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Suicidal Tendencies
Psychiatry is a medical field concerned with the diagnosis, treatment and prevention of mental health conditions.
Suicidal ideation is more common than completed suicide. Most persons who commit suicide have a psychiatric disorder at the time of death. Because many patients with psychiatric disorders are seen by family physicians and other primary care practitioners rather than by psychiatrists, it is important that these practitioners recognize the signs and symptoms of the psychiatric disorders (particularly alcohol abuse and major depression) that are associated with suicide. Although most patients with suicidal ideation do not ultimately commit suicide, the extent of suicidal ideation must be determined, including the presence of a suicide plan and the patients means to commit suicide.
Suicidal behavior can be characterized as a spectrum that ranges from fleeting suicidal thoughts to completed suicide.1 Suicidal ideation is more common than suicide attempts or completed suicide.2 A 1995 study found that 3.3 percent of patients in an urban primary care outpatient clinic reported suicidal ideation
EPIDEMIOLOGY
The overall suicide rate is 11.2 per 100,000 persons, ranking suicide as the ninth leading cause of death.8 Although age-specific rates of suicide have consistently been highest in the elderly, the incidence of suicide among adolescents and young adults has tripled since 1955. Suicide is more common in whites and Native Americans; higher rates of suicide are reported in the Western states. Other significant risk factors for suicide are listed.
- Male, white, age greater than 65 years
- Widowed or divorced
- Living alone; no children under the age of 18 in the household
- Presence of stressful life events
PSYCHIATRIC DISORDERS
Findings from psychologic autopsy studies have consistently indicated that more than 90 percent of completed suicides in all age groups are associated with psychiatric disorders, including substance abuse.1 It is not the psychiatric disorder itself that increases the risk of completed suicide, but the combination of the psychiatric disorder and a stressor, such as the death of a loved one, separation, divorce or recent unemployment.
An algorithm for the evaluation of suicidal patients is shown in Figure 1. The key factors in treatment include the patients suicide plan, access to lethal means, social support and judgment.
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