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Suicide Screening and Prevention.

Background

Suicide is a major public health problem not only in the United States (US) but in many western nations as well.

In the US, it is the 10th leading cause of death, accounting for nearly 44,000 deaths each year. Suicide is also the seventh leading cause of years of potential loss of life, surpassing liver disease, diabetes, and HIV.

Each year, nearly half a million individuals present to the emergency departments in the US following attempted suicide.

Data indicate that nearly 1 out of every 7 young adults admits to having some type of suicidal ideation at some point in their lives and at least 5% have made a suicide attempt.

Suicide has repercussions way beyond the affected individual. It costs the US healthcare system over $70 billion, and untold billions of dollars are lost by the families who are affected, in terms of loss of earning.

Suicides are at an all-time high and affect both genders. Men are nearly 3.5 times more likely than women to commit suicide, and on average 123 people kill themselves every day.

The World Health Organisation (WHO) has predicted that in the next 2 years, depression will be the leading cause of disability globally. Depression is not only a North American phenomenon but is now being diagnosed in almost every nation. The annual prevalence of major depressive disorders in North America is 4.5%, but this is a gross underestimate because many individuals do not seek medical help. Depression is a serious medical disorder and associated with a high risk of suicide. Data reveals that more than 90% of individuals with a major depressive disorder do see a healthcare provider within the first 12 months of the episode and at least 45% of suicide victims have had some contact with a primary health care provider within the 4 weeks of suicide.

This indicates that if their healthcare providers are more vigilant and alert, suicide could be prevented in these individuals. These grim statistics have led to a National Strategy for Suicide Prevention in the US.

Considering that many individuals who commit suicide have a mental health disorder and have visited their primary caregiver, the focus now is on health care providers to become aware of the factors that increase the risk of suicide and to refer these individuals to mental health professionals for some type of intervention.

The current United States Preventive Services Task Force (USPSTF) recommendations are that primary caregivers should screen adolescents and adults for depression only when there are appropriate systems in place to ensure adequate diagnosis, treatment, and follow-up.

Aetiology

Many factors have been identified in individuals who commit suicides or have attempted suicide. These factors include the following:

• Advanced age.
• Availability of a firearm.
• Chronic illness.
• A family history of suicides.
• Financial difficulties.
• Negative life experiences.
• Loss of job.
• Marital status divorced.
• Medications.
• Mental illnesses such as depression, anxiety, post-traumatic stress disorder (PTSD).
• Pain that is continuous.
• A physical illness that has led to disability.
• Race: white.
• Gender: Male.
• Social media.
• Stress.
• A sense of no purpose in life.

Other Risk Factors for Suicide

Over the years, several other factors have been identified that increases the risk of suicide and they include:

• Major childhood adverse events, for example, sexual abuse.
• Discriminated for being gay, lesbian, transgender or bisexual.
• Having access to lethal means.
• A long history of being bullied.
• Chronic sleep problems.

In Males and Older Individuals

• Loss of job or unemployment.
• Low income.
• Neurosis.
• Social isolation.
• Spousal loss, bereavement.
• Affective disease.
• Functional impairment.
• Physical illness.

Military Personnel

• Traumatic brain injury.
• PTSD.
• Other mental health issues.

The most important thing to understand is that having just one risk factor has very limited predictive value. Millions of Americans have one of these factors at any one point in time, but very few attempt suicide and even fewer die as a result. One has to look at the entire clinical picture to increase the predictive values of these risk factors.

Function

Which type of mental health disorder is associated with an increased risk of suicide?

Accumulated data reveal that many types of mental health disorders have been associated with an increased risk of suicide and they include the following:

• Major depression.
• Schizophrenia.
• Substance abuse.
• Alcoholism.
• Post-traumatic stress disorder.
• Bipolar disorder.
• Personality disorders.
• Emotional stress.
• Medications and Suicides.

You can read further @ https://www.ncbi.nlm.nih.gov/books/NBK531453/.

Reference

O’Rourke, M.C., Jamil, R.T. & Siddiqui, W. (2020) Suicide Screening and Prevention. Treasure Islan, Florida: StatPearls Publishing.