What is Suicide Risk?
Suicide is a serious issue that healthcare professionals need to tackle. It’s crucial to identify and respond effectively to those who may be at risk, as this can be key in preserving lives amidst suicidal tendencies. Keep in mind that suicide is a permanent result of what might be a temporary issue. This piece provides critical data and alerts on who might need extra help. It also guides us on the right questions to ask someone who may be contemplating suicide, explains the necessary actions to ensure the individual’s safety, and ends with advice on how to support family and friends if a suicide unfortunately takes place.
What Causes Suicide Risk?
Several factors can increase a person’s risk of attempting or completing suicide. These factors can include a wide range of things like:
* Prescription medications
* Mental health conditions
* Gender
* Genetic factors
* Easy access to guns
* Life experiences
* Physical health problems
* Financial troubles or insecurity
* Influence from media and the internet
* Deep-seated emotional and psychological issues
Understanding why someone behaves suicidally can not only help explain their self-harming behavior but can also guide healthcare providers in deciding on the best treatment approach for them. Once the person is safe, the healthcare provider can then address these underlying factors.
Risk Factors and Frequency for Suicide Risk
Suicide is the tenth leading cause of death in the United States and is particularly prevalent among children, adolescents, and young adults. In 2014 alone, the US saw 42,773 cases of suicide.
Often, several risk factors contributing to suicide can be observed in one individual. For instance, consider the situation where a male police officer, who is suffering from intense depression and major alcohol issues, commits suicide using his service gun. This tragic scenario happens more often than you might think – a single case like this one exhibits five common risk factors for suicide: gender, profession, depression, alcohol abuse, and access to firearms.
In terms of geographical data, suicide rates are not the same across the states. Western states typically report higher rates than others, though Vermont – not a Western state – is an exception. Moreover, living in a rural area is linked to a higher risk of suicide compared to residing in urban areas.
Signs and Symptoms of Suicide Risk
Self-destructive actions, including suicide, are often associated with certain thoughts and behaviors. Although it might be tempting to think someone talking about suicide won’t actually do it, the fact is that talking about suicide can lead to an attempt. Because of this, signs of suicidal thoughts should never be ignored, as studies have shown links between such ideation and actual attempts.
There are various behaviors that might indicate someone is planning suicide:
- Making a will
- Organizing personal affairs
- Unexpectedly visiting loved ones
- Buying a gun, hose, or rope
- Writing a suicide note
- Visiting a primary care doctor
Interestingly, a large number of people who end up committing suicide have seen their primary care doctor within the three weeks before their death. They usually show up with a range of health issues, but only rarely will they actually say they’re considering suicide. As such, healthcare providers must pay careful attention to a patient’s overall situation, not just the main complaint they have brought up.
People who are having suicidal thoughts have many common characteristics:
- An obsession with death
- A feeling of isolation and withdrawal from others
- A lack of friends or family connections
- Emotional distance from others
- Being inattentive, lack of humor, or seeming like they’re “in their own world”
- Dwelling on past losses and defeats without looking forward to the future
- Being overcome by feelings of hopelessness and helplessness, without any belief that things can improve or that anyone can help them
Testing for Suicide Risk
The process of assessing suicide risk involves careful observation and meaningful conversation with the patient. While certain risk factors may guide decision-making, direct communication with the patient is crucially important. Therapists often rely on both verbal responses and non-verbal signals from their patients to determine the level of suicide risk. Therefore, the doctor’s professional judgement plays a vital part in deciding the further course of action.
Suicidal Thoughts
The first step is to find out if the person has considered causing harm to themselves, which we call ‘suicidal ideation’. This thought process is often linked to actual suicidal actions. Some healthcare providers might hesitate to ask about this for fear of making the person uncomfortable or putting ideas into their heads. But, in many cases, patients value these questions as they show genuine care and concern about their wellbeing. A confirmation of such thoughts necessitates further investigation.
Suicide Plans
If the person admits to having suicidal thoughts, it’s essential to ask if they have a planned way of carrying it out. More profound danger is associated with specific plans than with vague intentions. For instance, a casual threat of suicide at an unspecified time in the future is concerning, but purchasing a gun or writing a will shows a greater risk. Determining whether they have access to the planned method, such as a gun, is crucial.
According to a 2014 survey, out of 9.4 million adults considering suicide, 2.7 million had made a suicide plan, and 1.1 million attempted suicide. Therefore, serious thoughts of suicide can indicate potential suicide plans and attempts.
Purpose of Suicide
Knowing why a person is contemplating suicide can give insight into its severity. Some may view it as a message to their loved ones about their psychological distress, while others see it as an escape from their mental anguish. Some may even link it with a hope of reuniting with a lost loved one in the afterlife. Regardless of the reason, understanding these motivations can help gauge the seriousness of the situation.
Considering Homicide Potential
When discussing suicide, it’s also crucial to explore any homicidal tendencies. Since suicide is technically an act of violence against oneself, it’s possible that similar aggression could be directed at others as well. Homicide-suicides are most often committed by males and their victims are usually spouses, partners or children. The assessment should, therefore, include questions about potential aggression towards others.
