A 71-year-old woman is brought to the emergency department with suicidal ideation. Medical history includes major depressive disorder as well as chronic knee and back pain due to injuries sustained in a motor vehicle collision. Developmental history is significant for physical abuse as a child. Family history is significant for bipolar disorder and completed suicide in her father. The patient reports increasing depression since losing her job a year ago and separating from her husband of 40 years 6 months ago. She has a history of 2 prior hospitalizations for depression and a previous suicide attempt. The patient is recovering from alcohol use disorder and attends weekly Alcoholics Anonymous meetings at her church. Although she lives alone, she is close to her daughter, who lives nearby. The patient reports that she owns a firearm that is kept in a locked cabinet. Which of the following is the strongest risk factor for completed suicide in this patient?

Question

A 71-year-old woman is brought to the emergency department with suicidal ideation.  Medical history includes major depressive disorder as well as chronic knee and back pain due to injuries sustained in a motor vehicle collision.  Developmental history is significant for physical abuse as a child.  Family history is significant for bipolar disorder and completed suicide in her father.  The patient reports increasing depression since losing her job a year ago and separating from her husband of 40 years 6 months ago.  She has a history of 2 prior hospitalizations for depression and a previous suicide attempt.  The patient is recovering from alcohol use disorder and attends weekly Alcoholics Anonymous meetings at her church.  Although she lives alone, she is close to her daughter, who lives nearby.  The patient reports that she owns a firearm that is kept in a locked cabinet.  Which of the following is the strongest risk factor for completed suicide in this patient?

Quizplus · Accepted Answer

11ec160b_3618_346f_9249_cb6ee5dc973d_MD0001_00 A comprehensive suicide risk assessment involves considering both risk and protective factors. This patient has multiple risk factors for suicide, including her marital status, unemployment, psychiatric illness, past suicide attempt, family history of suicide, chronic pain, childhood abuse, and access to a firearm. Of these risk factors, a history of attempted suicide is the strongest single factor predictive of completed suicide. Patients with previous suicide attempts are 5-6 times more likely to make another attempt. Studies suggest that 1 out of 100 people who survive a suicide attempt will complete suicide within a year. This is 100 times the risk seen in the general population. Protective factors in this patient include her status as a parent with a connection to her daughter, participation in her church, and sobriety (as alcohol and other drugs have disinhibiting effects that increase the risk of acting on suicidal impulses). (Choice A) Studies suggest that the risk of completed suicide in those who have access to firearms is 3 times greater than in those who do not. (Choices B, C, and H) Age, male sex, and being separated/divorced are risk factors for suicide. Elderly (age >75) white men have the highest suicide rate. Although women attempt suicide nearly twice as often, men use more lethal methods (eg, firearms) that result in completed suicide 3 times more often. Suicide risk is highest in individuals who have never married, followed by those who are widowed, separated, or divorced. (Choices D and E) A history of adverse childhood experiences (eg, abuse, parental discord, parental substance abuse) and a family history of suicide increase the risk of suicide, most likely due to both environmental and genetic factors. (Choice G) Psychiatric illness, especially when associated with hopelessness, is a strong predictive factor for suicide. Of patients who die by suicide, 90% have a diagnosable psychiatric disorder at the time of death. Increased severity of illness and recent discharge from psychiatric inpatient care are additional risk factors. Educational objective: Suicide risk assessment includes consideration of both risk and protective factors. A history of a previous suicide attempt is the strongest single risk factor for further attempts and completed suicide. __________ References: Determinants and outcomes of serious attempted suicide: a nationwide study in Finland, 1996-2003. (http://www.ncbi.nlm.nih.gov/pubmed/18343881) Depression in primary care: assessing suicide risk. (http://www.ncbi.nlm.nih.gov/pubmed/28210741) Literature-based recommendations for suicide assessment in the emergency department: a review. (http://www.ncbi.nlm.nih.gov/pubmed/23040403)

A 71-Year-Old Woman Is Brought to the Emergency Department with Suicidal