Suicide Facts and Myths

							Suicide: Facts and Myths

 JON EDWARD JURILLA., MD
 Makati Medical Center
 Asian Hospital and Medical Center
 Medical City
Suicide: Definition

   “The conscious act of self-induced
    annihilation, best understood as a
    multi-dimensional malaise in a needful
    individual who defines an issue for
    which the act is perceived as the best
    action.”
             Edwin



                      Edgardo Juan L. Tolentino, Jr,MD
     Why Talk of Suicide?

   The mortality from suicide is about 1 in 10,000
    of the adult population. Over 90% of suicide
    are associated with psychiatric illness and in
    70% of cases this is DEPRESSION
   Suicide risk is greatest among the untreated
    depressed patients
   Studies suggest that more than 50% of
    suicides saw a physician during the month
    before death
   Thus, death from suicide can be minimized, if
    not prevented.    Edgardo Juan L. Tolentino, Jr,MD
      Breaking Myths on Suicide

   When a person threatens suicide, he/she is merely
    attention-getting
   Once a person has tried suicide before, he/she
    won‟t do it again
   A deeply religious person will never commit
    suicide.
   Only crazy people commit suicide
   Asking a depressed person, if he/she is thinking of
    committing suicide only precipitates the act.
                       Edgardo Juan L. Tolentino, Jr,MD
    Calculating Suicidal Risk

   The risk is greater if:
       The person is depressed
       The person has attempted suicide before
       He/she has been recently bereaved or
        suffered some other stressful event
       The person talks about ending his/her own
        life
       He/she suddenly makes a will
       The person starts to write suicide notes.
                      Edgardo Juan L. Tolentino, Jr,MD
Epidemiology of Suicide
Incidence and Prevalence

   Completed suicides: 30,000 (U.S.)

   Attempted suicides: 240,000-300,000
    cases (U.S.)




                Edgardo Juan L. Tolentino, Jr,MD
Previous Suicidal Behavior

   A past suicide attempt is perhaps the
    best predictor that a patient is at
    increased risk to commit suicide
   40% of people who commit suicide
    have made a previous attempt



                 Edgardo Juan L. Tolentino, Jr,MD
Sex

   Men commit suicide 3x more often
    than women
   Women attempt suicide 4x more often
    than men




                Edgardo Juan L. Tolentino, Jr,MD
Methods

   Men use firearms, hanging or jumping
    from high places
   Women are more likely to take an
    overdose of drugs or poison




                Edgardo Juan L. Tolentino, Jr,MD
Age

   Suicide rates increase with age:
       Among men, suicide rates peak and
        continue to rise after age 45
       Among women, the greatest no. of
        completed suicides occurs after age 55
       The elderly account for 25% of suicides
       Among the 15-24 year old age group,
        suicide is the 2nd leading cause of death
                    Edgardo Juan L. Tolentino, Jr,MD
Race (U.S.)

   The rates of suicide among whites is
    nearly twice than among non-whites (2
    out of 3 suicides are white males).
   Suicide among immigrants is higher
    than in the native-born population



                Edgardo Juan L. Tolentino, Jr,MD
Religion

   Suicide rates among Catholic
    populations have been lower than
    rates among Protestants and Jews.




                Edgardo Juan L. Tolentino, Jr,MD
    Marital Status
   Marriage reinforced by children seems to
    lessen significantly the risk of suicide
   Suicide rates:
       11 per 100,000 among               married persons
       22 per 100,000 among               single, never-married
        persons
       24 per 100,000 among               the widowed
       40 per 100,000 among               the divorced:
           >69 per 100,000 among divorced men
           >18 per 100,000 among divorced women
                          Edgardo Juan L. Tolentino, Jr,MD
Occupation

   The higher a person‟s status is, the greater
    the suicide risk; but fall in social status also
    increases the risk.
   Professionals, particularly physicians, have
    traditionally been considered to be at higher
    risk for suicide.
   Among physicians, psychiatrists are
    considered to be at greatest risk, followed
    by ophthalmologists and anaesthsiologists.
                    Edgardo Juan L. Tolentino, Jr,MD
Physical Health

