Chronic risks

The most consistent demographic risks include being male, over 45 years old, white, living alone, and having a chronic medical illness where the patient perceives poor health

Completed suicides are most likely in older men who use more lethal means

• – These patients often have an associated mood disorder and substance abuse

Suicidal ideation is common and has been reported to occur in up to a third of the population in general

It is estimated that there are 18 suicide attempts for every completed suicide

Women have a higher rate of attempted suicide but much lower rates of completion

Men are four times more likely to complete suicide

Suicide is higher among whites and Native Americans than among African Americans, Hispanics, or Asians

• – 73% of all suicides in the United States are committed by white men

The strongest overall predictor for suicide is the presence of psychiatric illness

• – MDD and AUD are the most frequently made diagnoses in persons who commit suicide

• – More than 90% of all persons who commit suicide have a diagnosable psychiatric illness

5% of suicides occur in patients with chronic medical illnesses

Other patients at risk for suicide include those diagnosed with schizophrenia, borderline personality, antisocial personality, bipolar disorder, persistent depressive disorder, SUD, narcissistic personality disorder, and anxiety disorder

Acute risks predictive of future suicide attempt include*

Severe anxiety (92%) or panic attacks (80%)

Depressed mood (80%)

Recent loss of close relationship (78%)

Alcohol or substance abuse (68%)

Hopelessness (64%)

Helplessness (62%)

Worthlessness (29%)

Global insomnia (46%)

Partial insomnia (92%)

Anhedonia (43%)

Chronic deteriorating medical illness (41%)

Inability to maintain job or student status (36%)

Recent onset of impulsive behavior (29%)

Recent diagnosis of a life-threatening illness (e.g., cancer, AIDS) (9%)

• – Interestingly, 69% of patients do not admit suicidal thoughts prior to attempt

• – 67% of patients have no previous suicidal behaviors

*Percentage of patients exhibiting acute symptoms prior to suicide attempt

Summary

Both chronic demographics and acute suicide risks should be assessed in treatment planning

Any prescribed medication in these cases should be chosen based upon tolerability and safety in overdose for these at-risk patients

Psychotropics may actually lower some of these acute risk variables and save lives

• – Lithium has regulatory data and indication for lowering suicidal thinking in bipolar disorder

• – Clozapine has similar findings in schizophrenia

• – BZ sedatives may actively lower insomnia or anxiety (acute predictive risk factors) within single doses or within a few days of dose escalation

  • Limited quantities should be issued in case of overdose

  • Likely should not be used in alcohol-or opiate-misusing patients

• – Atypical antipsychotics may act similarly

  • Limited quantities should be issued due to potential QTc prolongation in case of marked overdose

  • Some atypical antipsychotics cause akathisia more than others

    • Adding this side effect to insomnia and agitation might provoke more suicide risk

    • Proper warning, informed consent, and provider access likely would mitigate this