The act constitutes a person willingly, perhaps ambivalently, taking his or her own life.

S: SEX Men are more likely to commit suicide than women. A: AGE The ages which are most dangerous for suicide vary over time. You should consult current statistics. As this is being written in 2006 individuals 15-24 have an elevated risk. Suicide is the third leading cause of death in this age group. Males over age 75 are also known to be at high risk. Current demographics suggest that women in the 45 to 54 age group are highest, but females in older or younger age ranges are not that different. After age 65 individuals as a whole have an attempt tovcompleted suicide rate of about 2:1. Up to age 65, it is about a 7:1 ratio.

D: Depression. The suicide rate for those who are clinically depressed is about 20 times greater than for the general population. Hopelessness is one aspect of depression that has a close tie to suicide. These two issues, depression and hopelessness, are the strongest predictors of wishes for a hastened death. Roughly 80% of completed suicides were preceded by a prior attempt.

P: Prior History.

E: Ethanol abuse. R: Rational thinking loss.

Alcohol and/or drug abuse increase risk. Psychosis ( I heard a voice saying I should kill myself ) increases risk. Some estimates suggest that 20-40% of schizophrenics make an attempt at some point, and the risk is highest early on in the illness.

S: Support System Loss of support can vary tremendously. With kids and Loss. adolescents it can be the break up of their first puppy love which they can take very seriously even though others like parents may view it as a trivial event. Other lost relationships for adolescents can include parents divorcing and remarrying someone else. Even a parent who is divorced or separated and living with a new person can be a trigger for adolescent suicide. The death of a relative, such as grandparents, can be another trigger for kids. Loss of a spouse can be devastating to some. Loss of a parent within the past 35 years increases risk of suicide. Among older individuals, men who are widowed, and women who are divorced or separated are at increased risk

O: Organized Plan. This speaks for itself. Having a method in mind creates more risk.

N: No Significant Other. See S above.

S: Sickness.

Terminal illness, such as cancer and AIDS, also carries with it a 20 fold increase in risk of suicide compared to the general population.

SCORING SYSTEM 1 point for each positive answer on the table. SCORE RISK


No real problems, keep watch


Send home, but check frequently Consider hospitalization involuntary or voluntary, depending on your level of assurance patient with return for another session


7 ± 10

definitely hospitalize involuntarily or voluntarily

SAD PERSONS: a mnemonic for assessing suicide risk S ex (male) A ge (elderly or adolescent) D epression P revious suicide attempts E thanol abuse R ational thinking loss (psychosis) S ocial supports lacking O rganized plan to commit suicide N o spouse (divorced > widowed > single) S ickness (physical illness)

SIGNS OF DEPRESSION Sleep, energy, weight, or appetite changes Decreased interest in sex and other pleasurable activities Feelings of helplessness and hopelessness Social isolation and withdrawal from others

SUICIDE RISK FACTORS In addition to untreated depression, other suicide risk factors include: mood disorder chronic anxiety previous suicide attempts genetics family history of suicide or psychiatric conditions conduct disorder child abuse sexual assault

stressful events, including relationship breakups, family problems, etc. drug and alcohol abuse eating disorders being bullied dropping out of school taking certain medications, including ANTIDEPRESSANTS, STRATTERA (atomoxetine), a medication for ADHD, and ACCUTANE (isotretinoin), which is used to treat teens with severe nodulocystic acne, and ANTISEIZURE DRUGS, such as Tegretol (carbamazepine), Depakoke (valproate), and Lamictal (lamotrigine) Suicide is also more common in bisexual and homosexual teens.

Suicide Warning Signs According to the American Association of Suicidology, the warning signs of suicide can include: Having thoughts of committing suicide, threatening to hurt himself, looking for a way to hurt himself, writing about dying, and other types of suicidal ideation Increased substance abuse, including abuse of alcohol and drugs Feelings of purposelessness or that they have no reason to live Anxiety symptoms Feeling trapped, like there is no way out of current situations or problems Feelings of hopelessness

A withdrawal from friends and family and usual activities Feeling uncontrolled anger and rage or wanting revenge against someone Acting reckless and impulsive Having dramatic mood changes If you think that your teen has any of the warning signs for suicide, don't ignore them. Trust your instincts and either try to get more information or seek additional help.

SUICIDE PREVENTION Recognizing the risk factors and warning signs for suicide

Seeking professional help

Making sure that GUNS and medications aren't easily available in your home if your teen might be suicidal

Getting teens professional help if they have depression and/or anxiety, which are often thought to be the biggest risk factors for suicide

Questions to Ask Do you have thoughts of suicide? Are they related to current stressors going on in your life, or have you had such thoughts before? Do you have a plan? Tell me. If you died in your sleep, would that be all right with you? Ask if they have access to the components of their plan, like a gun, pills, etc

None Mild Mod Severe Extreme - no suicidal ideation - some ideation, no plan - ideation, vague plan, low on lethality, wouldn't do it - ideation, plan specific and lethal, wouldn't do it - ideation, plan specific and lethal, will do it

Highest risk group has suicidal ideation (thoughts of killing self), a plan (any plan so long as it is definite and detailed is high risk), high lethality (guns and walking in front of busses are more serious than overdosing on Tylenol and slashing wrists), few inhibitors (few reasons not to kill self), low self-control (especially drinking or using drugs - can decide not to kill self but fail to act to reverse events and accidentally kill themselves)

SUICIDAL ASSESSMENT FIRST, remember to do three things: 1. CONSULT 2. DOCUMENT 3. EVALUATE THE CLIENT S RISK     Empathize with the client Make a No-Suicide Contract Family Intervention Hospitalization

SUICIDE is never the solution. Eternal life comes after physical death. where would u go?

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