Suicide risk assessment and intervention in people with mental illness

BMJ. 2015 Nov 9;351:h4978. doi: 10.1136/bmj.h4978.

Abstract

Suicide is the 15th most common cause of death worldwide. Although relatively uncommon in the general population, suicide rates are much higher in people with mental health problems. Clinicians often have to assess and manage suicide risk. Risk assessment is challenging for several reasons, not least because conventional approaches to risk assessment rely on patient self reporting and suicidal patients may wish to conceal their plans. Accurate methods of predicting suicide therefore remain elusive and are actively being studied. Novel approaches to risk assessment have shown promise, including empirically derived tools and implicit association tests. Service provision for suicidal patients is often substandard, particularly at times of highest need, such as after discharge from hospital or the emergency department. Although several drug based and psychotherapy based treatments exist, the best approaches to reducing the risk of suicide are still unclear. Some of the most compelling evidence supports long established treatments such as lithium and cognitive behavioral therapy. Emerging options include ketamine and internet based psychotherapies. This review summarizes the current science in suicide risk assessment and provides an overview of the interventions shown to reduce the risk of suicide, with a focus on the clinical management of people with mental disorders.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antidepressive Agents / therapeutic use
  • Antipsychotic Agents / therapeutic use
  • Anxiety / diagnosis*
  • Anxiety / therapy
  • Cognitive Behavioral Therapy / methods*
  • Crisis Intervention
  • Depression / diagnosis*
  • Depression / therapy
  • Evidence-Based Practice
  • Excitatory Amino Acid Antagonists / therapeutic use
  • Humans
  • Ketamine / therapeutic use
  • Lithium Compounds / therapeutic use
  • Risk Assessment
  • Self-Injurious Behavior
  • Substance-Related Disorders / diagnosis*
  • Substance-Related Disorders / therapy
  • Suicide / prevention & control*
  • Suicide / psychology
  • Suicide / statistics & numerical data*
  • Suicide, Attempted / prevention & control
  • Suicide, Attempted / statistics & numerical data

Substances

  • Antidepressive Agents
  • Antipsychotic Agents
  • Excitatory Amino Acid Antagonists
  • Lithium Compounds
  • Ketamine