Health Topic Categories

- Mental Health -

September 8th, 2014


Suicide Prevention

Scope

Suicide is the 10th leading cause of death and the 3rd among adolescents and young adults in the United States. During the last decade suicide surpassed motor vehicle accidents as the leading cause of death from injury.

 

Age

The incidence of suicide spikes among young adults, falls rapidly, and then gradually rises again until peaking in the over-75 year-old group.  In the youth group the incidence is higher among those pursuing Goth, Emo, and Punk lifestyles and occasionally occurs as a contagious phenomenon.  In the senior group the incidence is higher among those with cancer or intractable disease and occasionally occurs as murder-suicide.

 

Sex

Women make 2-3 times the suicide attempts of men, but men have 4 times the completed suicides of women.  Women tend to use means such as poison, while men tend to use firearms.  Suicide among females correlates with victimization by bullying.  In a Danish study, evidence of a prior infection with Toxoplasma gondii in women correlated with suicide incidence.

 

Mental Illness

Not surprisingly, suicide risk correlates with mental illness, including disabling obsessive-compulsive and phobic disorders, bulimia, post-traumatic stress disorder, traumatic brain injury, substance abuse, manic-depressive disorder, and schizophrenia.

 

In substance abuse, increased risk is present in all three stages: intoxication, withdrawal, and chronic.  Abusers using methamphetamine by intravenous injection are at special risk. 

 

Manic-depressives are at increased suicide risk during both the manic and depressive phases.  The most dangerous time for depressives is when they seem to be emerging from depression.

 

Schizophrenia sufferers are at heightened risk if they are relatively high-functioning or if they hear command hallucinations, ie, voices instructing them to harm themselves.

 

An especially risky time for psychiatric in-patients is when they are first released from the psychiatric institution.

 

Social Factors

Numerous social factors are also associated with increased suicide risk.  These include living alone, having a recent loss such as job or love relationship, and poverty.

 

History of a relative or parent who has died from suicide is a risk intensifier, more so when the parent was the mother rather than the father.  The risk is heightened on the anniversary of the death of the relative and when the person reaches the age of the deceased relative.

 

Suicide incidence is also higher among certain occupational groups such as police, firefighters, physicians, dentists, members of the military, and prisoners.

 

It is a myth that suicide incidence is highest during the winter holidays.  Suicides are actually lowest during the months of November to January and are highest in May.

 

Personal Characteristics

People who attempt suicide often share a number of personal characteristics: a preoccupation with death, isolation, emotional distance, a lack of humor, dwelling on past misfortunes, and a sense of hopelessness and helplessness.

 

Behavioral Red Flags

Red flags should spring up when someone at special risk of suicide exhibits certain activities.  These include giving away prized possessions, making a will, organizing personal affairs, unexpectedly visiting friends or family, and acquiring items potentially useful in a suicide attempt.

 

Intervention

It is a myth that persons who speak of suicide do not act on the thought.  If a person speaks suicidally or is reasonably considered to be suicidal, intervention must be immediate and definitive.  Here are some guidelines:

  •  Do NOT leave the person alone.  
  •  Do NOT act shocked or be judgmental.
  •  Do NOT deny the person’s feelings.  
  •  Do NOT promise to keep the person’s feelings a secret.
  •  DO listen attentively and encourage communication.
  •  DO reassure the person that their feelings are temporary.
  •  DO dial 911 if needed.
  •  DO remove scissors, knives, medications and other implements that could be used suicidally.
  •  DO get the person to a safe, supervised location.

No one expects to need to use these strategies, but the suicide statistics show otherwise.  Familiarity with the facts and knowledge of the strategies may well save someone’s life.

 

Thomas Falasca, DO

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