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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