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Detecting those at risk of suicide |
It is estimated that a GP in the UK with a patient list of 6000 will
encounter one patient each year who will commit suicide soon after
consultation (1). Considering that the suicide rate in the UK is
lower than in Australia and that there are about 20 attempts for
every completed suicide2, suicide related problems are not that rare.
Suicide is as common as multiple sclerosis, ulcerative colitis and
Crohn's disease (1).
The goal for the GP should not just be to detect the one completed
suicide a year but all those people at risk.
Watch for patients with:
- previous attempts
- depression
- affective disorder
- schizophrenia
- organic brain syndromes
- severe borderline personality
- alcohol/drug dependence
- being socially isolated
- being terminally ill
and also who are:
- young men, especially if they are unemployed
- adolescents with a history of child abuse
- living alone
Research has shown that up to two thirds of people committing
suicide see a doctor during the last month of their lives (1). Many
of them show their psychosocial and social distress as somatic
complaints (3). In this high risk group, questions about suicidal
symptoms should be part of routine history taking.
A common fear is that asking directly if someone has been thinking
about suicide will put ideas into the person's head or will offend
them. There is absolutely no evidence to support this. On the
contrary, a question like "Have you every thought about hurting or
killing yourself?" (3), will probably make your patient feel
relieved to be able to talk about his/her thoughts. It shows that you
are capable of dealing with the situation (4).
Many patients will readily admit self-harming ideas. Establishing
rapport will show the person they are not alone and that their
distress is acknowledged. However, consider your own attitude towards
suicide. If the question is asked in an insensitive or demeaning way,
it tells the patient that their GP does not really want to know
(3).
Wollersheim suggests the following statement to make it easier for
patients to admit to suicidal thoughts (5):
"Well, I ask this question since almost all people at one time or
another during their lives have thought about suicide. There is
nothing abnormal about the thought. In fact it is very normal when
one feels so down in the dumps. The thought itself is not harmful.
However, if we find ourselves thinking about suicide rather intently
or frequently, it is a cue that all is not well, and we should start
making some efforts to make life more satisfactory." (5,
P.223)
If patients do not admit to suicidal ideation, you have to decide
whether or not to continue to ask. If they do, more information such
as frequency, duration and intensity should be gathered. Your effort
in identifying those with suicidal thoughts might make the
difference.
The most successful prevention of the actual suicide attempt is
diagnosis and appropriate treatment of the underlying condition (see
above). However, one must be aware that psychotropic medication is
often used in an attempt. Therefore, only small amounts should be
prescribed at any one time. Family members or close friends should
also be involved since they can provide further information, give
support to the patient and might be able to watch him/her
closely.
The Suicide At Risk and Action/Intervention Strategy
Guidelines developed by the North Coast Public Health Unit in
conjunction with the Northern Rivers Division of General Practice can help you with the further assessment and possible interventions. A revised copy has
recently been sent out to all GPs in Richmond district. If you have
not received a copy or wish to obtain another one, please contact the
North Coast Public Health Unit on phone (02) 6621 7231.
Uta Dietrich is the suicide prevention officer at the Public Health Unit in
Richmond Health
1. Morgan HG. How feasible is suicide
prevention? Current Opinion in Psychiatry 1194; 7:111-118.
2. Diekstra RF, Gulbinat W. The epidemiology
of suicidal behavior: a review of three continents. World Health
Statistics Quarterly - Rapport Trimestriel de Statistiques Sanitaires
Mondiales 1993; 46:52-68.
3. Buzan RD, Weissberg M. Suicide: Risk factors
and therapeutic considerations in the emergency department. The
Journal of Emergency Medicine 1992; 10:335-343.
4. Sommers-Flanagan J, Sommers Flanagan R.
Intake interviewing with suicidal patients: a systematic approach.
Professional Psychology: Research & Practice 1995; 26:41-47.
5. Wollersheim JP. The assessment of
suicide potential via interview methods. Psychotherapy 1974;
11:222-225.
This page was last built on 21/01/03. It was originally posted on 12/4/98; 8:40:54 AM.
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