Recognizing Suicidal behavior

About this course

Suicide is the 10th leading cause of death in the United States. Often, healthcare professionals assess for suicide risk, but frequently, there is no follow-up or treatment instituted in someone who may be at risk. This independent study described depression and other psychiatric disorders, their influence in suicidal behavior, factors that require special intervention, major questions to ask a potentially suicidal individual, details the steps to ensure the patient’s safety, and concludes with steps that should be addressed with the family and friends in the case of a completed suicide.

Learning objectives

• Describe risk factors for Suicide
• Review the various types of depression
• Review the recommended tools to assess for depression and suicidal ideation
• Understand the various medications classifications used to treat depression and psychotic episodes
• Describe the steps to ensure the safety of an individual who is suicidal

Course outline

36 sections · finish in any order across devices

1. 1

   Introduction

   Suicide is a major public health problem. In the United States it is the 10th leading cause of death, accounting for nearly 44,000 deaths each year. Suicide is also the seventh leading cause of years of potential loss of life, surpassing liver disease, diabetes, and HIV. Men are nearly 3.5 times mor

   4 min

2. 2

   Suicide Risks

   Suicidal behavior does not discriminate. People of all ages, genders, and ethnicities can be at risk. Suicidal behavior is complex, and there is no single cause it. There are many different factors that can contribute to someone attempting suicide, however people who are most at risk tend to share s

   4 min

3. 3

   Suicide Risks in Males

   In recent years, there has been a steady increase in the numbers of men who have ended their life by committing suicide. While women tend to experience more suicidal thoughts, men are far more likely to die by suicide, possibly because of the increased likelihood that a male will use lethal methods

   4 min

4. 4

   Suicide Risks in the Military

   Historically, military suicide rates have been lower than rates within the general population, however, there has been a rise in the suicide rates within the military veterans over the past 10 years.¹⁵ Currently, suicide is the second leading cause of death in the military. According to the Departme

   4 min

5. 5

   Firearms and Suicide

   In the United States, the most common method of committing suicide is with the use of firearms. On average, approximately 50% of people who commit suicide will use a gun. Men more likely to use a firearm compared to women, as 56% who commit suicide will use a gun, compared to only 30% of women.⁴ Fur

   4 min

6. 6

   Major Depression

   Major depression is more than just a passing blue mood, a bad day, or temporary sadness. The symptoms of major depression are defined as lasting at least two weeks or more and may occur once, or repeatedly over one’s life. During a major depressive episode, thinking can become obscured. People with

   4 min

7. 7

   Schizophrenia

   Schizophrenia is a serious mental illness that affects how someone behaves, feels, and thinks. People with schizophrenia may appear to have a lack of sense of reality, which can cause significant distress for people with schizophrenia, their family members, and their friends.⁸ If schizophrenia is un

   4 min

8. 8

   Substance Abuse

   Drug addiction, also called substance use disorder, is a disease that affects one’s brain and behavior, and leads to an inability to control the use of legal or illegal drugs. Substance abuse can lead to dependency and physiological symptoms that develop after repeated substance use. The symptoms of

   4 min

9. 9

   Alcoholism

   Alcoholism is also known as alcohol abuse, alcohol dependence and alcohol use disorder. Alcoholism occurs when a person drinks alcohol to the point that the body becomes dependent on it. Those who suffer from alcoholism will continue to drink alcohol even when drinking causes negative consequences,

   4 min

10. 10

    Post-Traumatic Stress Disorder

    Post-traumatic stress disorder (PTSD) is a mental health condition that occurs after seeing or experiencing a traumatic event. Not everyone with PTSD has experienced a dangerous event such as war. Some experiences like the sudden death of a loved one can also cause PTSD. Symptoms of PTSD usually beg

    4 min

11. 11

    Bipolar Disorder

    Bipolar disorder is a mental health condition that causes extreme mood swings. The mood swings include emotional highs (mania or hypomania) and emotional lows (depression). The mood swings can occur rarely, or several times a year. ⁷

    4 min

12. 12

    Other Types

    These include bipolar and related disorders caused by drug or alcohol consumption, or due to a medical condition such as Cushing's disease, multiple sclerosis, or stroke.

