Exploring thoughts of suicideBMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j1128 (Published 30 March 2017) Cite this as: BMJ 2017;356:j1128
- Lindsey Sinclair, ST6 liaison psychiatry1,
- Richard Leach, general practitioner2
- 1Royal United Hospital Bath, Avon, UK
- 2Northlands Surgery, Calne, Wiltshire, UK
- Correspondence to L Sinclair
- Accepted 15 February 2017
What you need to know
Asking about suicide will not make patients more likely to harm themselves
Identify risk factors for suicide, but also ask about protective factors
Asking about suicide enables clinicians to gauge risk and formulate a treatment plan
A 50 year old man describes feeling low in mood. He has recently lost his job and his wife has left him. During the consultation he mentions that life is not worth living any more. Dr Smith is worried about how to follow up on this comment; the patient is making poor eye contact.
Many doctors worry about how best to assess suicide risk in individuals who present to them with thoughts of self harm.
The topic of suicide is difficult to research and consequently much of the evidence is of low quality. In a recent qualitative study, general practitioners in the UK reported that they found it difficult to identify who was “really” suicidal, to effectively assess risk, and to manage patients at risk of suicide.1 Patients who repeatedly self harm can evoke powerful emotions in the healthcare provider, such as anger, fear, or a desire to save them.2
Clinicians should not fear asking about suicide; a review article failed to identify any studies in which asking about suicidal ideation increased the risk of a further attempt.3 This article suggest how to asses someone who has thoughts of ending their life, perform a risk assessment, and decide who might benefit from additional input from a specialist mental health team.
How common are suicidal thoughts and suicide attempts?
Suicide itself is a rare event. In 2014 there were 10.8 deaths by suicide per 100 000 of the population in the UK.4 Between 3.5% and 5% of people reported suicidal thoughts in the last year, but only 0.5%-0.7% of individuals made an attempt to end their life, according to UK …