Advertisement

Suicide and Attempted Suicide

  • Akshay IlangoEmail author
Reference work entry

Abstract

To provide a broader perspective on suicide, this chapter has drawn on knowledge from the areas of suicide risk assessment in general psychiatry and consultation liaison psychiatry. Epidemiology of suicide and contextual factors are mentioned briefly to set the scene. A framework to assess and manage the suicidal patient is described in some detail, to assist the palliative care clinician. This is followed by a description of the key issues involved in the care of a psychiatric patient within the palliative care context. The latter part of the chapter elaborates on the experiences of those bereaved after a suicide. The impact of suicide on clinicians is explored, as well as strategies to manage the distress that can ensue. The chapter ends with a discussion of the unspoken issue of physician suicide. Terms such as mental illness, psychiatric illness, and psychiatric disorder will be used interchangeably. Specific aspects of management of underlying psychiatric disorders are detailed in the Chap. 85, “Distinguishing and Managing Severe Psychological and Psychiatric Distress” (authored by Ms. Jane Fletcher and Dr. Di Clifton). Acute non-suicidal self-harm (previously termed parasuicide), chronic suicidal ideation, chronic self-harm, and suicide in special populations, e.g., adolescents, have been excluded from the chapter. Requests for a hastened death, physician-assisted suicide, and euthanasia have been detailed in the chapter 90, “Request for Assisted Suicide” (authored by Dr. Diamond, Dr. Khurana, and Prof Quill).

References

  1. Agerbo E. Risk of suicide and spouse’s psychiatric illness or suicide: nested case-control study. BMJ. 2003;327(7422):1025–6.CrossRefPubMedGoogle Scholar
  2. Alici Y, Jaiswal R, Pessin H, Breitbart W. Suicide. In: Bruera E, Higginson I, von Gunten CF, Morita T, editors. Textbook of palliative medicine and supportive care. 2nd ed. Boca Raton: CRC Press; 2016. p. 887–95.Google Scholar
  3. American Foundation for Suicide Prevention [Internet]. New York: American Foundation for Suicide Prevention; 2016. Ten facts about physician suicide and mental health; 2016 [2016 December 2]. Available from: http://afsp.org/wp-content/uploads/2016/11/ten-facts-about-physician-suicide.pdf
  4. Andersohn F, Willich S. Interaction of serotonin reuptake inhibitors with tamoxifen. BMJ. 2010;340:c783.CrossRefPubMedGoogle Scholar
  5. Andriessen K, Draper B, Dudley M, Mitchell P. Bereavement after suicide. Crisis. 2015;36(5):299–303.  https://doi.org/10.1027/0227-5910/a000339.CrossRefPubMedGoogle Scholar
  6. Breitbart W, Rosenfeld B, Pessin H, Applebaum A, Kulikowski J, Lichtenthal WG. Meaning-centered group psychotherapy: an effective intervention for improving psychological well-being in patients with advanced cancer. J Clini Oncol. 2015;33:749–54.CrossRefGoogle Scholar
  7. Breitbart W, Pessin H, Rosenfeld B, Applebaum AJ, Lichtenthal WG, Li Y, et al. Individual meaning‐centered psychotherapy for the treatment of psychological and existential distress: a randomized controlled trial in patients with advanced cancer. Cancer. 2018.  https://doi.org/10.1002/cncr.31539CrossRefPubMedGoogle Scholar
  8. Berrios GE. The history of mental symptoms; descriptive psychopathology since the nineteenth century. Cambridge: Cambridge University Press; 1996. p. 443.CrossRefGoogle Scholar
  9. Borges G, Walters EE, Kessler RC. Associations of substance use, abuse, and dependence with subsequent suicidal behaviour. Am J Epidemiol. 2000;151(8):781–9.CrossRefGoogle Scholar
