Suicide Screening and Prevention(Archived)

Suicide is a major public health problem not only in the United States but also in many Western nations. In the United States, it is the 10th leading cause of death, accounting for nearly 44,000 deaths each year. Suicide is also the seventh leading cause of lost years of potential life, surpassing liver disease, diabetes, and HIV. Each year, nearly half a million individuals present to the emergency departments in the United States following attempted suicide. Data indicate that nearly 1 out of every 7 young adults admits to having some suicidal ideation at some point in their lives, and at least 5% have made a suicide attempt. Suicide has repercussions way beyond the affected individual. The US healthcare system incurs over $70 billion in costs, and the affected families lose untold billions of dollars in terms of lost earnings. Suicides are at an all-time high and affect both genders. Men are nearly 3.5 times more likely than women to commit suicide, and on average, 123 people kill themselves every day. The World Health Organization (WHO) has predicted that in the next 2 years, depression will be the leading cause of disability globally. Depression is not only a North American phenomenon but is now being diagnosed in almost every nation. The annual prevalence of major depressive disorders in North America is 4.5%, but this is a gross underestimate because many individuals do not seek medical help. Depression is a serious medical disorder and is associated with a high risk of suicide. Data reveals that more than 90% of individuals with a major depressive disorder see a healthcare provider within the first 12 months of the episode, and at least 45% of suicide victims have had some contact with a primary health care provider within the 4 weeks of suicide. This indicates that if their healthcare providers are more alert, suicide is preventable in these individuals. These grim statistics have led to a National Strategy for Suicide Prevention in the United States. Considering that many individuals who commit suicide have a mental health disorder and have visited their primary caregiver, the focus now is on health care providers becoming aware of the factors that increase the risk of suicide and referring these individuals to mental health professionals for some intervention. The current United States Preventive Services Task Force (USPSTF) recommendations are that primary caregivers should screen adolescents and adults for depression only when there are appropriate systems in place to ensure adequate diagnosis, treatment, and follow-up. Many factors have been identified in individuals who commit suicide or have attempted suicide. These factors include the following: Advanced age. Availability of a firearm. Chronic illness. A family history of suicides. Financial difficulties. Negative life experiences. Loss of job. Marital status divorced. Medications. Mental illnesses such as depression, anxiety, and post-traumatic stress disorder (PTSD). Continuous pain. A physical illness that has led to disability. Race: white. Gender: Male. Social media. Stress. A sense of no purpose in life. Over the years, several other factors have been identified that increase the risk of suicide, and they include: Major childhood adverse events, for example, sexual abuse. Discriminated for being gay, lesbian, transgender, or bisexual. Having access to lethal means. A long history of being bullied. Chronic sleep problems. Loss of job or unemployment. Low income. Neurosis. Social isolation. Spousal loss, bereavement. Affective disease. Functional impairment. Physical illness. Traumatic brain injury. PTSD. Other mental health issues. The most important thing to understand is that having just 1 risk factor has very limited predictive value. Millions of Americans have 1 of these factors at any 1 point in time, but very few attempt suicide, and even fewer die as a result. One must consider the entire clinical picture to enhance the predictive value of these risk factors.