Suicide risk assessment and intervention in people with mental illness

Abstract

Suicide is the 15th most common cause of death worldwide. Although relatively uncommon in the general population, suicide rates are much higher in people with mental health problems. Clinicians often have to assess and manage suicide risk. Risk assessment is challenging for several reasons, not least because conventional approaches to risk assessment rely on patient self reporting and suicidal patients may wish to conceal their plans. Accurate methods of predicting suicide therefore remain elusive and are actively being studied. Novel approaches to risk assessment have shown promise, including empirically derived tools and implicit association tests. Service provision for suicidal patients is often substandard, particularly at times of highest need, such as after discharge from hospital or the emergency department. Although several drug based and psychotherapy based treatments exist, the best approaches to reducing the risk of suicide are still unclear. Some of the most compelling evidence supports long established treatments such as lithium and cognitive behavioral therapy. Emerging options include ketamine and internet based psychotherapies. This review summarizes the current science in suicide risk assessment and provides an overview of the interventions shown to reduce the risk of suicide, with a focus on the clinical management of people with mental disorders.

Determinants and escitalopram treatment effects on suicidal ideation in patients with acute coronary syndrome: Findings from the K-DEPACS and EsDEPACS studies

“…Consistent with findings from the general population, depressive and anxiety disorders were the strongest determinants of suicidal ideation during the acute phase of ACS [3,27]. Moreover, two previous studies with heterogeneous evaluation points after ACS also found similar results [9,10].…”

MANAGEMENT OF ENDOCRINE DISEASE: Suicide risk in patients with diabetes: a systematic review and meta-analysis

“…There are several possible explanations for the increased risk of suicide associated with diabetes. Depressive symptoms and suicidal ideation are common in patients with diabetes, both of which are associated with increased risk of completed suicide (10,11,79). Apart from depression, other mental health problems are also common in diabetes patients, which can also lead to increased risk of suicide (80,81).…”

Can we usefully stratify patients according to suicide risk?

“…Incremental improvement in risk stratification might occur if there is identification of previously unknown risk factors, 23 or new ways of combining established risk factors with methods derived from artificial intelligence research. 24 But to be useful to a clinician, new methods of suicide risk stratification would need to be several orders of magnitude more powerful than the existing methods.…”