A 16-year-old boy with suicidal thoughts is brought to the office by his parents. He has been in constant conflict with his parents since refusing to stop drinking alcohol, which he does on a daily basis. The patient is the oldest of 6 children; his mother suffers from lower back pain and relies on him for child care, which he finds overwhelming. His father works 2 jobs and is often not around to help with the children. His mother keeps a firearm by her bedside for protection when she is alone with the children at night. The patient dropped out of high school last year after getting dumped by his girlfriend. He recently contracted Lyme disease with resultant symptoms of fatigue and myalgia. Which of the following interventions is the best next step to decrease this patient's risk of completed suicide?

Question

A 16-year-old boy with suicidal thoughts is brought to the office by his parents.  He has been in constant conflict with his parents since refusing to stop drinking alcohol, which he does on a daily basis.  The patient is the oldest of 6 children; his mother suffers from lower back pain and relies on him for child care, which he finds overwhelming.  His father works 2 jobs and is often not around to help with the children.  His mother keeps a firearm by her bedside for protection when she is alone with the children at night.  The patient dropped out of high school last year after getting dumped by his girlfriend.  He recently contracted Lyme disease with resultant symptoms of fatigue and myalgia.  Which of the following interventions is the best next step to decrease this patient's risk of completed suicide?

Quizplus · Accepted Answer

11ec160b_364c_8b12_9249_c7b5e7156c29_MD0001_00 Suicide is a major public health issue that is linked to approximately 1 million deaths worldwide each year. It is the second leading cause of death, after accidents, in those aged 15-24. Suicide risk management involves controlling modifiable factors that decrease the risk of suicide, such as decreasing stress, improving psychosocial support, treating psychiatric illness and substance abuse, managing pain, and limiting access to firearms or other means of self-harm. Other risk factors are static and cannot be modified. These include age (teenagers and the elderly), male sex, family history of suicide, and history of previous attempts. Individuals with access to firearms have 3 times the risk of suicide completion, as suicide by firearm is associated with a higher fatality rate compared to other methods. Due to the impulsivity often associated with suicide in teenagers, limiting this patient's access to firearms is the most important next step to decrease his risk. (Choice B) Treatment for this patient's depression should be offered. However, the next step is to advise his mother to lock away her firearm, so that the risk of completed suicide is decreased while treatment takes effect. (Choice C) Providing the mother with assistance could decrease the patient's burden in the long term but is not an immediate intervention. (Choice D) Although alcohol use increases the risk for suicide by impairing judgment, this teenager does not acknowledge that he has an alcohol problem and may not be willing to start counseling at this time. Removing access to weapons is a more immediate measure. (Choice E) Although decreasing this patient's isolation and improving his future prospects by helping him return to school is important in the long term, limiting access to firearms is the most pressing concern. (Choice F) Chronic illness involving pain is a strong risk factor for attempted suicide. Although the patient's Lyme disease should be treated to prevent further disability, removal of access to firearms is more likely to prevent a completed suicide at this stage. Educational objective: Access to firearms greatly increases the risk of completed suicide. Evaluation of a patient's access to guns is a key part of suicide risk assessment. Other interventions to reduce suicide risk include decreasing stress, increasing psychosocial support, treating psychiatric illness and substance use, and managing pain. __________ References: Firearm storage in gun-owning households with children: results of a 2015 national survey. (http://www.ncbi.nlm.nih.gov/pubmed/29748766) The accessibility of firearms and risk for suicide and homicide victimization among household members: a systematic review and meta-analysis. (http://www.ncbi.nlm.nih.gov/pubmed/24592495)

A 16-Year-Old Boy with Suicidal Thoughts Is Brought to the Office