Self-harm and suicide

Introduction

• 10% of people who commit suicide are seen in ED in month prior
• 1.6% of deaths in Australia
• 4x more common in males
• Leading cause of death among Australians aged 15-34yo
• Self-harm presentations 10x higher than suicide rates

introduction

• Suicide attempts more common in women
• 1-2% of patients commit suicide in the year following an attempt and 40% of suicides have previous hx of self-harm
• In repeated self-harm, suicide rate is 2% at 1 year and 7% after 9 years
• Hospitalisation and aftercare decrease the short-term risk of suicide after self-harm but have little impact on long-term suicide risk
• Exposure to suicide in adolescence does not cause an increased risk of suicide but does increase risk of depression, anxiety and PTSD

Repeated self-harm

• Usually invokes help from social supports and medical profession improving well-being
• Risk of repetition is 12-16% at 1 year, with 10% in first week
• Patients who leave ED without a psychosocial assessment have a higher risk for repeat self-harm
• Unemployment increases risk 10-15x

suicide

• Lifetime risk of suicide in MH inpatients is 3-12x higher than general poulation
  • 1/3 of episodes happen after discharge from hospital and 10% during leave from hospital
• Hopelessness is the most powerful predictor of attempted suicide
• Assess static and dynamic factors
• Consider protective factors
  • Higher intelligence individuals have better coping strategies and are at lower risk of suicide
• Need to assess and manage current stressors, relationship problems, employment, housing, legal problems, bereavement, alcohol and drug abuse
• Goal is to minimise mobifiable risk factors, least-restrictive management plan and early close follow-up

High-risk groups

• Psychiatric disorders
  • 60-70% suffer depression, 10% schizophrenia, some substance abuse, panic disorder, BPD and antisocial personality disorder
  • Particularly at risk at time of diagnosis or after resolution of exacerbation
• Alcohol or substance abuse
• Adolescents
• Elderly
• Chronic illness
• Terminal illness
• Dementia
• AIDS
• Homosexual/bisexual men

SAD pERSONS

• Sex (male)
• Age <19 or >45
• Depression or hopelessness (2)
• Previous attempts or psychiatric care
• Excess alcohol or drugs
• Rational thought loss (2)
• Separated, divorced or widowed
• Organised serious attempt (2)
• No social supports
• Stated future intent (2)

Sad persons

• 0-5: May be safe for discharge
• 6-8: Psych consult
• >8: Hospital admission

Suicide questioning

• Previous and current plans
• Severity
• Perceived lethality
• Likelihood of being found
• Motivation behind suicide

Last Updated on October 7, 2020 by Andrew Crofton