Suicide is a major public health crisis and an elusive and complex challenge for primary care physicians. To date, screening and early identification efforts have not been effective in identifying risk or predicting or preventing suicidal behavior.
Moreover, little is known about the relationship between non-suicidal self-injury (cutting, self-stimulation), suicidal ideation or plan, and suicide attempts. The study enrolled 2,513 patients (aged 14-24 years) who completed a brief but thorough health questionnaire as part of a routine well visit to determine the behavioral risk factors most correlated and predictive of suicidal ideation and suicide attempts.
Analysis of these data identified a risk profile of the characteristics and behavior associated with suicidality. Substance abuse, sexual assault, same-sex attraction and behavior, and unsafe sexual practice were the factors most associated and predictive of suicidality. The number of endorsed risk factors plus the frequency of engaging in these behaviors constituted overall risk.
Stratifying the Risk
Individuals in the high-risk group were:
- 11 times more likely to have made a suicide attempt
- 5 times more likely to report a history of suicidal ideation and/ behavior
- 3 times more likely to report recent suicidal ideation and/or behavior
Why Does This Matter?
Screening of behavioral risks and social stressors that increased the risk for suicide in the absence of major depression are desperately needed. The U.S. Preventive Services Task Force recommends screening for suicidality in adults during primary care visits and providing professional care or timely referral to a mental health professional to assure accurate diagnosis, effective treatment and follow-up.
For clinicians, the skyrocketing suicide rate should be a clarion call to action. The following peer-reviewed recommendations provide a guideline for early identification, prevention and ongoing treatment.
- Suicide prevention efforts need to start BEFORE an index attempt, as nearly two-thirds do not survive this attempt.
- Self-inflicted injury from a firearm is the most lethal means associated with suicides, especially for males. Accordingly, a diagnosis of depression or identification of known risk factors, coupled with easy access to a firearm, is associated with increased lethality. Herculean efforts by mental health professionals may be necessary in these circumstances, particularly when familial support is weak or absent.
- Follow-up appointments with a psychiatrist or highly trained mental health professional after a failed suicide attempt should be locked in place prior to discharge from the healthcare facility that provided emergency care.
- Because the initial 12 months following a first suicide attempt are critical, aggressive psychiatric treatment and access to preventative resources are absolutely essential and must be put into motion ASAP.
- Utilizing sensitive Behavioral Screening Instruments may assist primary care clinicians in identifying those patients at the highest-level risk and assist primary care providers to identify potential or active psychiatric and social stressors associated with suicide.
Resources for Clinicians
- Institute for Clinical Systems Improvement (ICSI) Health Care Guideline: Adult Depression in Primary Care Guideline