Suicide Screening and Prevention

Suicide is a major public health problem not only in the United States but also in many western nations. In the United States, it is the 10th leading cause of death, accounting for nearly 44,000 deaths each year. Suicide is also the seventh leading cause of lost years of potential life, surpassing liver disease, diabetes, and HIV. Each year, nearly half a million individuals present to the emergency departments in the United States following attempted suicide. Data indicate that nearly 1 out of every 7 young adults admits to having some type of suicidal ideation at some point in their lives, and at least 5% have made a suicide attempt. Suicide has repercussions way beyond the affected individual. It costs the US healthcare system over $70 billion, and untold billions of dollars are lost by the families affected in terms of loss of earnings.

Suicides are at an all-time high and affect both genders. Men are nearly 3.5 times more likely than women to commit suicide, and on average, 123 people kill themselves every day.

The World Health Organization (WHO) has predicted that in the next 2 years, depression will be the leading cause of disability globally. Depression is not only a North American phenomenon but is now being diagnosed in almost every nation. The annual prevalence of major depressive disorders in North America is 4.5%, but this is a gross underestimate because many individuals do not seek medical help. Depression is a serious medical disorder and associated with a high risk of suicide. Data reveals that more than 90% of individuals with a major depressive disorder see a healthcare provider within the first 12 months of the episode, and at least 45% of suicide victims have had some contact with a primary health care provider within the 4 weeks of suicide. This indicates that if their healthcare providers are more vigilant and alert, suicide is preventable in these individuals.

These grim statistics have led to a National Strategy for Suicide Prevention in the United States.

Considering that many individuals who commit suicide have a mental health disorder and have visited their primary caregiver, the focus now is on health care providers becoming aware of the factors that increase the risk of suicide and refer these individuals to mental health professionals for some type of intervention. The current United States Preventive Services Task Force (USPSTF) recommendations are that primary caregivers should screen adolescents and adults for depression only when there are appropriate systems in place to ensure adequate diagnosis, treatment, and follow-up.

Etiology

Many factors have been identified in individuals who commit suicides or have attempted suicide. These factors include the following:

1. Advanced age

2. Availability of a firearm

3. Chronic illness

4. A family history of suicides

5. Financial difficulties

6. Negative life experiences

7. Loss of job

8. Marital status divorced

9. Medications

10. Mental illnesses such as depression, anxiety, post-traumatic stress disorder (PTSD)

11. Continuous pain

12. A physical illness that has led to disability

13. Race: white

14. Gender: Male

15. Social media

16. Stress

17. A sense of no purpose in life

Other Risk Factors for Suicide

Over the years, several other factors have been identified that increases the risk of suicide, and they include:

1. Major childhood adverse events, for example, sexual abuse.

2. Discriminated for being gay, lesbian, transgender, or bisexual

3. Having access to lethal means

4. A long history of being bullied

5. Chronic sleep problems

In Males and Older Individuals

1. Loss of job or unemployment

2. Low income

3. Neurosis

4. Social isolation

5. Spousal loss, bereavement

6. Affective disease

7. Functional impairment

8. Physical illness

Military Personnel

1. Traumatic brain injury

2. PTSD

3. Other mental health issues

The most important thing to understand is that having just one risk factor has very limited predictive value. Millions of Americans have one of these factors at any one point in time, but very few attempt suicide, and even fewer die as a result. One has to look at the entire clinical picture to increase the predictive values of these risk factors.