    4 min

13. 13

    Personality Disorders

    Personality disorders are defined by patterns and behaviors that differ from social norms and expectations.¹⁹ A person who is diagnosed with a personality disorder has difficulty perceiving and relating to situations and people, thinking, functioning, and behaving. Personality disorders cause proble

    4 min

14. 14

    Characterized by a pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent. Indiv

    Cluster B personality disorders are characterized by dramatic, overly emotional, or unpredictable thinking or behavior. They include antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder.

    4 min

15. 15

    Cluster C Personality Disorders

    Cluster C personality disorders are characterized by anxious, fearful thinking or behavior. They include avoidant personality disorder, dependent personality disorder and obsessive-compulsive personality disorder.

    4 min

16. 16

    Dependent Personality Disorder

    Characterized by pervasive psychological need to be cared for by other people. Persons with this disorder may also exhibit:

    4 min

17. 17

    4

    Severe Personality Disorder

    4 min

18. 18

    Attribution

    Often, people who have a personality disorder do not recognize that their behaviors are abnormal and will refuse treatment. This group has been termed the Type R, or people with treatment-resisting personality disorders, as opposed to the Type S or those with treatment-seeking personality disorders.

    4 min

19. 19

    Emotional Stress

    Emotional stress is a condition that occurs when a person’s emotions are affected when they are stressed. There are several contributors to stress; finances, work, family life etc. and not being able to cope with stress can produce physical and emotional symptoms. Emotional signs of stress can inclu

    4 min

20. 20

    Medication Classifications

    Antidepressants: Medications used to treat depression, anxiety, pain, and insomnia

    5 min

21. 21

    Medications Linked to Suicidal Behavior

    Several medications have been linked to suicidal behavior, and this has prompted the United States Food and Drug Administration (FDA) to require a black box warning on several prescription medications which include analgesics, anticonvulsants, and antidepressants. ⁵

    4 min

22. 22

    Medical Management Considerations

    Bipolar Disorder:

    6 min

23. 23

    Age

    The risk of suicide varies by gender, age, ethnicity, and race. Suicide is known to occur in people of all ages, including high school students, but the highest rate of suicide is known to occur in seniors older than age 75. ¹⁷

    4 min

24. 24

    Occupation

    Professions associated with a high rate of suicide include law enforcement and public safety officers (firemen, emergency medical personnel, physicians, etc.). These professionals often have long, irregular work hours, witness various types of injuries, and have access to guns or potent drugs and na

    4 min

25. 25

    Seasonal Variances in Suicide

    Having the birthday blues, where an individual attempts suicide on or around their birthday, is a phenomenon that is resultant of psychological stress, depression, loss, increased drug and alcohol use, or lack of sense of accomplishment. Males between ages 25 to 54 are most likely to commit suicide

    4 min

26. 26

    Screening for Suicidal Behavior

    There has been a lot of debate on the use of universal screening for depression in primary care. The overall feeling is that such screening should only be undertaken if there is a strong commitment to provide treatment and follow up. There are many screening tools for suicide, but there is not one s

    4 min

27. 27

    Available Screening Tools

    The Joint Commission compiled a list of useful resources to meet the needs of assessing for depression and suicidal ideation. The list complied was created by Joint Commission staff and suicide prevention experts who verified that the instruments met the requirements of the standards for risk assess

    6 min

28. 28

    Assessing for Suicide

    An inquiry on suicide should be included in every mental health assessment, and the healthcare professional should keep in mind the person’s age and developmental level when conducting the exam. It is important to obtain a thorough history, especially regarding thoughts and self-destructive behavior

    7 min

29. 29

    First Phase of Intervention

    In many cases, swift intervention can prevent a person from committing suicide. It is critical to act when the risk for suicide is recognized. Based on the clinical assessment and all the information available, if the person is indeed suicidal, the intervention should consist of multiple steps.

    4 min

30. 30

    Second Phase of Intervention

    After the initial intervention, which usually includes hospitalization, it is critical that there be in place an ongoing management treatment plan.

