II. Risk factors: Suicide

  1. Current mental status
    1. Agitation
    2. Anxiety
    3. Insomnia
  2. Biologic factors
    1. Age 20 to 24 and over age 65 years
    2. Native American or native alaskan
    3. Caucasian
    4. Male gender (especially elderly male)
  3. Psychiatric factors
    1. Psychotic symptoms
    2. Previous Suicide attempt within last 2 years
    3. Family History of completed Suicide
    4. Major Depression symptoms
      1. Anhedonia
      2. Hopelessness
      3. Insomnia
      4. Irritability
    5. Comorbid mental illness
      1. Substance Abuse
      2. Major Depression
      3. Severe Anxiety Disorder (including PTSD)
      4. Bipolar Disorder
      5. Schizophrenia
      6. Borderline Personality disorder
  4. Social factors
    1. Solitary lifestyle or limited social support (e.g. divorced or widowed patient)
    2. Available means to carry out a Suicide plan (e.g. weapons in home)
    3. Stressful life event
  5. Comorbid medical conditions
    1. Associated chronic medical condition
    2. Seizure disorder (3 fold higher risk)
    3. Medications associated with increased Suicidal Ideation
      1. See Suicidality Associated with Medications

III. Screening

  1. Be alert for depressed mood in all patients
  2. Inquire about suicidal thoughts in depression
    1. Asking about Suicide does not increase its risk
    2. Guns
    3. Poisoning
    4. Hanging

IV. Evaluation: General

  1. Avoid confrontational approach
    1. Obtain patient comfort and trust first
    2. Maintain culturally sensitive approach
    3. Maintain good eye contact
  2. Sample questioning method:
    1. Have there been recent CHANGES with family, friends, home or work?
    2. What are your plans for the FUTURE?
    3. Do you ever lose HOPE with your current situation?
    4. What do you THINK ABOUT when feeling down?
    5. Do you ever consider Running AWAY from your problems?
    6. Have you had DEPRESSION, ANXIETY or OTHER mental illness in the past?
    7. Have you ever thought of HURTING yourself?
    8. Have you ever thought of KILLING yourself?
    9. How have you PLANNED to kill yourself?
    10. Have you PREPARED to do this?
    11. Has any FAMILY MEMBER attempted Suicide in the past?
    12. Are you CURRENTLY thinking about death or harming yourself?
    13. Do you use Alcohol or DRUGS?
    14. Do you make IMPULSIVE decisions or actions?
    15. Do you have WEAPONS, POISONS in PILLS at home you would use to harm yourself?
    16. Have you shared your self-harm thoughts with OTHERS?
    17. Do you have FRIENDS or FAMILY with whom you are close?
    18. What would happen to your FAMILY without you?
    19. What has PREVENTED you from committing Suicide?
  3. References
    1. Norris (2012) Am Fam Physician 85(6): 602-5 [PubMed]
    2. Stovall (2003) Am Fam Physician 68(9):1814-8 [PubMed]

V. Evaluation: Risk Assessment

  1. Static or Stable Risks
    1. History of mental illness (especially newly diagnosed)
    2. Chemical Addiction
    3. Personality Disorder
    4. Teenagers and the elderly (esp. white elderly males)
    5. Prior Suicide attempts
    6. Family History of completed Suicide attempts
    7. Gay, lesbian, Transgender or bisexual youth
  2. High Risk Dynamic factors
    1. Prepared or attempted with highly lethal means (guns or hanging)
    2. Planned or rehearsed Suicide in advance
    3. Attempts to avoid discovery of suicidal plans (e.g. at remote location)
    4. Suicide note left to put affairs in order
    5. Anger in response to failed Suicide attempt
  3. Moderate Risk Dynamic factors
    1. Use of limited number of medications or illicit substances in Suicide attempt
    2. Suicide attempt in location with high chance of discovery (or calling for help)
    3. Suicide note with overly manipulative or attention-getting language
  4. Low Risk Dynamic factors
    1. Small number of pills taken
    2. Suicide attempt in front of another person
    3. Glad that Suicide attempt was unsuccessful

VI. Management

  1. Evaluate patient safety
    1. Hospitalize imminently suicidal patients (especially with high risk dynamic factors)
    2. Remove all weapons in the home
    3. Family and friend involvement is critical
  2. Treat underlying psychiatric illness
    1. See Depression Management
    2. Treat Substance Abuse
    3. Initiate psychological counseling

VII. Resources

  1. American Foundation for Suicide Prevention
    1. http://www.afsp.org
  2. National Suicide Prevention Lifeline
    1. http://www.suicidepreventionlifeline.org
    2. Phone: 800-273-TALK
  3. Suicide Prevention Resource Center
    1. http://www.sprc.org
  4. Columbia Suicide Severity Rating Scale (C-SSRS)
    1. http://www.cssrs.columbia.edu/

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Ontology: Suicide (C0038661)

Definition (MEDLINEPLUS)

Suicide is the tenth most common cause of death in the United States. People may consider suicide when they are hopeless and can't see any other solution to their problems. Often it's related to serious depression,alcohol or substance abuse, or a major stressful event.

