Suicide

Introduction

Suicide is the act of intentionally ending one’s own life. It remains a major public health concern and is one of the leading causes of death among adolescents and adults. Suicide rates are especially high among individuals between 15–34 years of age, though middle-aged adults are also significantly affected.

Certain populations have a higher risk of suicide, including males who are divorced, widowed, or socially isolated. Mental health disorders, particularly depression, are strongly associated with suicidal behavior. Substance abuse, especially alcohol use disorder, further increases risk because alcohol acts as a central nervous system depressant and can impair judgment.

Additional suicide risk factors include:

• Depression or sudden mood improvement after severe depression
• Alcohol or substance abuse
• Recent loss of a loved one or relationship
• Chronic or disabling illness
• Schizophrenia or other serious mental illness
• Verbalized suicidal thoughts or detailed suicide plans
• Social isolation
• Prior suicide attempts
• Financial hardship or unemployment
• Family history of suicide

Suicidal behavior often develops when an individual feels overwhelmed by emotional pain, hopelessness, loss of control, or perceived loss of important relationships or life stability. Feelings of worthlessness and low self-esteem are also commonly present.

Assessment

All patients experiencing depression or significant emotional distress should be evaluated for suicide risk. Asking directly about suicidal thoughts is important and often provides relief to the patient because it gives them an opportunity to discuss their feelings openly.

Assessment may involve gradually asking questions related to:

• Thoughts of self-harm
• Suicidal intent
• Presence of a specific plan
• Access to means for self-harm
• Previous suicide attempts

Patients who have attempted suicide previously, possess a detailed suicide plan, or are considered high risk should receive immediate evaluation in a hospital setting. Some individuals may attempt to communicate suicidal intent indirectly or shortly before acting on their plan.

If a patient discusses suicidal thoughts or intentions, providers should continue supportive conversation and maintain communication until the patient can be transferred to definitive care or additional assistance arrives.

Management

• Never leave a suicidal patient unattended. Continuous observation is essential until care is transferred to another healthcare professional.
• Remove or secure potential means of self-harm whenever possible and transport these items with the patient if required by protocol.
• Acknowledge the patient’s emotions without judgment or argument. Avoid dismissing or minimizing their feelings.
• Provide calm, honest reassurance and supportive communication.
• Encourage transport to the hospital for further evaluation and treatment.
• If the patient refuses care, involve trusted family members, friends, or support persons when appropriate to help encourage acceptance of treatment.

The primary goals in managing suicidal patients are maintaining safety, offering compassionate support, and ensuring access to definitive psychiatric and medical care.