Suicidal Ideation: Assessment and Intervention

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Forty-five percent of individuals who die by suicide visit their primary care physician within a month before their death and 67% of those who attempt suicide receive medical attention as a result of their attempt Suicidal ideation can present in any healthcare setting. Be aware of suicide risks and warning signs to help prevent suicide. For additional information about suicide prevention within the primary care setting, access the Suicide Prevention Resource Center’s Suicide Prevention Toolkit for Primary Care Practices.

The U.S. Department of Veterans Affairs and the Department of Defense (VA/DoD) established a Clinical Practice Guideline for the assessment and management of patients at risk for suicide. The guideline identifies critical decision points in the management of suicide risk behavior, and provides clear recommendations on incorporating current information into practice. The guideline is only a tool to assist providers, and is not a substitute for clinical judgment.

Assessing for Suicidal Ideation

Ask the member if they feel suicidal or have thoughts of harming themselves then assess for the following:

Plan- Ask the member if they have a specific plan for how they would hurt themselves.

Access- Ask member if they have access to means they could hurt themselves with _weapons, pills, etc..

Lethality- Assess if the plan is lethal. Is it possible that the member or another person will be harmed?

Warning Signs

  • Threatening to kill oneself
  • Talking of wanting to hurt oneself
  • Looking for means to harm self _firearms, pills
  • Talking or writing about death and dying
  • Increased risky behavior
  • Increased substance use
  • Stops taking medication _insulin, blood pressure medications
  • Family history of suicide
  • PHQ-9 Score of 15 or higher
  • Anxiety, agitation, too much/too little sleep
  • Feeling trapped
  • Hopelessness
  • Withdrawal from friends or family
  • Rage, uncontrolled anger
  • Dramatic mood change
  • Sudden elevation in mood
  • Giving away belongings
  • Rapid weight loss
  • Previous suicide attempts

Interventions and Resources

4 Key Roles for Providers *Per the Suicide Prevention Resource Center

  1. Screen and treat or refer for major depressive disorders and substance use disorders.
  2. Assess and treat for common risk factors: insomnia, chronic pain, severe anxiety, PTSD.
  3. Educate patients and caregivers on warning signs and resources.
  4. Teach benefits of safe firearm, ammunition, and medication storage.

Additional Considerations

  • Suicide is the 3rd leading cause of death for 15-24 year old Americans _CDC.
  • Suicide is the 4th leading cause of death for adults ages 18-65 _CDC.
  • Suicide is the 5th leading cause of death among adults age 45-54 _CDC.
  • Suicide rates for males are highest among those aged 75+ _CDC.
  • Suicide rates for females are highest among those aged 45-54 _CDC.
  • The most common method of suicide is firearms for males and poisoning for females _CDC.
  • For children or adolescent members who have expressed suicidal ideation or suicide attempts, providers are encouraged to engage parents and recommend additional parenting support groups and resources _including, but not limited to, parenting support groups, individual and family counseling, faith- or community-based resources, resources available through school districts, etc..

According to the CDC, additional risk indicators may include specific groups that have higher suicide rates, such as:

  • American Indian/Alaska Natives and non-Hispanic White populations
  • Veterans
  • People in rural areas
  • Individuals in certan job industries, such as mining and construction
  • Young people who identify as LGBTQ+

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