This document discusses suicide and suicidal behaviors. It notes that over 90% of suicide victims have a diagnosable psychiatric disorder, with over half having a depressive disorder. While women are more likely to attempt suicide, men are more likely to complete suicide as they tend to use more lethal means. Risk factors for suicide include a history of previous attempts, depression, substance abuse, social isolation, unemployment, and certain medical conditions. Serotonin abnormalities and genetics may also play a role. Assessing suicide risk in patients is important, as is treatment and limiting access to lethal means. Depression is the most common diagnosis associated with suicide.

1. Mishra Rajat M.
IBS-Institute of Behavioural Science
Msc Forensic psychology semester-II(2016-2017)

2.  Suicide: intentional self-inflicted death
 Suicidal ideation: thoughts of killing
oneself (i.e., serving as the agent of
one’s death)
 Suicidal act: intentional self-injury (can
have varying degrees of lethal intent)

3.  Suicidal behaviors are the most common
psychiatric emergency
 The 11th leading cause of death in
(2001)
 About 30,000 suicides annually
 Over 90% of suicide victims have a
diagnosable psychiatric disorder—over
half have a depressive disorder

4.  Ratio of attempts to completions may be
as high as 25:7
 Women more likely to attempt suicide
 Men more likely to complete suicide
 They choose more aggressive and
dangerous ways
 Men use more lethal means

5.  Major depression
 Bipolar disorder
 Schizophrenia
 Substance use disorders
 Personality disorders: borderline,
antisocial
 Panic disorder

6.  History of previous attempts
 Depression
 Alcohol or drug abuse

7.  History of psychiatric hospitalization
 Chronic medical illness
 Family history of suicide
 History of childhood abuse (physical,
verbal, or sexual)
 Impulsiveness

8.  Social isolation:
-Living alone
-Not currently married (never married,
separated, divorced, or widowed)
 Unemployment
 Male gender
 Increased age (among white men)
 Certain occupations: police officers, physicians

9.  Serotonin abnormalities
 decreased CSF 5-HIAA
 increased 5-HT2A receptors
 linked with impulsivity and aggression
 PET: abnormal metabolism in prefrontal cortex
 Genetics
 familial association beyond risk for specific diagnoses

10.  Intoxication
 Stressful life events:
-loss of job
-death of a loved one
-divorce
-migration
-incarceration

11.  Hopelessness, despair, desperation
 aggression turned inward
 Escape from rage
 Guilt; self-punishment or atonement
 Rebirth or reunion fantasies
 Control over a relationship
 Revenge

12.  33-50% with schizophrenia will attempt suicide
 Approximately 10% with schizophrenia die by
suicide
 Gender: equal attempt ratio, more men die by
suicide
 Isolation (single, living alone, unemployed)
 Substance abuse

13.  Ask about suicidality in every initial psychiatric
assessment
 Asking about suicidality does not suggest it
 Do not dismiss someone’s suicidal comments
 Spectrum of suicidality: passive thoughts, plan, intent,
attempt
 Intent is not always communicated
 No absolute predictive test or criteria

14.  Pervasiveness of thoughts
 Plan
 Lethality of plan/attempt
 Availability of lethal means
 Likelihood of rescue

15.  Preparations for death: Settling affairs, giving
away personal items, writing a note,isolation
 Sudden change of mood
 Lack of future plans
 Recent loss
 Symptoms: Insomnia, hopelessness, severe anxiety,
extreme restlessness or agitation

16.  Determine treatment setting: Inpatient or
outpatient
 Caution regarding “contracts for safety”
 Medications
 Limit availability of firearms, lethal drugs, other
means
 Access to crisis services needed
 Therapy

17.  Risk factors alone or in combination do
not allow accurate prediction of a
specific individual’s suicide
 However, knowledgeable assessment of
risk and protective factors can allow
estimation of an individual’s risk and can
be used to formulate a plan to reduce the
risk of suicide

18.  Depression is the most common diagnosis
associated with suicide: recognize it, treat or refer
 Do not ignore suicidal comments, threats
 Asking about suicide does not suggest it
 The 3 most important risk factors: history of
suicide attempts, depression, substance abuse

19. Thank youThank you