The management of suicidality: assessment and intervention

A potentially suicidal patient is among the most difficult challenges faced by healthcare providers. This article reviews rates of suicide in America among the population as a whole and subpopulations based on age and race. In 2003, nearly 11 Americans out of every 100,000 killed themselves. The rates of suicide were highest among whites, Native Americans, and elderly males. Suicide rates are elevated among many common mental illnesses, including major depression, bipolar disorder, schizophrenia, and alcoholism. Although statistical risk factors are significant, they are of limited help in determining what should be done with specific patients. Documenting demographic information, checking off diagnostic criteria, and asking patients if they have thoughts of killing themselves are only the start of the evaluation of suicidality. The complete assessment of suicidality requires inquiring into static and dynamic risks factors, warning signs and psychosocial stresses. Patients who report suicide plans should be asked about the plan in detail, including the chance of rescue, preparations for, and rehearsal of the suicide attempt. Interventions to reduce the risk of suicide should then be targeted towards eliminating or minimizing these various factors. Despite our best efforts patients will occasionally kill themselves. Studies have found that a majority of experienced psychiatrists have had a patient commit suicide. Following the suicide of a patient, clinicians will often experience a professional as well as personal response. Most providers who have experienced a patient suicide find talking to co-workers, peers, and friends to be useful.