Suicide crisis

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A suicide crisis, suicidal crisis or potential suicide is a situation in which a person is attempting to kill themselves or is seriously contemplating or planning to do so. It is considered by public safety authorities, medical practice, and emergency services to be a medical emergency, requiring immediate suicide intervention and emergency medical treatment. Suicidal presentations occur when an individual faces an emotional, physical, or social problem they feel they cannot overcome and considers suicide to be a solution. Clinicians usually attempt to re-frame suicidal crises, point out that suicide is not a solution and help the individual identify and solve or tolerate the problems. [1]

Contents

Nature

Most cases of potential suicide have warning signs. [2] [3] Attempting to kill oneself, talking about or planning suicide, writing a suicide note, talking or thinking frequently about death, exhibiting a death wish by expressing it verbally or by taking potentially deadly risks, or taking steps towards attempting suicide (e.g., obtaining rope and tying it to a ligature point to attempt a hanging or stockpiling pills for an attempted overdose) are all indicators of a suicide crisis. More subtle clues include preparing for death for no apparent reason (such as putting affairs in order, changing a will, etc.), writing goodbye letters, and visiting or calling family members or friends to say farewell. The person may also start giving away previously valued items (because they "no longer need them"). In other cases, the person who seemed depressed and suicidal may become normal or filled with energy or calmness again; these people particularly need to be watched because the return to normalcy could be because they have come to terms with whatever act is next (e.g., a plan to attempt suicide and "escape" from their problems).

Depression is a major causative factor of suicide, and individuals with depression are considered a high-risk group for suicidal behavior. However, suicidal behaviour is not just restricted to patients diagnosed with some form of depression. [4] More than 90% of all suicides are related to a mood disorder, such as bipolar disorder, depression, addiction, PTSD, or other psychiatric illnesses, such as schizophrenia. [5] The deeper the depression, the greater the risk, [6] often manifested in feelings or expressions of apathy, helplessness, hopelessness, or worthlessness. [7]

Suicide is often committed in response to a cause of depression, such as the cessation of a romantic relationship, serious illness or injury (like the loss of a limb or blindness), the death of a loved one, financial problems or poverty, guilt or fear of getting caught for something the person did, drug abuse, old age, concerns with gender identity, among others. [8]

In 2006, WHO conducted a study on suicide around the world. The results in Canada showed that 80-90% of suicide attempts (an estimation, due to the complications of predicting attempted suicide). 90% of attempted suicides investigated led to hospitalizations. 12% of attempts were in hospitals.[ citation needed ]

Treatments

Crisis hotlines, such as the 988 Suicide & Crisis Lifeline, enable people to get immediate emergency telephone counselling 988 Suicide & Crisis Lifeline logo - navy - square.svg
Crisis hotlines, such as the 988 Suicide & Crisis Lifeline, enable people to get immediate emergency telephone counselling

Ketamine has been tested for treatment-resistant bipolar depression, major depressive disorder, and people in a suicidal crisis in emergency rooms, and is being used this way off-label. [9] [10] The drug is given by a single intravenous infusion at doses less than those used in anesthesia, and preliminary data have indicated it produces a rapid (within 2 hours) and relatively sustained (about 1–2 weeks long) significant reduction in symptoms in some patients. [11] Initial studies with ketamine have sparked scientific and clinical interest due to its rapid onset, [12] and because it appears to work by blocking NMDA receptors for glutamate, a different mechanism from most modern antidepressants that operate on other targets. [9] [13] Some studies have shown that lithium medication can reduce suicidal ideation within 48 hours of administration.

Intervention

Intervention is important to stop someone in a suicidal crisis from harming or killing themselves. Every sign of suicide should be taken seriously. Steps to take in order to help defuse the situation or get the person in crisis to safety include: [14]

In many countries police negotiators will be called to respond to situations where a person is at high risk of an immediate suicide crisis. [15] However offers of help are frequently rejected in these situations, because they have not been directly sought by the person in crisis, who wants to maintain a level of independence. Supporting those in crisis to make independent decisions, [16] [17] and adapting terminology, for example using the phrase ‘sort (x) out’ [18] can aid in minimising resistance to the help being offered.

