Suicide

MedAu Clinical

Suicide
Uta Dietrich

Aboriginal Health

Adolescent Medicine

Anaesthetics

Complementary Medicine

The Heart of Parenting (Book review)

Domestic Violence and the GP

Gambling Addiction

Children Disclosing Sexual Abuse

What Predicts Divorce?

Adult Sequelae of Child Sexual Abuse

Suicide

Rape Trauma Syndrome

It is estimated that a GP in the UK with a patient list of 6000 will encounter one patient each year who will commit suicide soon after consultation (1). Considering that the suicide rate in the UK is lower than in Australia and that there are about 20 attempts for every completed suicide2, suicide related problems are not that rare. Suicide is as common as multiple sclerosis, ulcerative colitis and Crohn's disease (1).

The goal for the GP should not just be to detect the one completed suicide a year but all those people at risk.

Watch for patients with:

previous attempts
depression
affective disorder
schizophrenia
organic brain syndromes
severe borderline personality
alcohol/drug dependence
being socially isolated
being terminally ill

and also who are:

young men, especially if they are unemployed
adolescents with a history of child abuse
living alone

Research has shown that up to two thirds of people committing suicide see a doctor during the last month of their lives (1). Many of them show their psychosocial and social distress as somatic complaints (3). In this high risk group, questions about suicidal symptoms should be part of routine history taking.

A common fear is that asking directly if someone has been thinking about suicide will put ideas into the person's head or will offend them. There is absolutely no evidence to support this. On the contrary, a question like "Have you every thought about hurting or killing yourself?" (3), will probably make your patient feel relieved to be able to talk about his/her thoughts. It shows that you are capable of dealing with the situation (4).

Many patients will readily admit self-harming ideas. Establishing rapport will show the person they are not alone and that their distress is acknowledged. However, consider your own attitude towards suicide. If the question is asked in an insensitive or demeaning way, it tells the patient that their GP does not really want to know (3).

Wollersheim suggests the following statement to make it easier for patients to admit to suicidal thoughts (5):

"Well, I ask this question since almost all people at one time or another during their lives have thought about suicide. There is nothing abnormal about the thought. In fact it is very normal when one feels so down in the dumps. The thought itself is not harmful. However, if we find ourselves thinking about suicide rather intently or frequently, it is a cue that all is not well, and we should start making some efforts to make life more satisfactory." (5, P.223)

If patients do not admit to suicidal ideation, you have to decide whether or not to continue to ask. If they do, more information such as frequency, duration and intensity should be gathered. Your effort in identifying those with suicidal thoughts might make the difference.

The most successful prevention of the actual suicide attempt is diagnosis and appropriate treatment of the underlying condition (see above). However, one must be aware that psychotropic medication is often used in an attempt. Therefore, only small amounts should be prescribed at any one time. Family members or close friends should also be involved since they can provide further information, give support to the patient and might be able to watch him/her closely.

The Suicide At Risk and Action/Intervention Strategy Guidelines developed by the North Coast Public Health Unit in conjunction with the Division of General Practice can help you with the further assessment and possible interventions. A revised copy has recently been sent out to all GPs in Richmond District. If you have not received a copy or wish to obtain another one, please contact the North Coast Public Health Unit on Phone 217231 or Fax 222151.

Uta Dietrich,
Suicide Prevention Officer
Public Health Unit
Richmond Health

1. Morgan HG. How feasible is suicide prevention? Current Opinion in Psychiatry 1194; 7:111-118.

2. Diekstra RF, Gulbinat W. The epidemiology of suicidal behavior: a review of three continents. World Health Statistics Quarterly - Rapport Trimestriel de Statistiques Sanitaires Mondiales 1993; 46:52-68.

3. Buzan RD, Weissberg M. Suicide: Risk factors and therapeutic considerations in the emergency department. The Journal of Emergency Medicine 1992; 10:335-343.

4. Sommers-Flanagan J, Sommers Flanagan R. Intake interviewing with suicidal patients: a systematic approach. Professional Psychology: Research & Practice 1995; 26:41-47.

5. Wollersheim JP. The assessment of suicide potential via interview methods. Psychotherapy 1974; 11:222-225.

Correspondence on this article

The author neglects to mention the high incidence in older males, rather than just the more topical adolescents.

Scott Harden

Return to top of page

This page was last built on 28/2/99; 1:38:39 PM.
It was originally posted on 12/4/98; 8:40:54 AM.
Webmaster:

lemlink@medicineau.net.au

Adult Sequelae of Child Sexual Abuse

Index

Rape Trauma Syndrome

MedicineAu