Evaluation and management of suicidal behavior

The danger of suicide is highest in depressed older people, especially men who have sustained a loss, who have an attitude of hopelessness, and who have not resolved feelings of grief. Factors associated with greater risk are chronic or serious illness, divorced, separated or widowed marital status, white race, drug abuse, excessive use of alcohol, unemployment, and poor living conditions. Commonly, those who commit suicide have made previous attempts and have directly or indirectly communicated their intention to others. The family physician is in the front line in the recognition and prevention of suicide. In the treatment of the suicidal, the physician should maintain a strong positive relationship to the patient and be consistently dedicated to his care including availability to see the patient frequently and to receive phone calls in the middle of the night. Those with the most serious risk should be referred to a psychiatrist and hospitalized to protect them from their suicidal impulses. Psychotherapy, antidepressant and tranquilizer drugs, and electric shcok treatment are the main therapeutic approaches. The physician's capacity for empathy and emotional commitment is of greater importance than his professional credentials.