If a friend or loved one is talking about suicide but is not yet in crisis, the following steps should be taken to help them get professional help and feel supported: [14]

See also

Related Research Articles

<span class="mw-page-title-main">Bipolar disorder</span> Mental disorder that causes periods of depression and abnormally elevated mood

Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that each last from days to weeks. If the elevated mood is severe or associated with psychosis, it is called mania; if it is less severe and does not significantly affect functioning, it is called hypomania. During mania, an individual behaves or feels abnormally energetic, happy, or irritable, and they often make impulsive decisions with little regard for the consequences. There is usually a reduced need for sleep during manic phases. During periods of depression, the individual may experience crying, have a negative outlook on life, and demonstrate poor eye contact with others. The risk of suicide is high. Over a period of 20 years, 6% of those with bipolar disorder died by suicide. 30–40% engaged in self-harm. Other mental health issues, such as anxiety disorders and substance use disorders, are commonly associated with bipolar disorder. The global prevalence of bipolar disorder is estimated to be between 1-5% of the world's population.

A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context. Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting. There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders. A mental disorder is one aspect of mental health.

<span class="mw-page-title-main">Mood disorder</span> Mental disorder affecting the mood of an individual, over a long period of time

A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where the main underlying characteristic is a disturbance in the person's mood. The classification is in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD).

According to a 2023 Centers for Disease Control and Prevention study, suicide is the second leading cause of death for adolescents between the ages of 10 and 14, and the third leading cause of death for those between 15 and 25

<span class="mw-page-title-main">Depression (mood)</span> State of low mood and aversion to activity

Depression is a mental state of low mood and aversion to activity. It affects about 3.5% of the global population, or about 280 million people worldwide, as of 2020. Depression affects a person's thoughts, behavior, feelings, and sense of well-being. The pleasure or joy that a person gets from certain experiences is reduced, and the afflicted person often experiences a loss of motivation or interest in those activities. People with depression may experience sadness, feelings of dejection or hopelessness, difficulty in thinking and concentration, or a significant change in appetite or time spent sleeping; suicidal thoughts can also be experienced.

<span class="mw-page-title-main">Suicide prevention</span> Collective efforts to reduce the incidence of suicide

Suicide prevention is a collection of efforts to reduce the risk of suicide. Suicide is often preventable, and the efforts to prevent it may occur at the individual, relationship, community, and society level. Suicide is a serious public health problem that can have long-lasting effects on individuals, families, and communities. Preventing suicide requires strategies at all levels of society. This includes prevention and protective strategies for individuals, families, and communities. Suicide can be prevented by learning the warning signs, promoting prevention and resilience, and committing to social change.

<span class="mw-page-title-main">Emergency psychiatry</span> Clinical application of psychiatry in emergency settings

Emergency psychiatry is the clinical application of psychiatry in emergency settings. Conditions requiring psychiatric interventions may include attempted suicide, substance abuse, depression, psychosis, violence or other rapid changes in behavior.

Suicide intervention is a direct effort to prevent a person or persons from attempting to take their own life or lives intentionally.

<span class="mw-page-title-main">Suicidal ideation</span> Thoughts, ideas, or ruminations about the possibility of ending ones life

Suicidal ideation, or suicidal thoughts, is the thought process of having ideas, or ruminations about the possibility of completing suicide. It is not a diagnosis but is a symptom of some mental disorders, use of certain psychoactive drugs, and can also occur in response to adverse life circumstances without the presence of a mental disorder.

A major depressive episode (MDE) is a period characterized by symptoms of major depressive disorder. Those affected primarily exhibit a depressive mood for at least two weeks or more, and a loss of interest or pleasure in everyday activities. Other symptoms can include feelings of emptiness, hopelessness, anxiety, worthlessness, guilt, irritability, changes in appetite, difficulties in concentration, difficulties remembering details, making decisions, and thoughts of suicide. Insomnia or hypersomnia and aches, pains, or digestive problems that are resistant to treatment may also be present.

The emphasis of the treatment of bipolar disorder is on effective management of the long-term course of the illness, which can involve treatment of emergent symptoms. Treatment methods include pharmacological and psychological techniques.