   Prior medical care appears to be
    positively correlated risk indicator of
    suicide:
       2% of suicides had medical attention
        within 6 mos. Of death
       25% - 75% of all suicide victims on
        postmortem studies showed physical
        illness.
                    Edgardo Juan L. Tolentino, Jr,MD
       Evaluation of Risk
Variable              High risk                     Low risk
Resources
- Personal            Prior achievements            Good achievement
                      Poor insight                  Insightful
                      Affect unavailable or         Affect available and
                      poorly controlled             appropriately controlled

- Social              Poor rapport                  Good rapport
                      Socially isolated             Socially integrated
                      Unresponsive family           Concerned family
   Source: K. Adam, Self-Destructive Behavior; Psychiatric Clinic of N. America 8;
                                  Edgardo Juan L. Tolentino, Jr,MD
   183;1995
     Dealing with Suicide

   Suspicion that someone may be about to
    harm him/herself must be taken very
    seriously.
   Every effort should be made to get
    him/her to see a doctor/psychiatrist.
   Seek help immediately from a member
    of the care team.
   Depression can be effectively treated
                  Edgardo Juan L. Tolentino, Jr,MD
     Program of Care for
     Depressed Patients
   Day Programs and Rehabilitation – where
    people can meet and learn social and
    vocational skills.
   Psychoeducation – to inc. understanding of the
    illness and its treatment, and to encourage the
    person to take more responsibility for his/her
    symptoms
   Social skills training – to improve the person‟s
    ability in terms of self-care, self-confidence,
    coping skills and relationships
                      Edgardo Juan L. Tolentino, Jr,MD
    Program of Care for
    Depressed Patients

   Cognitive behavioral therapy –
    education, advice and training on
    coping skills to help manage stress
    and overcome particular problems of
    living w/ depression
   Psychotherapy/Counseling
   Group therapy/Support groups –
    based on principle of identification
   Continuing medication
                  Edgardo Juan L. Tolentino, Jr,MD
     Communicating with the
     Depressed Patient
   Giving honest, positive feedback is very important.
   Try to include person who is ill in family matters;
    their views on and feelings about family matters
    relevant to them should be elicited.
   Work towards encouraging your loved one to
    regain independence
   However, when in the depressed state,
    discourage patient from making major decisions
    until fairly stable.
                       Edgardo Juan L. Tolentino, Jr,MD
      Communicating with the
      Depressed Patient

   Avoid making judgmental comments. If you need
    to express dissatisfaction or criticism, do it in a
    loving and constructive way- your tone of voice is
    important.
   Communicate clearly, concisely, and consistently
   Stay calm and relaxed. Working in a family
    environment that is safe, supportive, tolerant, and
    accepting will give the person who is ill their best
    chance of recovery. BUT, don‟t put too much
    pressure on yourself to achieve perfection
                       Edgardo Juan L. Tolentino, Jr,MD
        Reducing Stress at Home

   Look after your own personal needs:
       Have a good laugh, or a good cry w/ friends
       It may help to find someone outside the family you can talk to re
        your worries and concerns
       Networking w/ other families who are in the same position may be
        particularly useful
   Start keeping your own stress diary:
       Take note of your stressors, how you feel, and how you cope
       Look at your stress diary after a week and try to identify patterns
       Are there situations that make you particularly anxious? Is there
        anything you can do to reduce stress or change your behavior so
        that you are reacting more calmly?

                               Edgardo Juan L. Tolentino, Jr,MD
       Stress Diary
   TIME  Monday night
   STRESSOR Kris would not sleep and
    has been bugging me to listen to her
   MY FEELINGS      Why won’t she sleep?
    Doesn’t she understand I had too
    much to do at work today?
   MY RESPONSE      Lost my cool! Raised
    my voice. Really felt guilty after.
   MY PLAN/ MY GOAL      Will avoid
    making a critical comment. Will
    praise her for her next good deed.
                   Edgardo Juan L. Tolentino, Jr,MD
        Hospital Admissions and
        Difficult Situations
   Situations when the symptoms of depression are
    best treated in the hospital:
       Initial phase of illness. This is done so they can be
        given the tx needed in a place where progress can be
        monitored closely.
       When symptoms have come back again or if they are at
        risk of suicide.
       If the symptoms of depression have been complicated
        by psychosis and/or substance abuse and out patient
        management compromises safety of patient or others
       When patient has been deemed treatment resistant and
        other interventions or combinations are contemplated.
                          Edgardo Juan L. Tolentino, Jr,MD
    Hospital Admissions and
    Difficult Situations

