicide attempts by 50% over 18 month period

To be effective, psychotherapy must be:

Specifically designed to treat depression Relatively short-term (10-16 weeks) Structured (therapist should be able to give step-by-step treatment

instructions that any other therapist can easily follow)

Examples: Cognitive Behavior Therapy (CBT), Interpersonal Therapy (IPT), Dialectical Behavior Therapy (DBT)

(Brown et al., 2005)

Treatment Options

MedicationsAdequate prescription treatment and monitoring is critical to ensure successful treatment of underlying psychiatric disorders associated with suicidal ideations.

Commonly used Antidepressants: Prozac, Zoloft, Paxil, Luvox, Effexor, SerzoneCommonly used anti-anxiety meds: Ativan, Serax, Restoril, AmbienOther medications: lithium (mood stabilizer), Abilify, Clozaril and Risperdal (anti-anxiety)

Only 20% of medicated patients are adequately treated with prescription medications – possibly due to:

Side effects Lack of improvement Fear of drug dependency Concomitant substance use Didn't combine with psychotherapy Dose of medication too high/low

NOTE: Most antidepressants take 4-6 weeks to reach full potential and MAY result in increased suicidal ideations resulting from increased energy prior to reduction in depressive episodes.

(Demyttenaere , 2001)

Treatment Options

American Association of Suicidology . 2012. Fact Sheet and Statistics. 2012, May 15, http://www.suicidology.org/stats-and-tools/suicide-fact-sheets.

American Foundation for Suicide Prevention. 2012. About Suicide. 2012, May 15, http://www.afsp.org/index.cfm?fuseaction=home.viewPage&page_id=04EA1254-BD31- 1FA3C549D77E6CA6AA37.

Anil, K., Gliatto, F., & Rai, M. Evaluation and Treatment of Patients with Suicidal Ideation. Am Fam Physician. 1999 Mar 15;59(6):1500-1506

Brown et al, Journal of the American Medical Association, 2005

Center for Disease Control and Prevention. 2012. Suicide Prevention. 2012, May 15, http://www.cdc.gov/ViolencePrevention/suicide/index.html.

Demyttenaere K, et al, Journal of Clinical Psychiatry, 2001.

Gearing, R. & Worchell,D. (2010). Suicide Assessment and Treatment: Empirical and Evidence Based Practices. New York, NY. Springer Publishing Company.

Morrison, J. (2007). Diagnosis Made Easier: Principles and Techniques for Mental Health Clinicians. New York, NY: The Guilford Press

World Health Organization. 2012. Data and Statistics. 2012, May 15, http://www.who.int/research/en/.

References

Documents

Suicide