    4 min

31. 31

    Psychotherapy

    While drug treatment is useful for the management of acute symptoms like hallucinations, psychosis, or depression, psychotherapy is essential for long-term management. Psychotherapy is a general term for treating mental health problems by talking with a psychiatrist, psychologist, or other mental he

    4 min

32. 32

    If Suicide Occurs

    Healthcare professionals must work with the individual’s family and friends, as well as with the other patients who knew the deceased.

    4 min

33. 33

    Suicide Resources

    Prior to discharging patients with depression, anxiety, or suicidal ideations, it is important to provide them with resources and referrals. ⁵

    4 min

34. 34

    Conclusion

    Suicide is one of the most important actions that healthcare professionals must address. The healthcare professional’s assessment and intervention remain a critical step to saving a person’s life. The first step is to prevent harm to the person who is suicidal. The second step is to treat the cause

    4 min

35. 35

    Recognizing Suicidal Behavior Posttest

    Depression is a serious medical disorder and associated with a high risk of suicide.

    4 min

36. 36

    Recognizing Suicidal Behavior Posttest Answers

    Depression is a serious medical disorder and associated with a high risk of suicide.

    11 min

This course satisfies

Requirement summaries come from our state requirement records. Always confirm details with your board before you renew.

References and resources

• Agrrawal, P., Waggle, D., & Sandweiss, D. H. (2017). Suicides as a response to adverse market sentiment (1980-2016). PLOS ONE, 12(11), e0186913. https://doi.org/10.1371/journal.pone.0186913
• Ahn, J., Lee, J., & Jung, Y. (2018). Predictors of suicide attempts in individuals with eating disorders. Suicide and Life-Threatening Behavior, 49(3), 789-797. https://doi.org/10.1111/sltb.12477
• Anderson, J., Mitchell, P. B., & Brodaty, H. (2017). Suicidality: Prevention, detection, and intervention. Australian Prescriber, 40(5), 162-166. https://doi.org/10.18773/austprescr.2017.058
• Anestis, M. D., Selby, E. A., & Butterworth, S. E. (2017). Rising longitudinal trajectories in suicide rates: The role of firearm suicide rates and firearm legislation. Preventive Medicine, 100, 159-166. https://doi.org/10.1016/j.ypmed.2017.04.032
• Ballard, E. D., & Zarate, C. A. (2018). Preventing suicide: A multicausal model requires multimodal research and intervention. Bipolar Disorders, 20(6), 558-559. https://doi.org/10.1111/bdi.12656
• Betz, M. E., Brooks-Russell, A., Brandspigel, S., Novins, D. K., Tung, G. J., & Runyan, C. (2018). Counseling suicidal patients about access to lethal means: Attitudes of emergency nurse leaders. Journal of Emergency Nursing, 44(5), 499-504. https://doi.org/10.1016/j.jen.2018.03.012
• Depression (major depressive disorder) - Symptoms and causes. (2018, February 3). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007
• Dickerson, F., Origoni, A., Schweinfurth, L. A., Stallings, C., Savage, C. L., Sweeney, K., Katsafanas, E., Wilcox, H. C., Khushalani, S., & Yolken, R. (2018). Clinical and serological predictors of suicide in schizophrenia and major mood disorders. The Journal of Nervous and Mental Disease, 206(3), 173-178. https://doi.org/10.1097/nmd.0000000000000772
• Dueweke, A. R., & Bridges, A. J. (2018). Suicide interventions in primary care: A selective review of the evidence. Families, Systems, & Health, 36(3), 289-302. https://doi.org/10.1037/fsh0000349
• El-Den, S., O'Reilly, C. L., & Chen, T. F. (2015). A systematic review on the acceptability of perinatal depression screening. Journal of Affective Disorders, 188, 284-303. https://doi.org/10.1016/j.jad.2015.06.015
• Goodfellow, B., Kõlves, K., & Leo, D. (2018). Contemporary definitions of suicidal behavior: A systematic literature review. Suicide and Life-Threatening Behavior, 49(2), 488-504. https://doi.org/10.1111/sltb.12457
• Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Queen, B., Lowry, R., Chyen, D., Whittle, L., Thornton, J., Lim, C., Bradford, D., Yamakawa, Y., Leon, M., Brener, N., & Ethier, K. A. (2018). Youth risk behavior surveillance — United States, 2017. MMWR. Surveillance Summaries, 67(8), 1-114. https://doi.org/10.15585/mmwr.ss6708a1
• Lesage, A., Tra, C., Rahme, E., Renaud, J., Thibodeau, L., & Séguin, M. (2017). Innovative prospects for suicide prevention and action opportunities for the public health agency of Canada and the Government of Canada. Canadian Journal of Community Mental Health, 36(2), 205-237. https://doi.org/10.7870/cjcmh-2017-023
• Lopez-Morinigo, J., Fernandes, A. C., Shetty, H., Ayesa-Arriola, R., Bari, A., Stewart, R., & Dutta, R. (2018). Can risk assessment predict suicide in secondary mental healthcare? Findings from the south London and Maudsley NHS Foundation Trust biomedical research centre (Slam BRC) case register. Social Psychiatry and Psychiatric Epidemiology, 53(11), 1161-1171. https://doi.org/10.1007/s00127-018-1536-8
• Nelson, H. D., Denneson, L. M., Low, A. R., Bauer, B. W., O’Neil, M., Kansagara, D., & Teo, A. R. (2017). Suicide risk assessment and prevention: A systematic review focusing on veterans. Psychiatric Services, 68(10), 1003-1015. https://doi.org/10.1176/appi.ps.201600384
• NIMH » suicide prevention. (n.d.). NIMH » Home. https://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml
• Okolie, C., Dennis, M., Simon Thomas, E., & John, A. (2017). A systematic review of interventions to prevent suicidal behaviors and reduce suicidal ideation in older people. International Psychogeriatrics, 29(11), 1801-1824. https://doi.org/10.1017/s1041610217001430
• Padmanathan, P., Carroll, R., Biddle, L., Derges, J., Potokar, J., & Gunnell, D. (2016). Suicide and self-harm related internet use in patients presenting to hospital with self-harm: A cross-sectional study. The Lancet, 388, S2. https://doi.org/10.1016/s0140-6736(16)32238-3
• Personality disorders - Symptoms and causes. (2016, September 23). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463
• Pidd, K., Roche, A., Cameron, J., Lee, N., Jenner, L., & Duraisingam, V. (2018). Workplace alcohol harm reduction intervention in Australia: Cluster non-randomized controlled trial. Drug and Alcohol Review, 37(4), 502-513. https://doi.org/10.1111/dar.12660
• Schizophrenia - Symptoms and causes. (2020, January 7). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443
• Screening for suicide risk: Recommendation and rationale. (2004). Annals of Internal Medicine, 140(10), 820. https://doi.org/10.7326/0003-4819-140-10-200405180-00014
• Shin, H., Kim, H. J., Kim, S., Choi, S., Oh, H., & Lee, B. (2018). Should let them go? Study on the emergency department discharge of patients who attempted suicide. Psychiatry Investigation, 15(6), 638-648. https://doi.org/10.30773/pi.2018.04.15
• Stone, D. M., Simon, T. R., Fowler, K. A., Kegler, S. R., Yuan, K., Holland, K. M., Ivey-Stephenson, A. Z., & Crosby, A. E. (2018). Vital Signs: Trends in state suicide rates — United States, 1999–2016 and circumstances contributing to suicide — 27 states, 2015. MMWR. Morbidity and Mortality Weekly Report, 67(22), 617-624. https://doi.org/10.15585/mmwr.mm6722a1
• Symptoms of PTSD. (n.d.). Anxiety and Depression Association of America, ADAA. https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd/symptoms
• Tighe, J., Nicholas, J., Shand, F., & Christensen, H. (2018). Efficacy of acceptance and commitment therapy in reducing suicidal ideation and deliberate self-harm: Systematic review (Preprint). https://doi.org/10.2196/preprints.10732
• Why more men are taking their own lives. (n.d.). Verywell Mind. https://www.verywellmind.com/men-and-suicide-2328492
• Zhong, Q., Gelaye, B., Fricchione, G. L., Avillach, P., Karlson, E. W., & Williams, M. A. (2018). Adverse obstetric and neonatal outcomes complicated by psychosis among pregnant women in the United States. BMC Pregnancy and Childbirth, 18(1). https://doi.org/10.1186/s12884-018-1750-0

Update history