Suicide and suicide attempts are serious public health and societal concerns. Annual suicide rates have been on the rise for more than a decade with associated costs stretching well into the billions of dollars. While suicide is statistically rare, its effects are far-reaching. Each of us interacts with suicide survivors and with those who think of suicide on a daily basis—at home, at work, and in our communities.
Suicide affects certain groups differently, with high rates of suicidal behaviors in the American Native population, among teens and young adults, and among older men and women. There are gender differences also: women are more likely than men to attempt suicide although men are likely to use deadlier methods. Although research is lacking, nurses appear to be at higher risk for suicide than the general population due to demanding and stressful work, frequent exposure to human suffering, ethics-related stress, and perceived limited respect in their work.
Healthcare providers should become aware of risk factors, levels of risk, and warning signs. Suicide is overrepresented in people with mental illness and a large percentage of suicide victims have a diagnosable mental health disorder. Compared with the general population, individuals who abuse alcohol or drugs are at greater risk for suicide. Depression—a common co-occurring diagnosis among people who abuse substances—also confers risk for suicidal behavior.
Suicide screening and assessment is becoming a common part of many healthcare providers’ initial assessment. And this is not only limited to physicians and nurse practitioners. In many states physical and occupational therapists, social service professionals, chiropractors, nurses, dentists, speech pathologists, and other front-line providers are expected to screen for suicidal ideation and behaviors, provide information and support, and make timely referrals when needed. A number of simple screening and assessment tools are available to screen for suicidal thoughts and behaviors.
Management includes therapeutic interventions and, when indicated, psychiatric medications. Once a patient is thought to be at increased risk for suicidal behavior, continuity of care, restriction of lethal means, and a comprehensive safety plan are crucial. Tapping into social and community support services and identifying community engagement programs are critical elements of the plan of care.
Suicide in military and Veteran populations requires special consideration. Healthcare providers must familiarize themselves with military culture, including psychosocial issues that can lead to isolation, depression, and a loss of purpose. Service members and Veterans are particularly susceptible to PTSD and depression—potentially treatable conditions.
Reducing the rates of suicide in the United States and around the world is hampered by stigma, fear, and inadequate treatment of mental illness. Fortunately, suicide is preventable. Public health campaigns, healthcare provider education, and social support programs are succeeding in getting people in crisis the help they need.