psychiatric disorders
Suicidal Behavior
Prevention of Suicidal Behavior
Prevention of suicide requires identifying at-risk people (see table) and initiating appropriate interventions. There are strategies that health systems can employ to reduce suicide among the highest-risk patients. One such framework is calledZero Suicide, which advocates for universal training in suicide screening for all health system staff, the use of the electronic health record to help facilitate better patient care, and the use of interventions (safety planning, lethal means counseling, strong communication with the patient and family when possible, and appropriate referrals and follow-up). Suicide-prevention efforts are critically important at the regional and national levels. These efforts are supplemented by effective health care in reducing suicide risk. Interventions at the community level have also shown promising results for reducing suicide risk ( Prevention references ). In addition, the development of artificial intelligence on social media platforms has helped to identify at-risk individuals and provide timely assistance ( There are school-based and public health interventions. One example is the Sources of Strength suicide-prevention program, which is delivered by adolescent peer leaders in high schools ( Prevention references ). Studies also show that appropriately training volunteers who staff suicide lifelines helps save lives ( Another powerful example of the effectiveness of universal and selective suicide-prevention programming is evidenced by the outcomes associated with Garrett Lee Smith (GLS) Memorial Act grants. These grants have funded youth suicide-prevention activities in the United States since 2004, on college campuses as well as in community and tribal settings in many states. Over a 15-year period, a large proportion of counties in the United States received financial funding to engage in youth suicide-prevention initiatives, including the following ( Prevention references ): Establishment of outreach, awareness-raising, and screening programs Provision of “gatekeeper” training (ie, educating people in key front-line roles to recognize suicide risk and intervene accordingly) Development of coalitions (which typically include a number of local groups, eg, local government departments of mental health or suicide prevention, nonprofit organizations focused on suicide prevention, educators, parent groups, faith-based groups, law enforcement) Implementation of policies and/or protocols Establishment and funding of hotlines Forty percent of GLS grants are awarded in rural areas of the United States, where suicide rates are higher and where resources for programs and clinical treatment tend to be much less available than they are in other areas. In one study of counties with GLS activities compared with propensity-matched control counties that had not been exposed to GLS programs, statistically significant reductions were found both for short- and longer-term impact on suicidal behaviors and suicide deaths ( Prevention references ). The positive effect was greatest in rural areas of the United States. Another innovative nationwide initiative in the United States led by the American Foundation for Suicide Prevention (Project 2025) aims to reduce the US suicide rate by 20% by 2025. In the clinical arena, patients who are admitted to the hospital after a suicide attempt are at greatest risk of death by suicide during the first few days or weeks after discharge, and the risk remains high during the first 6 to 12 months after discharge ( Prevention references ). Consequently, before patients are discharged, they—along with family members and/or close friends—should be counseled about the immediate risk of dying by suicide, and an appointment for follow-up care in the first week after discharge should be made. A simple telephone call or two after discharge has been shown to significantly reduce the occurrence of repeat attempts ( During the first weeks after discharge, family and friends should make sure that The patient is not left alone. The patient's adherence to the prescribed medication regimen is monitored. The patient is asked daily about general state of mind, mood, sleep pattern, and energy (eg, for getting up, dressing, and interacting with others). The patient's family member or friend should take the patient to follow-up appointments and should inform the clinician of the patient's progress or lack of it. These interventions should be continued for several months after discharge. Although some attempted or completed suicides are met with surprise and shock, even by close relatives and associates, clear warnings may have been available to family members, friends, or clinicians. Warnings are often explicit, as when patients actually discuss plans or suddenly write or change a will. However, warnings can be more subtle, as when patients make comments about having nothing to live for or being better off dead. In one study, about 83% of people who died by suicide were seen by a physician in the months to year preceding their death, and approximately 24% had a mental health diagnosis in the month preceding their death ( Prevention references ). Because severe and painful physical disorders, Overview of Substance Use , and mental disorders (particularly Each depressed patient should be questioned about thoughts of suicide. The fear that such inquiry may implant the idea of self-destruction is baseless. Inquiry helps the clinician obtain a clearer picture of the depth of the depression, encourages constructive discussion, and conveys the clinician’s awareness of the patient’s deep despair and hopelessness. Even people threatening imminent suicide (eg, those who call and declare that they are going to take a lethal dose of a medication or who threaten to jump from a high height) are thought to have some desire to live. The clinician or another person to whom they appeal for help must support the desire to live. Emergency psychiatric aid for suicidal peopleincludes the following: Establishing a relationship and open communication with them Inquiring about current and past psychiatric care and medications currently being taken Helping sort out the problem that has caused the crisis Offering constructive help with the problem, which includes a written safety plan developed with the patient Beginning treatment of the underlying mental disorder Referring them to an appropriate place for follow-up care as soon as possible Discharging low-risk patients to the care of a loved one or a dedicated and understanding friend Providing these patients with the 988 number for Lifeline Chat & Text or with links to helpful web sites (988 Suicide and Crisis Lifeline,American Foundation for Suicide Prevention) Providing access to information about suicide prevention 1.National Action Alliance for Suicide Prevention: Transforming communities: Key elements for the implementation of comprehensive community-based suicide prevention. 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