Can we really prevent suicide ? Curr Psychiatry Rep: Oct 2012

17.10.2012

Suicide is the second leading cause of death in the 10–24 years age group and it is among the top three causes of death  among those aged 15–44 year.For every suicide, there are 50 suicide attempts. It is hard to predict as risk factors are common,  non specific  and the event itself is rare and only a minority of those with risk factors will commit suicide. some suicide occur among those belonging to no risk groups as well. No wonder prevention is a hard task.

90 % of the people who commit suicide suffer from a psychiatric disorder.Among psychiatric populations, suicidal behavior is not rare and the rate of attempts among psychiatric patients ranges between 15–50 % making identification and treatment of mental disorders as one key element of suicide prevention.

Interventions based on Risk factors:

1.Depressive Disorders. Special attention to hopelessness, feelings of guilt, loss of interest, insomnia, and low self esteem as these are associated with more suicide in this disorder. Treating suicidal depressed patients actively and intensively might offer an effective way of preventing suicidal behavior.

2.Bipolar disorders:As many as half of those who have bipolar disorder attempt suicide at least once.Risk  is highest early in the course of Bipolar Disorder, particularly in the first year of the illness. The presence of depressive and dysphoric–irritable states in Bipolar Disorder is reported to be a risk factor for suicide.Effective management of depressive phases is essential, as depressive phases are high risk periods for suicidal behavior.

3.Anxiety disorders:Anxiety disorders are associated with lifetime suicidal ideation and suicide attempts, especially in adolescents and in young adults. In many anxiety disorder it is the depression that increase the suicide risk. Role of severe anxiety as a marker of acute suicide risk requires further study.

4.Alcohol: Misuse and abuse predispose to impulsivity, aggression, depression, hopelessness, and other negative factors that increase the risk for suicidal behavior. High risk for younger males, divorced or separated and those experiencing recent adverse life events.

5.Schizophrenia: Suicide attempt occurs in as many as 23–31 %. Lifetime suicide risk for people with schizo- phrenia is estimated to be about 5 %. Risk factors are past and present suicidal behavior, past depressive episodes, drug abuse or dependence and more frequent psychiatric admissions.The great majority of suicides in schizophrenia occur in the active phase of the disorder, in the context of depressive symptoms.

6.Personality disorders: Borderline personality disorder is the only personality disorder that lists suicidal behavior as a criterion, other personality disorders, such as antisocial and other Cluster B personality disorders also increase risk of suicidal behavior.  Impulsivity, aggression, alcohol and substance abuse,  major depressive episodes- all of which increase the risk.

Other Risk Factors: Aggression, impulsivity, hostility,  hopelessness, Heredity (could be independent of mental disorders), childhood trauma, past attempts : (50 % increase in the risk of future suicidal behavior for each previous attempt made by the individual).

Preventive Measures:

Means Restriction:Examples: increasing firearm control in the US and Canada, detoxification of domestic and motor vehicle gas, restrictions on use of toxic pesticides in rural areas, and physical barriers at jumping sites , reducing access to ligature and ligature points in prisons and hospitals, selling smaller packages of analgesics

Responsible Media Coverage:Glorification and dramatization of a suicidal act can be followed by a series of suicides. Emphasizing the importance of reporting suicide as a public health issue, in a non-sensational way with focus on treatable causes of suicide.

Identification Methods:  Friends, family, school staff, primary care givers etc should be equipped with tools to properly identify risk and make a timely referral.

General Public Education: Improving suicide risk recognition and help-seeking behavior and reducing the stigma of mental illness.

Primary Care Physicians Training: 77 % of the people who commit suicide were in contact with a primary care physician in the year before their death, and about 45 % came in contact with a primary care provider in the month prior to their death. Education of primary care physicians in recognition and treatment of depression may be an efficient means for lowering suicide rates.Screening high-risk groups (depressed patients, substance abusers) in primary care settings may decrease suicide rates.

Gatekeeper Training: Individuals  with the potential to influence the suicidal person on a temporary or ongoing basis.

 Treatments: CBT, IPT, DBT, PST are effective in reducing suicidal behaviour in different patient groups.Antidepressants, Mood stabilisers ( Lithium with specific antisuicide effect) ,atypical antipsychotics (probably through antidepressant action) , clozapine ( antisuicidal effect in schizophrenia)  and  ECT ( in severe depression) are treatments that substantially reduce the possibility of suicide in the high risk disorders.

Adequate follow-up care after a suicide attempt for patients and their families is crucial in prevention. Ongoing contact after hospital discharge via postcards lowered the number of repeat suicide attempts by nearly 50 %.

Authors conclude that policy should cover means restriction and public awareness campaigns as well as strategies directed at the individual, including identification, proper diagnosis and effective treatments to prevent suicides.

Limitations: This is a narrative overview of the topic and hence the range of evidence and its limitations are not explored.

This is the summary of the article:

Can We Really Prevent Suicide? Schwartz-Lifshitz M, Zalsman G, Giner L, Oquendo MA. Curr Psychiatry Rep. 2012 Sep 21 (Epub ahead)

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s