Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system
where everyone receives fair and equal treatment regardless of their background or characteristics.
INTRODUCTION
The U.S. Centers for Disease Control (CDC; 2022) has identified suicide as one of the top 10 leading causes of death in the 10–65 age group. Not only does the suicidal behavior of a loved one cause an emotional toll on family members and place others within the family unit at risk of dying by suicide, it also results in increased medical costs Suicide terminology In recent years, the vernacular on suicide has changed. Clinicians and researchers are encouraged not to say that an individual “tried to commit suicide” or “committed suicide” because the word commit has negative connotations and suggests a capacity for intentional, rational action (Jacobs & Klein-Benheim, 2021). Instead of “committed” or “completed,” it is currently recommended to use the
for individuals and families, lost income for families, and lost productivity for employers and the community (Suicide Prevention Resource Center [SPRC], 2021). This topic must be addressed throughout the healthcare community to prevent further avoidable loss of life.
phrase “died by suicide.” Furthermore, suicide attempts are no longer categorized as “failed,” “unsuccessful,” or “successful” (Jacobs & Klein-Benheim, 2021). Rather, it is recommended to use the phrases “aborted or self- interrupted attempt” or “interrupted attempt. (Jacobs & Klein-Beheim, 2021).
SUICIDE RISK FACTORS
Although research has identified that multiple factors can increase one’s risk for suicide, no studies show that one factor or set of factors is predictive of suicide (Jacobs &
Klein-Benheim, 2021). Table 1 briefly outlines risk factors that are positively associated with suicide risk.
Table 1. Risk Factors for Suicide Individual
Relationship
Community
Societal
• Previous attempts. • Mental illness, particularly clinical depression. • Social isolation. • Criminal problems. • Financial problems. • Impulsive or aggressive tendencies. • Job problems or loss (relational, social, work, or financial). • Serious illness. • Substance use disorder.
• Adverse childhood experiences, such as child abuse or neglect. • Bullying. • Family history of suicide. • Relationship problems, such as a break-up, violence, or loss. • Sexual violence.
• Local epidemics of suicide. • Barriers to accessing mental health treatment. • Cultural and religious beliefs, such as the belief that suicide is a noble resolution of a personal problem.
• Easy access to lethal methods (firearms, medications). • Stigma associated with mental illness or help- seeking. • Unsafe media portrayals of suicide.
Note : Adapted from Centers for Disease Control and Prevention. (2021, May 13). Risk and protective factors . https://www.cdc.gov/suicide/ facts/index.html
Protective factors in the general population There are several factors that can mitigate the risk in a person with a moderate to low risk for suicide, which can inform safety planning and assessment. Protective factors include (CDC, 2021): ● Effective coping and problem-solving skills. ● Self-esteem and a sense of purpose and meaning in life. ● Cultural and religious beliefs that discourage suicide. ● Connections to family, friends, and community support. Suicide warning signs Since suicide is a relatively rare event, it is challenging to predict suicide based on risk factors (Jacobs & Klein- Benheim, 2021). A recent meta- analysis found that predicting suicide is no better than chance and has not significantly improved over the past 50 years. The goal of identifying warning signs or clinical situations that warrant a suicide assessment is not a prediction but rather a determination of an individual’s suicide risk (i.e., “low”, “medium”, or “high”) and a plan for informed interventions (Jacobs & Klein-Benheim, 2021). It is important to note that the risk of suicide is greater if the warning sign is new, has increased, is after a perceived or experienced emotionally
● Supportive relationships with care providers. ● Availability of physical and mental healthcare services. ● Limited access to lethal means among people at risk. Healthcare Consideration: Safety planning and assessment of patients at increased risk for suicide should also include an examination of each patient’s protective factors that serve to reduce suicidal acts. challenging event, or is associated with the acute onset of mental illness (Jacobs & Klein-Benheim, 2021). Examples of clinical situations that warrant a suicide assessment include (Jacobs & Klein-Benheim, 2021): ● Crisis evaluations in the emergency department. ● Intake evaluations for all patients, especially those with severe mental illness. ● Patients with depression; someone who is either anticipating or experiencing significant loss or stress. ● Patients with certain physical illnesses, especially if life threatening or associated with severe or chronic pain or loss of function.
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