Problems in family practice: the suicidal patient

Suicidal patients are common in family practice. Risk factors can alert the family physician to persons at unusual risk. Demographic factors, especially those revealing changing social status, recent loss, intentionality, lethality, past history, and high-risk groups, can be rapidly assessed. Viewing suicide as a final common pathway of system dysfunction at any or all major levels-biologic, psychologic, sociocultural-leads to an appreciation of the ubiquitous nature of passive or active "self murder" impulses. Persons depressed for any significant length of time for whatever reasons are potentially suicidal. Thus, the "typical" depression is suicidal but so are persons whose depression is related to drug side effects, primary illness effects, to living in a dysfunctional family system, or to normal grief. Diagnosis requires inquiry about the depth of the patient's depression pain. Treatment takes into account the aforementioned risk factors, plus interventions appropriate to the malfunctioning system.