  10. Breitbart W, Rosenfeld B, Pessin H, Kaim M, Funesti-Esch J, Galietta M, Nelson CJ, Brescia R. Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA. 2000;284(22):2907–11.CrossRefPubMedGoogle Scholar
  11. Cavanagh JT, Carson AJ, Sharpe M, Lawrie SM. Psychological autopsy studies of suicide: a systematic review. Psychol Med. 2003;33(03):395–405.CrossRefGoogle Scholar
  12. Center C, Davis M, Detre T, Ford DE, Hansbrough W, Hendin H, Laszlo J, Litts DA, Mann J, Mansky PA, Michels R. Confronting depression and suicide in physicians: a consensus statement. JAMA. 2003;289(23):3161–6.CrossRefGoogle Scholar
  13. Centers for Disease Control and Prevention. Definitions: self-directed violence [Internet]. Georgia: Centers for Disease Control and Prevention; 2016. [updated 2016 August 15; cited 2016 October 14]. Available from: http://www.cdc.gov/violenceprevention/suicide/definitions.html
  14. Chesney E, Goodwin GM, Fazel S. Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry. 2014;13(2):153–60.CrossRefPubMedGoogle Scholar
  15. Chochinov HM, Wilson KG, Enns M, Lander S. Depression, hopelessness, and suicidal ideation in the terminally ill. Psychosomatics. 1998;39(4):366–70.CrossRefGoogle Scholar
  16. Cotton PG, Drake RE Jr, Whitaker A, Potter J. Dealing with suicide on a psychiatric inpatient unit. Psychiatr Serv. 1983;34(1):55–9.CrossRefGoogle Scholar
  17. Druss B, Pincus H. Suicidal ideation and suicide attempts in general medical illnesses. Arch Intern Med. 2000;160(10):1522–6.CrossRefGoogle Scholar
  18. Fan W, Yang H, Sun Y, Zhang J, Li G, Zheng Y, Liu Y. Ketamine rapidly relieves acute suicidal ideation in cancer patients: a randomized controlled clinical trial. Oncotarget. 2016;8(2):2356–60.PubMedCentralPubMedGoogle Scholar
  19. Fang CK, Chang MC, Chen PJ, Lin CC, Chen GS, Lin J, et al. A correlational study of suicidal ideation with psychological distress, depression, and demoralization in patients with cancer. Support Care Cancer. 2014;22:3165–74.  https://doi.org/10.1007/s00520-014-2290-4CrossRefPubMedGoogle Scholar
  20. Gitlin MJ. A psychiatrist’s reaction to a patient’s suicide. Am J Psychiatr. 1999;156(10):1630–4.CrossRefGoogle Scholar
  21. Goldney R. The importance of mental disorders in suicide. Aust N Z J Psychiatry. 2015;49(1):21–3.  https://doi.org/10.1177/0004867414549200.CrossRefGoogle Scholar
  22. Goodwin RD, Marusic A, Hoven CW. Suicide attempts in the United States: the role of physical illness. Soc Sci Med. 2003;56(8):1783–8.CrossRefGoogle Scholar
  23. Grad OT. Suicide: how to survive as a survivor? Crisis. 1996;17(3):136–42.CrossRefGoogle Scholar
  24. Grassi L, Caruso R, Hammelef K, Nanni MG, Riba M. Efficacy and safety of pharmacotherapy in cancer-related psychiatric disorders across the trajectory of cancer care: a review. Int Rev Psychiatry. 2014;26(1):44–62.CrossRefGoogle Scholar
  25. Harris EC, Barraclough B. Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry. 1997;170(3):205–28.CrossRefGoogle Scholar
  26. Hawton K, Zahl D, Weatherall R. Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital. Br J Psychiatry. 2003;182(6):537–42.CrossRefGoogle Scholar
  27. Hodgkiss A, Mascarenhas S. Psycho-oncology. In: Guthrie E, Rao S, Temple M, editors. Seminars in liaison psychiatry. Glasgow: Bell and Bain Limited; 2012. p. 190.Google Scholar
  28. Howard LM, Barley EA, Davies E, Rigg A, Lempp H, Rose D, Taylor D, Thornicroft G. Cancer diagnosis in people with severe mental illness: practical and ethical issues. Lancet Oncol. 2010;11(8):797–804.CrossRefGoogle Scholar
  29. Hunt IM, Kapur N, Webb R, Robinson J, Burns J, Shaw J, Appleby L. Suicide in recently discharged psychiatric patients: a case-control study. Psychol Med. 2009;39(03):443–9.CrossRefGoogle Scholar
