suicide

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Introduction

also see suicidal ideation

Etiology

Epidemiology

  • 33% of people have suicidal ideation during their lifetime
  • 9th leading cause of death
  • 3rd leading cause of death in adolescents (age 15-24)
  • white males > 85 years of age have highest rate
  • rates in elderly tend to be underestimated because they are easily confused with medical complications
  • 20 cases per 100,000 in > 65 age group vs 12 per 100,000 in younger population
  • deteriorating physical health is more important than psychiatric illness in predicting self-harm in the elderly[7]
  • 2nd leading cause of death among persons 10-24 years of age[15]
  • one person dies by suicide every 40 seconds worldwide[13]
  • increase in suicide in U.S. from 1999-2014
    • suicide among people 35-64 years of age increased 28% from 1999 to 2010[11]
    • ~2% yearly increase in suicides from 2004-2013[24]
  • suicide rate in 2014 3-fold greater in males than females (20.7 vs 5.8 per 100,000) [19
  • increase in suicide 1999-2016[26]
    • suicide rate increased > 30% in 25 states
    • North Dakota with highest increase of 58%
    • in 2015, 18% of suicides had served in the military
    • >50% of cases had no documented mental health disorder
  • suicide among U.S. health care workers 2008-2019 higher than among non-health care workers for registered nurses, health technicians, & health care support workers, but not physicians[44]

Pathology

Diagnostic criteria

* USPSTF concludes that current evidence is insufficient to assess the balance of benefits & harms of screening for suicide risk in the adult population, including pregnant & postpartum women & older adults[43]

