A more frequent and dangerous behavior that common knowledge ascertains. Considered as extreme aggressions that is directed against the self. We distinct between:

Suicicdal

1.      Ideas (ideation)

2.      Attempt (tentament)

3.      “successful” suicide

“cry for help” - usually 6 month before an attempt or drastic suicidal behavior itis an indirect and not conscious way of sending message of suicidal ideations. Most of the cases it can be discovered with careful history taking, but mental health professionals may discover in time such indirect messages and act properly.

Risk factors:

·         Serious prior suicide attempt

·         30% of people after attempt will try again

·         10% of all attempts is “successful”

·         The more serious the previous attempt the higher the risk

Demographics:

8^th leading cause of death (12/100,000)

Age: most frequent in teenagers and people after 55 years

Teenagers:

Third leading cause of death (accident/homicide/suicide)

Tends to occur in clusters

Positively increase with age

Increase againg @ 55 y

Elderly: decreasing trend at women, increasing at men

Highest risk group: white man above 65 y

Sex & ethnicity

Women attempt 4x often as men

Men 3x more often successful!

High rate:         white

Native americans

Immigrants of any origin

Marital status & religion

Strong social support = less suic

Highest @ protestants

Low suicidal behavior Muslim and Catholic religion: because of strong rules and principles against suicidal behavior

Occupation

Professionals are @ higher risk e.g. ;

Female physicians

Attorneys

Musicians

Other risk factors;

Substance abuse

When intoxicated

If violent behavior is in history

Recent loss of spouse, friend etc

If suicide is previous history

Genetics (supported by adoption & twin studies) e.g.  When suicide is in family history

Death of a parent by suicide

Death of parent before age of 11

Loss of parent by divorce in adolescence

mental & physical health

e.g. Loss of health or perception of serious illness or delusional ideation in psychotics

Major depressions

Antidepressant therapy dilemma:

during antidepressant therapy sometimes the motoric inhibition is relieved first, and the suicidal ideations or mood congruent depressive delusions are still not t improved. At this stage the patient easily can commit suicide.

Hospitalization: If patient is @ risk, hospitalization indicated

Physician responsibility

If fails to hospitalize such patient

If prescribes drug which used in suicide

Case Studies

v  Mr. P is a 37-year-old accountant who presents to the primary health care clinic with complaints of insomnia. Upon further questioning, he admits that he has felt “blue” for 6 weeks since getting passed over for promotion. Since that time, he has had poor sleep often awakening early in the morning. He also has had a decreased appetite with a 10–15-lb weight loss, poor energy, guilt over “not being good enough,” and he has been distracted at work. For the past 3 days, he has had thoughts of “ending my life.” What is this patient’s most likely risk of completed suicide?

(A) 0–10%

(B) 10–20%

(C) 20–30%

(D) 30–40%

(E) 40–50%

(B) This patient is displaying symptoms consistent with MDD. Asking about suicidal ideation and assessing suicide risk is extremely important in individuals with depressive disorders, as the risk of completed suicide is approximately 10–15%.