  30. International Association for Suicide Prevention IASP (Internet). Washington, D.C.: Grad O; Guidelines to assist clinical staff after the suicide of a patient; [cited 2016 October 11]. Available from: https://www.iasp.info/pdf/postvention/guidelines_to_assist_clinical_staff_after_suicide_patient_grad.pdf
  31. Kadan-Lottick NS, Vanderwerker LC, Block SD, Zhang B, Prigerson HG. Psychiatric disorders and mental health service use in patients with advanced cancer. Cancer. 2005;104(12):2872–81.CrossRefPubMedGoogle Scholar
  32. Kellner CH, Fink M, Knapp R, Petrides G, Husain M, Rummans T, Mueller M, Bernstein H, Rasmussen K, O’Connor K, Smith G. Relief of expressed suicidal intent by ECT: a consortium for research in ECT study. Am J Psychiatr. 2005;162(5):977–82.CrossRefPubMedGoogle Scholar
  33. Kisely S, Smith M, Lawrence D, Maaten S. Mortality in individuals who have had psychiatric treatment. Population-based study in Nova Scotia. Br J Psychiatry. 2005;187(6):552–8.CrossRefPubMedGoogle Scholar
  34. Kisely S, Crowe E, Lawrence D. Cancer-related mortality in people with mental illness. JAMA Psychiat. 2013;70(2):209–17.CrossRefGoogle Scholar
  35. Kisely S, Forsyth S, Lawrence D. Why do psychiatric patients have higher cancer mortality rates when cancer incidence is the same or lower? Aust N Z J Psychiatry. 2015;50(3):254–63.CrossRefPubMedGoogle Scholar
  36. Kissane DW, Levin T, Hales S, Lo C, Rodin G. Psychotherapy for depression in cancer and palliative care. In: Kissane DW, Maj M, Sartorius N, editors. Cancer and depression. Wiley: Chichester; 2011.Google Scholar
  37. Kissane DW. Demoralization – a life-preserving diagnosis to make in the severely medically ill. J Palliat Care. 2014;30(4):255–8.CrossRefPubMedGoogle Scholar
  38. Kissane DW, Bobevski I, Gaitanis P, Brooker J, Michael N, Lethborg C, et al. Exploratory examination of the utility of demoralization as a specifier for adjustment disorder and major depression. Gen Hosp Psychiatry. 2017;46:20–4.  https://doi.org/10.1016/j.genhosppsych.2017.01.007CrossRefPubMedGoogle Scholar
  39. Law MK, Furr RM, Arnold EM, Mneimne M, Jaquett C, Fleeson W. Does assessing suicidality frequently and repeatedly cause harm? A randomized control study. Psychol Assess. 2015;27(4):1171–81.CrossRefPubMedGoogle Scholar
  40. Lethborg C, Kissane DW, Schofield, P. Meaning and Purpose (MAP) Therapy I: therapeutic processes and paradox in how it helps patients with advanced cancer. Palliat Support Care. 2018 (in press).Google Scholar
  41. Lindeman S, Henriksson M, Isometsä E, Lönnqvist J. Treatment of mental disorders in seven physicians committing suicide. Crisis. 1999;20(2):86–9.CrossRefPubMedGoogle Scholar
  42. Little JD. Staff response to inpatient and outpatient suicide: what happened and what do we do? Aust N Z J Psychiatry. 1992;26(2):162–7.CrossRefPubMedGoogle Scholar
  43. Luoma JB, Martin CE, Pearson JL. Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatr. 2002;159(6):909–16.CrossRefPubMedGoogle Scholar
  44. Malhi GS, Bassett D, Boyce P, Bryant R, Fitzgerald PB, Fritz K, Hopwood M, Lyndon B, Mulder R, Murray G, Porter R. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry. 2015;49(12):1087–206.CrossRefPubMedGoogle Scholar
  45. McGirr A, Renaud J, Seguin M, Alda M, Turecki G. Course of major depressive disorder and suicide outcome: a psychological autopsy study. J Clin Psychiatry. 2008;69(6):966–70.CrossRefPubMedGoogle Scholar
  46. Middleton JL. Today I’m grieving a physician suicide. Ann Fam Med. 2008;6(3):267–9.CrossRefPubMedGoogle Scholar
