Abstract
To the Editor
Suicidal behavior is a major medical and social problem in many parts of the world including Australia, China, Eastern and Western Europe, Japan and North America. Despite increased understanding of suicide as a major problem, many health care professionals do not have sufficient training in suicide assessment techniques and management of suicidal patients (US Department of Health and Human Services, 2001). Insufficient training frequently leads to multiple mistakes including the following:
Some medical professionals do not understand the rationale for suicide risk assessment and the part they play in preventing suicide (Boeke et al., 2011). They should be educated that about a million people around the world kill themselves each year. Millions of people make suicide attempts and many suicide attempters become sick and disabled as a result of their attempts.
Many clinicians believe that direct questioning of patients about suicidal ideation, intent or plan is sufficient to evaluate suicide risk. However, suicidal patients may hide their intentions and provide misleading information. For example, a research study found that 78% of patients who die by suicide plainly deny suicidal ideation in their last verbal communications before killing themselves (Busch et al., 2003).
Many health care professionals believe that non-psychiatric patients do not need to be evaluated for suicidality. This is a misconception. For example, in the USA, about 14% of suicides take place in the non- psychiatric wards of general hospitals, and about 8% of suicides occur in the emergency department of general hospitals (The Joint Commission Sentinel Event Alert, 2010).
Compared to females, practitioners less often screen for emotional distress among males or talk with males about getting help if they feel sad or depressed (Ozer et al., 2009). This is a wrong practice. Females attempt suicide more often than males, but males are more likely to die by suicide than are females.
Many clinicians do not know about the role of contagion in suicidal behavior, especially among adolescents and young adults. Contagion is a process by which exposure to suicide or suicidal behavior of one or more individuals influences others to attempt or commit suicide. Practitioners should be educated that a person who was acquainted with the person who committed suicide is at an increased risk of attempting or committing suicide. Media-related suicide contagion has also been reported.
We should acknowledge that predicting and preventing suicide represent difficult challenges for health care professionals. Lectures, seminars, role playing and participation in the evaluations of suicidal patients may help clinicians to fill in gaps in their training.