BMED-suicide/non suicidal self injury

What was the number of suicides in the US in 2023?

49,315

In 2021, where did suicide rank among leading causes of death in the US?

11th leading cause of death

Which racial group has the most suicides in the US?

American Indian/Alaska Natives

Which racial group has the least suicides in the US?

Asians

Which group has the highest suicide rate: non-Hispanic American Indian/Alaska Native or non-Hispanic White?

Non-Hispanic American Indian/Alaska Native (people with origins in the original peoples of North and South America (including Central America) who identify as American Indian or Alaska Native and do not identify as Hispanic or Latino)

Which group has the second highest suicide rates after non-Hispanic American Indian/Alaska Native?

Non-Hispanic White

Which group follows in high suicidal rates in order?

1. Non-Hispanic Native Hawaiian/Other Pacific Islander

2. Non-Hispanic Multiracial

3. Non-Hispanic Black

4. Hispanic

Which group has the lowest suicide rate in the ordering given?

Non-Hispanic Asian

Which sex completes suicide more often: males or females?

Males > females

Which age group has higher suicide rates: older or younger?

Older > younger

What is the most commonly used method of suicide in the US?

Firearms

After firearms, what is the next most common suicide method?

Suffocation

What suicide method follows firearms and suffocation in frequency?

Poisoning

In 2021, what was Arkansas' rank in the nation for suicide rates?

12th

What is the 3rd leading cause of death among US adolescents?

Suicide

Among adolescents and children, which method is most likely to be used for suicide?

Firearms

What percentage of boys' suicides use firearms?

66%

What percentage of girls' suicides use firearms?

50%

What is suicidal ideation?

Thoughts about killing oneself; may or may not include a plan

What is a suicide attempt?

Self-injurious behavior intended to kill oneself but not fatal

How is any SIB (self-injurious behavior) with any intent to die classified?

Suicide attempt

Which organizations' practice is consistent with classifying SIB with any intent to die as a suicide attempt?

Most clinicians, researchers, and the CDC

What is suicide (definition)?

Self-injurious behavior intended to kill oneself and is fatal

What is a suicide threat?

Verbalized thoughts of SIB intended to make others think one wants to die without actual intent to die

Give an example of a suicide threat statement.

"If you leave me, I will kill myself"

What is a suicide gesture?

SIB (self-injurious behavior) intended to make others think one wants to die, without intent to die (not verbalized thoughts only)

What is controversial about the term "suicide gesture"?

Subjective and often negative nature; debate about "genuine" attempt vs only a gesture

What are nonsuicidal self-injurious thoughts?

Thoughts of SIB with deliberate destruction of body tissue without intent to die and not socially sanctioned (thoughts to perform destruction of body tissue without intention to die)

What is nonsuicidal self-injury? More focused on wanting to feel something (e.g. pain).

SIB with deliberate destruction of body tissue without intent to die and not socially sanctioned

Name some examples of nonsuicidal self-injury.

Cutting, burning, banging head, vomiting, ingesting or inserting

In suicide completion rates, which sex is higher: men or women?

Men > women

In suicide attempt rates, which sex is higher: women or men?

Women > men

How do suicide rates compare in sexual minorities?

Higher rates of suicide in sexual minorities

What general effect does religious faith have on suicide attempts?

Religious faith protects against suicide attempt and severity

Does religious faith protect against suicidal ideation?

No

What must be considered before assuming religious affiliation is protective?

Culture-specific implications of affiliating with a particular religion

What question should be asked about religious groups and culture?

Is the culture or religious group a minority?

How might religious affiliation affect suicide attempt risk?

Whether it fosters belonging or makes a person feel ostracized

In Switzerland, which group has the highest crude suicide rates by religious affiliation?
crude suicide rates: basic statistical measure of the number of suicide deaths in a specific population over a defined period, divided by the total population, and typically expressed as a rate per 100,000 individuals

Those with no religious affiliation

In China, compared to controls, what is more likely about suicide and religion?

Suicide is more likely to have a religious affiliation than controls

What kind of worship offers less social support?

Private worship

Which religious idea may encourage suicide in some cases?

Buddhist ideas about reincarnation

What is the majority belief in China regarding religion?

Atheism is the majority belief

What does being religious in China imply in terms of group status?

Religious believers are a minority group

How does marital status affect suicide risk?

Single/divorced/widowed > married

Which occupations have the highest suicide rates?

Labor jobs without skills and veterans

How does major physical illness affect suicide risk?

Higher in major physical illness, especially with chronic pain

Which type of mental health condition increases suicide risk?

CNS disorders, including TBI

What is the strongest predictor for future suicidal behaviors?

Previous suicidal behavior

Why might health care professionals have higher suicide risk?

High stress, burnout, access to lethal means, stigma around seeking support

What model is used to organize etiological factors of suicidal and non-suicidal behavior?

Biopsychosocial model

In the sociological domain, what factors contribute to suicide risk?

Life traumas and stresses

What early-life factor in the sociological domain may contribute to suicide risk?

Early life experiences

What family-related factor in the sociological domain may contribute to suicide risk?

Family relationships

In the psychological domain, what diagnosis is a key factor?

Severe major depression

In the psychological domain, what symptom involving outlook is important to consider?

Hopelessness

What psychological trait involving actions is a risk factor?

Impulsivity

What recurrent behavior involving substances is a psychological risk factor?

Recurrent substance use

What kind of behavioral history is a psychological risk factor?

History of aggressive behavior

In the biological domain, what factor involves inheritance?

Genetic

In the biological domain, what brain chemicals are involved?

Neurotransmitters

In the biological domain, what structural factor is involved?

Brain damage

In the genetic domain, what family-related factor is important?

Family history

What heritable traits are noted in the genetic domain?

Heritable impulsivity traits

What is a key first step in evaluating a suicidal patient?

Ask about their suicidal thoughts

How should you ask about suicide?

Directly, non-judgmental, non-condescending, matter-of-fact

What should you always ask about when evaluating suicide risk?

Past attempts

When characterizing suicidal thoughts, what three aspects should be assessed?

Frequency, duration, and intensity

What should you ask regarding a patient's plan for suicide?

If they have a plan and get specifics

In evaluating intent, what are you trying to understand?

Patient's belief about lethality of attempt vs self-injury

What is one question to explore reasons for dying?

"What would it accomplish if you were to end your life?"

What question assesses perceived burden?

"Do you feel as if you're a burden to others?"

What question explores what affects their distress level?

"What makes you feel better/worse?"

What question explores protective factors against suicide?

"What keeps you from ending your life?"

What are preparatory behaviors in suicide assessment?

Actions taken to initiate or prepare the plan

What question explores preparatory behaviors?

"What have you done to initiate your plan?"

What question explores arrangements related to suicide?

"Have you made any arrangements?"

What is meant by suicide rehearsal?

How close the patient has gotten to carrying out the act

What question explores suicide rehearsal?

"How close have you gotten to doing this?"

Another question exploring rehearsal is what?

"Have you rehearsed what you would do?"

What is the purpose of a suicide risk assessment?

To review risk and protective factors and identify modifiable targets for intervention

What percentage of patients who committed suicide had contact with a PCP within 1 year of their death?

80%

What percentage of patients had contact with psychiatric clinicians within 1 year of their death?

25-30%

What are common outpatient treatments for suicidal and non-suicidal injury patients?

CBT, dialectical behavior therapy, medication, mindfulness-based therapies

What are the two types of inpatient treatment status?

Voluntary and involuntary

In which patients is involuntary inpatient treatment considered?

People at higher risk