  47. Milner AJ, Maheen H, Bismark MM, Spittal MJ. Suicide by health professionals: a retrospective mortality study in Australia, 2001–2012. Med J Aust. 2016;205(6):260–5.CrossRefGoogle Scholar
  48. Miovic M, Block S. Psychiatric disorders in advanced cancer. Cancer. 2007;110(8):1665–76.CrossRefPubMedGoogle Scholar
  49. Misch DA. When a psychiatry resident’s patient commits suicide: transference trials and tribulations. J Am Acad Psychoanal Dyn Psychiatry. 2003;31(3):459–75.CrossRefGoogle Scholar
  50. Misono S, Weiss NS, Fann JR, Redman M, Yueh B. Incidence of suicide in persons with cancer. J Clin Oncol. 2008;26(29):4731–8.CrossRefPubMedGoogle Scholar
  51. Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, Meader N. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 2011;12(2):160–74.CrossRefPubMedGoogle Scholar
  52. Mitchell AJ, Santo Pereira IE, Yadegarfar M, Pepereke S, Mugadza V, Stubbs B. Breast cancer screening in women with mental illness: comparative meta-analysis of mammography uptake. Br J Psychiatry. 2014;205(6):428–35.CrossRefGoogle Scholar
  53. Murrough JW, Iosifescu DV, Chang LC, Al Jurdi RK, Green CE, Perez AM, Iqbal S, Pillemer S, Foulkes A, Shah A, Charney DS. Antidepressant efficacy of ketamine in treatment-resistant major depression: a two-site randomized controlled trial. Am J Psychiatr. 2013;170(10):1134–42.CrossRefGoogle Scholar
  54. O’Reilly D, Rosato M. Religion and the risk of suicide: longitudinal study of over 1 million people. Br J Psychiatry. 2015;206(6):466–70.CrossRefGoogle Scholar
  55. Passik SD, Gibson C, Breitbart W, Rotta ML. Psychiatric issues in cancer pain management. In: Fisch M, Burton AW, editors. Cancer pain management. New York: McGraw-Hill; 2007. p. 140.Google Scholar
  56. Pitman AL, Osborn DP, Rantell K, King MB. Bereavement by suicide as a risk factor for suicide attempt: a cross-sectional national UK-wide study of 3432 young bereaved adults. BMJ Open. 2016;6(1):e009948.CrossRefPubMedGoogle Scholar
  57. Pokorny AD. Prediction of suicide in psychiatric patients: report of a prospective study. Arch Gen Psychiatry. 1983;40(3):249–57.CrossRefGoogle Scholar
  58. Qin P, Agerbo E, Mortensen PB. Suicide risk in relation to family history of completed suicide and psychiatric disorders: a nested case-control study based on longitudinal registers. Lancet. 2002;360(9340):1126–30.CrossRefGoogle Scholar
  59. Reinstatler L, Youssef NA. Ketamine as a potential treatment for suicidal ideation: a systematic review of the literature. Drugs R&D. 2015;15(1):37–43.CrossRefGoogle Scholar
  60. Results from the 2013 National survey on Drug Use and Health: Mental Health Findings [Internet]. Rockville: Substance Abuse and Mental Health Services Administration; November 2014a. Suicidal thoughts and behaviour; November 2014 [cited 2016 September 21]; p. 29. Available from: http://www.samhsa.gov/data/sites/default/files/NSDUHmhfr2013/NSDUHmhfr2013.pdf
  61. Results from the 2013 National Survey on Drug Use and Health: Mental Health Findings [Internet]. Rockville: Substance Abuse and Mental Health Services Administration; November 2014b. Substance use among adults with mental illness; November 2014 [cited 2016 September 21]; pp. 48–49. Available from: http://www.samhsa.gov/data/sites/default/files/NSDUHmhfr2013/NSDUHmhfr2013.pdf
  62. Robinson S, Kissane, DW, Brooker, J, Burney, S. A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research. J Pain and Symptom Manage. 2015;49(3):595–610.  https://doi.org/10.1016/j.jpainsymmanCrossRefGoogle Scholar
  63. Robinson S, Kissane DW, Brooker J, Burney S. A review of the construct of demoralization: history, definitions, and future directions for palliative care. Am J Hosp Palliat Med. 2016;33(1):93–101.  https://doi.org/10.1177/1049909114553461CrossRefGoogle Scholar
