Suicidal ideation and behavior in adults

INTRODUCTION

Each year, about 30,000 people in the United States and one million worldwide die by suicide; 650,000 people in the United States receive emergency treatment each year after attempting suicide [1].

Primary care providers may be in a unique position due to their frequency of interaction with suicidal patients. A review of 40 studies found that over 75 percent of patients who committed suicide had contact with primary care providers within the year of their death, compared with one-third who had contact with mental health services [2]. Similarly, twice as many suicide victims had contact with primary care providers as mental health services in the month before their suicide (45 versus 20 percent).

Despite this, there are no data to show that screening for suicide in primary care reduces mortality. Additionally, predicting which patients with suicidal thoughts will go on to attempt suicide cannot be achieved with a high degree of sensitivity or specificity [3,4].

Nevertheless, the fact that primary care clinicians see a large portion of the patients who subsequently commit suicide suggests that an approach to case finding based on risk factors a sensitivity to high-risk situations in depressed patients, and clear documentation that suicidality was assessed in patients being treated for depression are appropriate in the primary care setting, and may uncover occasional patients who make their intent known and are amenable to intervention.

This topic reviews risk factors for suicide, and the evaluation, initial management, and appropriate follow-up of the suicidal patient. A discussion of suicidality related to use of antidepressants is presented separately (see "Effect of SSRIs and other newer antidepressants on suicide risk in adults".