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Summary psychiatric evaluation on suicide
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we dive into the psychiatric causes of suicide
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Chapter 18Suicide
122
, Chapter 18: Suicide
Risk factors
Variable – Page 1 of 2 Increased risk – Page 1 of 2
Demographics
Age. • Male: 25-35 year old (most recent data for Ireland).
• Female: 45-54 year old (most recent data for Ireland).
Gender. • Males > females.
Marital status. • Single, divorced or widowed (married have the lowest rate).
Socio-economic group. • Group I and V.
Employment. • Unemployment and retired (of those who are employed, increased risk is associated
with: doctors [anaesthetists, community health doctors, general practitioners and
psychiatrists have significantly increased rates of suicide compared with general
hospital doctors], dentists, vets, pharmacists, lawyers, law enforcement officers,
hotel and bar trade owners, farmers), school and work-related difficulties
(including bullying), financial difficulties and economic recession.
Living situation. • Living alone (socially isolated), urban living (overcrowded inner cities).
Race. • Caucasians and Native Americans > blacks and Hispanics.
Inter-country comparisons. • Industrialised countries > poorer, developing countries.
Culture and religion. • Cultural and religious disintegration.
Note: suicide is decreased
at times of war.
Psychiatric history
Presenting difficulties. • Suicide plan, significant mental health problem (see section below).
Past psychiatric history. • Previous episodes of self-harm or attempted suicide.
Family history. • Family history of suicide.
Alcohol and substance • Misuse and dependency of alcohol and illicit substances.
misuse history.
Forensic history. • Suicide rates 3-4 times higher in prisoners than in the general population.
• 90% of prisoner suicides occur by hanging.
• 50% of suicides occur in the first three months of imprisonment.
• Increased risk is associated with prisoners convicted of serious offences (e.g. murder,
violent or sexual offences) prisoners expected to serve a long sentence, remand
prisoners, young offenders.
Health
Physical health. • Chronic pain, severe and debilitating illnesses (e.g. cancer, AIDS).
Mental • Recurrent severe mental illness associated with inpatient psychiatric admissions.
health. • Poor treatment adherence.
Note: 90% of people • Mood disorders
who die by suicide had a o Depression is the commonest psychiatric diagnosis in people who die by suicide.
history of suffering from o 10-15% of depressed people end their lives by suicide.
a psychiatric illness o Highest risk is early rather than later in the illness.
(depression accounts for o Increased risk is associated with a feeling of hopelessness.
70-80% of this figure). o Risk in bipolar depression > unipolar depression.
Note: 70% of people see o Depression is more frequently associated with suicide in older people than in
their GP within four younger people.
weeks of suicide and 40% • Schizophrenia
see their GP the week o 2% end their lives by suicide.
prior to suicide. o Highest risk is early rather than later in the illness.
o Lower rates of schizophrenia in older people who end their lives by suicide
compared to younger people who die by suicide.
• Neuroses (e.g. panic disorder, post-traumatic stress disorder), personality disorder (e.g.
borderline personality disorder, dissocial personality disorder).
• Alcohol/substance misuse and dependence (highest risk is later rather than earlier in
the illness.
123
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