Suicide and DSH

Objectives
• State prevalence
• Know characteristics of each category
• Assess seriousness of attempt
• Predict future risk
• Formulate management plan for suicidal
patients
• Advise preventive measures
 Suicide
• Amongst 10 commonest causes of death
• 540 persons per year commit suicide in
Kuwait
• 2/3 women & 1/3 men take O/D
• 1 in 6 leave a note
• Peak in spring
• Correlates: social isolation, H/O DSH, Family H/O
psych dis, chr phys illness, recent loss
 Suicide
Characteristics
• Elderly males 60-75 Professional risk
• Rates increasing in younger • Unemployed
age group
• Univ students
• Social classes 1 & V • Doctors
• Psychiatric illness 90% • Policeman
• Depression
Substance abuse
• Insurance agents
•
• Antisocial personality
• Schizophrenia
 Deliberate Self Harm
(DSH)
• 1 in 100 admitted at least
once
• Younger females 15-19
• Social classes V & 1V
• Commonest hospital
admission in women
• 90% O/D; 10%
laceration/violent attempt
• Personality: impulsivity,
unstable mood, difficulty I/P
relationships, low self-
esteeme, substance abuse
• 15% serious intent
while most seeking
Intermission/cry for help
• Risk ↑ 30 times
• 1-2% die within 2 years
• 15-25% repeat within a
year
• Predictors
• Previous history of DSH
• Psychiatric treatment
• Criminal record
• Personality disorder
 Prevention
Suicide DSH
• 2/3 express to GP, • Involve GP: one third
emotional problems ; 1/4
1/4 psych OP recurrent psych dis
• Treat psych • Intervention: medical,
social, family counseling
disorder
• First timers, respond best
• Ensure F/U • Compliance poor
• Establish helpline
 Evaluation of suicidal
attempt
Establish rapport Family or Past H/O
• Express sympathy • Suicidal attempts
• Show empathic concern • Psychiatric disorder
• Be non judgmental Feeling about the attempt
Establish seriousness of • Guilty for having attempted
intent • Unlucky to be alive
• Timing Risk factors
• Precautions • Marital status
• Planning • Physical illness
• Suicidal note • Psychosocial stressors
Substance abuse
Reasons given •
• Personality disorder
• Self worthless
• Future hopeless Inviting questions
• State helpless Reassurance
• World meaningless