Suicide Risk: A Growing Concern

2018 has brought a heightened awareness of the severity of the suicide problem in the United States. Between the high-profile celebrity deaths, suicidal mass shooters, controversial television dramas and the nearly 45,000 deaths by suicide in 2016 alone, we are noticing the impacts of suicide risk and the need to care for those affected by suicide more than ever before.

Suicide is the tenth leading cause of death in the United States and the second leading cause of death among 15-34-year-olds. Per the CDC, the suicide rate increased 25 percent in less than two decades across the United States, and more than 1 million people have made a suicide attempt in the past year.

Many healthcare professionals often feel the pull to help address suicide risk with their patients but worry that they may be blamed if something happens to the patient or feel limited in how they can support them.

Common Myths About Suicide

Healthcare providers are also not immune to believing the myths about suicide. Some common myths include:

  • Asking patients about the presence of suicidal thoughts will cause suicidal ideation or prompt them to act on those thoughts.
  • If a patient is prevented from a suicide attempt using one method, they will just find another way to do it.
  • People who have attempted suicide multiple times are not seriously trying to kill themselves or they are just “seeking attention.”
  • Only people who suffer from depression or other mental illness diagnoses are at risk for suicide.
  • Patients with past suicide attempts don’t actively seek help.

If healthcare providers want to feel competent in assessing for and intervening where suicide risk has been identified, then being knowledgeable about suicide trends, risks and protective factors, as well as assessment tools will boost confidence about being effective. So, what should providers know about suicide?

For starters, men are more vulnerable to death by suicide and suicide attempts than women. While the presence of a known mental health diagnosis is a risk factor, more than half of people who die by suicide do not have a known mental health diagnosis. Also, firearms and suffocation are the two most common methods of suicide, so understanding means and intent are equally important.

Risk Factors Associated with Suicide Risk

Risk factors associated with suicide risk span all domains of health including the biological, psychological and social. Some important risk factors for suicide include:

  • Relational problems and dissatisfaction. This includes social isolation, loneliness and a history of abuse. Relational problems are the leading risk factors for suicide.
  • New or chronic financial or employment problems.
  • History of problematic alcohol or substance use disorders.
  • Acute or persistent physical health problems.
  • Feelings of hopelessness or extreme mood swings.

Protective Factors

On the other hand, there are many protective factors that act as a buffer between suicidal thoughts, actions and follow-through. As healthcare providers, it is imperative to help patients access the resources that serve as protective factors.

These resources often include:

  • Access to quality healthcare, particularly to mental health services.
  • Family and community support: someone who can check in and genuinely cares.
  • Religious or cultural beliefs that value life.
  • Coping skills for stressful life events.
  • High self-esteem.
  • Strong quality of life, including a purpose for living.

Finally, most people who attempt suicide had a visit with a healthcare provider within one month of their attempt (see below). This points to a critical need for all healthcare providers to be competent in assessing for suicide risk.

Assessment Tools

Two, validated, public access, easy-to-implement assessment tools are the PHQ-9 and the Columbia-Suicide Severity Rating Scale (C-SSRS). Healthcare providers of all levels can find these tools online and use them with minimal training. PHQ-9 is an assessment that asks nine questions about depressive symptoms experienced in the prior two weeks, with one question devoted to thoughts of dying or being better off dead. C-SSRS is a brief self-report questionnaire that delves into current and previous suicidal thoughts and attempts. Used in practice, these two tools help providers and their patients start conversations about risk factors, protective factors, and available options to help with coping and safety.

Providers should rest assured that asking the questions about suicide risk will not make an individual more likely to attempt suicide, but early assessment and intervention will help patients receive the care and support they need from their healthcare providers and social support systems and prevent suicide attempts.

Length of Time Appointment and Suicide Attempt Any Healthcare Visit Any Mental Health Visit
1 Week 38.3% 24.6%
1 Month 63.7% 43.9%
1 Year 94.6% 73.3%

**If you or someone you know needs support in the United States, please contact the National Suicide Prevention Lifeline for help at 1-800-273-TALK (8255). Another helpful resource is this international list of suicide prevention hotlines found on the website of the International Bipolar Foundation, to offer support to people around the world.

Rola Aamar

Partner, Behavioral Health Solutions, Relias

Rola Aamar, PhD, is currently the senior clinical effectiveness consultant at Relias for behavioral health, bringing her clinical and operational knowledge of integrated care, data analytics, and behavioral healthcare to support client use of analytics to improve clinical performance and patient health. In this role, she provides clinically-informed, data-driven consulting to clients to promote performance improvement. Rola began her career as a behavioral health clinician in integrated care working with multidisciplinary healthcare teams to develop comprehensive treatment programs for comorbid chronic health and mental health condition. Rola completed her PhD at Texas Tech University, where she focused her clinical research on the importance of treatment alliance between patients and healthcare providers to address treatment attrition and treatment adherence. Prior to Relias, she developed and managed integrated care programs in primary care clinics, specialty clinics, community health centers, schools, and hospitals.

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