‫‪Suicide‬‬

‫‪Risk assessment‬‬

‫تقييم خطورة الميول االنتحارية‬

‫د‪.‬علي رياض شمخي‬

 Introduction &Epidemiology
❖suicide is the primary emergency In psychiatry
❖Suicide is to the psychiatrist as cancer is to the internist
❖Suicide is among the ten leading causes of death in most
countries for which information is available and the
second most common cause of death in young people.

❖ Patients who present with self-harm have a 100-fold

greater chance of completing suicide in the following
year in comparison to the general population,
emphasizing the need for comprehensive risk
assessment.
•Suicide -definitions
• Suicide has been defined as an act with a fatal outcome, deliberately initiated
and performed in the knowledge or expectation of its fatal outcome.
• Suicide attempt: self injurious behavior with a nonfatal outcome
accompanied by explicit or implicit evidence that the person intended to
die.
• Suicidal intent: subjective expectation and desire for a self-
destructive act to end in death.
• Suicidal ideation: thought of serving as the agent of ones' own
death seriousness may vary depending on the specificity of suicidal
plans and the degree of the Suicidal intent.
• Deliberate self harm: willful self inflicting of painful, destructive
,or injurious act.
• Aborted Suicide attempt: potentially self injurious behavior
with explicit or implicit evidence that the person intended to die but
stopped the attempt before physical damage occur.
•Risk factors
Category Factor Increased Risk Decreased Risk

Demographic factors Age Elderly (persons aged Children (up to age

65 years 15 y)
and older, especially Young adults (age
men) 25–40 y)
Middle aged (over
age 55 y in
women and age 45 y
in men)
Adolescents (suicide
is the second
leading cause of
death in
those 15–24 y of age.
Sex Male Female
Category Factor Increased Risk Decreased Risk

Occupation Professionals Nonprofessionals

Specific occupation Physicians (especially women
and psychiatrists)
Dentists and veterinarians
Police officers
Attorneys
Musicians
Unemployed

Employed
Race Caucasian Non-Caucasian

Religion Not religious Religious

Jewish Catholic
Protestant Muslim

Economic Economic recession or Strong economy

conditions depression
Category Factor Increased Risk Decreased
Risk
History Personal history Serious suicide attempt Suicidal gesture but not
(about a serious attempt
30% of people who
attempt
suicide try again and 10%
succeed)
<3 mo. since previous >3 mo. since previous
attempt attempt
Possibility of rescue was Rescue was very likely
remote

Family history Parent committed suicide No family history of

Early loss of a parent suicide
through Intact family
divorce or death throughout childhood
Current, social, Psychiatric Depression Dysthymia or no
psychological, Symptoms Psychotic symptoms depressive symptoms
and physical Hopelessness No psychotic
Factors Impulsiveness symptoms
Some hopefulness
Thinks things out

Depth of Initial stages of The depth of severe

depression recovery from depression;
deep depression; patients rarely have
recovering the clarity of
patients may have thought or energy
enough needed to plan
energy to commit and commit suicide
suicide
Substance use Alcohol and drug Little or no substance
dependence use
Current intoxication
Physical health Serious medical Good health
illness (e.g.,
cancer, AIDS)
Perception of serious
illness
(most patients have No recent visit to a
visited a physician
physician in the 6 mo
prior to
suicide)

Social relationships Divorced (particularly Married

men) Strong social support
Widowed Has children
Single, never married Lives with others
Lives alone
Lethality of attempt Plan and mean A plan for suicide No plan for suicide
(e.g., decision
to stockpile pills)
A means of No means of suicide
committing suicide
(e.g., access to a gun)
Sudden appearance
of
peacefulness in an
agitated,
depressed patient
(he has
reached an internal
decision
to kill himself and is
now
calm)
Method Shooting oneself Taking pills or poison
Crashing one’s Slashing one’s wrists
vehicle
Hanging oneself
Jumping from a high
place
Assessment and
management of
suicidal patient
Aim of Suicide Risk assessment
identifying subjects at risk.
estimating the chances of suicidal ideas
leading to acts or of repetition of self-harm
behavior.
Prevention of repeated self-harm and
completed suicide.
‫كيفية السؤال عن الميول االنتحارية‬
SAD PERSONS scale
 SAD PERSONS scale

• This score is then mapped onto a risk

assessment scale as follows:
• 0–4: Low
• 5–6: Medium
• 7–10: High
 Management of suicidal behavior
∞ Establishing therapeutic alliance.
∞Determining the appropriate treatment
setting.
∞ Interventions to reduce risk.
Psychotherapy
• Dialectical behavioral therapy
• Cognitive behavioral therapy
• Interpersonal therapy
• Psychodynamic therapy
Home work
1. prevention of suicide
2. MMSE