Essential Knowledge about Suicide Prevention

The New York Psychological Association
Published on Jan 31, 2013

"Essential Knowledge about Suicide Prevention-Evidence-Based Practices for Mental Health Professionals," sponsored by the NYS Psychological Association and the NYS OMH Suicide Prevention Initiative provides concepts and resources for clinicians as a starting point to build competency and preparedness for a suicide event, before it becomes a reality. Featuring Dr. Richard Juman, Dr. John Draper and Dr. Shane Owens, the video addresses issues including clinician anxiety about suicide, suicide and professional liability, and core competencies for suicide prevention in clinical practices, providing perspectives from both experts and clinicians.

NAASP: Clinical Care & Intervention Task Force Report

GPs Reminded to Regularly Assess Depressed Patients for Risk of Suicide

Originally Published on May 4, 2012

The Medical Defence Union

GPs are being advised to ensure patients with depression are regularly assessed for a risk of suicide. The Medical Defence Union (MDU) issued the advice after being notified of a small number of complaints in which GPs were criticised for failing to appreciate that the patient was a suicide risk.

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The MDU's advice for GPs to help them avoid such problems includes:

• Be aware of the current guidance on the treatment of depression, including the role of non-drug interventions.
• Ensure patients understand what is being prescribed and have been warned about the risks involved, any side-effects and alternatives to treatment.
• Have a system in place to review patients on long-term medication.
• All patients who present with depression need to be assessed regularly for risk of suicide.
• Be prepared to refer patients for specialist treatment where necessary and have a system to track referrals.
• Take care with prescriptions for drugs with similar names and with dosages.

The entire story is here.

One in 10 suicides is among people with a physical illness

By Anne Gulland
BMJ 2011; 343:d5464

A report on the link between suicide and physical ill health has found that one in 10 people who take their own life is chronically or terminally ill.

The report, by think tank Demos, is one of the first such comprehensive studies to look at the links between suicide and physical ill health. It says that the figure, which came from coroners and primary care trusts (PCTs), is likely to be a substantial underestimate because coroners do not always include the relevant health information with their inquest reports.

Demos believes that the findings provide strong evidence that people with chronic and terminal illnesses should be regarded as a high risk group for suicide and should be given better “medical, practical, and psychological support.”

Demos believes that the findings provide strong evidence that people with chronic and terminal illnesses should be regarded as a high risk group for suicide and should be given better "medical, practical, and psychological support."

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The government launched a consultation on suicide in July which identified five high risk groups for suicide: people in the care of mental health services (1200 suicides a year); people in the criminal justice system (80 suicides in prison a year); adult men aged under 50 (2000 suicides a year); people with a history of self harm (950 suicides a year), and occupational groups such as doctors, nurses, and farmers.

There were 4390 suicides in England in 2009, which, using Demos's calculation, would mean that more than 400 of these were among people with a chronic or terminal illness.

Demos believes that this group should be identified as high risk.

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Louise Bazalgette, author of the report, said it was important that doctors treating people with a chronic or terminal illness were aware of the issue.

"Doctors should be thinking about the possibility that a person with chronic health problems may be depressed and struggling. They should ask them if they ever feel suicidal," she said.

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Simon Gillespie, chief executive of the Multiple Sclerosis Society, said: "There is a big difference between someone wanting to end their life having explored and received every care option, and someone giving up hope because they feel they have nothing available to them. The right care and support can make a huge difference to an individual's life."

Clare Wyllie, head of policy and research at the Samaritans, said it was important that a suicide prevention strategy was implemented locally.

"It is vital that commissioners of local NHS, social care and public health services recognise that poor physical health and poor mental health are often closely linked [and] that depression is often undiagnosed in people with poor physical health," she said.

Thanks to Ken Pope for this information.

A War Inside: Saving Veterans from Suicide

From Penn Medicine

PHILADELPHIA — An estimated 18 American military veterans take their own lives every day -- thousands each year -- and those numbers are steadily increasing. Even after weathering the stresses of military life and the terrors of combat, these soldiers find themselves overwhelmed by the transition back into civilian life. Many have already survived one suicide attempt, but never received the extra help and support they needed, with tragic results. A team of researchers from the Perelman School of Medicine at the University of Pennsylvania and colleagues found that veterans who are repeat suicide attempters suffer significantly greater mortality rates due to suicide compared to both military and civilian peers. The research was published this month in BMC Public Health.

The study is the largest follow-up of suicide attempters in any group in the United States, and is unique even among the relatively few studies on veteran suicide: "We looked at suicide among veterans who had already attempted suicide one time," notes study author Douglas J. Wiebe, PhD, assistant professor of Epidemiology. The findings, he says, "should have us very concerned about current veterans in the more contemporary era."

Wiebe, along with Janet Weiner of Penn's Leonard Davis Institute of Health Economics and Therese S. Richmond of the School of Nursing, teamed with Joseph Conigliaro of the New York University School of Medicine to conduct a study of military veterans who received inpatient treatment at a Department of Veterans Affairs (VA) medical center for a suicide attempt between 1993 and 1998. Using additional data from the VA, as well as the National Center of Health Statistics, these veterans were followed for incidence, rate, and cause of mortality through the end of 2002.

Among the total of 10,163 veterans treated for a suicide attempt between 1993-1998, 1,836 died during the follow-up period through 2002, with heart disease, cancer, accidents, and suicide accounting for over 57% of those deaths. Suicide, however, was the second- leading cause of death among the male veterans, and the leading cause among females, accounting for just over 13% of all the deaths in the study cohort. In comparison, suicide accounted for only 1.8% of deaths in the general U.S. population during those years.

Wiebe and his colleagues discovered that veterans who have attempted suicide not only have an elevated risk of further suicide attempts, but face mortality risks from all causes at a rate three times greater than the general population. The so-called "healthy soldier effect," that military personnel should be healthier than an average person of the same sex and age because they have passed military fitness requirements, does not protect veterans from death from chronic disease, and does not appear to mitigate their risk of suicide. "The 'healthy soldier effect' is no reason to think that veterans should be more emotionally and mentally resilient than anyone else," says Wiebe. "The consequences of military service can include both physical and emotional health challenges that veterans continue to face long after their 'war' is no longer on the front page."

The current study strongly emphasizes the increased need for more intensive and vigorous efforts to identify and support veterans who are at risk, especially those who have already actually attempted suicide, say the authors. With military personnel now facing combat in numbers not seen since the Vietnam War, developing better strategies for suicide prevention is more important than ever. "Almost all of today's soldiers are seeing combat and repeated tours, so that could be a reason to be even more concerned about veteran populations in the years moving forward," Wiebe says.

Wiebe's next step is to analyze the collected data to identify more specific risk factors for suicide or other premature causes of death. Although he argues that "we need to be more tuned into this problem in America in general," he is hopeful that examples of successful suicide prevention programs, particularly one conducted by the U.S. Air Force, could provide an inspiration and foundation for new efforts. "A major part of the success of that program was just changing the climate around how people think and talk about suicide," he says. "There's evidence out there to suggest that could work among veterans too. The time to get started is now."