PsychEd Episode 40: Suicide Epidemiology and Prevention with Dr. Juveria Zaheer
PsychEd: Educational Psychiatry Podcast
Are You Redischarging Patients Too Early?
Three thousand suicide deaths per 100,000 person years is almost 300 times population base rate. Is there some sort of am lack of risk assessment going on i discharge, period? Or how do you understand that sort of a really high risk curiod right after discharge,. for sure. Epidemiological data tells us what's happening, it often doesn't tell us why. And so the other half of my work is isqualitative, where we interview people about their lived experiences.
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers suicide epidemiology, and prevention with Dr. Juveria Zaheer, a Clinician Scientist with the Institute for Mental Health Policy Research, and Education Administrator in the Gerald Sheff and Shanitha Kachan Emergency Department at CAMH in Toronto, Ontario. She is also an Assistant Professor in the Department of Psychiatry at the University of Toronto. She utilizes both quantitative and qualitative methods to better understand suicide and identify areas of potential improvement.
The learning objectives for this episode are as follows:
By the end of this episode, you should be able to…
- Develop an awareness of suicide risk and prevalence, as it pertains to the general population and psychiatric populations
- Incorporate additional contextual information into suicide risk assessment that goes beyond SADPERSONS and other list-based approaches
- Develop a deeper understanding of how to approach and help individuals with suicidal thoughts and behaviours
Guest expert: Dr. Juveria Zaheer
Hosts: Dr. Chase Thompson (PGY4)
Episode production: Dr. Weam Sieffien, Dr. Vincent Tang, and Dr. Chase Thompson
Audio editing: Dr. Chase Thompson
Show notes: Dr. Chase Thompson
00:00 – Introduction
01:14 – Learning objectives
04:00 – Overview of suicide rates across populations
07:20 - Sex and gender differences in suicide
08:50 - Suicide following discharge from hospital
14:10 - Finding suitable dispositions for individuals dealing with suicidal thoughts and behaviors
20:50 - Meeting patients and families where they are at
23:30 - Suicide safety plans
28:30 - Evidence-based approaches to suicide prevention
32:30 - Commentary on strength of evidence for interventions in suicide prevention
38:40 - Addressing suicidality in borderline personality disorder
47:00 - Ethics of involuntary hospitalization for suicidality
50:00 - Future of suicide prevention
References:
- Borecky, A., Thomsen, C., & Dubov, A. (2019). Reweighing the ethical tradeoffs in the involuntary hospitalization of suicidal patients. The American Journal of Bioethics, 19(10), 71-83.
- Cipriani, A., Hawton, K., Stockton, S., & Geddes, J. R. (2013). Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. Bmj, 346.
- Chung, D., Hadzi-Pavlovic, D., Wang, M., Swaraj, S., Olfson, M., & Large, M. (2019). Meta-analysis of suicide rates in the first week and the first month after psychiatric hospitalisation. BMJ open, 9(3), e023883.
- Chung, D. T., Ryan, C. J., Hadzi-Pavlovic, D., Singh, S. P., Stanton, C., & Large, M. M. (2017). Suicide rates after discharge from psychiatric facilities: a systematic review and meta-analysis. JAMA psychiatry, 74(7), 694-702.
- Guzmán, E. M., Cha, C. B., Ribeiro, J. D., & Franklin, J. C. (2019). Suicide risk around the world: a meta-analysis of longitudinal studies. Social psychiatry and psychiatric epidemiology, 54(12), 1459-1470.
- Kessler, R. C., Bossarte, R. M., Luedtke, A., Zaslavsky, A. M., & Zubizarreta, J. R. (2020). Suicide prediction models: a critical review of recent research with recommendations for the way forward. Molecular psychiatry, 25(1), 168-179.
- Mann, J. J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., ... & Hendin, H. (2005). Suicide prevention strategies: a systematic review. Jama, 294(16), 2064-2074.
- Miller, I. W., Camargo, C. A., Arias, S. A., Sullivan, A. F., Allen, M. H., Goldstein, A. B., ... & Ed-Safe Investigators. (2017). Suicide prevention in an emergency department population: the ED-SAFE study. JAMA psychiatry, 74(6), 563-570.
- Sakinofsky, I. (2014). Preventing suicide among inpatients. The Canadian journal of psychiatry, 59(3), 131-140.
- Stanley, B., Brown, G. K., Brenner, L. A., Galfalvy, H. C., Currier, G. W., Knox, K. L., ... & Green, K. L. (2018). Comparison of the safety planning intervention with follow-up vs usual care of suicidal patients treated in the emergency department. JAMA psychiatry, 75(9), 894-900.
- Zaheer, J., Jacob, B., de Oliveira, C., Rudoler, D., Juda, A., & Kurdyak, P. (2018). Service utilization and suicide among people with schizophrenia spectrum disorders. Schizophrenia research, 202, 347-353.
- Zaheer, J., Links, P. S., & Liu, E. (2008). Assessment and emergency management of suicidality in personality disorders. Psychiatric Clinics of North America, 31(3), 527-543.
CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association (CPA).
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