Additional Questions
A thorough assessment should also enquire about any family or friends who have committed suicide and identifiable risk factors like symptoms of depression, psychosis, dementia, recent personal losses, or substance abuse.
Treatment Options for Suicide Risk
Treating a patient who is feeling suicidal is a two-step process. The first step is to ensure that the patient is safe. This part, called an intervention, is based on understanding the risk factors for suicide and then speaking with the patient to assess their feelings and thoughts. The second step is to identify and start treatment for any mental health issues that could be causing the suicidal thoughts.
In the initial phase of this process, quick action can often prevent an at-risk person from taking their own life. Because suicide is usually preventable, it’s crucial to notice the warning signs and take action if you think someone could be at risk. If, based on a professional assessment and all available information, the person is indeed having suicidal thoughts, the intervention should involve several important steps.
First, the person should never be left alone. If this is happening in a hospital, security staff can make sure the patient isn’t left on their own. If you’re not in a hospital or another healthcare setting, get help immediately. If you’re truly isolated, call 911. It’s also a good idea to involve the person’s friends or family. They can stay with the person while you arrange for professional help.
During the intervention, be sure to remove anything the person could use to hurt themselves. This can include sharp objects or anything else that could be potentially dangerous. If the person has a weapon, like a knife or drugs, gently ask them to give it to you and then put it somewhere safe where the person can’t access it.
To keep a person who is feeling suicidal safe, it’s best if they’re in a secure and closely supervised place. A hospital is often the best place for this, and many health insurance plans understand the need for hospitalization in situations where the risk of suicide is immediate.
One study showed that making it more difficult for patients in a hospital to hang themselves can lower the number of suicides in that hospital. It’s also crucial to carefully manage other potential methods of suicide, such as prescription medications or access to guns.
Prescription medications can pose a unique challenge for healthcare providers. Medications that are prescribed to help alleviate symptoms of mental illness can also be used by the patient to cause harm to themselves, creating a difficult balance to maintain. Paying close attention to how many medications a patient has access to is an important step in preventing suicide.
After the intervention has taken place and the immediate risk has been dealt with, usually through hospitalization, it’s important to have a plan in place to continue treating the patient. The main goal of the second phase of intervention is to find and treat what caused the patient to consider suicide. This could involve managing chronic physical pain, treating depression with medications and therapy, or managing symptoms of schizophrenia, such as hallucinations or delusions. The most important thing is to make an accurate diagnosis and then come up with a comprehensive treatment plan that addresses all of the patient’s needs.
What else can Suicide Risk be?
These are some mental health conditions:
- Alcoholism
- Anxiety disorders
- Bipolar disorder
- Delirium
- Depression
- Personality disorders
- Posttraumatic stress disorders
- Schizophrenia
What to expect with Suicide Risk
It might seem obvious to say that the outlook on suicide is devastating as it results in the loss of life. However, when it comes to suicidal thoughts, research indicates that one-third of individuals go on to form ‘plans’. Among those who both have suicidal thoughts and a plan, 55% will make an attempt to take their own life, while only 15% of those who only have suicidal thoughts will make such an attempt. Experts believe that the shift from having suicidal thoughts to making plans and attempting suicide usually occurs within a year of first experiencing such thoughts.
Possible Complications When Diagnosed with Suicide Risk
It’s generally believed that strong, proactive treatment after a suicide attempt can be effective in reducing harm and preventing future attempts. A study by Morthorst et al., sought to examine this idea by evaluating the effectiveness of an outpatient production designed for those 12 years and above who had attempted suicide within the last two weeks and were admitted to local hospitals in Copenhagen.
The treatment included assertive outreach that offered crisis intervention and flexible problem-solving assistance. This proactive self-harm intervention program also provided motivational support and actively helped patients with their scheduled appointments. A total of 243 patients were monitored for a year.
At the end of the study, the rate of repeat suicide attempts were found to be roughly the same between the group that received the intervention and the one that didn’t. Even though this research didn’t demonstrate a clear benefit of intensive follow-up care, it does emphasize the importance of having a well outlined set plan in place for treatment after a suicide attempt.
Preventing Suicide Risk
A research study looked at a type of therapy called brief Cognitive Behavioral Therapy (brief CBT) in a group of active-duty military personnel based in Colorado, who either tried to take their own lives or had thoughts about doing so. The study found the therapy to be effective in preventing further suicide attempts. This research spanned over two years, focusing on 76 participants.
Of these participants, 13.8% or 8 people who received their usual treatment combined with brief CBT, and 40.2% or 18 people who didn’t receive CBT tried to take their own lives at least once. The study revealed that soldiers who received brief CBT were about 60% less likely to attempt suicide than soldiers who didn’t receive this therapy. In other words, this specific type of therapy significantly helped reduce suicide attempts among soldiers.
