Evaluating suicidal risk

Suicide is seldom, if ever, a comfortable subject to deal with. Medical school curricula, for various reasons, are too often unable to include the subject in a useful way, and consequently physicians feel unprepared when confronted with a severely depressed or desperate patient in practice. In addition, suicide is an unsettling reality because it relects and reminds us of our own frailty and humanity. Nearly everyone has had an experience of depression or some fleeting thought of suicide at some time in his life. Growing up can often be almost unbearably painful at certain times during adolescence. Middle age inevitably brings with it losses, possibly of loved ones, and with this uncertainties about whether it is really all worth the effort. And as age advances, health and vigor and aspirations slowly depart. Exactly when, at times of crisis such as these, suicidal thoughts take over and lead to action is difficult to define, but the physician must always be prepared for this possibility. Factors have been described which may be useful in alerting the physician to the possibility of suicide. Physical illness may give rise to feelings of hopelessness to which the physician must stay attuned; the patient may also use physical illness as a pretext for seeking help for deeper things that trouble him. As Havens points out, neither reassurance, nor criticism, nor abbreviating the interview will help the situation of a desperate patient. Clarification of the patient's feelings and thoughts are mandatory. Psychiatric consultation can be an important adjunct in achieving this goal and may at times be life saving.