  64. Robinson S, Kissane DW, Brooker J, Hempton C, Burney S. The relationship between poor quality of life and desire to hasten death: a multiple mediation model examining the contributions of depression, demoralization, loss of control, and low self-worth. J Pain Symptom Manage. 2017;53(2).  https://doi.org/10.1016/j.jpainsymman.2016.08.013CrossRefGoogle Scholar
  65. Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatr. 2004;161(12):2295–302.CrossRefGoogle Scholar
  66. Selzer R, Ellen S. Formulation for beginners. Australas Psychiatry. 2014;22(4):397–401.CrossRefGoogle Scholar
  67. Simon RI. Suicide risk assessment forms: form over substance? J Am Acad Psychiatry Law. 2009;37(3):290–3.Google Scholar
  68. Spoletini I, Gianni W, Caltagirone C, Madaio R, Repetto L, Spalletta G. Suicide and cancer: where do we go from here? Crit Rev Oncol Hematol. 2011;78(3):206–19.CrossRefGoogle Scholar
  69. Statham DJ, Heath AC, Madden PA, Bucholz KK, Bierut L, Dinwiddie SH, Slutske WS, Dunne MP, Martin NG. Suicidal behaviour: an epidemiological and genetic study. Psychol Med. 1998;28(04):839–55.CrossRefGoogle Scholar
  70. Suominen K, Isometsä E, Suokas J, Haukka J, Achte K, Lönnqvist J. Completed suicide after a suicide attempt: a 37-year follow-up study. Am J Psychiatr. 2004;161(3):562–3.CrossRefGoogle Scholar
  71. Sveen CA, Walby FA. Suicide survivors’ mental health and grief reactions: a systematic review of controlled studies. Suicide Life Threat Behav. 2008;38(1):13–29.CrossRefGoogle Scholar
  72. Tabarés-Seisdedos R, Dumont N, Baudot A, Valderas JM, Climent J, Valencia A, Crespo-Facorro B, Vieta E, Gómez-Beneyto M, Martínez S, Rubenstein JL. No paradox, no progress: inverse cancer comorbidity in people with other complex diseases. Lancet Oncol. 2011;12(6):604–8.CrossRefGoogle Scholar
  73. Tillman J. The suicide of patients and the quiet voice of the therapist. J Am Acad Psychoanal Dyn Psychiatry. 2003;31(3):425–7.CrossRefGoogle Scholar
  74. Trevino KM, Abbott CH, Fisch MJ, Friedlander RJ, Duberstein PR, Prigerson HG. Patient-oncologist alliance as protection against suicidal ideation in young adults with advanced cancer. Cancer. 2014;120(15):2272–81.CrossRefPubMedGoogle Scholar
  75. Turecki G, Brent DA. Suicide and suicidal behaviour. Lancet. 2016;387(10024):1227–39. Panel 1, page 1233CrossRefGoogle Scholar
  76. Vehling S, Kissane DW, Lo C, Glaesmer H, Hartung TJ, Rodin G, Mehnert A. The association of demoralization with mental disorders and suicidal ideation in patients with cancer. Cancer. 2017;123(17):3394–401.  https://doi.org/10.1002/cncr.30749CrossRefGoogle Scholar
  77. Violence Prevention (Internet). Atlanta: Centers for Disease Control and Prevention; 2016. Suicide: risk and protective factors; 2016 (date cited 2016 February 24). Available from http://www.cdc.gov/violenceprevention/suicide/riskprotectivefactors.html
  78. Vyssoki B, Gleiss A, Rockett IR, Hackl M, Leitner B, Sonneck G, Kapusta ND. Suicide among 915,303 Austrian cancer patients: who is at risk? J Affect Disord. 2015;175:287–91.CrossRefGoogle Scholar
  79. World Health Organisation. Global Health Observatory data [Internet]. Geneva: World Health Organization; 2012. [cited 2016 November 13]. Available from: http://www.who.int/gho/mental_health/suicide_rates/en/
  80. Zwil AS, Pelchat RJ. ECT in the treatment of patients with neurological and somatic disease. Int J Psychiatry Med. 1994;24(1):1–29.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.RANZCPMelbourneAustralia
  2. 2.Monash HealthMelbourneAustralia
  3. 3.Austin HealthMelbourneAustralia

Personalised recommendations