Number of suicide attempts for each complete suicide
Number of suicide deaths in America annually
36,000 deaths, 90% of whom have a mental disorder
Peak ages of suicide rates
Peaks in suicide rates occur during late adolescence (which correlates with the first presentation of schizophrenia, BPD, and depression), middle age (changing responsibilities, mid-life crises), and in the elderly.
Races with the highest rates of suicide in the US
Native Americans and Caucasians
True or false: men >65 have no increased risk of suicide.
False. Suicide rates in men older than 65 are six times the national average
Suicide rate of schizophrenia
Risk factors of suicide
1. Depression, substance-related and other comorbid mental disorders
2. Chronic illness
3. Prior attempts
4. Family history of mental disorder or substance abuse
5. Family violence, physical or sexual abuse
6. Availability of firearms
7. Exposure to suicidal behavior of others
8. Neurobiological risk factors
Which is more likely to complete a suicide attempt:
a. 23 yo woman from a low socioeconomic background with a history of sexual abuse who breaks up with her boyfriend and attempts suicide.
b. 66 yo white male who has been experiencing financial problems and just lost his wife to breast cancer. He is an avid gun collector.
The elderly male is more likely to complete suicide.
-Suicide attempt is associated with females, younger age, Native Americans, financial difficulty, social isolation, and recent adverse events.
-Suicide completion is associated with males, the elderly, Caucasians, financial difficulty, social isolation, and recent adverse events.
True or false: a patient who has attempted suicide in the past is not very serious about completing suicide. She is just seeking attention
False: there is a misconception that the more people attempt suicide, the less serious they are. However, prior attempts is a significant risk factor for suicide
True or false: the availability of firearms increases the risk of impulsive suicide but not planned suicide.
False: the availability of firearms increases the risk of completion from both impulsive and planned suicide attempts.
The Wether Effect
Imitative suicide first observed after Goethe’s novel triggered a serious of suicides in 1774. Other notable moments of imitative suicide include the 1984-1987 Viennese subway suicide clusters. Marilyn Monroe’s suicide in 1962 was followed by a 12% increase in the national suicide rate, copy cat suicides at NYU.
True or false: decreased dopamine in the CSF has been found at autopsy in those who committed suicide
False: decreased levels of the serotonin metabolite 5-HIAA in the CSF have been linked to impulsivity and aggression, which correlate to an increased risk in suicide.
True or false: the ratio of attempts to completed suicides in bipolar disorder is very high
False: the ratio of attempts to completed suicides is low, and the risk is similar in men and women with bipolar disorder.
Suicide in Bipolar Disorder
Associated with a significant increase in suicide risk, especially during the early years of the illness (delays in diagnosis, poor compliance). The ratio of attempts to completed suicides is low, and the risk is similar in men and women with BPD. Suicide risk is associated with depressive or mixed states. Lithium is the only drug that lowers the suicide risk in non-psychotic patients.
True or false: the number of military personnel killed in battle is greater than the number of military personnel who have committed suicide.
False: more military personnel have died by suicide than from battle. The suicide rate has also increased in the army reserve soldiers who have never seen combat
Three research methods to identify risk factors
1. Vital statistics: use data from patients who have already completed suicide.
2. Psychological autopsies: speaking with friends/family to uncover a psychiatric diagnosis or other risk factors
3. Follow up of clinical samples: we observe those at high risk for suicide attempt and determine additional risks prospectively.
True or false: chronic pain is rarely a trigger for suicide attempt.
False: a study in the UK found that 17% of those who attempted suicide cited pain as a trigger for the act.
CBT reduces the rate of repeated suicide attempts by _____
True or false: discussing suicide with a patient may give him or her ideas
True or false: people who talk about suicide do not carry it out
False. 68% of people who attempted suicide communicated their intent at some point in the previous year
True or false: in the case of serious medical illness, suicidal ideations are an expected and transient response
False. Only a minority of patients with life-threatening illness become suicidal, although many meet the criteria for depression.
True or false: elderly individuals rarely see their health care provider in the year prior to an attempted or completed suicide.
False. 58% of elderly individuals sought out their primary care physician in the month prior to their death and 11% of them saw a mental health provider
True or false: low cholesterol may decrease serotonin transporter concentration, increasing an individual’s risk for suicide
For every suicide, how many other people are affected?
For every suicide, at least six people (family, friends, providers) are affected. Grieving individuals feel shame, guilt, blame, anger, and maybe even some relieve