WEDNESDAY, Dec. 15 (HealthDay News) -- A group that accredits
many U.S. hospitals has urged hospital and emergency-room
caregivers to watch for attempted suicides occurring in their
facilities -- even in patients with no history of psychiatric
The new alert, issued by the Joint Commission, stresses that
it's not just psychiatric patients who kill themselves, citing as
an example someone recently diagnosed with cancer who goes to an ER
because the cancer-related pain has become unbearable.
"A patient who attempts suicide in the emergency room or a hospital's medical or surgical unit often has a different set of presenting complaints or a different diagnosis than a patient hospitalized in a psychiatric unit," said Dr. Robert Wise, a psychiatrist and medical adviser to the commission's division of healthcare quality evaluation.
The alert suggests strategies to help hospitals and ERs reduce
the risk for suicide among such patients.
Of the 827 in-hospital suicides reported to the commission since
1995, almost 25 percent occurred in non-psychiatric settings, such
as emergency rooms, cancer and intensive-care units and long-term
care hospitals, the commission noted. The methods most often used
were hanging, suffocation, intentional drug overdose and
Because the suicides are reported voluntarily, there's no way to
know how common the act is, Wise said. But a hospital in which a
suicide occurs examines the circumstances to determine potential
causes, "and that's probably more important than the actual
prevalence, as it can help to prevent future occurrences," he
People with illnesses that cause chronic pain, such as cancer,
or that cause a slow mental deterioration, such as dementia, may
begin to have thoughts of suicide, he said.
"A patient diagnosed with cancer who is in intense, intractable pain may feel worn out and hopeless, even though they may not talk about the associated emotional issues of their disease," Wise said, adding that caregivers may not think to ask about it because that's not their initial focus.
"Emergency room and hospital staffs tend to see medical illness -- the high fever, chest pains that suggest serious medical problems," he said. "They may be less likely to think about how a cancer patient in unremitting pain feels when they are told the increase of pain is caused by the spread of the disease."
Elana Premack Sandler, a prevention specialist with the U.S.
Suicide Prevention Resource Center, said that the commission's
alert highlights the fact that not every person who dies by suicide
has a psychiatric history. It gets health-care providers in
hospital settings "to think outside the box about their roles -- to
be equipped to know the warning signs of suicide and respond
appropriately," she said.
Those warnings include irritability, agitation, complaints of
unrelenting pain, refusing visitors or medications and requesting
early discharge, the commission noted. Dementia, chronic pain or
illness, end-stage cancer, acute signs of depression and drug or
alcohol intoxication may also heighten suicide risk.
"These are signs that anyone -- like friends, family or co-workers -- can be aware of," Sandler said. And anyone who notices such signs, she said, should reach out to hospital staff or other mental-health professionals who could help.
Teaching hospital and ER staff members about suicide risk
factors and warning signs of an imminent attempt is the first step,
the alert said. Other strategies include:
Suicide is the 10th leading cause of death in the United States,
with 34,598 reported suicides in 2007, according to the U.S.
National Institute of Mental Health.
The U.S. National Institute of Mental Health has more on
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