Suicide: recognition and management

Patient suicide is a common clinical problem. In the United States, 28,000 people commit suicide annually, and most of these victims have had a consultation with a physician during the 6 months preceding death. Two conditions frequently associated with suicide are affective disorders and alcoholism, and recognition and management of these conditions will help to prevent many suicides. Hospitalized patients seem to be at high risk for suicide--particularly apparent victims of "accidents", which may be well-disguised suicide attempts. Physicians should be aware of verbal and behavioral warning signs of suicidal tendencies in patients, such as a morbid preoccupation with death, giving away possessions, and poor work or school attendance. Empathic listening and intervention by the physician should lead to suggestions for alternative resolutions to the problem that prompted the suicidal behavior and should decrease the level of perturbation. Hospitalization should be considered for the suicidal patient with impaired rational thinking or severe depression.