_____________________________________________________________ Suicide Assessment and Prevention
In one survey of adults who experienced depression in the pre- vious year, 56.3% thought it would be better if they were dead during their worst or most recent episode, 40.3% contemplated suicide, 14.5% made a suicide plan, and 10.4% attempted suicide [65]. Among persons with depression, those with a history of multiple episodes of depression and those with an alcohol or other substance use disorder are at greatest risk [2]. Persons with depression who exhibit the following symptoms are at heightened risk for suicide [2; 13]: • Extreme hopelessness or desperation • A lack of interest in previously pleasurable activities • Intense anxiety and/or panic attacks • Insomnia • Talk of suicide or history of attempts • Irritability, agitation, or enraged behavior • Isolation Feelings of hopelessness (e.g., belief that there is no solution) are more predictive of suicide risk than a diagnosis of depres- sion per se. It is also important to remember that patients who desire an early death during a serious or terminal illness are usually experiencing a treatable depressive illness [2]. Bipolar Disorder Between 5 and 10 million Americans currently have bipolar disorder. Of these, as many as 1 in 5 will die by suicide [67]. Like depression, bipolar disorder is treatable, and effective treatment decreases the risk of suicide. Alcohol and Substance Abuse Alcohol and drug abuse are second only to depression and other mood disorders as conditions most associated with sui- cide. Substance use disorders and disordered mood are often comorbid. The suicide risk among patients with alcohol use disorder is 50% to 70% higher than the general population. Alcohol abuse is a factor in roughly 30% of suicides, and about 7% of persons with alcohol dependence die by suicide [2; 13; 68]. In 2011, an estimated 228,366 emergency department admis- sions were made for alcohol- or drug-related suicide attempts. Almost all (94.7%) involved either a prescription drug or an over-the-counter medication [69]. Approximately 64.4% involved multiple drugs, and 29% involved alcohol [69]. As mentioned, comorbid psychiatric and substance use disorders substantially increase the risk of suicide behavior. Combined data from 2004 and 2005 indicated that 16.4 million adults 18 years of age and older experienced a major depressive episode in the previous year. Of these persons, more than 10% attempted suicide. But when alcohol abuse or illicit drug use occurred with major depression, the proportion of
• Family history of suicide • Suicidal ideas, plans, or attempts (current or previous) • Lethality of suicidal plans or attempts In addition, environmental factors can impact an individual’s suicide risk. Attention to the presence of job or financial loss, relationship or social loss, easy access to lethal means, and local clusters of suicide (due to contagious influence) is necessary. Lack of social support and sense of isolation are risk factors for suicide, along with cultural factors. Some cultural practices and/or beliefs can predispose an individual to suicide, such as stigma associated with help-seeking behavior; barriers to accessing mental health care and substance abuse treatment; certain cultural and religious beliefs (e.g., suicide as an honor- able act); and media exposure to and the influence of others who have died by suicide [2; 5; 62]. According to the American Psychiatric Association, the assessment and treatment of major depressive disorder should consider the impact of language barriers, as well as cultural variables that may influence symptom presentation, treatment preferences, and the degree to which psychiatric illness is stigmatized. (https://psychiatryonline.org/pb/assets/raw/sitewide/ practice_guidelines/guidelines/mdd.pdf. Last accessed March 24, 2023.) Strength of Recommendation : I (Recommended with substantial clinical confidence) Psychiatric Disorders At least 90% of people who die by suicide have diagnosable psychiatric illness [2; 3]. The psychiatric conditions with the greatest association with suicidal behavior are depression, bipolar disorder, substance abuse, schizophrenia, and person- ality disorders. Depression Major depression is the psychiatric diagnosis most commonly associated with suicide. The risk of suicide in persons with major depression is roughly 20 times that of the general popu- lation [13]. About 30% of all patients with major depression attempt suicide, half of whom ultimately take their own lives [63]. More than 60% of persons who die by suicide are clini- cally depressed at the time of their deaths, although this climbs to 75% when patients with comorbid depression and alcohol use disorder are added. Seven of every 100 men and 1 of every 100 women diagnosed with depression will die by suicide [13].
57
EliteLearning.com/Psychology
Powered by FlippingBook