Difference between revisions of "Suicide"

Revision as of 17:28, 20 May 2011

Introduction

This article addresses both the epidemiology of suicide and assessment of suicidality.

Epidemiology

About two-thirds of individuals who commit suicide are depressed.

Sexual abuse is a major risk factor for adolescent suicide attempts and reattempt. Up to 20% of adolescent suicide attempts are attributed to sexual abuse-related PTSD; these adolescents are also eight times more likely to reattempt suicide as compared to their suicidal peers who were not sexually abused. (JACAAP PTSD parameter p.416)

Definitions

Suicidal Events from the Columbia Classification Algorithm of Suicide Assessment (C-CASA)

• Completed Suicide - deadly self-injurious behavior associated with some intent to die.
• Suicide Attempt - self-injurious behavior with some intent to die.
  • intent may be stated/explicit or clinically inferred from seriousness of the event.
  • a self-injury that did not result in any harm is still a suicide attempt if intent to die as a result was present.
• Preparatory acts toward imminent suicidal behavior - this includes patients who prepared for or began a behavior leading to self-injury with intent to die only to be discovered and interrupted.
• Suicidal Ideation - Thoughts about dying (passive SI) or killing self (active SI) without preparation

Many incidents will be outside the above definitions, e.g.

• purposeful self-injurious behavior without suicide intent
• non-deliberate self-injury
• self-injury where intent is unknown and can not be inferred from the details of the incident (e.g. a child who learns that his favorite teacher is leaving and starts scratching his wrist with a pencil)
• other incidents lacking information (e.g. school note: "child stabbed himself in the neck with a pencil" does not mention if the self-injury was deliberate or if suicidal intent was present)

Screening

Assessment

The Modified Scale for Suicide Ideation is available online. It's an 18-question clinican-administered scale of acute (past 48 hours) suicidality; it allows a score of 0-3 for most of the questions. Serious Suicidal Ideation is defined as presence of the following 4 factors: total score >20, Intensity score >1 (Range 0-3), active suicidality >1, and plan/method specificity >1. Total score of 9-20 signifies Mild to Moderate Suicidal Ideation.

References

Posner K., Columbia Classificaiton Algorithn of Suicide Assessment (C-CASA), AmJPsych 164:7 1035-43.

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