A 64-year-old woman comes to the office due to insomnia, fatigue, and a 9.1-kg (20-lb) weight loss. Thorough medical and laboratory evaluations show normal results. The patient is frequently tearful and increasingly socially isolated. She no longer returns phone calls from her friends and says, "I can't be around anybody because I just burst into tears." Although previously a regular churchgoer, she has recently stopped attending because she feels hopeless and that "God has abandoned me." The patient has had thoughts of suicide but no specific plan. She has no history of suicide attempts. Her medical problems include coronary artery disease, hypertension, basal cell carcinoma, and osteoarthritis. She does not use tobacco, alcohol, or illicit drugs. There is no family history of suicide. The patient is married and lives with her husband, adult daughter, and 3 young grandchildren. She says, "Taking care of my grandchildren is truly the only thing that keeps me going anymore." A diagnosis of major depression is made, and the patient is started on an antidepressant and referred for psychotherapy. Which of the following would be considered the best protective factor against suicide in this patient?

Question

A 64-year-old woman comes to the office due to insomnia, fatigue, and a 9.1-kg (20-lb) weight loss.  Thorough medical and laboratory evaluations show normal results.  The patient is frequently tearful and increasingly socially isolated.  She no longer returns phone calls from her friends and says, "I can't be around anybody because I just burst into tears."  Although previously a regular churchgoer, she has recently stopped attending because she feels hopeless and that "God has abandoned me."  The patient has had thoughts of suicide but no specific plan.  She has no history of suicide attempts.  Her medical problems include coronary artery disease, hypertension, basal cell carcinoma, and osteoarthritis.  She does not use tobacco, alcohol, or illicit drugs.  There is no family history of suicide.  The patient is married and lives with her husband, adult daughter, and 3 young grandchildren.  She says, "Taking care of my grandchildren is truly the only thing that keeps me going anymore."  A diagnosis of major depression is made, and the patient is started on an antidepressant and referred for psychotherapy.  Which of the following would be considered the best protective factor against suicide in this patient?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c1b7_5287_8f63_6722ab9590c6_MD0005_00 A comprehensive suicide risk assessment includes consideration of risk and protective factors. This patient has a number of risk factors for suicide, including depression with suicidal ideation, hopelessness, and physical illness. Her connection to her family and responsibility to her grandchildren (lives with daughter, is caregiver for grandchildren) are important protective factors. Although religious affiliation is generally considered a protective factor, it must be carefully assessed on an individual basis. Patients experiencing spiritual distress may be at increased risk. In this case, the patient has stopped attending church and believes that God has "abandoned" her, making her religious affiliation less of a protective factor (Choice E). (Choice B) Suicide risk varies with marital status, with highest risk in those never married, followed in descending order by those widowed, separated, and divorced. However, it is this patient's connection to her grandchildren and sense of responsibility to her family, and not just her marital status per se, that provide the most protection. (Choices C and D) Although this patient has no prior suicide attempts or family history of suicide, these are not protective factors. Her connection to her family and sense of responsibility to them mitigates her current risk and protects her from acting on suicidal thoughts. Educational objective: Physicians should evaluate both risk and protective factors when performing suicide risk assessments. Connection to family, pregnancy, and responsibility for children are important protective factors. Religious affiliation is often protective but should be carefully assessed to rule out negative religious coping. References: Social support as a protective factor in suicide: findings from two nationally representative samples. (http://www.ncbi.nlm.nih.gov/pubmed/23466401) Negative religious coping as a correlate of suicidal ideation in patients with advanced cancer. (http://www.ncbi.nlm.nih.gov/pubmed/24577802) Religion and suicide risk: a systematic review. (http://www.ncbi.nlm.nih.gov/pubmed/26192968)

A 64-Year-Old Woman Comes to the Office Due to Insomnia