Suicide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Suicide is the third leading cause of death among all children and adolescents in the United States. According to the American Society of Suicidology, suicide can be classified based on method employed and psychiatric behavior of person committed into 10 and 8 types. Common risk factors include family history of suicidal behavior, mental disorders such as major depression, substance use disorders, hospitalization or psychotic disorders, history of physical or sexual abuse, previous suicide attempt or exposure to suicide, gay, lesbian, or bisexual orientation, or transgender or gender non-conforming identity, biologic factors, access to firearms, alcohol and drug abuse, social stress, social isolation, adoption, emotional and cognitive factors. Physical examination should be focused towards vital signs, level of consciousness and orientation, manifestations of toxidromes, signs of recent or remote suicide attempts, scars from cutting, bruises from hanging, signs of Physical or sexual abuse, characteristic bruising patterns or genital trauma, signs of substance abuse, track marks from intravenous drug use, nosebleeds or perioral blisters from inhalant use and signs of hyperthyroidism. Psychiatric evaluation is done by the clinicians with specialized training and experience in the psychiatric problems of children and adolescents or general medical emergency department clinicians. Psychiatric evaluation is done once the patient is medically stable. The mnemonic “MALPRACTICE” is used to ensure that all the areas for psychiatric evaluation are being covered. Effective medical management include hospitalization of high risk individuals and stabilizing. Effective psychotherapies for suicide prevention include cognitive behavioral therapy, dialectical behavioral therapy, family therapy and group psychothe. Antidepressants has no proven role in the acute management of the suicidal adolescent or child. The American Society of Suicidology recommends administration of appropriated medications for an underlying psychiatric disorder in pediatric patients hospitalized for suicidal ideation or behavior. There are no effective or concrete strategies in preventing suicides. However, American society of Sucidology brought up certain recommendations in identification of risk factors and warning signs to get aware of an individual at risk. American Society of Sucidology also came up with a mnemonic for warning signs ‘IS PATH WARM”.

According to the American Society of Suicidology, suicide can be classified based on method employed and psychiatric behavior of person committed into 10 and 8 types.

Suicide is the third leading cause of death among all children and adolescents in the United States. In the United States, the incidence rate of suicide among children aged 5 to 11 years was 1 per 1 million, between 2008 and 2012. Among adolescents, the suicide rate is highest for white males.

Common risk factors include family history of suicidal behavior, mental disorders such as major depression, substance use disorders, hospitalization or psychotic disorders, history of physical or sexual abuse, previous suicide attempt or exposure to suicide, gay, lesbian, or bisexual orientation, or transgender or gender non-conforming identity, biologic factors, access to firearms, alcohol and drug abuse, social stress, social isolation, adoption, emotional and cognitive factors. Mnemonic for identification of risk factors “IS PATH WARM”.

The United States Preventive Services Task Force (USPSTF) have declared that there is insufficient evidence to determine the benefits of screening for suicide risk in the general population of United States adolescents having no prioe history of mental disorders or previous suicide attempts.

Physical examination should be focused towards vital signs, level of consciousness and orientation, manifestations of toxidromes, signs of recent or remote suicide attempts, scars from cutting, bruises from hanging, signs of Physical or sexual abuse, characteristic bruising patterns or genital trauma, signs of substance abuse, track marks from intravenous drug use, nosebleeds or perioral blisters from inhalant use and signs of hyperthyroidism.

Commonly performed screening laboratory tests include complete blood count, serum chemistry panels, urinalysis, thyroid stimulating hormone, human chorionic gonadotropin, urine toxicology screen for drugs of abuse, aspirin, and acetaminophen.

Psychiatric evaluation is done by the clinicians with specialized training and experience in the psychiatric problems of children and adolescents or general medical emergency department clinicians. Psychiatric evaluation is done once the patient is medically stable. The mnemonic “MALPRACTICE” is used to ensure that all the areas for psychiatric evaluation are being covered.

