Emergency physicians have a significant responsibility in recognizing, managing and preventing suicidal behavior. This paper proposes a theoretical model for disposition of patients with suicidal ideas and behavior. This model is based on five well documented predictors of suicide: intention and lethality of the suicide attempt, psychiatric diagnosis, demographic and clinical factors, attitude towards the attempt and support system.
Treatment recommendations are based on initial assessment of these factors. Inpatients must be carefully supervised; the commonest forms of suicide in hospital are hanging and jumping from heights. Treatment plans should be implemented immediately. Since compliance with follow-up is very low in these patients, outpatient treatment should be implemented with an outreach program and integrated with community psychiatric and mental health services.
Factors which can be responsible to induce suicidal thoughts
- Severe anxiety
- Panic attack
- Severe anhedonia
- Alcohol abuse
- Substantially decreased ability to concentrate
- Repeated deliberate self harm
- History of physical or sexual abuse
- Employment problems
- Relationship loss
- Poor response to medication
- Hopelessness
- Family history of psychiatric illness