USMLE® Step 1 style questions USMLE
A 21-year-old woman presents to the emergency department for evaluation of suicidal ideation. The patient was brought by her roommate, who found the patient’s journal with notes regarding a detailed suicide plan via a self-inflicted gunshot wound. The patient is currently a junior in college and has been under increased stress due to a recent break-up with her partner and failing two classes this semester. Past medical history is notable for bipolar disorder, cocaine and alcohol use, and depression. She has a history of two prior psychiatric admissions, one due to an attempted suicide during high school and another due to a manic-depression episode. On evaluation the patient is evasive and unwilling to provide any history. Scattered superficial lacerations are noted on the forearms. Given this patient’s presentation, which of the following is the strongest risk factor for suicide completion?
Content Reviewers:Rishi Desai, MD, MPH, Yifan Xiao, MD, Vincent Waldman, PhD, Amin Azzam, MD, MA
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.