   When is hospital admissions necessary?
       When a patient is considered a danger to
        himself or others the patient may be given
        treatment against his will
       When a patient may not believe he/she is ill
        and refuses treatment, supervised treatment
        may become necessary


                      Edgardo Juan L. Tolentino, Jr,MD
     Hospital Admissions and
     Difficult Situations
   How do we become prepared for hospital admission?
     Draw up an emergency plan, even if you never need it.
     Make a note of emergency nos., including police,
      psychiatrist, doctors, ambulance service, and an
      emergency center for psychiatric admission
     Find out from your psychiatrist which hospital you
      should take your relative to in an emergency
     Make arrangements for other family members to care
      for children or pets, ensure that the home is secure and
      deal w/ bills in case a relative needs to be hospitalized.
     Draw up a „contract‟/contingency plan with the patient
      for what to do if he/she becomes too ill to understand
      the need for help. Patient may wish to have a copy of
                                                       a
      the plan or to carry the name ofJr,MD friend or relative to be
                            Edgardo Juan L. Tolentino,
      contacted in an emergency.
      What To Ask the Care Team
   When a relative is admitted to hospital, you may feel
    anxious, upset and confused esp. it is the 1st time. When a
    person is admitted, they will be given a thorough psychiatric
    and physical exam to determine the appropriate tx and
    whether it should be given in hospital.
   Ask questions so you know what‟s happening but try to be
    cooperative. Develop good relationship w/ the hospital staff.
    It might help to write down everything you‟ve been told
    before you forget them.
   Make a note of all the questions you want to ask and any
    responses you are given
   Ask for info about the signs and symptoms of the illness
    and the proposed tx methods. Use the space on flip side to
    record the names and telephone nos. of the care team
    assigned to your relative.
                          Edgardo Juan L. Tolentino, Jr,MD
      Dealing with
      Difficult Behavior

   When a depressed relative or friend has
    gone into psychotic behavior (losing touch
    w/ reality), you can help this person by
    staying calm and maintaining his/her trust in
    you.
   The person may be frightened and feel as if
    he/she is losing control

                    Edgardo Juan L. Tolentino, Jr,MD
        Guidelines for Coping with
        Difficult Behavior
                                    DON’T’s:
DO’s:
   Remember the person may be  Try to reason with the person
    frightened                       Shout or get angry
   Try to stay as calm as possible  Patronize or criticize
   Dec. other distractions
                                     Argue with other people about
   Sit down w/ the person
                                      what to do
   Talk slowly
                                     Block a doorway or exit route
   Avoid touching the person
   Avoid direct eye contact
   Ask the person what‟s bothering
    him or her
   Allow the person personal
    space
                               Edgardo Juan L. Tolentino, Jr,MD
      Realizing You Have Done Your
      Best….
   Sometimes it is necessary to accept that you have
    done the best you can in a situation, even if things
    don‟t work out as planned.
   If this happens try not to blame yourself. Talk to
    others about how you feel.
   Try to learn from the experience.
   Sometimes it may be necessary to step back from
    a situation. It will not help to get overly involved in
    the needs of the person with the illness or let family
    life revolve around him/her.
                         Edgardo Juan L. Tolentino, Jr,MD
     Avoiding Future Difficulties
   Three key strategies:
      Be vigilant for sings of relapse
      Try to maintain a calm family environment
      Encourage you relative to take their medication and
       continue with other non-drug treatments, as well as follow
       up with their doctor
   There is always HOPE. Take comfort from the
    strength you and your family have shown in
    coping so far. Share experience with a support
    group. People who have been through similar
    things with their own relatives or friends may
    be able to give you practical tips on how to
    deal with difficult behavior.
                          Edgardo Juan L. Tolentino, Jr,MD
      Thank you!

“Knowing is not enough;
we must apply.
Willing is not enough,
we must do.
                                              -Goethe



           Edgardo Juan L. Tolentino, Jr,MD