September is Suicide Awareness Month, a time to shed light on this highly stigmatized and taboo topic. Here are some excerpts from our Internal Medicine and Pediatrics Core to help you provide the best treatment for your patients.
Suicide ranks as the 10th leading cause of death in the U.S., and globally, and estimated 1 million individuals commit suicide annually. It is 1 of the top 3 causes of death in adolescents and young adults. While females have a higher rate of depression and attempt suicide more frequently by poisoning, males ≥ 75 years of age have the highest rate of completed suicide, with white males completing 80% of the suicides, using firearms 60% of the time. The male-to-female suicide rate is 4.5:1. Ethnically, Native Americans and Alaskan Natives between 15 and 35 years of age have a suicide rate 2-fold the national average. 95% of people who commit suicide have mental illness.
Risk factors for suicide include the following. Remember the mnemonic SAD PERSONS.
Suicide risk factors
*The relationship between antidepressant use and suicide varies with age: While there is an increase in suicidality in individuals ≤ 24 years of age, there is no evidence of increased risk in individuals > 24 years of age, and the risk decreases after 65 years of age.
Suicide attempts should always be treated despite the wishes of the patient. These patients are “crying for help.” They are also often in a pathological mental state that may be transitory or treatable. This situation is different from the patient who refuses life-sustaining treatment. The difference is that with refusal of care, the patients are not killing themselves–rather, they are refusing the help that will keep them alive.
Major depressive disorder (MDD) is associated with high mortality, much of which is accounted for by suicide. It has a lifetime prevalence of 20%, with a female-to-male ratio of 1.5 to 3:1. The average age of onset is 29 years of age. The twin concordance rate is 40-50%, and individuals with a 1st degree relative have a 3-fold risk for developing depression. Depression is more common in females 40-60 years of age than in any other age group, and rate of depressive symptoms are lower among non-Hispanic individuals.
In prepubertal children, there is no gender difference in the prevalence of depression. However, adolescent girls are 2-3x more likely than boys to experience depression. 9% of teenagers meet criteria for depression, with ~1 in 5 teenagers having a history of depression. Comorbidities are common, including anxiety disorders, substance use disorders, ADHD, learning disabilities, and disruptive behaviors (e.g., ODD, conduct disorder). Unfortunately ~70% of depression in adolescents is unrecognized and goes untreated. It happens partly because of a lack of access to mental health specialists. Pediatricians should be particularly attentive in monitoring teenagers with a family history of depression, trauma, substance use, or adversity and often in the best position to identify and help teens with depression. In 2018, the AAP published updated medical guidelines on adolescent depression and its treatment. AAP guidelines endorse universal adolescent depression screening for children 12 years of age and over, using different depression scales.
Get more of the latest medical guidelines on how to recognize and treat suicidal thoughts and depression in the Internal Medicine or Pediatrics Core.