Suicide prevention and first aid


A resource for GPs

Suicide

☰ Table of contents


People who are contemplating suicide will often give some clues or signs to those around them, including friends, family, colleagues, their GP or other mental health professionals.7 Preventing suicide starts with recognising and acting on warning signs, which usually occur in combination, and being aware of the specific risk factors involved. It should be noted, however, that in some cases there might not be any warning signs.


Did you know …


In 2013, 65,000 people attempted suicide in Australia, and in 2014, 2864 lives were lost by suicide.4 That is almost eight people every day.


Risk factors


Risk factors for suicide include:

  • previous suicide attempt(s)
  • substance abuse
  • low/limited social support
  • male gender
  • a feeling of hopelessness/absolute despair
  • having lost a family member to suicide
  • mental disorders.


Protective factors


Personal protective factors include:

  • adaptive coping skills
  • effective problem solving skills
  • self-understanding
  • sense of competence
  • spirituality.

Work protective factors include:

  • supportive work environment
  • positive relationships with colleagues
  • professional development opportunities
  • access to employee assistance programs.

Family and community protective factors include:

  • relationship to family
  • sense of responsibility
  • involvement in social/community activities/support group
  • access to support within their means.

 


Suicide warning signs

Does your patient describe any of the following?

  • Quitting activities that were once important Withdrawing from family/friends
  • Writing a suicide note or goodbye letter to people
  • A sense of hopelessness or no hope for the future
  • Isolation or feeling alone – ‘No one understands me’
  • Aggressiveness and irritability – ‘Leave me alone’
  • Possessing lethal means – medication, weapons
  • Negative view of self – ‘I am worthless’
  • Drastic changes in mood and behaviour
  • Frequently talking about death – ‘If I died would you miss me?’
  • Self-harming behaviours (eg cutting)
  • Engaging in ‘risky’ behaviours – ‘I’ll try anything, I’m not afraid to die’
  • Making funeral arrangements
  • Giving things away (clothes, expensive gifts) – ‘When I am gone, I want you to have this’
  • Substance abuse
  • Feeling like a burden to others – ‘You would be better off without me’
  • Making suicide threats – ‘Sometimes I feel like I just want to die’


 

The videos below present some common warning signs of suicide and thoughts and feelings experienced by people who were at risk of suicide.
 

 

beyondblue – Suicide warning signs

beyondblue – Suicidal thoughts


Risk factor – Mental disorders


Literature suggests that there is a significant correlation between suicide and diagnosed mood disorders; notably mood, substance-related, anxiety and psychotic disorders with comorbidity being common.3 It is important that GPs be able to detect the key warning signs and assess for mental disorders.


Further reading and resources


Australian Institute of Male Health and Studies (AIMHS) – Male suicide,
beyondblue – Suicide

Living Is For Everyone (LIFE) – Fact sheets

Lifeline – Facts about suicide

Mental Health First Aid (MHFA) Australia – First aid guidelines: Suicidal thoughts and behaviours

Suicide Call Back Service

Suicideline – Estimating the risk of suicide

Suicideline – Warning signs and risk factors

On The Line - 24/7 professional telephone, video and online-chat counselling services