Suicide risk assessment is a process of estimating the likelihood for a person to attempt or die by suicide. The goal of a thorough risk assessment is to learn about the circumstances of an individual person with regard to suicide, including warning signs, risk factors, and protective factors. Risk for suicide is re-evaluated throughout the course of care to assess the patient's response to personal situational changes and clinical interventions. Accurate and defensible risk assessment requires a clinician to integrate a clinical judgment with the latest evidence-based practice, although accurate prediction of low base rate events, such as suicide, is inherently difficult and prone to false positives.

<span class="mw-page-title-main">Mental distress</span> Symptoms and experiences that are troubling, confusing, or unusual

Mental distress or psychological distress encompasses the symptoms and experiences of a person's internal life that are commonly held to be troubling, confusing or out of the ordinary. Mental distress can potentially lead to a change of behavior, affect a person's emotions in a negative way, and affect their relationships with the people around them.

Crisis intervention is a time-limited intervention with a specific psychotherapeutic approach to immediately stabilize those in crisis.

Youth suicide is when a young person, generally categorized as someone below the legal age of majority, deliberately ends their own life. Rates of youth suicide and attempted youth suicide in Western societies and elsewhere are high. Female youth are more likely to attempt suicide than male youth but less likely to die from their attempt. For example, in Australia, suicide is second only to motor vehicle accidents as its leading cause of death for adolescents and young adults aged 15 to 25.

<span class="mw-page-title-main">Suicide</span> Intentional act of causing ones own death

Suicide is the act of intentionally causing one's own death. Mental disorders, physical disorders, and substance abuse are common risk factors.

<span class="mw-page-title-main">Dennis S. Charney</span> American medical researcher

Dennis S. Charney is an American biological psychiatrist and researcher, with expertise in the neurobiology and treatment of mood and anxiety disorders. He is the author of Neurobiology of Mental Illness, The Physician's Guide to Depression and Bipolar Disorders and Molecular Biology for the Clinician, as well as the author of over 600 original papers and chapters. In 2022, he was listed #49 on Research.com's "Top Medicine Scientists in the United States," with an h-index of 218 with 173,960 citations across 887 publications. Charney is known for demonstrating that ketamine is effective for treating depression. Ketamine's use as a rapidly-acting anti-depressant is recognized as a breakthrough treatment in mental illness.

<span class="mw-page-title-main">Depression in childhood and adolescence</span> Pediatric depressive disorders

Major depressive disorder, often simply referred to as depression, is a mental disorder characterized by prolonged unhappiness or irritability. It is accompanied by a constellation of somatic and cognitive signs and symptoms such as fatigue, apathy, sleep problems, loss of appetite, loss of engagement, low self-regard/worthlessness, difficulty concentrating or indecisiveness, or recurrent thoughts of death or suicide.

<span class="mw-page-title-main">Differential diagnoses of depression</span> Differential diagnoses

Depression, one of the most commonly diagnosed psychiatric disorders, is being diagnosed in increasing numbers in various segments of the population worldwide. Depression in the United States alone affects 17.6 million Americans each year or 1 in 6 people. Depressed patients are at increased risk of type 2 diabetes, cardiovascular disease and suicide. Within the next twenty years depression is expected to become the second leading cause of disability worldwide and the leading cause in high-income nations, including the United States. In approximately 75% of suicides, the individuals had seen a physician within the prior year before their death, 45–66% within the prior month. About a third of those who died by suicide had contact with mental health services in the prior year, a fifth within the preceding month.

<span class="mw-page-title-main">Igor Galynker</span> American psychiatrist

Igor Galynker is an American psychiatrist, clinician and researcher. His research interests include bipolar disorder, suicide prevention, and the role of family dynamics in psychiatric illness. He has published on these topics both in professional journals and in the lay press. His recent research has been devoted to describing Suicide Crisis Syndrome (SCS), an acute suicidal cognitive-affective state predictive of imminent suicidal behavior.