Complications

Management

More general terms

More specific terms

Additional terms

References

  1. ↑ Contributions from Linda Kuribayashi MD, Dept of Medicine, UCSF Fresno
  2. ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  3. ↑ 3.0 3.1 UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  4. ↑ 4.0 4.1 4.2 Carter GL, Clover K, Whyte IM, Dawson AH, D'Este C. Postcards from the EDge project: randomised controlled trial of an intervention using postcards to reduce repetition of hospital treated deliberate self poisoning. BMJ. 2005 Oct 8;331(7520):805. Epub 2005 Sep 23. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16183654
  5. ↑ 5.0 5.1 Eddleston M, Dissanayake M, Sheriff MH, Warrell DA, Gunnell D. Physical vulnerability and fatal self-harm in the elderly. Br J Psychiatry. 2006 Sep;189:278-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16946365
  6. ↑ 6.0 6.1 Bolton JM and Robinson J. Population-attributable fractions of axis I and axis II mental disorders for suicide attempts: Findings from a representative sample of the adult, noninstitutionalized US population. Am J Public Health 2010 Dec; 100:2473. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21068419
  7. ↑ 7.0 7.1 Oude Voshaar RC et al First episode of self-harm in older age: A report from the 10-year prospective Manchester Self-Harm project. J Clin Psychiatry 2011 Jun; 72:737. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21733475
  8. ↑ 8.0 8.1 Maguen S et al. Killing in combat may be independently associated with suicidal ideation. Depress Anxiety 2012 Apr 13 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22505038 <Internet> http://onlinelibrary.wiley.com/doi/10.1002/da.21954/abstract
  9. ↑ 9.0 9.1 Barr B et al. Suicides associated with the 2008-10 economic recession in England: Time trend analysis. BMJ 2012 Aug 13; 345:e5142 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22893569
  10. ↑ 10.0 10.1 O'Connor E et al Screening for and Treatment of Suicide Risk Relevant to Primary Care: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. 23 April 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23609101 <Internet> http://annals.org/article.aspx?articleid=1681063
    U.S. Preventive Services Task Force Screening for Suicide Risk in Adolescents, Adults, and Older Adults: U.S. Preventive Services Task Force Recommendation Statement. DRAFT http://www.uspreventiveservicestaskforce.org/draftrec3.htm
    LeFevre ML et al Screening for Suicide Risk in Adolescents, Adults, and Older Adults in Primary Care: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2014;160(10):719-726. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24842417 <Internet> http://annals.org/article.aspx?articleid=1872851
  11. ↑ 11.0 11.1 Centers for Disease Control and Prevention Suicide Among Adults Aged 35-64 Years - United States, 1999-2010. MMWR. May 3, 2013 / 62(17);321-325 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6217a1.htm
  12. ↑ 12.0 12.1 Tsai AC et al. Social integration and suicide mortality among men: 24-year cohort study of U.S. health professionals. Ann Intern Med 2014 Jul 15; 161:85 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25023247
  13. ↑ 13.0 13.1 First WHO report on suicide prevention WHO calls for coordinated action to reduce suicides worldwide News release. Sept 4, 2014 http://www.who.int/mediacentre/news/releases/2014/suicide-prevention-report/en/
    Preventing suicide. A globabl imperative. World Health Organization. 2014. http://apps.who.int/iris/bitstream/10665/131056/1/9789241564779_eng.pdf?ua=1&ua=1
  14. ↑ Vyssoki B et al. Direct effect of sunshine on suicide. JAMA Psychiatry 2014 Sep 10 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25208208 <Internet> http://archpsyc.jamanetwork.com/article.aspx?articleid=1901524
  15. ↑ 15.0 15.1 15.2 Sullivan E et al Suicide Trends Among Persons Aged 10-24 Years - United States, 1994-2012 MMWR Weekly. March 6, 2015 / 64(08);201-205 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6408a1.htm
  16. ↑ 16.0 16.1 Guldin MB et al Incidence of Suicide Among Persons Who Had a Parent Who Died During Their Childhood. A Population-Based Cohort Study. JAMA Psychiatry. Published online November 11, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26558351 <Internet> http://archpsyc.jamanetwork.com/article.aspx?articleid=2469106
  17. ↑ 17.0 17.1 Armitage CJ et al. An exploratory randomised trial of a simple, brief psychological intervention to reduce subsequent suicidal ideation and behaviour in patients admitted to hospital for self-harm. Br J Psychiatry 2016 Jan 7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26743808
  18. ↑ 18.0 18.1 Fralick M, Thiruchelvam D, Tien HC, Redelmeier DA. Risk of suicide after a concussion CMAJ February 8, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26858348 <Internet> http://www.cmaj.ca/content/early/2016/02/08/cmaj.150790
  19. ↑ 19.0 19.1 Curtin SC, Warner M, Hedegaard H Increase in Suicide in the United States, 1999-2014 NCHS Data Brief No. 241, April 2016 Centers for Disease Control & Prevention (CDC) http://www.cdc.gov/nchs/products/databriefs/db241.htm
  20. ↑ 20.0 20.1 Franklin JC, Fox KR, Franklin CR et al. A brief mobile app reduces nonsuicidal and suicidal self- injury: Evidence from three randomized controlled trials. J Consult Clin Psychol 2016 Jun; 84:544 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27018530 <Internet> http://psycnet.apa.org/?&fa=main.doiLanding&doi=10.1037/ccp0000093
  21. ↑ 21.0 21.1 Lund-Sorensen J, Benros ME, Madsen T et al A Nationwide Cohort Study of the Association Between Hospitalization With Infection and Risk of Death by Suicide. JAMA Psychiatry. Published online August 10, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27532502 <Internet> http://archpsyc.jamanetwork.com/article.aspx?articleid=2542681
