- 5000 deaths/year in the UK
- Increasing in young males
- In men <35, suicide is the greatest cause of death
- At all ages, men are at greater risk than women
- In those >35, they are likely to have seen their GP within the last month
- Those <35 are not
- Men more likely to use violent methods (shooting, hanging)
- Women more likely to take prescribed/OTC drug overdoses
- Increasing in the last few decades
- 300 to 400 per 100 000
- In women – most common cause of acute admission
- Peak age – 15-24
- In the UK, women of south Asian origin 2.5x risk than general population
- In men – second most common cause
- Peak age – 25-34
- Roughly equal rates in men and women (women used to be higher)
- Causes – Bipolar, depression, eating disorders, personality disorders
- 15% of cases will have further self harm episodes in the next year
- Most of these occur soon after the initial incident
- Suicide after self harm – there is a 1% suicide rate in the next year in those who have committed self harm. This rises to 3% in 5 years and 7% in 10 years. Those hwo commit suicide tend to be: Older, Male, Have a mental illness, Have poor physical health
Assessing Suicide Risk
Assessing suicide is an important part of any psychiatric exam.
Talking about suicide DOES NOT increase the risk of a patient harming themselves!
This is even true when a patient is ‘in crisis’ (i.e. just after a suicide attempt). Infact, often the reverse is true, and the individual may feel relief at being able to talk about these issues.
Assessing a patient in crisis
Talk to the patient – but remember they may still be drowsy after any drugs they have taken (both in the suicide attempt, and afterward at hospital)
Get a thorough collateral history
- Look for evidence of continued suicide intention
- is the patient happy to still be alive?
- If they took an overdose, What did they take?
- Did they think this would be enough to die?
- What did they take it with? (e.g. water, alcohol)
- Did they want to be found?
- Who found them? Was this person expected home? In the house? Did they phone them?
- Did they leave a note?
- Have they been planning it?
- E.g. giving away possessions
- Stocking up on pills over several weeks/days/months
- If the patient tries to leave before the assessment is complete…you may need to detain them
- Some patient may be fine to go home (usually with care of a relative…e.g. a girl who takes 10 paracetomol infront of her girlfriend after a row. She says she has no intention to kill herself, and seem upset by the incident.
- When discharging it is VITAL that you inform community care representatives..e.g. the GP, communit mental health team etc etc. You should phone as well as sending a letter. Usually, there is a follow-up clinic appointment made as well.
- Don’t prescribe any potentially lethal drugs for the patient to take home with them!
- You may need to get a psychiatrist to advise you in other cases/cases where patients may need detaining…e.g. an old man who has been stockpiling paracetomol for a long time. He lives alone, and took an overdose whilst in his shed. He was discovered by chance by a neighbour. He had left a note, and had been giving away his belongings.
Pathos score – mainly used in adolescents (age 13-18) who prevent with an overdose. It is used to asses
- P – Problems – have you had problems for more than 1 month?
- A – Alone – were you alone at the time?
- T – Time – have you planned it for more than 3 hours?
- Ho – Hopeless – are you feeling hopeless about the future
- S – Sad – were you feeling sad for most of the time before the overdose?
Each ‘Yes’ answer is an indicator of greater risk of future harm, and intent.