Differences

Last edited on April 30, 2020

This shows you the differences between two versions of the page.

--- teaching:suicide [on April 12, 2020]
+++ teaching:suicide [on March 7, 2024] (current)
psychdb [Treatment]
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 == Incidence ==
-The average incidence of suicide in most psychiatric illnesses is about 10% and eating disorders is >10%. Suicide affects all socioeconomic levels and all professions.[([[https://www.thestar.com/news/canada/2017/06/17/tragic-case-of-robert-chu-shows-plight-of-canadian-medical-school-grads.html|Toronto Star: Tragic case of Robert Chu shows plight of Canadian medical school grads]])]
+  * The average prevalence of suicide in most psychiatric illnesses is about 10% and eating disorders is >10%. Suicide affects all socioeconomic levels and all professions.[([[https://www.thestar.com/news/canada/2017/06/17/tragic-case-of-robert-chu-shows-plight-of-canadian-medical-school-grads.html|Toronto Star: Tragic case of Robert Chu shows plight of Canadian medical school grads]])]
+  * Most completed suicides are not preceded by previous suicide attempts.[(American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.)]
+== Impact ==
+Suicide attempts can often have a ripple effect on other individuals, including those who witness it, and family members. Subway operators who are involved in a suicide death can often report higher rates of absenteeism, as well as develop other psychiatric conditions.[([[http://www.cbc.ca/news/canada/toronto/absenteeism-rate-ttc-suicides-cluster-staff-report-subway-operators-1.3939686|CBC: Suicides on the subway tracks are driving up employee absenteeism, TTC says]])]
+===== Philosophy and Ethics =====
+  * [[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4222167/|Sanati, A. (2009). Does suicide always indicate a mental illness?.]]
+  * [[https://pubmed.ncbi.nlm.nih.gov/30286223/|Sisti, D. A., & Joffe, S. (2018). Implications of zero suicide for suicide prevention research. Jama, 320(16), 1633-1634.]]
+===== Factors =====
+==== Cultural ====
+  * Suicide varies on a cultural level, both in terms of stigma, means of suicide, and incidence.
+==== Japan ====
+  * [[https://www.theguardian.com/commentisfree/2010/aug/03/japan-honourable-suicide-rate|Chambers, A. (2010). Japan: ending the culture of the ‘honourable’suicide. The Guardian, 3.]]
+==== United States ====
+  * [[https://blog.samhsa.gov/2019/01/24/suicide-and-a-reflection-on-our-changing-american-society|SAMHSA: Suicide—and a Reflection on Our Changing American Society]]
+==== Gender ====
+  * In women, the risk for suicide attempts is higher, and while th risk for suicide completion is lower (compared to men).[(American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.)]
+==== Dementia ====
+<alert type="info" icon="fa fa-book fa-lg fa-fw">
+See also: **[[https://pubmed.ncbi.nlm.nih.gov/19368760/|Haw, C., Harwood, D., & Hawton, K. (2009). Dementia and suicidal behavior: a review of the literature. International Psychogeriatrics, 21(3), 440.]]**
+</alert>
+  * Overall, the risk for suicide in dementia is the same of that in the general population.[([[https://pubmed.ncbi.nlm.nih.gov/19368760/|Haw, C., Harwood, D., & Hawton, K. (2009). Dementia and suicidal behavior: a review of the literature. International Psychogeriatrics, 21(3), 440.]])]
+  * Exceptions to this are that rates of self-harm increase in mild dementia; is higher before than after predictive testing for Huntington's disease; and is higher in patients diagnosed with dementia during hospitalization.
+===== Suicide Risk Assessment =====
+<alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">See main article: **[[teaching:suicide-risk-assessment-sra]]**</alert>
+Suicide risk assessment remains a daunting and elusive task that mental health professionals face. One of the main challenges in risk-stratifying individuals is that almost half of completed suicide attempts are by individuals who are considered low risk.
+== High-risk ==
+Individuals for high risk of suicide include those recently discharged from a psychiatric hospital.[([[https://www.ncbi.nlm.nih.gov/pubmed/27654151|Olfson, M., Wall, M., Wang, S., Crystal, S., Liu, S. M., Gerhard, T., & Blanco, C. (2016). Short-term suicide risk after psychiatric hospital discharge. JAMA psychiatry, 73(11), 1119-1126.]])]
+== Future ==
+The role of machine learning and artificial intelligence in predicting suicide risk is currently being investigated.[([[https://www.nature.com/articles/s41562-017-0234-y|Just, M. A., Pan, L., Cherkassky, V. L., McMakin, D. L., Cha, C., Nock, M. K., & Brent, D. (2017). Machine learning of neural representations of suicide and emotion concepts identifies suicidal youth. Nature Human Behaviour, 1.]])]