    Brundin LC, Grit J Ascertaining Whether Suicides Are Caused by Infections. JAMA Psychiatry. Published online August 10, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27533721 <Internet> http://archpsyc.jamanetwork.com/article.aspx?articleid=2542678
  22. ↑ 22.0 22.1 Bostwick JM et al. Suicide attempt as a risk factor for completed suicide: Even more lethal than we knew. Am J Psychiatry 2016 Aug 13 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27523496
  23. ↑ 23.0 23.1 Kahn MW Psychocatalytic Benefits of the Unexpected. N Engl J Med 2017; 376:205-207. January 19, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28099822 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMp1611557
  24. ↑ 24.0 24.1 24.2 Olfson M, Blanco C, Wall M et al. National trends in suicide attempts among adults in the United States. JAMA Psychiatry 2017 Sep 13; PMID: https://www.ncbi.nlm.nih.gov/pubmed/28903161
    Caine ED. Suicide and attempted suicide in the Unites States during the 21st century. JAMA Psychiatry 2017 Sep 13 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28903162
  25. ↑ 25.0 25.1 Caputi TL, Smith D, Ayers JW Suicide Risk Behaviors Among Sexual Minority Adolescents in the United States, 2015. JAMA. 2017;318(23):2349-2351 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29260214 https://jamanetwork.com/journals/jama/article-abstract/2666491
  26. ↑ 26.0 26.1 Stone DM, Simon TR, Fowler KA, et al. Vital Signs: Trends in State Suicide Rates - United States, 1999-2016 and Circumstances Contributing to Suicide - 27 States, 2015. MMWR Morb Mortal Wkly Rep 2018;67:617-624
  27. ↑ 27.0 27.1 Stanley B, Brown GK, Brenner LA et al Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department. JAMA Psychiatry. Published online July 11, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29998307 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2687370
  28. ↑ 28.0 28.1 Madsen T, Erlangsen A, Orlovska S et al Association Between Traumatic Brain Injury and Risk of Suicide. JAMA. 2018;320(6):580-588. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30120477 https://jamanetwork.com/journals/jama/fullarticle/2697009
    Goldstein L, Diaz-Arrastia R. Traumatic Brain Injury and Risk of Suicide JAMA. 2018;320(6):554-556 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30120461 https://jamanetwork.com/journals/jama/fullarticle/2696989
  29. ↑ 29.0 29.1 Petrosky E, Harpaz R, Fowler KA et al Chronic Pain Among Suicide Decedents, 2003 to 2014: Findings From the National Violent Death Reporting System. Ann Intern Med. 2018. Sept 11. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30208405 <Internet> http://annals.org/aim/fullarticle/2702061/chronic-pain-among-suicide-decedents-2003-2014-findings-from-national
    Ilgen M Pain, Opioids, and Suicide Mortality in the United States. Ann Intern Med. 2018. Sept 11. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30208406 <Internet> http://annals.org/aim/fullarticle/2702063/pain-opioids-suicide-mortality-united-states
  30. ↑ 30.0 30.1 Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
  31. ↑ Sall J, Brenner L, Bell AMM, Colston MJ. Assessment and Management of Patients at Risk for Suicide: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines. Ann Intern Med. 2019. Aug 27 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31450237 https://annals.org/aim/fullarticle/2748922/assessment-management-patients-risk-suicide-synopsis-2019-u-s-department
    D'Anci KE, Uhl S, Giradi G, Martin C. Treatments for the Prevention and Management of Suicide: A Systematic Review. Ann Intern Med. 2019. Aug 27 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31450239 https://annals.org/aim/fullarticle/2748923/treatments-prevention-management-suicide-systematic-review
    Caine ED Seeking to Prevent Suicide at the Edge of the Ledge. Ann Intern Med. 2019. Aug 27 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31450242 https://annals.org/aim/article-abstract/2748925/seeking-prevent-suicide-edge-ledge
    Hogan M. Veteran Suicide: Not Just a VA Issue; It's a U.S. Issue. Ann Intern Med. 2019. Aug 27 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31450241 https://annals.org/aim/article-abstract/2748924/veteran-suicide-just-va-issue-s-u-s-issue
  32. ↑ 32.0 32.1 Kaufman JA, Salas-Hernandez LK, Komro KA, Livingston MD Effects of increased minimum wages by unemployment rate on suicide in the USA. BMJ. Journal of Epidemiology and Community Health. Jan 2020 https://jech.bmj.com/content/early/2020/01/03/jech-2019-212981
  33. ↑ Fazel S, Runeson B. Suicide. N Engl J Med 2020; 382:266-274. Jan 16. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31940700 PMCID: PMC7116087 Free PMC article https://www.nejm.org/doi/full/10.1056/NEJMra1902944
  34. ↑ 34.0 34.1 Grant K Dementia, Mild Cognitive Impairment Tied to Suicide Risk. Cohort study analyzing VA healthcare data found that those recently diagnosed have greater risk. MedPage Today March 24, 2021 https://www.medpagetoday.com/psychiatry/dementia/91783
    Gunak MM, Barnes DE, Yaffe K et al Risk of Suicide Attempt in Patients With Recent Diagnosis of Mild Cognitive Impairment or Dementia. JAMA Psychiatry. 2021 Jun 1;78(6):659-666 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33760039 PMCID: PMC7992018 (available on 2022-03-24)
  35. ↑ Talebraza S et al Geriatrics Evaluation & Management Tools American Geriatrics Society. 2021 https://geriatricscareonline.org/ProductAbstract/geriatrics-evaluation-management-tools/B007/
  36. ↑ Safety Planning Intervention A brief intervention for reducing suicide risk. http://www.suicidesafetyplan.com/Home_Page.html
