Suicide Prevention - Case Studies

Suicide Prevention Case Studies

History of Suicide Attempts

Most professionals in Psychiatry find suicide very challenging. There seems to be an unwritten expectation that all cases can be avoided and a completed suicide is evidence of poor care. The latest figures for the UK can be found here.

Suicide is associated severe mental illness and is not a diagnosis in itself. There is a significant overlap with Deliberate Self Harm.

In case one you will see clips from interviews over several months. The probable diagnosis is depression. In the first interview the patient did not recognise she was depressed, highlighting the importance of the mental state examination in reaching a diagnosis and formulation. She seemed brighter in mood in subsequent interviews. At this point she was at home with local support but in the final clip there are pointers towards relapse or at least deterioration in mood, with some social withdrawal.

There is not the space here to present a thesis on management in psychiatry, but I hope you may already be able to begin to consider the importance of continuity of care.

First Attempt

Addictions can be a sign of a maladaptive response to stress or unhappiness. There may also be other underlying psychiatric symptoms which the patient may not recognise. Alcohol and drugs are then used for self medication.

Case two illustrates some of these themes. Some have a detox as an inpatient with a follow-up aftercare package and then go on to do well in life. There are many bio-psycho-social factors that can account for variable outcomes.

In this case, a simple detox intervention was not sufficient and you might want to argue that it made her more vulnerable to suicide because her addiction was protecting against profound unhappiness.

Was I Depressed for longer?

Grief is a powerful risk factor for physical and mental health via the mechanism of life events. But in case three I think this is most usefully understood as a pure bereavement presentation. Although she displays some reactive depression, it is her unresolvable grief that dominates her thinking.