+===== Scales =====
+<panel title="Suicide Assessment Scales" no-body="true">
+<mobiletable 1>
+^ Name                                             ^ Rater      ^ Description                                                                                                                                                                    ^ Download                              ^
+^ Columbia-Suicide Severity Rating Scale (C-SSRS)  | Clinician  | The Columbia-Suicide Severity Rating Scale (C-SSRS) is a questionnaire used for suicide assessment. Several versions of the C-CCRS have been developed for clinical practice.  | [[https://cssrs.columbia.edu/|Link]]  |
+</mobiletable>
+</panel>
+===== Suicide Contagion =====
+Suicide contagion is of significant public health concern. Unfortunately, the term contagion is has a heterogenous definition, making research on contagion challenging.[([[https://pubmed.ncbi.nlm.nih.gov/25259604/|Cheng, Q., Li, H., Silenzio, V., & Caine, E. D. (2014). Suicide contagion: A systematic review of definitions and research utility. PloS one, 9(9), e108724.]])] There is strong evidence that vulnerable youth are especially susceptible to the influence of reports and portrayals of suicide in the mass media.[([[http://journals.sagepub.com/doi/abs/10.1177/0002764202250670|Gould, M., Jamieson, P., & Romer, D. (2003). Media contagion and suicide among the young. American Behavioral Scientist, 46(9), 1269-1284.]])] More recently, this became an issue of discussion when Netflix released //13 Reasons Why//, a show about a teenager who completed suicide. Debate has continued about the role that media plays in the portrayal of suicide and the negative effects that result from it.[([[https://www.scientificamerican.com/article/13-reasons-why-and-suicide-contagion1/|Scientific American: 13 Reasons Why and Suicide Contagion]])][([[https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2734859|Niederkrotenthaler, T., Stack, S., Till, B., Sinyor, M., Pirkis, J., Garcia, D., ... & Tran, U. S. (2019). Association of increased youth suicides in the United States with the release of 13 Reasons Why. JAMA psychiatry, 76(9), 933-940.]])]
-===== Contagion =====
+==== Reducing Contagion ====
-Suicide contagion is of significant public health concern. There is strong evidence that vulnerable youth are especially susceptible to the influence of reports and portrayals of suicide in the mass media.[([[http://journals.sagepub.com/doi/abs/10.1177/0002764202250670|Gould, M., Jamieson, P., & Romer, D. (2003). Media contagion and suicide among the young. American Behavioral Scientist, 46(9), 1269-1284.]])] More recently, this became an issue of discussion when Netflix released //13 Reasons Why//, a show about a teenager who completed suicide. Debate has continued about the role that media plays in the portrayal of suicide and the negative effects that result from it. (See: [[https://www.scientificamerican.com/article/13-reasons-why-and-suicide-contagion1/|Scientific American: 13 Reasons Why and Suicide Contagion]])
 One approach to reducing the harmful effects of media portrayals is to educate journalists and media programmers about ways to present suicide so that imitation will be minimized and help-seeking encouraged.
-== Media reporting ==
+==== Media ====
 The role of the media in suicide prevention is often underestimated. The media plays an important role and have an important responsibility reporting suicide. Various media guidelines exist for the reporting of suicides.[([[http://www.who.int/mental_health/prevention/suicide/resource_media.pdf|Preventing suicide: A resource for media professionals. World Health Organization. (2008).]])]
-== Copycat suicides ==
+==== Copycats ====
 Copycat suicides, also known as the Werther effect, is the phenomenon of an individual copying suicidal behaviour that they have in the media.[([[http://econtent.hogrefe.com/doi/abs/10.1027/0227-5910.27.2.82|Pirkis, J., Blood, R. W., Beautrais, A., Burgess, P., & Skehan, J. (2006). Media guidelines on the reporting of suicide. Crisis, 27(2), 82-87.]])][([[https://www.ncbi.nlm.nih.gov/pubmed/24386428|Kim, J. H., Park, E. C., Nam, J. M., Park, S., Cho, J., Kim, S. J., ... & Cho, E. (2013). The werther effect of two celebrity suicides: An entertainer and a politician. PloS one, 8(12), e84876.]])] In Canada, the Aboriginal population recently dealt with a series of youth suicides on reserves, some of which could also be attributed to suicide contagion.[([[http://www.cmaj.ca/content/187/11/E335.full|Eggertson, L. (2015). Aboriginal youth suicide rises in Northern Ontario. CMAJ: Canadian Medical Association journal, 187(11), E335.]])]
-===== Prevention =====
+===== Suicide Prevention =====
+<alert type="info" icon="fa fa-book fa-lg fa-fw">See also: **[[https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2771928|Perlis, R. H., & Fihn, S. D. (2020). Hard Truths About Suicide Prevention. JAMA Network Open, 3(10), e2022713-e2022713.]]**</alert>
 Suicide prevention can be implemented on an individual, local, and systemic levels.[([[http://jamanetwork.com/journals/jama/article-abstract/201761|Mann, J. J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., ... & Mehlum, L. (2005). Suicide prevention strategies: a systematic review. Jama, 294(16), 2064-2074.]])]
