Suicide.I'm in the last few days of my psych rotation and I realized I can't finish without saying something about suicide. I've switched to a different unit, where there is much less psychosis, and much more suicidality and substance use. Here are some quick facts about suicide:
- 9th leading cause of death in the US (30,000 people per year).
- 3rd leading cause of death in individuals 15-24, accounting for 13% of deaths in this age group (following accidents, 46%; and homicides, 15%)
- 95% of people who commit suicide have an existing psychiatric diagnosis.
Like every Catholic kid, I was taught that suicide is the worst sin a person can commit since there is no opportunity to ask forgiveness. I remember it being presented as a choice people make, akin to stealing or adultery. But like everything in life, it's much more complicated. One of my patients (who had paced across the bridge) did incredibly well during his hospitalization. His depression was treated, he participated in therapeutic groups, he sobered up, and he was discharged into an inpatient alcohol treatment program. Unfortunately, there is no evidence that inpatient treatment actually prevents suicide, and studies have shown that psychiatrists can't predict which individuals with suicidal ideation will go on to attempt. Thus, although it is one of the most common problems seen in psychiatry and primary care, it remains one of the most baffling. Every depressed patient should be asked about suicide, and every doctor should know the right questions to ask.
4 comments:
http://www.npr.org/templates/story/story.php?storyId=5031520
Haunting and a little bit creepy, but I think worth listening to. There are other NPR links to stories about the Golden Gate Bridge, but lest anyone think I'm obsessed, I guess I'll leave those to be found. From a non-medical standpoint, just knowing what it's like to have someone ask if everything is okay when you're having a bad day, it would seem that such a small gesture can make a substantial difference.
As someone who has spent a career working with young people, I am also worried about the collateral devastation attendent to a suicide. A family I know was reeling from the death of their junior high daughter when older brother ended his life. I echo Lee's statement that a small gesture such as a simple "How you doin'" can give people an opportunity to open up or at least give insight as to their mental affect.
You two make a good, simple point which is easy for me to forget since right now I see people after they've already been admitted to the hospital. One study showed that 50% of people who completed suicide had seen their primary doctor in the past month, 40% in the past week. Presumably, suicidality was not assessed in those visits. As medical students, it is stressed to us how important it is to ask about suicide because asking someone can break up the isolation that leads some people to go through with the act. And as you both pointed out, you don't have to be a doctor to break up that isolation.
These statistics are daunting. Very interesting entry. It needs to get out to everyone!
Post a Comment