Suicide prevention Study Guide

📖 Core Concepts Suicide prevention – coordinated actions (individual to societal) to lower suicide risk; most suicides are preventable. Levels of prevention Primary: before any suicidal thoughts/behaviour appear. Secondary: after warning signs or early ideation are identified. Tertiary: after a suicide attempt, aimed at preventing recurrence. Risk assessment – looks at Assessment of risk, Behavioural indicators, Contextual factors (the “ABC” model). Means restriction – removing or limiting access to highly lethal methods (e.g., firearms, pesticides, jumping sites). Key therapeutic approaches – Dialectical Behavior Therapy (DBT), Cognitive‑Behavioral Therapy for suicide prevention (CBT‑SP), lithium therapy, caring‑letters outreach, crisis hotlines. Public‑health impact – suicide is the 10ᵗʰ leading cause of death in the U.S.; 75 % of decedents saw a physician in the year before death. 📌 Must Remember Firearms: 85 % case‑fatality; restricting them lowers suicide rates. Lithium: reduces suicide risk in mood disorders by 87 % (RCT data). Screening: recommended for children/adolescents (U.S. Surgeon General); positive screens need a follow‑up interview. Warning signs: talk of death, sudden calm after depression, giving away possessions, reckless behaviour, substance misuse, hopelessness. Risk factors: mental illness, prior attempts, chronic pain/medical illness, trauma, socioeconomic stress, family history, access to lethal means, recent discharge from incarceration or mental‑health facility. Effectiveness hierarchy: population‑level means restriction > clinical screening > individual counselling (evidence strongest for the first). Antidepressant caution: initiation, dose changes, or abrupt discontinuation can transiently increase suicidal ideation. 🔄 Key Processes ICARE model (conversation) Identify the concern Connect with empathy Assess evidence of suicidality Restructure thoughts/plan coping Express ongoing support Tripartite “ABC” risk assessment Assessment (clinical interview, scales) Behavioural indicators (plans, attempts, means) Contextual factors (stressors, supports, access) Coping‑planning workflow Strength‑based self‑soothing → moderate‑intensity strategies (e.g., activity scheduling) → high‑intensity professional help. Means‑restriction implementation Identify high‑lethality method → legislate or engineer barriers (firearm laws, bridge nets, pesticide bans) → monitor outcomes. 🔍 Key Comparisons Primary vs. Secondary vs. Tertiary prevention Primary: universal education, community resilience → no suicidal thoughts yet. Secondary: screening, early‑intervention, warning‑sign identification. Tertiary: post‑attempt care, safety planning, long‑term follow‑up. DBT vs. CBT‑SP DBT: skills‑focused (emotion regulation, distress tolerance); strong evidence for reducing attempts in adolescents. CBT‑SP: structured problem‑solving, cognitive restructuring; improves ideation and coping, especially in youth. Means restriction vs. Psychological counseling Means restriction: population‑level, immediate impact on fatality rates. Counseling: individual‑level, improves coping but depends on access and adherence. ⚠️ Common Misunderstandings “Asking about suicide plants the idea.” – Direct, compassionate questioning does not increase risk. Risk‑assessment tools reliably predict attempts. – Meta‑analyses show poor sensitivity/positive predictive value; tools are screening aides, not definitive predictors. Screening alone prevents suicide. – Positive screens must be followed by clinical interview and safety planning. Only mental‑health care matters. – Access to lethal means and socioeconomic factors are equally critical. 🧠 Mental Models / Intuition Lethality gradient – Think of methods on a scale; the higher the lethality, the lower the “buffer” needed (e.g., firearms need strict restriction, while overdoses may be mitigated by medication limits). Suicide as a preventable disease – Like infection, it has exposure (means), susceptibility (risk factors), and intervention points (vaccination = prevention programs, antibiotics = treatment). 🚩 Exceptions & Edge Cases Antidepressant initiation – May transiently increase ideation; requires close monitoring especially in young adults. False‑positive screens – Especially common in high‑sensitivity questionnaires; avoid over‑triage by confirming with a clinical interview. Military/veteran populations – Higher baseline risk; caring‑letters and targeted outreach are especially beneficial. 📍 When to Use Which If a person has access to firearms & expresses ideation → prioritize means‑restriction (temporary removal, safe‑storage) plus safety planning. Adolescent with chronic hopelessness but no plan → consider CBT‑SP or DBT, start coping‑plan, monitor. Recent discharge from prison/psychiatric unit → gatekeeper outreach + rapid follow‑up appointment. Widespread community suicide hotspot → install physical barriers and crisis signage (population‑level means restriction). Patient on lithium with mood disorder → continue lithium for its proven anti‑suicidal effect unless contraindicated. 👀 Patterns to Recognize Sudden calm after a period of depression → possible imminent attempt. Giving away prized items / making amends → preparatory behaviour. Escalating substance use + insomnia → heightened impulsivity risk. Repeated talk of “being a burden” + social withdrawal → classic hopelessness cluster. High‑lethality method mentions (firearms, jumping) → prioritize means restriction immediately. 🗂️ Exam Traps Distractor: “Suicide risk‑assessment scales have high predictive value.” – Wrong; they have limited sensitivity and PPV. Distractor: “Only primary prevention works; secondary and tertiary are ineffective.” – Incorrect; all three levels are essential and evidence‑based. Distractor: “Crisis hotlines reduce overall suicide mortality.” – Evidence shows short‑term relief but limited impact on mortality rates. Distractor: “Antidepressants always decrease suicide risk.” – Not true; they can increase ideation during early treatment phases. Distractor: “Means restriction is only useful for firearms.” – False; it also works for pesticides, carbon‑monoxide gas, and jumping sites.