The management of suicidality: assessment and intervention.
A potentially suicidal patient is among the most difficult challenges faced by healthcare providers. This article reviews rates of suicide in America among the population as a whole and subpopulations based on age and race. In 2003, nearly 11 Americans out of every 100,000 killed themselves. The rates of suicide were highest among whites, Native Americans, and elderly males. Suicide rates are elevated among many common mental illnesses, including major depression, bipolar disorder, schizophrenia, and alcoholism. Although statistical risk factors are significant, they are of limited help in determining what should be done with specific patients. Documenting demographic information, checking off diagnostic criteria, and asking patients if they have thoughts of killing themselves are only the start of the evaluation of suicidality. The complete assessment of suicidality requires inquiring into static and dynamic risks factors, warning signs and psychosocial stresses. Patients who report suicide plans should be asked about the plan in detail, including the chance of rescue, preparations for, and rehearsal of the suicide attempt. Interventions to reduce the risk of suicide should then be targeted towards eliminating or minimizing these various factors. Despite our best efforts patients will occasionally kill themselves. Studies have found that a majority of experienced psychiatrists have had a patient commit suicide. Following the suicide of a patient, clinicians will often experience a professional as well as personal response. Most providers who have experienced a patient suicide find talking to co-workers, peers, and friends to be useful.
Welton
Randon S
RS
Dr. Welton is a Lieutenant Colonel with the United States Air Force, Medical Corps, Wright-Patterson Medical Center, Wright-Patterson Air Force Base, Ohio.
Am J Psychiatry. 1996 May;153(5):667-73
8615412
Int J Geriatr Psychiatry. 2006 Apr;21(4):363-7
16534772
Psychiatr Serv. 2002 Jun;53(6):738-42
12045312
J Clin Psychiatry. 1999;60 Suppl 2:53-6; discussion 75-6, 113-6
10073388
Natl Vital Stat Rep. 2006 Apr 19;54(13):1-120
16689256
Arch Gen Psychiatry. 1983 Mar;40(3):249-57
6830404
Am J Psychiatry. 2005 Feb;162(2):297-303
15677594
Psychiatr Serv. 1995 May;46(5):449-51
7627668
Am J Psychiatry. 1990 Sep;147(9):1189-94
2104515
Death Stud. 2006 Nov;30(9):859-71
17004369
Am J Psychother. 1965 Oct;19(4):570-6
5837157
Am J Psychiatry. 2004 Mar;161(3):562-3
14992984
J Clin Psychiatry. 2001;62 Suppl 25:27-30
11765092
Psychiatr Clin North Am. 1999 Sep;22(3):667-73, ix-x
10550861
J Clin Psychiatry. 2001;62 Suppl 25:35-43
11765095
Psychol Med. 2006 Sep;36(9):1265-74
16734947
Bull Menninger Clin. 1991 Spring;55(2):216-27
2043898
Suicide Life Threat Behav. 2006 Jun;36(3):255-62
16805653
Am J Psychiatry. 2002 Jun;159(6):909-16
12042175
Br J Psychiatry. 1998 Jan;172:35-7
9534829
Suicide Life Threat Behav. 2006 Jun;36(3):296-301
16805657
Br J Psychiatry. 2000 Oct;177:360-5
11116779
Am J Psychiatry. 2005 Nov;162(11):2116-24
16263852
Int Rev Psychiatry. 2005 Jun;17(3):153-62
16194786
Am J Psychiatry. 1995 Jun;152(6):919-22
7755124
J Clin Psychiatry. 2005 May;66(5):579-85
15889943
Br J Psychiatry. 1997 May;170:447-52
9307695
Am J Psychiatry. 2000 Dec;157(12):2022-7
11097970
J Clin Psychiatry. 2005 Apr;66(4):412-7
15816781
J Clin Psychiatry. 1999;60 Suppl 2:57-62; discussion 75-6, 113-6
10073389
Mil Med. 2006 Sep;171(9):844-8
17036604
Arch Gen Psychiatry. 2005 Mar;62(3):247-53
15753237
J Clin Psychiatry. 2005 Jun;66(6):693-704
15960561
Crisis. 2005;26(3):104-11
16276752
Am J Psychother. 1984 Jul;38(3):319-28
6486283
BMJ. 2000 Jun 10;320(7249):1571-4
10845964
Br J Psychiatry. 2005 Jul;187:9-20
15994566
CNS Spectr. 2006 Jun;11(6):465-71
16816785
Am J Psychiatry. 1999 Oct;156(10):1590-5
10518171
Am J Psychiatry. 1988 Feb;145(2):224-8
3341466
Psychiatr Serv. 2005 Mar;56(3):260-2
15746498
Arch Gen Psychiatry. 1991 May;48(5):418-22
2021294