EDITORIAL
Suicide Is Still With Us John A. Talbott, MD
S
uicide has occupied the news media in recent years largely because of its shocking incidence among active duty and retired military personnel, but the publicity and concern have diverted our attention from its continuing existence among civilian populations. Three articles in this issue of the Journal bring us back to those groups. When I was in training, it was drummed into me that suicide (along with anorexia) was one of the few life-threatening conditions psychiatrists had to deal with, as opposed to those faced by other specialists. And not asking about depression, suicidal thoughts and past actions was one of the few items that ensured failure on clinical interviews or “Board” examinations. In the contribution by Wang et al., the top three perceived causes of suicide among gay men in Geneva were social/interpersonal problems, love/relationship problems, and accepting one’s homosexuality, with depression less often cited but still significant (10%). While the authors state that the solution largely lies in a “continued need for sociopolitical changes to mitigate the stigma of homosexuality, eradicating discrimination and homophobia at the micro and macro levels,” as clinicians, we are helpless to wave such a wand, except working as individual citizens, to hurry this up and instead should focus on “supporting individual personal development by bolstering interpersonal skills to cope with relationship issues and psychological processes in coming to terms with one's homosexuality.” Predicting suicide is a very tricky issue. For my entire professional life, I have had the hope that there would be some biological test or psychological instrument that would replace the painful process of interviewing and judging the impact of various known predictors (parental suicide, depression, recent loss(es), alcohol abuse, etc.). Wang et al. found that in two tertiary hospitals in Manitoba, Canada, only two items in their study were predictive: suicidal ideation and previous attempts or psychiatric care. “Wait,” you say, “we knew that already, and since every attempter has suicidal ideation and a large percent are repeaters, what help is that to us as we sit in the ER?” Well, it narrows down the number who deserve more thorough evaluation or hospitalization. But you are correct, we have not stumbled on a foolproof holy grail as yet. Finally, Brüdern et al. ask if “Suicide attempters [are] wired differently”—an intriguing question and one that each of us must have asked at one point or another in our professional lives. The authors look at a very small sample at the University Hospital of Psychiatry in Bern, Switzerland, zero in on the plans made by suicide attempters, and conclude that they are different from those of nonsuicidal depressed individuals in that they “are especially related to social perfectionism and withdrawal to protect their self-esteem.” So here, the authors offer clinicians specific advice stating that “it is important for clinicians to understand the motives and inner logic of the suicide attempt, which may help to engage the patient in a therapeutic relationship and prevent future suicide attempts. To come back to the point of this editorial, although we do not have iron-clad methods to either predict who will attempt suicide or prevent suicide, studies like these “move the ball down the field” and we are closer to evaluating and treating persons who have attempted or might attempt suicide. It is slow progress, but it is progress.
DISCLOSURE The author declares no conflict of interest.
Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Send reprint requests to John A. Talbott, MD, Department of Psychiatry, University of Maryland School of Medicine, 110 S Paca St, 4th Floor, Baltimore, MD 21201. E-mail: [email protected]. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0022-3018/15/20307–0485 DOI: 10.1097/NMD.0000000000000326
The Journal of Nervous and Mental Disease • Volume 203, Number 7, July 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.jonmd.com
485
Suicide Is Still With Us John A. Talbott, MD
S
uicide has occupied the news media in recent years largely because of its shocking incidence among active duty and retired military personnel, but the publicity and concern have diverted our attention from its continuing existence among civilian populations. Three articles in this issue of the Journal bring us back to those groups. When I was in training, it was drummed into me that suicide (along with anorexia) was one of the few life-threatening conditions psychiatrists had to deal with, as opposed to those faced by other specialists. And not asking about depression, suicidal thoughts and past actions was one of the few items that ensured failure on clinical interviews or “Board” examinations. In the contribution by Wang et al., the top three perceived causes of suicide among gay men in Geneva were social/interpersonal problems, love/relationship problems, and accepting one’s homosexuality, with depression less often cited but still significant (10%). While the authors state that the solution largely lies in a “continued need for sociopolitical changes to mitigate the stigma of homosexuality, eradicating discrimination and homophobia at the micro and macro levels,” as clinicians, we are helpless to wave such a wand, except working as individual citizens, to hurry this up and instead should focus on “supporting individual personal development by bolstering interpersonal skills to cope with relationship issues and psychological processes in coming to terms with one's homosexuality.” Predicting suicide is a very tricky issue. For my entire professional life, I have had the hope that there would be some biological test or psychological instrument that would replace the painful process of interviewing and judging the impact of various known predictors (parental suicide, depression, recent loss(es), alcohol abuse, etc.). Wang et al. found that in two tertiary hospitals in Manitoba, Canada, only two items in their study were predictive: suicidal ideation and previous attempts or psychiatric care. “Wait,” you say, “we knew that already, and since every attempter has suicidal ideation and a large percent are repeaters, what help is that to us as we sit in the ER?” Well, it narrows down the number who deserve more thorough evaluation or hospitalization. But you are correct, we have not stumbled on a foolproof holy grail as yet. Finally, Brüdern et al. ask if “Suicide attempters [are] wired differently”—an intriguing question and one that each of us must have asked at one point or another in our professional lives. The authors look at a very small sample at the University Hospital of Psychiatry in Bern, Switzerland, zero in on the plans made by suicide attempters, and conclude that they are different from those of nonsuicidal depressed individuals in that they “are especially related to social perfectionism and withdrawal to protect their self-esteem.” So here, the authors offer clinicians specific advice stating that “it is important for clinicians to understand the motives and inner logic of the suicide attempt, which may help to engage the patient in a therapeutic relationship and prevent future suicide attempts. To come back to the point of this editorial, although we do not have iron-clad methods to either predict who will attempt suicide or prevent suicide, studies like these “move the ball down the field” and we are closer to evaluating and treating persons who have attempted or might attempt suicide. It is slow progress, but it is progress.
DISCLOSURE The author declares no conflict of interest.
Department of Psychiatry, University of Maryland School of Medicine, Baltimore. Send reprint requests to John A. Talbott, MD, Department of Psychiatry, University of Maryland School of Medicine, 110 S Paca St, 4th Floor, Baltimore, MD 21201. E-mail: [email protected]. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0022-3018/15/20307–0485 DOI: 10.1097/NMD.0000000000000326
The Journal of Nervous and Mental Disease • Volume 203, Number 7, July 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.jonmd.com
485
