The Potentially Suicidal Person

• suicide
• risk assessment
• see also:
  • Depression
  • Human Behaviour
  • Australian Suicide Prevention organisation
  • Australian Mens Help Line
  • Australian Crisis Support
  • Protection for Life - A Guide to Suicide Awareness & Prevention

Suicide:

• the 9th leading cause of death in Western populations
  • in Australia in 2005, there were approx. 2100 suicides for the year, of which 80% were men and 50% of all were men aged 25-44 yrs old. 
• the 2nd leading cause of death in persons aged < 24yrs
• but only 2% population actually seriously contemplate suicide and 1% complete suicide
• 2 different but overlapping groups:
  • suicide attempters:
    • 40 x the number of suicide completers
    • tend to be female, younger, or with personality disorders
    • NB. a significant number of these will complete suicide within 5yrs!!!!
  • suicide completers:
    • tend to be male, older, living alone, or physically ill
    • 3 differentiating factors from those with depression who are not suicidal (BJPsych 2003):
      • a sensitivity to particular life events reflecting signals of defeat, based on attentional biases ('perceptual popout') leading to involuntary hypersensitivity to stimuli signalling 'loser' status.
      • the sense of being trapped, which is related to an insufficient capacity to solve problems, commonly of an interpersonal or social nature
      • the absence of rescue factors, mediated by deficient prospective cognitive processes and leading to feelings of hopelessness
    • potential neural basis of suicidal cognition (BJPsych 2003):
      • social cognitive component modulated by frontal & temporal cortices in conjunction with the hippocampus & mediated by 5HT1A and noradrenaline neurotransmission
        • attention level is related to NA release
        • drugs that influence 5HT1A function (buspirone) selectively affect performance on neuropsychological tests of memory and learning without affecting executive functions
      • executive functions which may be modulated by prefrontal cortex in conjunction with the amygdala and mediated by 5HT2A and dopamine
        • comprises the need to achieve and maintain a problem-solving set

Risk assessment - is someone you know at risk and not seeking help?:

• the sad fact is that many have lost partners & parents dear to them, partly because they did not see the warning signs & ensure help was sought to assist in reversing this potentially lethal state of mind.
• whilst there have been a number of risk assessment scales developed to assist the clinician in assessing these patients, no one scale has been adequately validated to be reliable. It usually comes down to a clinician's experience taking into account the various elements of risk.
• one approach is a risk categorisation table. This allows one to get a feel for which category a person lies  and then arrange appropriate disposition according to the category. While all persons with depression, particularly with suicidal thoughts should be strongly encouraged to seek professional help, those in the high risk category would most likely require admission to an acute mental health facility ASAP.

Other suicidal risk assessment measures:

• Sad Persons Index:
  • this is a mnemonic for assessment of suicide risk
    • Sex: M = 3xF
    • Age: youth or age > 55yrs
    • Depression
    • Previous attempts - esp. within the last year
      • Prison
      • Psychiatric illness: 10% of schizophrenics will eventually kill themselves
    • Ethanol - alcoholics have 50x suicide risk; 25% of all successful suicides are associated with alcohol
    • Rationality
    • Single - suicide risk higher if divorced, separated or single
    • Organised plan
    • No supports
    • Sickness
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