References

  1. ↑ Murray, Declan (2016-02-18). "Is it time to abandon suicide risk assessment?". BJPsych Open. 2 (1): e1 –e2. doi:10.1192/bjpo.bp.115.002071. ISSN   2056-4724. PMC   4998936 . PMID   27703761.
  2. ↑ Britton PC, Ilgen MA, Rudd MD, Conner KR (2012). "Warning signs for suicide within a week of healthcare contact in Veteran decedents". Psychiatry Res. 200 (2–3): 395–9. doi:10.1016/j.psychres.2012.06.036. PMC   5064427 . PMID   22796102.
  3. ↑ "Warning Signs of Suicide". University of Maryland. Archived from the original on 2017-10-23. Retrieved 2017-10-23.
  4. ↑ Barker, P. (2003). Psychiatric and Mental Health Nursing The craft of caring. pp 227. New York, NY: Oxford University Press Inc.
  5. ↑ "Suicide and suicidal behavior". MedlinePlus Medical Encyclopedia. 15 January 2009. Retrieved 22 August 2009.
  6. ↑ Stewart, George (2004). "Suicide & Mental Distress". Suicide Reference Library. Archived from the original on 30 September 2007. Retrieved 22 August 2009.
  7. ↑ "Understanding the Symptoms of Depression". WebMD. 12 November 2008. Retrieved 22 August 2009.
  8. ↑ "Suicide". 2 March 2004. Archived from the original on 25 May 2006. Retrieved 22 August 2009.
  9. 1 2 Caddy; et al. (Apr 2014). "pharmacodynamic actions, and a systematic review and meta-analysis of efficacy". Ther Adv Psychopharmacol. 4 (2): 75–99. doi:10.1177/2045125313507739. PMC   3952483 . PMID   24688759.
  10. ↑ Tondo L; et al. (Feb 2014). "Options for pharmacological treatment of refractory bipolar depression". Curr. Psychiatry Rep. 16 (2): 431. doi:10.1007/s11920-013-0431-y. PMID   24425269. S2CID   24308373.
  11. ↑ ECRI Institute, under contract to AHRQ. December 2013 AHRQ Healthcare Horizon Scanning System – Potential High-Impact Interventions Report. Priority Area 05: Depression and Other Mental Health Disorders Archived 2014-08-08 at the Wayback Machine
  12. ↑ National Institute of Mental Health (7 August 2006). "Experimental Medication Kicks Depression in Hours Instead of Weeks". NIH News (Press release). National Institutes of Health; Dept. of Health and Human Services; United States. National Institute of Mental Health director Thomas Insel said, "To my knowledge, this is the first report of any medication or other treatment that results in such a pronounced, rapid, prolonged response with a single dose. These were very treatment-resistant patients."
  13. ↑ Naughton, M; Clarke, G; O'Leary, OF; Cryan, JF; Dinan, TG (Mar 2014). "A review of ketamine in affective disorders: current evidence of clinical efficacy, limitations of use and pre-clinical evidence on proposed mechanisms of action". Journal of Affective Disorders. 156: 24–35. doi:10.1016/j.jad.2013.11.014. PMID   24388038.
  14. 1 2 Hall-Flavin, Daniel (2018). "Suicide: What to do when someone is suicidal". Mayo Clinic. Retrieved 23 March 2021.
  15. ↑ Clugston, Bobbie; Meurk, Carla; Harris, Meredith; Burgess, Philip; Heffernan, Ed (2024). "Persons with mental disorders and suicidality in crisis or high-risk situations involving police negotiation: a systematic review". Psychiatry, Psychology and Law. 31 (1): 57–75. doi:10.1080/13218719.2023.2175066. ISSN   1321-8719. PMC   10916924 . PMID   38455272.
  16. ↑ Sikveland, Rein Ove; Kevoe-Feldman, Heidi; Stokoe, Elizabeth (2019-02-01). "Overcoming suicidal persons' resistance using productive communicative challenges during police crisis negotiations". Applied Linguistics. 41 (4): 533–551. doi:10.1093/applin/amy065. ISSN   0142-6001.
  17. ↑ Sikveland, Rein; Kevoe-Feldman, Heidi; Stokoe, Elizabeth (2019-02-01). "Overcoming suicidal persons' resistance using productive communicative challenges during police crisis negotiations". Loughborough University Research Repository. doi:10.1093/applin/amy065'] (inactive 1 November 2024).{{cite journal}}: CS1 maint: DOI inactive as of November 2024 (link)
  18. ↑ Sikveland, Rein Ove; Stokoe, Elizabeth (2023-07-12). "A Cry for "Help"? How Crisis Negotiators Overcome Suicidal People's Resistance to Offers of Assistance". Journal of Language and Social Psychology. 42 (5–6): 565–588. doi:10.1177/0261927x231185734. hdl: 11250/3114867 . ISSN   0261-927X.
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