Kimberly Yonkers, MD, discusses suicide prevention tips

Kimberly Yonkers, MD, professor of psychology, of epidemiology and of obstetrics, gynecology and reproductive sciences; Director, Division of Psychological Medicine; Director, Center for Wellbeing of Women and Mothers, Yale School of Medicine, New Haven, Conn.

Dr. Yonkers: I think it’s difficult to really talk too much about suicide which is the tenth leading cause of death and the fourth leading cause of death for people who are ages 10-34. So, what we know is that there are certain psychiatric conditions and substance use disorder conditions which increase the risk of suicide. So, for example, people who have major depressive disorder have a two-fold higher risk of having a suicide attempt and people with bipolar disorder, which is manic-depressive illness, have an elevated, greater than two-fold elevation in the risk of suicide attempt or suicide completion. And if you have somebody with one of these very significant illnesses and you add, for example, a substance use disorder on top of it, it’s sort of like adding fuel to the fire in terms of risk.  And that increases the risk even more.

I talked a little bit about how clinicians can talk to patients and ask them about depressive symptoms as well as thoughts about self-harm or thoughts about suicide, and I also presented a model which tries to sort of incorporate some of the risk factors that we know are related to suicide, such as genetics, as well as psychiatric illness, and having the means by which somebody could complete a suicide attempt.

Well, I think the first and most important thing is to transmit to patients that you are concerned about their health and that you want to help them. And then, if somebody discloses that they have difficulty with something like depression or a severe anxiety disorder – so, for example, PTSD, which is Post Traumatic Stress Disorder – are they in treatment, are they benefitting from treatment? And if they’re symptomatic, whether they’re in treatment or not, that relationship can go a long way to really understanding if somebody is at risk for thoughts of self-harm, and it can also go a long way in terms of referring them to a mental health provider who can then take the next step and help patients care for themselves.