  1. Mental Health First Aid Australia. What we do at Mental Health First Aid. Melbourne: MHFA, 2015.  [Accessed 4 March 2016].
  2. Ferrari AJ, Norman RE, Freedman G, et al. The burden attributable to mental and substance use disorders as risk factors for suicide: Findings from the global burden of disease study 2010. PLoS One 2014;9(4):e91936.
  3. Hawton K, van Heeringen K. Suicide. Lancet 2009;373(9672):1372–81.
  4. Australian Bureau of Statistics. Causes of death, Australia, 2014. Cat. no. 3303.0. Canberra: ABS, 2016.  [Accessed 1 February 2016].
  5. Australian Bureau of Statistics. Australian social trends, March, 2011. Cat. no. 4102.0. Canberra: ABS, 2011.  [Accessed 13 January 2016].
  6. Carey M, Jones K, Meadows G, et al. Accuracy of general practitioner unassisted detection of depression. Aust N Z J Psychiatry 2014;48(6):571–78.
  7. beyondblue. Common warning signs. Hawthorn West, Vic: beyondblue, 2016.  [Accessed 14 December 2015].
  8. Mitchell AJ, Rao S, Vaze A. International comparison of clinicians’ ability to identify depression in primary care: Meta-analysis and meta-regression of predictors. Br J Gen Pract 2011;61(583):e72–80. doi:10.3399/bjgp11X556227.
  9. Lampe L, Fritz K, Boyce P, et al. Psychiatrists and GPs: Diagnostic decision making, personality profiles and attitudes toward depression and anxiety. Australas Psychiatry 2013;21(3):231–37.
  10. Wilhelm KA, Finch AW, Davenport TA, Hickie IB. What can alert the general practitioner to people whose common mental health problems are unrecognised? Med J Aust 2008;188(12 Suppl):S114–18.
  11. Kyrios M, Mouding R, Nedeljkovic M. Anxiety disorders – Assessment and management in general practice. Aust Fam Physician 2011;40(6):370–74.
  12. Nepon J, Belik SL, Bolton J, Sareen J. The relationship between anxiety disorders and suicide attempts: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Depress Anxiety 2010;27(9):791–98.
  13. beyondblue. What causes anxiety? Hawthorn West, Vic: beyondblue, 2016.  [Accessed 16 February 2016].
  14. Stensland MD, Zhu B, Ascher-Svanum H, Ball DE. Costs associated with attempted suicide among individuals with bipolar disorder. J Ment Health Policy Econ 2010;13(2):87–92.
  15. Cerimele JM, Chwastiak LA, Chan YF, Harrison DA, Unutzer J. The presentation, recognition and management of bipolar depression in primary care. J Gen Intern Med 2013;28(12):1648–56.
  16. Black Dog Institute. Bipolar disorder: Symptoms. Randwick, NSW: Black Dog Institute, 2012. [Accessed 4 February 2016].
  17. Benazzi F. Bipolar disorder – Focus on bipolar II disorder and mixed depression. Lancet 2007;369(9565):935–45.
  18. Almeida OP, Pirkis J, Kerse N, et al. A randomized trial to reduce the prevalence of depression and self-harm behavior in older primary care patients. Ann Fam Med 2012;10(4):347–56.
  19. Women’s Web. Analogies to help one understand depression and other mental health conditions. Women’s Web, 2014.  [Accessed 3 March 2016].
  20. Parker J. Recovery in mental health. S Afr Med J 2014;104(1):77.
  21. Lloyd C, Waghorn G, Williams PL. Conceptualising recovery in mental health rehabilitation. Br J Occup Ther 2008;71(8):321–28.
  22. Department of Health. Principles of recovery oriented mental health practice. Canberra: DoH, 2010. [Accessed 3 March 2016].
  23. Sivasankaran B. Mental health risk assessment: A guide for GPs. Aust Fam Physician 2011;40(6):366–69.  [Accessed 30 May 2016].
  24. Hawgood J, De Leo D. Screening tool for assessing risk of suicide (STARS). Nathan, Qld: Australian Institute for Suicide Research and Prevention, Griffith University, 2015. [Accessed 3 March 2016].
  25. Melvin GA, Gresham D, Beaton S. Safety first – not last! Suicide Safety Planning Intervention (SPI). InPsych 2016; 38(1):14–15. 
    [Accessed 30 May 16].
  26. Zantinge EM, Verhaak PF, de Bakker DH, van der Meer K, Bensing JM. Does burnout among doctors affect their involvement in patients’ mental health problems? A study of videotaped consultations. BMC Fam Pract 2009;10:60.
  27. Wade D, Howard A, Fletcher S, Cooper J, Forbes D. Early response to psychological trauma – What GPs can do. Aust Fam Physician 2013;42(9):610–14.
  28. Brondt A, Sokolowski I, Olesen F, Vedsted P. Continuing medical education and burnout among Danish GPs. Br J Gen Pract 2008;58(546):15–19.

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