+==== Inpatient ====
+On inpatient psychiatric units, removing ligature anchor points (i.e. - protrusions capable of supporting the weight of a person more than 100 pounds, such as doors, hooks or handles, windows, belts, and sheets or towels) decreases the risk for suicide.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4079240/|Sakinofsky, I. (2014). Preventing suicide among inpatients. The Canadian journal of psychiatry, 59(3), 131-140.]])]
+==== Insomnia ====
+The co-prescription of a non-benzodiazepine hypnotic during initiation of an antidepressant may be beneficial in suicidal outpatients with severe insomnia.[([[https://pubmed.ncbi.nlm.nih.gov/31537089/|McCall, W. V., Benca, R. M., Rosenquist, P. B., Youssef, N. A., McCloud, L., Newman, J. C., ... & Krystal, A. D. (2019). Reducing suicidal ideation through insomnia treatment (REST-IT): a randomized clinical trial. American journal of psychiatry, 176(11), 957-965.]])]
 == Blue lights ==
 There is some research that suggests the installation of blue lights may reduce the incidence of suicide.[([[https://www.ncbi.nlm.nih.gov/pubmed/22980401|Matsubayashi, T., Sawada, Y., & Ueda, M. (2013). Does the installation of blue lights on train platforms prevent suicide? A before-and-after observational study from Japan. Journal of affective disorders, 147(1), 385-388.]])]
 == Helplines ==
 It is difficult to research the exact effect of suicide hotlines and distress helplines, but most of the research suggests it is effective in reducing the crisis state of callers. Anecdotally, of course, phone line counsellors are able to recall specific situations where callers had lethal means (e.g. - a gun) while on the phone, and stopped the attempt by talking to the caller. Helplines continue to play a supportive role on the population level.[([[https://www.ncbi.nlm.nih.gov/pubmed/22320194|Gould, M. S., Munfakh, J. L., Kleinman, M., & Lake, A. M. (2012). National suicide prevention lifeline: enhancing mental health care for suicidal individuals and other people in crisis. Suicide and Life-Threatening Behavior, 42(1), 22-35.]])]
-== Barriers ==
+==== Barriers ====
 High lethality suicide attempts include deaths by jumping from lethal heights, or in front of high speed objects, such as trains or in the subways. Current studies have demonstrated that installing barriers reduced the incidence of deaths at the location, but more importantly, did not result in an increase in suicide by other means.[([[https://www.ncbi.nlm.nih.gov/pubmed/28634260|Sinyor, M., Schaffer, A., Redelmeier, D. A., Kiss, A., Nishikawa, Y., Cheung, A. H., ... & Pirkis, J. (2017). Did the suicide barrier work after all? Revisiting the Bloor Viaduct natural experiment and its impact on suicide rates in Toronto. BMJ open, 7(5), e015299.]])] This means that the installation of barriers actually led to an overall decrease in suicide attempts. Work is being done around the world to install more barriers, including at the famous [[https://www.nytimes.com/2017/07/20/us/california-today-california-bridges-suicide.html|Golden Gate Bridge]].
-== Restricting access ==
+==== Restricting Access ====
 Other high lethality means of suicide include firearms and toxins like pesticides. Worldwide, pesticides account for an estimated one-third of the world's suicides. In the United States, suicide by firearms.
 ===== Treatment =====
-Treatment of suicide includes medications, psychotherapy, and/or hospitalization. Medications that have bee providing to reduce the risk of suicide include lithium and clozapine.
+  * Management of suicidal behaviours or ideation may include the use medications, psychotherapy, and/or hospitalization.
+  * Psychotherapies may include cognitive therapy for suicidal behavior, [[psychotherapy:dbt|dialectical behavioral therapy]], Collaborative Assessment and Management of Suicidality, and the Safety Planning Intervention.[([[https://pubmed.ncbi.nlm.nih.gov/29998307/|Stanley, B., Brown, G. K., Brenner, L. A., Galfalvy, H. C., Currier, G. W., Knox, K. L., ... & Green, K. L. (2018). Comparison of the safety planning intervention with follow-up vs usual care of suicidal patients treated in the emergency department. JAMA psychiatry, 75(9), 894-900.]])]
+  * Medications that have been shown to reduce the risk of suicide include [[meds:mood-stabilizers-anticonvulsants:1-lithium|lithium]] (for bipolar disorder) and [[meds:antipsychotics:second-gen-atypical:7-clozapine|clozapine]] (for schizophrenia).
