USMLE® Step 1 style questions USMLE
USMLE® Step 2 style questions USMLE
A 77-year-old white man is seen by his primary care physician because of fatigue for the last several months. During the course of the interview, the physician discovers that the man was widowed seven months ago and has felt depressed ever since. His daughter and her family live in close proximity and have been trying to persuade him to move in with them. He is hesitant to do so, especially since he has become accustomed to drinking "quite a few" shots of whiskey daily since his wife died. The physician becomes concerned about the patient's suicide risk. Which of the following factors decreases this man's risk for successful suicide completion?
Every 40 seconds someone around the world dies by suicide.
The US Centers for Disease Control cite suicide as the second leading cause of death among individuals aged 15 to 34, right after unintentional injuries like car crashes.
And it’s a major cause of death among the elderly as well.
In fact, for every one that dies by suicide, there are over 20 others that have attempted suicide!
Now, prior to any suicide or attempted suicide, a person usually has suicidal thoughts, and that’s called suicidal ideation.
There’s a range - from passive suicidal ideation, where a person thinks they would be better off dead, to active suicidal ideation, where a person starts to make specific plans to die by suicide.
Fortunately, most people with suicidal ideation never attempt suicide, but there’s no reliable way to identify those who will.
Having said that, there are some predictive risk factors to consider.
To identify individuals at higher risk of completing suicide, there’s a risk assessment scale, which can be remembered with the acronym SAD PERSONS.
S stands for male sex, A for age younger than 19 or older than 45, D for Depression, P for Previous suicide attempt, E for Excess alcohol or substance use, R for Rational thinking loss - having a distorted sense of reality, S for Separated or Single, O for Organized plan - like overdosing on pills, N for No social support and S for Sickness.
More risk factors - means a higher suicide risk.
There are a few mental health conditions that can increase the risk for suicide- in particular, clinical depression and alcohol or substance addiction.
Clinical depression, which is sometimes called major depressive disorder or unipolar depression, is a relatively common but very serious condition that interferes with someone’s day to day life like working, studying, eating, sleeping— essentially leading to an overall feeling that life isn’t enjoyable.
Sometimes, this feeling is so intense that a person loses hope or meaning in life or starts believing that the world would be a better place without them.
In alcohol or substance addiction, individuals tend to be more impulsive, taking risks they normally wouldn’t take like driving recklessly.