Friday, November 11, 2016

Suicide Attempts and Follow Up Risks

After A Suicide Attempt, The Risk of Another Try:

Suicide surpasses homicide in this country. Every 13 minutes someone in the United States dies by his own hand, making suicide the nation’s 10th leading cause of death over all (42,773 deaths in 2015), but second among those aged 15 to 34. Among children aged 10 to 14, the suicide rate has caught up to the death rate from traffic accidents.
Let me pause here and note, this latter statistic among the 10-14 set has been getting a lot of mileage lately in the press, but it's taken out of context. Yes, the suicide rate has increased marginally among this group in the past decade (up a few cases, literally); what's changed is that the number of deaths related to traffic accidents has continued to drop annually. Meaning, while the suicide rate for 10-14's is higher than traffic fatalities, we're talking about such small populations they are almost statistically insignificant (384 v. 425).

Not that these lives are insignificant by any measure, just that when comparing rates among populations so small (we're talking hundreds of cases out of the millions of children aged 10-14) even the slightest increase or decrease can cause a huge shift in rate.
Many times that number – more than a million adults and 8 percent of high school students — attempt suicide each year, according to the Centers for Disease Control and Prevention. Yet a woeful minority receive the kind of treatment and attention needed to keep them from repeating a suicide attempt.

A common yet highly inaccurate belief is that people who survive a suicide attempt are unlikely to try again. In fact, just the opposite is true. Within the first three months to a year following a suicide attempt, people are at highest risk of a second attempt — and this time perhaps succeeding.

A recent analysis of studies that examined successful suicides among those who made prior attempts found that one person in 25 had a fatal repeat attempt within five years.
Which begs the question, what methods were used in the attempts, and how do they vary by lethality?
Now a new study reveals just how lethal suicide attempts, as a risk factor for completed suicide, are. The study, led by Dr. J. Michael Bostwick, a psychiatrist at the Mayo Clinic, tracked all first suicide attempts in one county in Minnesota that occurred between January 1986 and December 2007 and recorded all the deaths by suicide for up to 25 years thereafter. Eighty-one of the 1,490 people who attempted suicide, or 5.4 percent, died by suicide, 48 of them in their first attempt. The findings were reported in the American Journal of Psychiatry.

When all who succeeded in killing themselves were counted, including those who died in their first attempt, the fatality rate among suicide attempters was nearly 59 percent higher than had been previously reported.

“No one had included people who died on their first recorded attempt, so it’s not in the medical literature,” Dr. Bostwick explained in an interview. “That almost two-thirds end up at the medical coroner after a first attempt is astounding. We need to rethink how we look at the data and the phenomenon of suicide. We need to know more and do more for those who will complete suicide before they get to us for any kind of help.”

The study also showed that the odds of successfully committing suicide are 140 times greater when a gun is used than for any other method. Dr. Bostwick said that most suicide attempts are “impulsive acts, and it’s critical to prevent access to tools that make impulsive attempts more deadly.

“Suicide attempters often have second thoughts, but when a method like a gun works so effectively, there’s no opportunity to reconsider,” he said.
As I've noted for years, the lethality of the method leaves no room for reconsideration. The easy access and availability of firearms in our gun-soaked culture virtually guarantee these trends will continue: that first attempters will be successful attempters, and the numbers of people who attempt suicide and live will continue to decline. 

Yet gun control is rarely mentioned in the suicide prevention literature.
Equally if not more important to preventing successful suicide is paying attention to premonitory signs of suicidal intent and taking appropriate action to diffuse it. People who are depressed, who abuse substances like alcohol or illegal drugs or are having serious relationship difficulties should be considered high risk, Dr. Bostwick said.

More often than not, family members and friends are in the best position to spot a potential suicide and take steps to head it off. In addition to depression and substance abuse, signs include making statements (verbal or written) of being better off dead; withdrawing from family and friends; feeling helpless, hopeless, enraged, trapped, excessively guilty or ashamed; losing interest in most activities; acting impulsively or recklessly; and giving away prized possessions.
All very good and informative, but again, it fails to mention the thousand pound elephant in the room, namely the preferred lethality of the chosen method, in this case guns. No, gun control won't stop every suicide and no one is suggesting such a thing. But you 're never going to lower the rate of suicide overall, or at all, unless you talk about gun control.

When the number of people shooting themselves every year is approaching the same number who get the flu, you've got a big f'ing problem in your society. And failing to do something about guns is like discouraging people from getting flu shots.

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