SUICIDE AND

ATTEMPTED SUICIDE
MOYA MCLEOD

WHAT IS SUICIDE?
the act or an instance of taking one's own
life voluntarily and intentionally (MerriamWebster, 2015).
Attempted suicide is an attempt at taking
ones own life voluntarily and
intentionally.
Parasuicide refers to an act of self-harm
without the realistic expectation of death

 Over 800,000 people die due to

suicide every year and there are many
more who attempt suicide.
Leading cause of death among 15-29
year olds globally in 2012.
75% of global suicide occurred in lowand middle-income countries in 2012.
Suicide accounted for 1.4% of all
deaths worldwide, making it the 15th
leading cause of death in 2012

 From 1986 to 2000, suicide rates in the

U.S. droppedfrom 12.5 to 10.4 suicide
deathsper 100,000 people in the
population.
Over the next 12 years, however, the rate
generally increased and by 2013 stood at
12.6 deaths per 100,000
About 1% of total deaths are a result of
suicide
Unsuccessful attempts outnumber
completed suicides by a multiple of 16

METHODS OF SUICIDE
It is estimated that around 30% of
global suicides are due to pesticide
self-poisoning, most of which occur in
rural agricultural areas in low- and
middle-income countries.
Other common methods of suicide
are hanging and firearms.

GROUPS AT RISK

ELDERLY
MALES
ALDOLSCENTS/ YOUNG ADULTS
SERIOUS/TERMINAL ILLNESS
MOOD DISORDERS- depression and bipolar
SCHIZOPHRENIA- newly diagnosed and those with command
hallucinations.
SUBSTANCE ABUSE
STRESS AND LOSS

Do not confuse self-injurious

behaviour (cutting) with
suicide attempts, although
some who repeatedly cut
themselves to relieve
emotional pain also attempt
suicide. May be a form of
stress reduction

RISK FACTORS FOR SUICIDE

Mood disorders (depression and bipolar)

Substance Abuse (dual diagnosis)
Previous suicide attempt
Loss-marital partner, partner, close relationship,
job, health

Expressed hopelessness or
helplessness (does not see a future)

 Impulsivity/Aggressiveness
Family suicides, significant other or peer
suicide
Isolation
Stressful life event
Previous or current abuse (emotional/ physical/
sexual)

Sexual identity crisis/ conflict

Available lethal method (eg. Gun)
Legal Issues/incarceration

RISK REDUCING FACTORS

Willingness to accept help

Future-oriented goals and plans
Hopefulness
Good Social Support
Absence of suicidal intention
Stable mood
Lower severity of mental illness symptoms
Religious prohibitions
Moral objections to suicide

SUICIDE

HANDLING AN
EMERGENCY

 A 45 year old man comes to the ER after

attempting to cut his wrists six months
after his 7 year old daughter was in a
motor vehicle collision. The patient is
upset and restless and wrings his hands
frequently. He cannot sleep at night, has
lost his appetite, cries easily and
frequently. He is preoccupied with
thoughts of his daughter. He sees her
sometimes in his living room and wishes
he was hit by the car instead.

AFTER STABILIZATION
IDENTIFY A SUICIDE ATTEMPT
A patient being evaluated in the ER
should not be allowed to leave prior to
a full evaluation
Intoxication and delirium should be
ruled out. The patient must be sober
before the formal suicide evaluation
can take place.

INTERVENTION
Assess-

What caused the crisis and what are the

individuals reaction to it?

Plan-

Evaluate the persons strengths and

weaknesses, support systems, coping skills

Intervention-

establish relationship, help

understand event and explore feelings and alternative
coping strategies

Evaluation-

Evaluate outcomes/ plan for future/ need

for follow up (Aguilera, 1998)

 Rapid focused assessment

Mental status exam: normally with
psychiatrist

Risk assessment: violence, suicide

Neurological exam as needed
Records and family
Lab work
Diagnosis
Accurate, timely documentation

INTERVIEWING TECHNIQUES
Behavioural Incident-

eg. How many pills did you

take?

Shame Attenuation-

Do other people pick fights with

you?

Gentle Assumption-what other ways have you

thought of killing yourself?

Symptom Amplification-

how many fights have you

been in 20, 30?

Denial of the Specific- have you ever thought

about?

Assess
Hopelessness- a key element; unable to see future (seen in
depression)
Speaks of suicide- ask if there are thoughts of
suicide
Plan- Patient has exact method for suicide
Giving away possessions
Auditory Hallucinations- commanding to kill oneself
Lack of support
Substance abuse
Previous suicide attempt in family or with self
Precipitating event
Media- suicide of famous personality

INTERVENTION
Effective assessment and knowledge of risk
factors
Observation and safe environment
Identification of triggers- identify triggers to patient
to seek help early

Substance abuse treatment/ support

Psyhotherapy/ cognitive behavioural
therapy/ electroconvulsive therapy
Treatment of medical disorders- thyroid/ cancer

 Increased activity- if able

Support network/ family involvement
Involvement in outside activities - avoid
isolation

Client and family education

Psychopharmacology, especially SSRIsclosely monitor children, adolescents and young adults

Knowledge of the patient's attitudes and feelings

about their illness may be very relevant.
Have frequent consultations after an attempt

THANK YOU

REFERENCES
http://www.psychiatrictimes.com/all/editorial/psychiatrictim
es/pdfs/psych-survival2.pdf
http://www.dsm5.org/Documents/changes%20from
%20dsm-iv-tr%20to%20dsm-5.pdf
http://medind.nic.in/maa/t04/i1/maat04i1p59.pdf
http://home.apu.edu/~ksetterlund/20122013/Articles/Newhill%20-%20Psychiatric%20Emergencies%20Overview%20of%20Clinical%20Principles%20(2).pdf
http://www.who.int/mental_health/prevention/suicide/suicid
eprevent/en/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC419387/