People who have the highest risk of suicide are white men. But women and teens report more suicide attempts. If someone talks about suicide, you should take it seriously. Urge them to get help from their doctor or the emergency room, or call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). It is available 24/7.

Therapy and medicines can help most people who have suicidal thoughts. Treating mental illnesses and substance abuse can reduce the risk of suicide.

NIH: National Institute of Mental Health

Definition (NCI_NCI-GLOSS) The act of taking one's own life on purpose.
Definition (NCI) The act of ending one's own life.
Definition (MSH) The act of killing oneself.
Definition (CSP) act or an instance of intentionally killing oneself.
Concepts Finding (T033)
MSH D013405
SnomedCT 287196001, 158084004, 158074000, 222000000, 44301001
LNC LA10587-6, LA18036-6
English Suicides, Suicide, SUICIDE, Suicide NOS, suicide completion (diagnosis), suicide completion, suicides, suicide, Suicide NOS (event), [X]Suicide, -- Suicide, Suicide, NOS, Suicide (disorder), Suicide NOS (finding), Suicide (event)
French SUICIDE, Suicide
Portuguese SUICIDIO, Suicídio
Spanish SUICIDIO, suicidio (evento), suicidio (trastorno), suicidio, SAI (hallazgo), suicidio, SAI (evento), Suicide NOS, suicidio, SAI, suicidio, Suicidio
German SUIZID, Selbstmord, Suizid, Selbsttötung
Dutch zelfmoord, Zelfdoding, Zelfmoord
Japanese 自殺, ジサツ
Swedish Självmord
Czech sebevražda, suicidium, Sebevražda
Finnish Itsemurha
Polish Samobójstwo
Hungarian Öngyilkosság
Norwegian Selvmord, Suicid
Italian Suicidio

Ontology: Feeling suicidal (finding) (C0424000)

Definition (MSH) A risk factor for suicide attempts and completions, it is the most common of all suicidal behavior, but only a minority of ideators engage in overt self-harm.
Definition (NCI) Thoughts of taking one's own life.
Definition (NCI_CTCAE) A disorder characterized by thoughts of taking one's own life.
Definition (PSY) Thoughts of or an unusual preoccupation with suicide.
Concepts Finding (T033)
MSH D059020
ICD9 V62.84
SnomedCT 6471006, 271950009, 139586008, 225457007
LNC LA6394-6
Italian Idea suicida, Ideazione suicida
English Suicidal Thought(s), Suicidal ideation, intellectual content suicidal, thinking about suicide, suicidal thought content, suicidal ideation, thoughts about suicide, suicidal ideation (physical finding), thinking about suicide (symptom), suicidal thought content (physical finding), Feeling suicidal (finding), Ideation, Suicidal, Suicidal Ideation, Ideations, Suicidal, Suicidal Ideations, suicide thoughts, Feeling;suicidal, ideations suicidal, ideation suicidal, suicidal thoughts, Thoughts of suicide, Suicidal thoughts, Feeling suicidal, Suicidal thoughts (finding), feeling suicidal
Japanese 自殺念慮, ジサツネンリョ
Czech Sebevražedná představa, sebevražedné myšlenky
French Idéation de suicide, Idées suicidaires, Idéation suicidaire
German Suizidaler Gedanke, Suizidgedanke, Selbstmordgedanke, Suizidgedanken
Spanish Ideación Suicida, Ideas Suicidas, ideación suicida (hallazgo), ideación suicida, ideas de suicidio, siente deseos suicidas (hallazgo), siente deseos suicidas, siente ganas de suicidarse, Ideación suicida
Portuguese Ideação Suicida, Ideação suicida
Hungarian Suicid gondolatok
Polish Myśli samobójcze
Croatian Suicidne misli
Norwegian Selvmordstanker
Dutch zelfmoordgedachte