Suicide: What needs to be known and what needs to be done

This is a class presentation.

1. Suicide Presenter: Sunil Timilsina , Resident GP and EM (PGY1) Date: 079/02/05

2. Contents Terminologies Epidemiology Risk Factors Etiological Factors Assessment Management Prevention

3. Terminologies Suicidal threat Suicide ideation Suicidal Intent Suicide attempt Deliberate self harm/Suicidal gesture Suicide Nonsuicidal self-injurious thoughts Nonsuicidal self-injury

4. Reference: Nock MK. Self-injury. Annu Rev Clin Psychol 2010; 6:339.

5. Epidemiology More than 700 000 people die due to suicide every year . 4 th leading cause of death among 15 – 35 years of age. For every 1 suicide there are over 20 cases of suicide attempt. 77% of global suicides occur in low- and middle-income countries . Ref: https://www.who.int/news-room/fact-sheets/detail/suicide

6. Epidemiology As per WHO report, 2019: Total deaths due to suicide: 2571 Male: 2145 Female: 427 Ref: Suicide worldwide in 2019: global health estimates ISBN 978-92-4-002664-3 (electronic version)

7. https://www.who.int/data/gho/data/themes/mental-health/suicide-rates

8. Crude Suicide rate (Nepal) per 100,000 population https://www.who.int/data/gho/data/themes/mental-health/suicide-rates

9. Risk Factors - @ SAD PERSONS   S ex Male A ge <19 or >45 D epression P revious Suicidal Attempt E thanol/Substance Abuse R ational thinking loss (psychosis) S ick (chronic illness) O rganized plan(Acquisition of weapons/tools/ getting drugs) N o social support S eparated or single

10. Etiological Factors Biological factors Psychological factors Sociological factors

11. Durkheim’s theory

12. Assessment Screening Detailed History taking and Physical Examination Admission in inpatient unit as required Investigations as required

13. Suicide Intent Scale

14. Reference : Practice guideline for the assessment and treatment of patients with suicidal behaviors . Am J Psychiatry. 2003;160(11 Suppl):1 .

15. Management Stabilization and Admission Treatment of underlying psychiatric condition. Psychotherapy Formulating safety plan Monitoring and follow-up

16. Prevention WHO’s LIVE LIFE approach : limit access to the means of suicide interact with the media for responsible reporting of suicide . foster socio-emotional life skills in adolescents early identification, assessment, management and follow up anyone who is affected by suicidal behaviours  

17. Fig: An evidence-based multitier framework for suicide prevention (Menon et al.2019) Tier 1 Policy making Awareness programmes Media Strategies Tier 2 Gatekeeper Training Screening Helpline/hotlines Tier 3 Pharmacothepray Psychotherapy Follow up care and access

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19. THANK YOU