Suicide

Suicide
Suicide is a deliberate act performed in the expectation of death, where the outcome is fatal. Although suicide is clearly defined by death, establishing intent retrospectively is often difficult – some suicides are acts of self-harm in association with distress, which go tragically wrong.
There is no international consensus regarding the nomenclature for acts that do not result in death, which can lead to some confusion. Common terms include:
a- Self-harm (SH) is the umbrella term for self-inflicted non-fatal harm regardless of whether the person expressed a wish to die. Self-cutting is the most common in the community, though self-poisoning accounts for 90% of medical presentations of SH.
b- Attempted suicide is a term that may be used where there was a definite attempt by the individual to take his or her life; and Para suicide can be used when the degree of suicidal intent associated with the act is not clear, although this term is not frequently used.
c- Non suicidal self-injury (NSSI) is a relatively new term that is used extensively in the United States. It is used to describe self-injurious behavior that is not suicidal in nature. However, it is not clear who determines intent (patient or clinician) and given that intent varies as well as the elevated risk of suicide associated with NSSI many clinicians believe the term to be unhelpful.

The top five risk factors for suicide from highest to lowest risk are
1. serious prior suicide attempt
2. age older than 45 years
3. alcohol dependence
4. history of rage and violent behavior
5. male sex.
Causes (Mental illness)
All mental illness Raise the risk of suicide but the highest risk factors are:
1- Depression
2- Substance abuse
3- Schizophrenia
4- OCD
5- Personality disorders
Risk Factors for Suicide
Category Factor Increased Risk Decreased Risk
History Previous suicidal
behavior
(highest risk factor) Serious suicide attempt (about 30% of people who attempt suicide try again and 10% succeed)
- Less than 3 months have passed since the previous attempt
- Possibility of rescue was remote Suicidal gesture, but not a serious attempt, was made
- More than 3 months have passed since
the suicidal gesture
- Rescue was very likely
Family history
Close family member (especially parent) committed suicide
-Having divorced parents (especially for adolescents)
-Being younger than 11 years old at the time of a parent s death
No family history of
Suicide

- Intact family


- Parents alive through childhood
Current
psychological,
physical, and
social
factors Psychiatric symptoms Severe depression
Psychotic symptoms
Hopelessness
Impulsiveness Mild depression
No psychotic
symptoms
Some hopefulness
Thinks things out
Depth of depression Initial stages of recovery
from deep depression;
recovering patients may have enough energy to commit suicide
The depth of severe
depression; patients rarely have the clarity
of thought or energy needed to plan and
commit suicide
Substance use

Alcohol and drug dependence Current intoxication Little or no substance
use
Physical health -Serious medical illness
(e.g., cancer, AIDS)
-Perception of serious illness (most patients have visited a physician in the 6 months prior to suicide) -Good health

- No recent visit to
a physician

Social relationships Divorced (particularly men)
Widowed
Single, never married
Lives alone
Married
Strong social support
Has children
Lives with others



Demographic
factors
Age -Elderly (persons 65 years of age and older, especially
elderly men)
-Middle-aged (over 55 years of age in women and 45 years in men)
-Adolescents (suicide is the
third leading cause of death in those 15–24 years of age; rates increase after neighborhood suicide of a teen or when media depict teenage suicide)
- Children (up to
15 years)

-Young adults (age
25–40 years)


Sex
Male sex (men successfully
commit suicide three times
more often than women)
Female sex (although
women attempt
suicide three times more often than men)
Occupation Professionals
Physicians (especially women and psychiatrists)
Dentists
Police officers
Attorneys
Musicians
Unemployed Non-professionals






Employed
Race Caucasian Non-Caucasian
Religion No religion
Jewish
Protestant Religious
Catholic
Muslim
Economic conditions Economic depression Strong economy
Lethality Plan and means A plan for suicide (e.g., decision to stockpile pills)
- A means of committing suicide (e.g., access to a gun)
-Sudden appearance of peacefulness in an agitated, depressed patient (he has
reached an internal
decision to kill himself and is now calm) No plan for suicide

No means of suicide
Method Shooting oneself
Crashing one s vehicle
Hanging oneself
Jumping from a high place Taking pills or poison
Slashing one s wrists
Antidepressants – while antidepressant prescribing reduces suicide at a population level there have been some reports of increases in suicidal ideation and behavior in the first 10–14 days of treatment. This is particularly true in those under the age of 25. This is not a reason to avoid prescribing but patients and relatives should be advised of this and patients should be more closely monitored during this period.