Suicidal ideation is thoughts of causing one’s own death. Suicidal ideation can be associated with a desire or wish to die (intent) and a reason or rationale for wanting to die (motivation). Most people who die by suicide have communicated some intent. In most cases, suicidal ideation precedes the onset of suicidal planning and action.
The acute risk of suicide is often time-limited. If you can help the person survive the immediate crisis, you will go a long way toward a positive outcome. Most people who attempt suicide do not attempt again. 16% repeat within 1 year, and 21% repeat within 1-4 years. 2% of attempters die by suicide within 1 year of their attempt.
Every 16.6 minutes, one American dies by suicide, totaling over 30,000 suicides per year.
Risk Factors for Suicide
Risk factors include an episode of depression, recent interpersonal loss (i.e., divorce or financial loss), poor social support, unemployment, living alone, serious medical illness, and communication of suicidal ideation. The risk of suicide in persons with a diagnosis of depression is 20x higher than that of the general population.
The warning signs of suicide include (a) threatening to harm or kill self, (b) looking for ways to kill self, and (c) talking about death, dying or suicide. Additional risk factors for suicide include:
- Making financial arrangements to pay bills,
- Saying goodbye to loved ones,
- Making preparations to update wills,
- Onset of psychiatric symptoms (depression),
- Loss of housing,
- Gender (male)
Suicide Risk Assessment
Risk assessment of depressed individuals is crucial for the detection of suicidal ideation and the prevention of attempts or completion of suicide. Any reference to suicidal ideation mandates a suicide risk assessment.
If a person is having suicidal thoughts, the healthcare provider should ask specifically about frequency, duration, and intensity of those thoughts. A suicide risk assessment is a comprehensive psychiatric evaluation that should be performed by a psychiatrist regarding:
- Suicide inquiry (thoughts/plan/intent),
- Frequency, duration, and intensity of suicidal ideation,
- Assess risk factors for suicide (i.e., access to weapons, depression, male gender),
- Assess protective factors (i.e., supporting family members and a place to live),
- Collateral information from other clinicians, family members, friends and others,
- Mental health history (i.e., history of depression, prior suicide attempts),
- Substance abuse history
All of the information should be documented in the patient’s medical chart.
Treatment consists of involuntary admission to the hospital for observation, treatment, and medication. Individuals can be involuntarily admitted to hospitals for 72 hours for observation and treatment and the hospital admission can be extended to 15 days by Court Order. Medication, such as Selective Serotonin Reuptake Inhibitors (SSRI), are recommended for the treatment of depressive disorders when suicidal risk is present.
While under observation in a mental health unit, the patient’s family and friends should be contacted to obtain additional information about their suicidal ideation. Patients are more likely to tell a family member than a physician that they are suicidal and family members and friends will be able to provide additional information about the circumstances leading to the suicidal ideation.
Simply asking the patient to promise that he/she will not commit suicide has been shown to be essentially worthless from a clinical and management perspective.