-===== Cultural Factors =====
+===== Suicides in Clinical Practice =====
-Suicide varies on a cultural level, both in terms of stigma, means of suicide, and incidence.
+<alert type="info" icon="fa fa-book fa-lg fa-fw">
+See also: **[[https://www.cambridge.org/core/journals/psychiatric-bulletin/article/what-to-do-when-a-patient-commits-suicide/9E26F0A6B7FF85C47957E27FAC1A0636|Hodelet, N., & Hughson, M. (2001). What to do when a patient commits suicide. Psychiatric bulletin, 25(2), 43-45.]]**
+</alert>
-== Japan ==
-== United States ==
-===== Suicide Risk Assessment =====
+===== Guidelines =====
-<callout type="success">{{fa>arrow-circle-right?color=green}} See main article: **[[teaching:suicide-risk-assessment-sra]]**</callout>
+{{page>teaching:clinical-practice-guidelines-cpg#suicide&nouser&noheader&nodate&nofooter}}
-Suicide risk assessment remains a daunting and elusive task that mental health professionals face. One of the main challenges in risk-stratifying individuals is that almost half of completed suicide attempts are by individuals who are considered low risk.
-== High-risk ==
-Individuals for high risk of suicide include those recently discharged from a psychiatric hospital.[([[https://www.ncbi.nlm.nih.gov/pubmed/27654151|Olfson, M., Wall, M., Wang, S., Crystal, S., Liu, S. M., Gerhard, T., & Blanco, C. (2016). Short-term suicide risk after psychiatric hospital discharge. JAMA psychiatry, 73(11), 1119-1126.]])]
-== Future ==
-The role of machine learning and artificial intelligence in predicting suicide risk is currently being investigated.[([[https://www.nature.com/articles/s41562-017-0234-y|Just, M. A., Pan, L., Cherkassky, V. L., McMakin, D. L., Cha, C., Nock, M. K., & Brent, D. (2017). Machine learning of neural representations of suicide and emotion concepts identifies suicidal youth. Nature Human Behaviour, 1.]])]
-== Impact on others ==
-Suicide attempts can often have a ripple effect on other individuals, including those who witness it, and family members. Subway operators who are involved in a suicide death can often report higher rates of absenteeism, as well as develop other psychiatric conditions.[([[http://www.cbc.ca/news/canada/toronto/absenteeism-rate-ttc-suicides-cluster-staff-report-subway-operators-1.3939686|CBC: Suicides on the subway tracks are driving up employee absenteeism, TTC says]])]
 ===== Resources =====
 <WRAP group>
 <WRAP quarter column>
 ==== For Patients ====
 </WRAP>
 <WRAP quarter column>
 ==== For Providers ====
+  * [[https://pubmed.ncbi.nlm.nih.gov/37706324/|Gibbons R. Eight 'truths' about suicide. BJPsych Bull. 2023 Sep 14:1-5. doi: 10.1192/bjb.2023.75. Epub ahead of print. PMID: 37706324.]]
   * [[http://cssrs.columbia.edu/the-columbia-scale-c-ssrs/cssrs-for-communities-and-healthcare/#filter=.general-use.english|Columbia-Suicide Severity Rating Scale (C-SSRS)]]
   * [[http://www.who.int/mental_health/prevention/suicide/resource_media.pdf|World Health Organization. (2008). Preventing suicide: A resource for media professionals.]]
@@ Line 68: / Line 115: @@
 </WRAP>
 <WRAP quarter column>
 == Research ==
   * [[https://www.ncbi.nlm.nih.gov/pubmed/27974046|Mishara, B. L., Bardon, C., & Dupont, S. (2016). Can CCTV identify people in public transit stations who are at risk of attempting suicide? An analysis of CCTV video recordings of attempters and a comparative investigation. BMC public health, 16(1), 1245.]]
@@ Line 74: / Line 122: @@
 </WRAP>
 <WRAP quarter column>
 == Suicide in the Media ==
   * [[https://www.scientificamerican.com/article/13-reasons-why-and-suicide-contagion1/|Scientific American: 13 Reasons Why and Suicide Contagion]]
@@ Line 80: / Line 129: @@
   * [[https://www.thestar.com/opinion/contributors/2017/11/21/netflixs-glorification-of-suicide-will-lead-to-more-youth-deaths.html|Toronto Star: Netflix’s glorification of suicide will lead to more youth deaths]]
   * [[https://www.theglobeandmail.com/news/toronto/the-ttc-can-learn-from-japan-about-suicide-prevention/article36029664/|The Globe and Mail: The TTC can learn from Japan about suicide prevention]]
+  * [[https://www.nytimes.com/2014/08/14/upshot/the-science-behind-suicide-contagion.html|Sanger-Katz, M. (2014). The Science Behind Suicide Contagion. The New York Times.]]
 </WRAP>
 </WRAP>
 {{tag>sh-suicide-death}}