Effective medical management include hospitalization of high risk individuals and stabilizing.

Effective psychotherapies for suicide prevention include cognitive behavioral therapy, dialectical behavioral therapy, family therapy and group psychotherapy.

Antidepressants has no proven role in the acute management of the suicidal adolescent or child. The American Society of Suicidology recommends administration of appropriated medications for an underlying psychiatric disorder in pediatric patients hospitalized for suicidal ideation or behavior.

There are no effective or concrete stratagies in preventing suicides. However, American society of Sucidology brought up certain recommendations in identification of risk factors and warning signs to get aware of an individual at risk. American Society of Sucidology also came up with a mnemonic for warning signs ‘IS PATH WARM”.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

According to the American Society of Suicidology, suicide can be classified based on method employed and psychiatric behavior of person committed into 10 and 8 types.

According to the American Society of Suicidolgy, based on method employed to commit suicide, suicide can be classified into 10 types

• Cult suicide
• Euthenasia
• Copycat suicide
• Femilicide
• Internet suicide
• Mass suicide
• Murder suicide
• Suicide pact
• Suicide by cope
• Teenage suicide

Sucide can also be classified based on the psychiatric behavior of the patient committed suicide into 8 types

• Egoistic suicide
• Altruistic suicide
• Anomic suicide
• Fatalistic suicide
• Egoistic suicide
• Altruistic suicide
• Anomic suicide
• Fatalistic suicide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Suicide is the third leading cause of death among all children and adolescents in the United States. In the United States, the incidence rate of suicide among children aged 5 to 11 years was 1 per 1 million, between 2008 and 2012. Among adolescents, the suicide rate is highest for white males.

Prevalence

• Suicide is the third leading cause of death among all children and adolescents in the United States.^{[1][2][3][4][5][6]}
• During the time period of 1960s and the 1990s, suicide rates doubled in the 15- to 19-year age group and tripled in the 10- to 14-year age group, in the United States.^[7][8]
• Survey data from the United States in 2001, 2003, 2005, and 2007 found that about 7 to 9% of all adolescents attempted suicide in the 12 months before the survey.^{[9][10][11][12][13][14]}

Age

• In the United States, the incidence rate of suicide among children aged 5 to 11 years was 1 per 1 million, between 2008 and 2012.^{[15][16][17][18][19]}

Sex

• The rate of suicidal ideation is greater in high school girls than boys (21 to 31% versus 13 to 20%)^[11]
• Suicide attempts are also more common in adolescent girls than boys^[12]
• Adolescent boys are more likely to complete suicide than girls^[20][21]

Race/ethnicity

• The suicide rates are variable among different ethnic groups^[22]
• Among adolescents, the suicide rate is highest for white males^[14]
• During 1980 and 1996, the suicide rate increased most rapidly among black males ages 15 to 19 years (from 3.6 to 8.1 per 100,000)

National suicide rates sometimes tend to remain stable. For example, the 1975 rates for Australia, Denmark, England, France, Norway, and Switzerland were within 3.0 per 100,000 of population from the 1875 rates.^[23] The rates in 1910–14 and in 1960 differed less than 2.5 per 100,000 of the population in Australia, Belgium, Denmark, England and Wales, Ireland, Japan, New Zealand, Norway, Scotland, South Africa, Spain, Sweden, and the Netherlands.^[24]

There are considerable differences in national suicide rates among various countries. Findings from two studies showed a range from 0 to more than 40 suicides per 100,000 of population.^[28]

National suicide rates, apparently universally, show a long-term upward trend. This trend has been well-documented in European countries.^[29] The trend for national suicide rates to rise slowly over time might be an indirect result of the gradual reduction in deaths from other causes, i.e. falling death rates from causes other than suicide uncover a previously hidden predisposition towards suicide.^[30][31] There may also be an explanation in the reduced stigma attached to survivors as suicide is no longer considered a crime or a sin. This may allow coroners to record more suicides as such and so increase stats.