  37. ↑ 37.0 37.1 37.2 Dong XQ, Xu Y, Ding D. Elder self-neglect and suicidal ideation in a U.S. Chinese aging population: findings from the PINE study. J Gerontol A Biol Sci Med Sci. 2017;72(suppl 1):S76-S81 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28575261 PMCID: PMC5861963 Free PMC article https://academic.oup.com/biomedgerontology/article/72/suppl_1/S76/3859671
    Dong XQ. Associations between the differential definitions of elder mistreatment and suicidal ideation outcomes in U.S. Chinese older adults: do the definitions matter? J Gerontol A Biol Sci Med Sci. 2017;72(suppl 1):S82-S89 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28575267 PMCID: PMC5861847 Free PMC article https://academic.oup.com/biomedgerontology/article/72/suppl_1/S82/3859677
    Li LW, Gee GC, Dong XQ. Association of self-reported discrimination and suicide ideation in older Chinese Americans. Am J Geriatr Psychiatry. 2018;26(1):42-51 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28917505 PMCID: PMC5725252 Free PMC article https://www.ajgponline.org/article/S1064-7481(17)30421-9/fulltext
    Wei JW, Zhang J, Deng Y, et al. Suicidal ideation among the Chinese elderly and its correlates: a comparison between the rural and urban populations. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29495615 PMCID: PMC5876967 Free PMC article https://www.mdpi.com/1660-4601/15/3/422
  38. ↑ 38.0 38.1 Brooks M Ketamine Fast, Effective for Suicidal Crises. Medscape. February 10, 2022 https://www.medscape.com/viewarticle/968269
  39. ↑ 39.0 39.1 Watts BV et al. Association of medication treatment for opioid use disorder with suicide mortality. Am J Psychiatry 2022 Apr; 179:298. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35360916 https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2021.21070700
    Mooney LJ. Medication treatment for opioid use disorder reduces suicide risk. Am J Psychiatry 2022 Apr; 179:262. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35360917 https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.20220173
  40. ↑ 40.0 40.1 Alothman D, Card T, Lewis S et al Risk of Suicide After Dementia Diagnosis. JAMA Neurol. Published online October 3, 2022. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36190708 https://jamanetwork.com/journals/jamaneurology/article-abstract/2796654
  41. ↑ 41.0 41.1 Schmutte T, Olfson M, Maust DT et al. Suicide risk in first year after dementia diagnosis in older adults. Alzheimers Dement. 2022. Feb;18(2):262-271. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34036738 PMCID: PMC8613307 (available on 2023-02-01)
  42. ↑ 42.0 42.1 DePeau-Wilson M Abortion Access Tied to Suicide Rates Among Young Women. Enforcing restrictions on reproductive care linked with nearly 6% rise in suicide rate. MedPage Today December 28, 2022 https://www.medpagetoday.com/obgyn/abortion/102418
  43. ↑ 43.0 43.1 43.2 US Preventive Services Task Force Screening for Depression and Suicide Risk in Adults; US Preventive Services Task Force Recommendation Statement. JAMA. 2023;329(23):2057-2067 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37338872 https://jamanetwork.com/journals/jama/fullarticle/2806144
    Simon GE et al. Reframing the key questions regarding screening for suicide risk. JAMA 2023 Jun 20; 329:2026. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37338888 https://jamanetwork.com/journals/jama/fullarticle/2806177
  44. ↑ 44.0 44.1 Olfson M et al. Suicide risks of health care workers in the US. JAMA 2023 Sep 26; 330:1161-1166. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37750880 PMCID: PMC10523169 (available on 2024-03-26) https://jamanetwork.com/journals/jama/fullarticle/2809812
  45. ↑ Turecki G, Brent DA. Suicide and suicidal behaviour. Lancet. 2016 Mar 19;387(10024):1227-39. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26385066 PMCID: PMC5319859 Free PMC article. Review.
  46. ↑ 46.0 46.1 Alexopoulos GS, Raue PJ, Banerjee S et al Modifiable predictors of suicidal ideation during psychotherapy for late-life major depression. A machine learning approach. Transl Psychiatry. 2021 Oct 18;11(1):536. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34663787 Free PMC article. Clinical Trial.
  47. ↑ 47.0 47.1 Chitavi SO, Patrianakos J, Williams SC, et al. Evaluating the Prevalence of Four Recommended Practices for Suicide Prevention Following Hospital Discharge. Jt Comm J Qual Patient Saf. 2024;50(6):393-403 PMID: https://www.ncbi.nlm.nih.gov/pubmed/38538500 Free article
  48. ↑ 48.0 48.1 48.2 Ostergaard SD, Momen NC, Heide-Jorgensen U, Plana-Ripoll O Risk of Suicide Across Medical Conditions and the Role of Prior Mental Disorder. JAMA Psychiatry. Published online September 4, 2024 PMID: https://www.ncbi.nlm.nih.gov/pubmed/39230910 https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2822967
  49. ↑ Fernandez-Rodrigues V, Sanchez-Carro Y, Lagunas LN et al Risk factors for suicidal behaviour in late-life depression: A systematic review. World J Psychiatry. 2022 Jan 19;12(1):187-203. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35111588 PMCID: PMC8783161 Free PMC article.
  50. ↑ Raue PJ, Ghesquiere AR, Bruce ML. Suicide risk in primary care: identification and management in older adults. Curr Psychiatry Rep. 2014 Sep;16(9):466. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25030971 PMCID: PMC4137406 Free PMC article. Review.
  51. ↑ Van Orden K, Conwell Y. Suicides in late life. Curr Psychiatry Rep. 2011 Jun;13(3):234-41. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21369952 PMCID: PMC3085020 Free PMC article. Review.
  52. ↑ National Institute of Mental Health Suicide Prevention https://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml

Patient information

suicide patient information

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