This document discusses suicide and its prevention. It provides information on risk factors for suicide like mental illness, past attempts, and life stressors. Common warning signs and methods are outlined. The assessment and management of suicidal patients is also described, including treatment, observation in hospitals, and ensuring community support after discharge. Suicide prevention strategies discussed include restricting access to lethal means, educating the public, and improving mental healthcare.

1. Dr Paing Soe
SAS
Mental Health
Monywa General Hospital

2. 1. Introduction
2. Suicide
3. The assessment of suicidal risk
4. The management of suicidal patients
5. Suicide prevention

4. Every Suicide is a tragedy that contains long-term results on
the people left behind and affects families, communities and
countries

5. • Every 40 seconds, someone dies by Suicide
• According to WHO, more than 800 000 people die by
Suicide a year
• With regard to age, Suicide rates are highest in persons
aged 70 years or above for both men and women
• In 2016, Suicide was the second leading cause of death
among 15-29 year-olds globally
• Tenth leading cause of death worldwide
• Over 79 % of Suicides occur in low and middle-
income countries

7. • The age-adjusted Death Rate in 2017 is 4.49 per 100,000 of
population
• # 153 rank in the world

8. o Para suicide : Episodes of intentional self-harm that did
not lead to death and may or may not have been motivated
by a desire to die
o Attempted Suicide : an acute non-fatal act of intentional
self-harm with or without motivation by a desire to end
life. Without the accidental discovery, the individual would
be dead
o Suicide gamble : one in which patients gamble their lives
that they will be found in time and that the discoverer will
save them
o Suicide equivalent : a situation in which the person does
not attempt suicide. Instead, he or she use behavior to get
some of the reactions that suicide would have caused

10.  Insecticide poisoning
 Hanging
 Drug overdose
 Firearms
 Fatal injuries
(jumping,stabbing,accid
ent ,burns ,etc.,)
 Hand cut
 Suffocation
 Drowning

12. • Genetic loading
• Personality
characteristics
(e.g. impulsivity,
aggression)
• Early traumatic life
events
Risk factors

13. Depressive disorders
Alcohol dependence or abuse
Drug dependence or abuse
Schizophrenic disorders
Organic mental disorders
Personality disorders
 36-90%
 43-54%
 4-45%
 3-10%
 2-7%
 5-44%

14. Depression
Schizophrenia
Addiction
Family or past history of suicide
Dysregulated serotonin system
Older age
Male sex
Vulnerable period
Early parental loss
Isolation
Unemployment
Adverse life events

15. • Skills in problem solving,
conflict resolution and
non-violent handling of
disputes
• Personal, social, cultural
and religious beliefs that
discourage suicide and
support self-preservation
• Restricted assess to means
of suicide
Protective factors

16.  Psychiatric patients
 Strong association between mental disorder and Suicide
 The rate of suicide is also raised in the period following
discharge from inpatient psychiatric care
 The first week after discharge is the period of highest
risk

17.  “Rational” suicide
 Suicide can be the rational act of a mentally healthy
person
 “Euthanasia”
 Several European countries (e.g. Switzerland, the
Netherlands, Belgium) have recognized this and made
changes in their law to allow those with a long-term
illness to take their own life with the help from friends,
family, or even medical practitioners

18. • Older people
• The highest rate of suicide is among people aged over 75
years
• The most frequent methods are hanging among men
and drug overdose among women
• In addition to active self-harm, some older adults die
from deliberate self-neglected (e.g. by refusing food or
necessary treatment)

19.  Children
 Suicide is rare in children
 Children who have died by suicide have usually shown
antisocial behavior
 Suicidal behavior and depressive disorders are common
among their parents and siblings
 Before death, the children had appeared depressed and
withdrawn, and some had stayed away from school

20.  Adolescents
 Suicide rates among adolescents have increased in resent
years
 About 70% of adolescents who killed themselves had had
psychiatric disorders mainly depressive and personality
disorders (sometimes comorbid)
 Many of them had misused alcohol or drugs
 Often due to mal-adaptive coping of long-term difficulties
with relationships and other psychosocial problems
 Approximately two-third of them have previous suicide
attempt

21.  Ethnic groups
 Rates among immigrants closely reflect those in their
countries of origin
 High-risk occupational groups
 Doctors;
 female doctors
 Rate is higher in anesthetists, community health doctors,
general practitioners, and psychiatrists
 Veterinary surgeons
 Farmers

22.  Suicide pacts
 Eastern countries – lovers aged under 30 yrs
 Western countries- interdependent couples aged over 50
yrs
 Those have particularly close relationship but socially
isolated from others

23.  Mass suicide
 913 followers of the People’s Temple cult died at
Jonestown, Guyana in 1978
 39 members of the Heaven’s Gate cult in California died
in 1997

24. 1. The common purpose of suicide is to seek a solution.
2. The common goal of suicide is cessation of consciousness.
3. The common stimulus (or information input) in suicide is
intolerable psychological pain
4. The common stressor in suicide is frustrated psychological
needs.
5. The common emotion in suicide is hopelessness-helplessness
6. The common internal attitude in suicide is ambivalence
7. The common cognitive state in suicide is constriction
8. The common action in suicide is escape
9. The common interpersonal act in suicide is communication of
intention
10. The common consistency in suicide is with life-long coping
patterns.

