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Course Sample:
SUICIDE Suicide is a self-inflicted, intentional death. It has been called the "permanent solution to a temporary problem". With estimates of over 30,000 completed suicides annually (National center for Health Statistics, 1991), it has become the eight leading cause of death among all ages. Physical disease has been identified as an independent risk factor present for a significant number of patients who commit suicide (Kontaxakis et. al., 1988). Among all suicide victims, physical illness was present in 25 to 75 percent (Roy, 1989), although many had unrecognized, psychiatric and neurological illness (Davidson, 1993). These illnesses typically include depression, substance-related disorders, chronic or terminal illness, hopelessness, agitated delirium and pain. Subsequently, the evaluation of depression and associated suicidal thoughts and behaviors need to be aggressively explored, particularly among the medically ill. The medically ill patient is often faced with numerous adjustments and losses related to their medical illness. In turn they can trigger depression and related suicidal thoughts. These may include loss or disfigurement of body parts, loss in ability to work, loss or changes in social networks due to the illness, pain, etc. In addition, the underlying medical condition can lead to suicidal thoughts and plans. Kishi and his colleagues (1996) investigated suicidal plans of patients immediately post stroke and at three, six, twelve, and twenty-four month follow up. They found that 6.6 percent of patients developed suicidal plans during the hospital treatment (acute-onset suicidal plans) and 11.3 percent developed suicidal plans at follow up (delayed-onset suicidal plans). The development of both types of suicidal plans was strongly associated with major depression. However, acute-onset suicidal patients had more anterior lesion locations while delayed-onset suicidal patients had more posterior lesion strokes. Delayed-onset suicidal plans were associated with greater physical impairments and poorer social support during the acute post stroke period. The authors concluded that the suicidal plans during the acute onset phase may be related to biological mechanisms while delayed onset plans may be related to psychological mechanisms. Therefore, clinicians may need to closely monitor patients during the acute post-stroke period. It is important to recognize that patients who may not have many of the traditional psychological risk factors considered below they may be at significant risk simply related to the biological mechanisms of the illness. It is at this time, that you may need to take safety precautions by utilizing suicide watches while in the hospital, limiting access to lethal items and educating family and friends about potential risks during the acute phase of treatment. Following the acute phase, social support and level of physical impairment will need to be assessed and treatment strategies implemented to reduced the risk of suicide months after a stroke when the patient may begin to realize the reality of his or her deficits. In summary, research findings as that noted above highlights the importance of not only understanding traditional psychological risk factors for suicide but the biological triggers related to the medical illness itself. This will lead to better assessment of suicide risk factors and the implementation of strategies to reduce them. |
