Hi. We’re gonna be talking about the approach to the suicidal patient.
So suicide was the fourth leading cause of death in the United States in 2011.
And each year there’s one million suicide attempts
which results in approximately 41.000 deaths
and it’s important to know that rates are on the rise.
Now, women attempt suicide three to four times as frequently as men,
but men are three to four times more successful in dying from suicide.
And the reason for that is because of the mechanisms and the methods
in which men use versus the methods that women use to attempt suicide.
Now, who has the highest rates of suicide?
Who should we be most worried about?
So elderly white male patients have a highest rate of suicide.
Patients who have access to firearms, LGBT patients,
so lesbian gay bisexual transgender patients,
the military personnel, patients who live in rural areas,
and then also, healthcare workers and veterinary workers
presumably due to access to medications
or knowledge of rates to commit suicide
and also due to increasing stressors related to the jobs.
So when patients come to the Emergency Department for suicidal ideation,
one of the key things we need to do is figure out
how much risk could they actually have to hurt themselves or commit suicide.
Now, the things that we think about and ask about would be prior incident of self-harm.
So has the patient tried to hurt themselves before
and if so, what mechanisms did they use?
Do they have a history of mental illness?
Something important to remember is that
shortly after starting anti-depressant medications,
patients may have an increased risk of suicidality.
The thinking behind that is because patients who are very depressed
don’t have a lot of energy generally.
They don’t have energy to get out of bed, to do things,
and shortly after they start the antidepressants,
they may still actually be very depressed but they have more energy,
so the medications kind of give them that additional energy burst.
Risk is also greatest shortly after discharge from the psychiatric hospital.
So trying to figure out if someone has recently been discharged
from a psychiatric facility can be helpful.
Alcohol and substance use, alcohol and substance abuse
and psychiatric illnesses oftentimes do go hand in hand.
And we know that a lot of patients
who present with depression and with suicidal ideation
also abuse some kind of substances.
So there’s lots of risk factors.
These patients may have a history of mental and medical illness,
they may also have unemployment related to their substance use.
Patients who are adolescents are patients who are at increased risk.
Older patients especially elderly white males,
patients with chronic medical illness,
patients who have very severe, serious medical illnesses,
they’re on a lot of medications,
they may get very depressed and despondent about that.
They may have suicidal thoughts or suicidal ideation.
And then lastly, life stressors.
Almost every patient who comes to the Emergency Department
with suicidal ideation has some element of life stressors,
homelessness, financial stressors, socio economic stressors.
Do patients have a place to live?
Do they have money to afford groceries?
Do they have stress amongst their family, amongst their friends?
What else is going on in the persons’ life?