26.  General issues
 Every doctor should be able to assess the risk of Suicide
 Two requirements;
a. A willingness to make direct but tactful enquiries about the
patient’s intentions
b. To be alert to factors that predict suicide
 The most obvious warning sign is a direct statement of
intent
 Just before the act, there may be a subtle change in their
way of talking about dying, sometimes in the form of
oblique hints instead of former more open statements

27. • Unhurried and sympathetic manner
• Starting about current problems and patient’s reaction
to them
• Enquires about their losses; both personal
(bereavement, divorce) and financial ,even loss of
status
• Conflict with others, social isolation
• Physical illness ( painful condition in the elderly)
• Mood swing, impulsive or aggressive tendencies
• Altitudes towards religion and death

28. Warning signs

29.  “I can’t go on living anymore”
 “I wish I was never born”
 “I wish I were dead”
 “I won’t need this anymore”
 “I am so tired of living”

30.  “My parents won’t have to worry about me
anymore”
 “Everyone w0uld be better off if I was dead”
 “Nobody cares if I live or die”
 “I wish I were disappeared suddenly”

31. 1. Act carried out in isolation
2. Act timed so that intervention is unlikely
3. Precautions taken to avoid discovery
4. Preparations made in anticipation of death
5. Preparations made for the act ( e.g. purchasing the means
of suicide, saving up tablets)
6. Communicating intent to others beforehand
7. Extensive premedication
8. Leaving a note
9. Not alerting potential helps after the act
10. Admission of suicidal intent

32. Management
of
Suicidal patients

33. A. Assessment of suicide risk
B. Treatment
 Psychiatric disorders to be treated
 Community therapy- problems solving and outreach
 Adolescents- family therapy and group therapy

34.  Pharmacological treatment
 Antidepressants
 Antipsychotics
 Lithium or mood stabilizers
 Psychosocial treatment
 Problems solving skill
 Psychotherapy
 Cognitive behavioral therapy
 Outreach
 Family therapy
 Group therapy

35. General requirements
 Safe ward environment
 An adequate number of well-trained staff
 Good working relationships among staff, and between
staff and patients
 Agreed policies for the observation, assessment and
review of patients

36. On admission
 assess risk
 Agree the level of observation
 Remove any objects that might be used for suicide
 Discuss and agree plans with the patient
 Agree a policy for visitors ( number, duration of visit,
and what they need to know)

37. During admission
 Regular review of risk and plans
 Agreed plans for the level of supervision
 Clear communication of assessments and plans between
staff, especially when shifts change
 Agree action to be taken if the patient leaves the ward
without notice or permission

38. At discharge
 Agree date and plan for aftercare in advance of discharge
 Discuss and agree the plan with the patient and those
involved in their care
 Prescribe in adequate but non-dangerous amounts
 Arrange follow-up and agree action to be taken if the
patient dose not attend

39.  Full assessment of patient and proposed cares
 Organization of adequate social support
 Regular review of the suicide risk and the
arrangements
 Safe psychiatric medications given in adequate dosage
using less toxic drugs
 Small prescriptions
 Involvement of relatives in the safe storage of tablets

40.  Better and more accessible psychiatric services
 Restriction of the means of suicide
 Encouragement of responsible media reporting
 Educational programs
 Improved care for high-risk groups
 Crisis centers and telephone ‘hotlines’

44.  Although suicidal thoughts may return, they are not
permanent
 Heightened suicide risk is often short-term and
situation-specific.
 An individual with previously suicidal thoughts and
attempts can go on to live a long life

45. • Given the widespread stigma around suicide, most people
who are contemplating suicide do not know who to speak
to.
• Rather than encouraging suicidal behavior, talking openly
can give an individual other options or the time to rethink
his/her decision, thereby preventing suicide.

46.  Suicidal behavior indicates deep unhappiness but not
necessarily mental disorder.
 Many people living with mental disorders are not
affected by suicidal behavior, and not all people who
take their own lives have a mental disorder.

47.  The majority of suicides have been preceded by
warning signs, whether verbal or behavioral.
 Of course there are some suicides that occur without
warning.
 But it is important to understand what the warning
signs are and look out for them.

48.  On the contrary, suicidal people are often ambivalent
about living or dying.
 Someone may act impulsively by drinking pesticides,
for instance, and die a few days later, even though they
would have liked to live on.
 Access to emotional support at the right time can
prevent suicide.

49.  A significant number of people contemplating suicide
are experiencing anxiety, depression and hopelessness
and may feel that there is no other option.
 People who talk about suicide may be reaching out for
help or support.