Suicide – medical revision notes

Suicide – medical revision notes

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Key Points

• Suicide is death caused by an act of self-harm that is intended to be lethal
• Suicidal behaviour encompasses a spectrum of behaviour from suicide attempt and preparatory behaviours to completed suicide
• Suicidal ideation refers to the process of thinking about, considering, or planning suicide.

1. Definition

Suicide is defined as death caused by an act of self-harm where the individual’s intent was to end their life.

2. Epidemiology

Suicide is a major public health issue, consistently ranking as one of the leading causes of death worldwide.

• Globally, suicide claims more lives than HIV, malaria, breast cancer, or war and homicide combined. In 2019, over 700,000 people died by suicide, accounting for 1 in every 100 deaths
• In 2020, it was the 12th leading cause of death in the United States
• In 2022, there were 5,642 suicides registered in England and Wales (a rate of 10.7 deaths per 100,000 people)
  • Males accounted for three-quarters of these deaths, with 4,179 male deaths compared to 1,463 female deaths.

Age and gender differences

• Men are more likely to die by suicide, often due to using more lethal means, though women are more likely to attempt suicide
• For those aged 20-34 years, suicide and accidental poisoning are the leading causes of death, affecting 24% of men and 12% of women in this age group.

Mental health correlation

• There is a strong link between mental health disorders and suicide
• Around 90% of individuals who die by suicide have a diagnosable mental health condition, such as depression, bipolar disorder, schizophrenia, or substance abuse.

3. Risk factors

• Male gender
• Being widowed, divorced, or separated
• Living in a lone-person household
• Certain professions: vets (highest risk), doctors/dentists, pharmacists, farmers, journalists, and those in the armed forces
• Unemployment
• Substance abuse (drugs/alcohol)

Suicide rates are also high in vulnerable groups who face discrimination, including refugees, migrants, LGBTQ+ individuals, and prisoners.

4. Causes

Suicide is a complex event influenced by multiple factors, including genetics, environment, and psychological/behavioural factors.

• Psychiatric illnesses are strongly linked to suicide, with nearly 90% of those who die by suicide having a diagnosable mental health condition at the time of death.

5. Symptoms (and behaviour)

Suicide is not an isolated event; it exists on a spectrum of suicidal behaviours. For every suicide, there are numerous other attempts and self-harm events:

• 3 hospitalisations for self-harm
• 8 A&E visits related to suicide
• 38 self-reported attempts in the past year
• 265 people seriously considered suicide in the past year

6. Diagnosis

Suicide is diagnosed through post-mortem confirmation that death resulted from an intentional act of self-harm with lethal intent.

7. Treatment (of suicidal behaviour)

Managing a suicidal patient requires a non-judgmental, compassionate approach, involving:

• Brief interventions such as safety planning and lethal means counselling
• Involving family and close friends in the patient’s care
• Providing crisis support, including access to mental health services such as 116 123 (Samaritans helpline)
• Referring the patient to appropriate care, such as a consultant psychiatrist
• Follow-up contact with the patient between visits to assess ongoing risk

Stigma and barriers to treatment
Stigma around mental health and suicide often prevents individuals from seeking help. Many fear being judged or fail to recognise the severity of their condition, which leads to delayed or missed treatment.

8. Complications

The impact of suicide extends beyond the emotional toll on loved ones. It also has significant economic consequences due to lost productivity, medical expenses, and the costs associated with caring for those who survive suicide attempts.

9. Prognosis

Predicting long-term outcomes for those who attempt suicide is challenging – and there is surprisingly little long-term data.

• In a 22-year UK study, out of 223 individuals (69% women, average age 32) who had attempted suicide, 25 had died, and 12 (probably) from suicide – i.e. about 5%. This (probably) reflects a higher risk than expected, particularly given their relatively young age.

10. Prevention

• Crisis intervention and mental health education
• Promoting social connectedness
• Improving access to mental health care, particularly for at-risk individuals.

Warning signs

• Talking about wanting to die or feeling hopeless
• Withdrawing from friends and family
• Changes in sleeping or eating habits
• Engaging in risky or self-destructive behaviours.

Other information

Access to means

Restricting access to common means of suicide (firearms, pesticides, medications) has been shown to reduce suicide rates. Promoting safe storage and regulation of these items is a crucial prevention measure.

Global variability

Methods and rates of suicide vary across different regions and cultures. For example, some countries may have higher rates of hanging, while others see more deaths from firearms or poisoning.

Parasuicide (suicide attempt) vs suicide

Conclusion

Suicide is a serious public health issue, but with early intervention, support, and mental health care, many lives can be saved. Recognising warning signs and providing compassionate care are key components in preventing suicide.

Summary

We have described 10 medical revision notes about suicide. We hope it has been helpful. Please seek help now if you are having suicidal thoughts. At MyHSN, we care about you.

Other resources

Suicide – getting help (NHS England)
Suicide – getting help (NHS Scotland)
Review article: Soreff, 2023