Practice Practice Pointer

Assessing risk of suicide or self harm in adults

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4572 (Published 25 July 2013) Cite this as: BMJ 2013;347:f4572
  1. Richard Morriss, professor of psychiatry and community mental health1,
  2. Nav Kapur, professor of psychiatry and population health2,
  3. Richard Byng, clinical senior lecturer3
  1. 1Institute of Mental Health, University of Nottingham Innovation Park, University of Nottingham, Nottingham NG7 2TU, UK
  2. 2University of Manchester, Manchester, UK
  3. 3Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
  1. Correspondence to: R Morriss richard.morriss{at}nottingham.ac.uk

This review discusses how general practitioners and non-psychiatric specialists can assess suicide risk and self harm

A middle aged man presents to his general practitioner having just lost his job. He seems to be low in mood and asks for something to help him to “pick myself up.” He is reluctant to talk. Meanwhile, a teenage girl presents to the local emergency department having made a third drug overdose in the past two months. In both situations the attending doctor wants to know what factors would suggest that the person was more likely or less likely to be at risk of suicide or repeat self harm.

The clinical problem

Suicide is one of the top three causes of death in people aged 10-44 years throughout the world. In the UK, suicide rates fell from a peak in the 1980s in men and women, but they have started to rise again in the past few years (11.8 per 100 000 in 2011) (www.ons.gov.uk/ons/dcp171778_295718.pdf), with the highest rates in men aged 30-59 years. Self harm is defined here as any act of self poisoning or self injury irrespective of motivation1 but generally excludes habitual behaviours such as hair pulling and the consequences of excessive consumption of alcohol or drugs. Self harm is one of the five leading causes of hospital admission2 and is associated with a significantly increased risk of subsequent death, much of it by suicide.3

Methods

Data on the assessment of suicide risk and self harm have been compiled primarily from recent systematic reviews of risk factors for guidelines developed by the National Institute for Health and Care Excellence (NICE),4 a review of 15 years of findings from the UK National Confidential Inquiry into Suicide,5 a systematic review of risk factors for suicide in people with depression,6 and a …

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