Ethnic groups and suicide: In the USA, Asian-Americans are more likely to die by suicide than any other ethnic group. Caucasians die by suicide more often than African Americans do. This is true for both genders. Non-Hispanic Caucasians are nearly 2.5 times more likely to kill themselves than are African Americans or Hispanics.^[32]

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Season and suicide: People die by suicide more often during spring and summer. The idea that suicide is more common during the winter holidays (including Christmas in the northern hemisphere) is a common misconception.^[33] There is also potential risk of suicide in some people experiencing Seasonal affective disorder.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief:

Common risk factors include family history of suicidal behavior, mental disorders such as major depression, substance use disorders, hospitalization or psychotic disorders, history of physical or sexual abuse, previous suicide attempt or exposure to suicide, gay, lesbian, or bisexual orientation, or transgender or gender non-conforming identity, biologic factors, access to firearms, alcohol and drug abuse, social stress, social isolation, adoption, emotional and cognitive factors. Mnemonic for identification of risk factors “IS PATH WARM”.

• Risk factors for suicide may include:^[1][2][3][4]
  • Family history of suicidal behavior
  • Mental disorders such as major depression, substance use disorders, hospitalization or psychotic disorders
  • History of physical or sexual abuse
  • Previous suicide attempt or exposure to suicide
  • Gay, lesbian, or bisexual orientation, or transgender or gender non-conforming identity^[5]
  • Biologic factors
  • Access to means
    • Firearms
  • Alcohol and drug use
  • Social stress
    • Social isolation
  • Adoption
  • Emotional and cognitive factors

Less Common Risk Factors

• Poor self-esteem^[6]
• Impulsivity and risk-taking behavior^[7]
• Aggressiveness^[8]
• Delinquent behavior^[9]
• Family dysfunction^[10]
• Parenting style characterized by little warmth and little control (rejecting and neglectful)
• Nonintact family
• Having run away from home

Warning signs help to determine one at risk for suicide, especially if the behavior is new, has increased, or seems related to a painful event. Warning signs include:

• Talking about wanting to die or to kill themselves
• Looking for a way to kill themselves, like searching online or buying a gun
• Talking about feeling hopeless or having no reason to live
• Talking about feeling trapped or in unbearable pain
• Talking about being a burden to others
• Increasing the use of alcohol or drugs
• Acting anxious or agitated; behaving recklessly
• Sleeping too little or too much
• Withdrawing or isolating themselves
• Showing rage or talking about seeking revenge
• Extreme mood swings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

The United States Preventive Services Task Force (USPSTF) have declared that there is insufficient evidence to determine the benefits of screening for suicide risk in the general population of United States adolescents having no prioe history of mental disorders or previous suicide attempts.

The United States Preventive Services Task Force (USPSTF) have declared that there is insufficient evidence to determine the benefits of screening for suicide risk in the general population of United States adolescents having no prioe history of mental disorders or previous suicide attempts.^[1]

Primary care

• Direct questioning: Screening adolescents for suicidal ideation by directly asking about it in the context of screening for depression (Practice guidelines from the American Academy of Pediatrics)
• Patient Health Questionnaire (PHQ-9): A self-report screening tool, such as the nine-item Patient Health Questionnaire (PHQ-9) modified for teens, which screens for depression and as such, includes one item that asks about suicidal ideation^[2][3]
• Screening for depression

Emergency department

• The Ask Suicide-Screening Questions is a four-item instrument that clinicians can administer to screen for risk of suicide in patients who present to pediatric emergency departments with psychiatric or general medical complaints. ^[4]
• It includes following four items:

• • In the past few weeks, have you wished you were dead?
  • In the past few weeks, have you felt that you or your family would be better off if you were dead?
  • In the past week, have you been having thoughts about killing yourself?
  • Have you ever tried to kill yourself?

• A positive response to atleast one of the above mentioned 4 questions trigger a more extensive evaluation of the patient’s risk for suicide.

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