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New Strategies for Suicide Risk Assessment: Can we Prevent Suicide?

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW

“She was just there joking with all of us. She was getting ready for Valentine’s Day, explaining how much shopping she had to do, to have enough gifts for everyone. The last thing I thought about was that she would be ending her life.” Lola’s mother, Eileen, inconsolable, said these words to Claire, Lola’s clinician, after Lola was found in the park, hanging and then pronounced dead at the hospital.  Claire could not hold back her tears, and being alone in her office, behind her phone, allowed her all the privacy she would need to tear up, with Lola’s mother on the other line.

This summary introduced our first article of this series, entitled, New Strategies for Suicide Risk Assessment: 9 Main Data Points and 11 Main Risk Factors, in which I outlined salient data and risk factors for suicide.

Below are 6 of the 9 salient data I described:

  1. The most commonly used method is based on availability of effective means.  This means proper education and proper policies around lethal means can help make some impact on this public health crisis;

  2. Suicide is the 10th leading cause of death.  This represents alarming data;

  3. Suicide has been increasing and not decreasing.  This is despite a lot of financial resource invested in Suicide Crisis Hotlines, for example;

  4. Suicide notes are typically left in 15% to 40% of the cases; this demonstrates there are ways we can intervene, if we learn better what to look for;

  5. Major Depressive Disorder may have been present in 50% of those who died by suicide, while a personality disorder, especially Borderline Personality Disorder may also have been present in that same number of cases. This suggests that addressing mood disorders and other forms of mental illness is at the cornerstone of addressing suicide;

  6. The higher the rates of alcohol use in a specific country, the higher the rates of suicide.  This highlights the correlation between suicide and substance use, notably alcohol and benzodiazepines.

Almost a million individuals in the United States alone attempt suicide, and about 40,000 of them die.  Many of those who survive suffer from long-term, negative consequences.  Limited education to individuals, their families, and friends has been shown to be one of the obstacles to preventing suicide.  The solution to this is to take steps to educate the public about suicide, the risk factors, and signs to look for, and when to seek professional help, and how to best do so.

2. Limited expertise:

Some clinicians still believe that asking their patients and clients about suicide may lead to an increase of suicide.  While studies have shown the exact opposite, it is surprising how these types of beliefs still linger, either subconsciously or unconsciously.  The solution to this is arming all our clinicians with tools, secrets, and new strategies for suicide risk assessment.  This will also help de-bunk the myths, and provide clinicians with what they need to feel confident when addressing suicidal behavior in their patients and clients.

In Summary, suicide is real, it hurts, its ramifications are significant, and it needs to be addressed.  From a problem-solving process standpoint, appreciating the causes of a problem, especially through a root cause analysis is one of the first steps to solving a problem.  The data and risk factors point us towards the right direction, and the question remains, what do we do next?  Can we prevent suicide?  The answer to this requires a process, which starts with the appreciation of

(1) The value of education on suicide and

(2) Limited expertise of health professionals on effectively dealing with suicide.

With the proper education and adequate expertise, suicide will cease being the 10th leading cause of death, similar to the way much progress has lead to the eradication polio.

References:

  1. Wasserman, editors, Danuta Wasserman, Camilla (2009). “Extended suicide”. Oxford textbook of suicidology. Oxford: Oxford University Press.

  2. Pompili, M; Girardi, P; Ruberto, A; Tatarelli, R (2005). “Suicide in borderline personality disorder: a meta-analysis”. Nordic Journal of Psychiatry. 59 (5): 319–24.

  3. Angelakis, I; Gooding, P; Tarrier, N; Panagioti, M (July 2015). “Suicidality in Obsessive Compulsive Disorder (OCD): a systematic review and meta-analysis”. Clinical Psychology Review. 39: 1–15.

  4. Eliason, S (2009). “Murder-suicide: a review of the recent literature”. The journal of the American Academy of Psychiatry and the Law. 37 (3): 371–6.

  5. Reisch, T; Steffen, T; Habenstein, A; Tschacher, W (September 2013). “Change in suicide rates in Switzerland before and after firearm restriction resulting from the 2003 “Army XXI” reform”. The American Journal of Psychiatry. 170 (9): 977–84.

  6. Sher, L (May 2011). “Brain-derived neurotrophic factor and suicidal behavior”. QJM : Monthly Journal of the Association of Physicians. 104 (5): 455–8.

  7. Williams, SB; O’Connor, EA; Eder, M; Whitlock, EP (April 2009). “Screening for child and adolescent depression in primary care settings: a systematic evidence review for the US Preventive Services Task Force”. Pediatrics. 123 (4): e716–35.

  8. Goodman, M; Roiff, T; Oakes, AH; Paris, J (February 2012). “Suicidal risk and management in borderline personality disorder”. Current psychiatry reports. 14 (1): 79–85.

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