7 ms·

i agree to a large degree, though even 1/10 is an appalling rate of suicide vs the general population of 1/5000~

robocat 7y ago
It looks to me like you are comparing a lifetime figure against a yearly figure. Suicide figures are usually given on an annual basis, but we often mistake the figures for lifetime risk, and we are then surprised with how common suicide is within our own experience/extended acquantancy.
- autokad 7y ago
  thats true, but my statement remains correct regardless. correct me if i fudge my math. 1- 1/5000 =.9998. .9998^72 = .985702, thus <1.5% chance of suicide over a life time. .1 is still appallingly high vs .015 (and I think 1/5000 is actually a generous estimate, rates are age adjusted so its hard to apples to apples, but according to wikipedia its 13.42 / 100k - much less than 1/5k).
bayesian_horse 7y ago
From the numbers it could very well be that a lot of the ones who die in a subsequent attempt could be bipolar or have some other serious comorbidity in addition to "just" major depression. There are multiple conditions which can lead to depressive symptoms and suicidal tendencies. Some are more malign than others, which is a strange thing to say about conditions that make you want to kill yourself. But basically, suicidality in bipolar patients can only be significantly reduced by exactly one specific medication.
- hiram112 7y ago
  Are you referring to Lithium or just saying they need one more medication, on average, to get them out of their very deep hole?
  - bayesian_horse 7y ago
    They get out of their deep hole very much on their own, usually within weeks or months. But that's actually the problem in bipolar disorder. They can go from total depression to a much more energetic state in days or a few weeks, such that suicidal ideation and feeling like shit can overlap with high motivational energy. And that's the most dangerous time for suicidal tendencies. In a very deep depressive episodes, suicide is just too much effort. And yes, I was referring to Lithium as the only medication which significantly reduces the incidence of suicide attempts in bipolar patients. But that effect is only visible long-term.
DanBC 7y ago
Risk prediction is really tricky. We think the best predictor of risk is a previous suicide attempt, or a previous self harm attempt. About half of people who die by suicide have a history of self harm, and in the year after attending A&E for self harm people are at 30* to 50* the risk of dying by suicide. We need the short term intervention to save life, and we need an intense package of community support for the next few months addressing the full range of bio-psycho-social needs of the patient. We're not getting this right in the UK at the moment. I can't speak about the US.
- Fnoord 7y ago
  Would you mind defining self harm? Is it auto-mutilation strictly, or does something like smoking/drinking/other_drugs also count?
  - DanBC 7y ago
    For self harm here the definition comes from NICE guidance. https://www.nice.org.uk/guidance/qs34 https://www.nice.org.uk/guidance/qs34 > The term self‑harm is used in this quality standard to refer to any act of self‑poisoning or self‑injury carried out by a person, irrespective of their motivation. This commonly involves self‑poisoning with medication or self‑injury by cutting. Self‑harm is not used to refer to harm arising from overeating, body piercing, body tattooing, excessive consumption of alcohol or recreational drugs, starvation arising from anorexia nervosa or accidental harm to oneself. This definition excludes drug use, but that would be covered elsewhere. For example, the front page of NCISH (National Confidential Inquiry into Suicide and Self Harm, previously NCIS and Homicide by MH patients) has this (under "improving safety in mental health services"): https://sites.manchester.ac.uk/ncish/ https://sites.manchester.ac.uk/ncish/ > Reducing alcohol and drug misuse > We recommend there are drug and alcohol services available that work closely with mental health services for patients with mental illness and alcohol and drug misuse. > Our evidence > Only a minority of patients who died by suicide between 2006 and 2016 were in contact with specialist substance misuse services, despite alcohol and drug misuse being a common antecedent of patient suicide in all UK countries. In England, there was a 25% fall in rates of suicide by patients in those NHS Trusts which had put in place a policy on the management of patients with co-morbid alcohol and drug misuse. Guidance

It looks to me like you are comparing a lifetime figure against a yearly figure. Suicide figures are usually given on an annual basis, but we often mistake the figures for lifetime risk, and we are then surprised with how common suicide is within our own experience/extended acquantancy.

autokad 7y ago
thats true, but my statement remains correct regardless. correct me if i fudge my math. 1- 1/5000 =.9998. .9998^72 = .985702, thus <1.5% chance of suicide over a life time. .1 is still appallingly high vs .015 (and I think 1/5000 is actually a generous estimate, rates are age adjusted so its hard to apples to apples, but according to wikipedia its 13.42 / 100k - much less than 1/5k).

bayesian_horse 7y ago

From the numbers it could very well be that a lot of the ones who die in a subsequent attempt could be bipolar or have some other serious comorbidity in addition to "just" major depression. There are multiple conditions which can lead to depressive symptoms and suicidal tendencies. Some are more malign than others, which is a strange thing to say about conditions that make you want to kill yourself. But basically, suicidality in bipolar patients can only be significantly reduced by exactly one specific medication.

hiram112 7y ago
Are you referring to Lithium or just saying they need one more medication, on average, to get them out of their very deep hole?
- bayesian_horse 7y ago
  They get out of their deep hole very much on their own, usually within weeks or months. But that's actually the problem in bipolar disorder. They can go from total depression to a much more energetic state in days or a few weeks, such that suicidal ideation and feeling like shit can overlap with high motivational energy. And that's the most dangerous time for suicidal tendencies. In a very deep depressive episodes, suicide is just too much effort. And yes, I was referring to Lithium as the only medication which significantly reduces the incidence of suicide attempts in bipolar patients. But that effect is only visible long-term.

DanBC 7y ago

Risk prediction is really tricky. We think the best predictor of risk is a previous suicide attempt, or a previous self harm attempt. About half of people who die by suicide have a history of self harm, and in the year after attending A&E for self harm people are at 30* to 50* the risk of dying by suicide. We need the short term intervention to save life, and we need an intense package of community support for the next few months addressing the full range of bio-psycho-social needs of the patient. We're not getting this right in the UK at the moment. I can't speak about the US.

Fnoord 7y ago
Would you mind defining self harm? Is it auto-mutilation strictly, or does something like smoking/drinking/other_drugs also count?
- DanBC 7y ago
  For self harm here the definition comes from NICE guidance. https://www.nice.org.uk/guidance/qs34 https://www.nice.org.uk/guidance/qs34 > The term self‑harm is used in this quality standard to refer to any act of self‑poisoning or self‑injury carried out by a person, irrespective of their motivation. This commonly involves self‑poisoning with medication or self‑injury by cutting. Self‑harm is not used to refer to harm arising from overeating, body piercing, body tattooing, excessive consumption of alcohol or recreational drugs, starvation arising from anorexia nervosa or accidental harm to oneself. This definition excludes drug use, but that would be covered elsewhere. For example, the front page of NCISH (National Confidential Inquiry into Suicide and Self Harm, previously NCIS and Homicide by MH patients) has this (under "improving safety in mental health services"): https://sites.manchester.ac.uk/ncish/ https://sites.manchester.ac.uk/ncish/ > Reducing alcohol and drug misuse > We recommend there are drug and alcohol services available that work closely with mental health services for patients with mental illness and alcohol and drug misuse. > Our evidence > Only a minority of patients who died by suicide between 2006 and 2016 were in contact with specialist substance misuse services, despite alcohol and drug misuse being a common antecedent of patient suicide in all UK countries. In England, there was a 25% fall in rates of suicide by patients in those NHS Trusts which had put in place a policy on the management of patients with co-morbid alcohol and drug misuse. Guidance