The document discusses suicide, including definitions, risk factors, methods, rates, signs, theories, and treatments. It defines suicide and related terms and identifies depression, mental illness, substance abuse, stressful life events, and prior attempts as major risk factors. Males are more likely to use violent methods like firearms. Treatments discussed include hospitalization, medications, and psychotherapy. Emergency response may include first aid, CPR or hospitalization to prevent future attempts through psychiatric intervention.

2.  Suicide is the act of deliberately taking one’s
own life.
 Suicidal behavior is any deliberate action with
potentially life-threatening consequences,
such as taking a drug over-dose.

3.  Suicidal attempt: it involves a serious act, such as
taking a fatal amount of medication, and
someone intervening accidentally. Without the
accidental discovery, the individual would be
dead.
 Suicidal gesture: denotes a person undertaking
an unusual, but not fatal behavior as a cry for
help or to get attention.
 Suicide gamble: is for example, to ingest a fatal
amount of drugs with the belief that family
members will be home before death occurs.
Patients gamble their lives that they will be found
in time and that the discoverer will save them.

4.  Intent:
Subjective expectation and desire for a self
destructive act to end in death.
 Degree of ambivalence: wish to live, wish to
die.
 Deterrents: ( e.g family, religion, positive
therapeutic relationships, positive support
system- including work)

5.  The method of suicide can be relatively
nonviolent ( such as poisoning or overdose)
or violent ( such as shooting oneself.
 Males are more likely to choose violent
methods, which probably accounts for the
fact that suicide attempts by males are more
likely to be completed
 Many suicides involves a firearm. This is
especially true in elderly men, in which 80% of
suicides are performed with a gun.

6.  The principal mode of choice among those
who attempted suicide was household
poison(40%), pesticides (27%), followed by
hanging (12%), shooting (11%), cutting,
burning and drowning oneself (2%). The
remaining modes used were electrocution, hit
by train, car etc which accounted for 14
percent of attempted suicides.

7.  According to national institute of mental
health suicide is a major, preventable public
health problem. In 2021, it was the eleventh
leading cause of death in U.S, accounting for
32,439 deaths. The overall rate was 10.9
deaths per 100,000 people. An estimated 8-
25 attempted suicides occur per every suicide
death.

8.  In Pakistan, suicide rates have alarmingly increased
over the past few years, and a great majority of them
are among the youth of this nation.
 In 1999, more than 332 death suicide cases were
reported; rising to 550 in the year 2000.
 this figure jumped four fold in 2001 when 2386
suicidal cases were reported, suggesting that
approximately 6-7 suicides occur everyday in
Pakistan. These figures are the recognized reports
from different sources, yet the number of unreported
suicides is an unknown factor.
 Hence the actual figures may be as high as 10
suicides per day, which would translate to over 3,500
suicides in forthcoming year.

9.  Depression an other mental disorders, or a
substance-abuse disorder ( often in
combination with other mental disorders).
More than 90 percent of people who die by
suicide have these risk factors.
 Stressful life events, in combination with
other risk factors, such as depression.
However, suicide and suicidal behavior are
not normal responses to stress, many people
have these risk factors, but are not suicidal.
 Prior suicide attempts.

10.  Family history of mental disorder or
substance abuse
 Family history of suicide
 Family violence, including physical or sexual
abuse
 Firearms in the home, the method used in
more than half of suicides
 Incarceration
 Exposure to the suicidal behavior of others,
such as family members, peer, or media
figures.

11. Suicide by Males % Female %
Fire arm 57 32
Suffocation 23 20
Poisoning 13 38

12.  Economic ( poverty, unemployment) (52%)
 Social exclusion (32%)
 Failure in love (11%)
 Police torture (1%)
 Mental disorder (3%)
 Not reported (1%)

13.  Early signs:
 Depression
 statements or expressions of guilt feelings
 Tension or anxiety
 nervousness
 impulsiveness
 Critical signs:
 Sudden change in behavior, especially calmness after
a period of anxiety
 Giving away belongings, attempts to “get one’s affairs
in order”
 Direct or indirect threats to commit suicide
 Direct attempts to commit suicide

14.  Hopelessness
 Impulsivity
 Anxiety
 Command hallucinations

15. Theories of
suicide
Psychological
theory
Biological
theory
Sociological
theory

16.  Attend to issue of patient’s safety
 Assess treatment plan/setting/alliance.
Somatic treatment modalities
 ECT- used to treat acute suicidal behavior
 Benzodiazepenes: may reduce risk by treating anxiety
 Antidepressants
 Lithium
 Anticonvulsants
 Antipsychotics- recent study on clozapine
 Psychotherapeutic interventions: widely used as helpful for
suicidal patients, evidence is limited
 Provide education to patient and family
 Monitor psychiatric status and response to treatment
 Reassess for safety and suicide risk frequently

17.  Appreciate the complexity of suicide/ multiple
contributing factors
 Conduct a thorough psychiatric examination,
identifying risk factors and protective factors and
distinguishing risk factors which can be modified
from those which cannot
 Ask directly about suicide; specific suicide
inquiry
 Determine level of suicide risk; low, moderate,
high
 Determine treatment setting and plan
 Document assessment

18.  Emergency measures may be necessary after
a person has attempted suicide. First aid,
CPR, or mouth to mouth breathing may be
required.
 Hospitalization is often needed to treat the
recent actions and to prevent future attempts
 Psychiatric interventions is one of the most
important aspects of treatment

19. ECT Evidence for short term reduction of suicide but not
long term
Benzodiazepene
s
May reduce risk by treating anxiety
Antidepressants A mainstay treatment of suicidal patients with
depressive illness/ symptoms. No cunclusive
evidence of suicide reduction
Lithium and
Anti-
convalsants
Lithium has a demonstrated anti-suicide effects, anti
convalsants do not
Antipsychotics Evidence for clozapine reducing suicidality in
schizophrenia and schizoaffective disorder

20.  Research has shown that mental and substance-
abuse disorders are major risk factors for
suicide, may programs also focus on treating
these disorders
 Studies showed that a type of psychotherapy
called cognitive therapy reduced the rate
repeated suicide attempts by 50% during a year
of follow up. A previous suicide attempt is
among the strongest predictors of subsequent
suicide and cognitive therapy helps suicide
attempters consider alternative actions when
thoughts of self harm arise.

21.  Suicide attempts and threats should always
be taken seriously. About one third of people
who attempt suicide will repeat the attempt
within one year, and about 10% of those who
threaten or attempt suicide eventually do kill
themselves.
 Complications:
Vary depending on the type of suicide attempt

22.  A person who threatens or attempts suicide
MUST be evaluated immediately by a mental
health professional. NEVER IGNORE A SUICIDE
THREAT OR ATTPMPT.