Can Neurologists Identify Patient Suicide Warnings?

High-profile suicides have been in the news over the past several years, and the Centers for Disease Control and Prevention reports that suicide rates have increased by 30% since 2014 in 25 states.¹ While no article or study could possibly fully address all of the complex issues that may be contributing to the increasing tragedy of a human being taking his or her own life, it is important for the medical community to attempt to examine the many variables that are involved and for doctors to be as aware as possible of warning signs.

So far, it does not appear that there are reliably clear patterns of behavior or measurable indicators prior to a suicide. However, a scientific approach to deeper analysis of the changes that occur in a person’s life before suicide may identify warning signs that could help alert neurologists and other physicians to initiate preventative measures when possible.

The role of the neurologist is similar to that of other non-psychiatrist physicians. Office and hospital consults are primarily focused on medical illness rather than on mood disorders, behavioral disorders, or psychiatric illness. However, trends in pre-suicidal markers may be of interest to neurologists who are concerned about patients who have the potential to attempt suicide.

Physician communication with patients’ family members

One study reported an increased incidence in next-of-kin initiated contact with the patient’s doctor prior to patient suicide.² These incidents of family members reaching out to the doctor suggest that close relatives become concerned about the health or well-being of their loved one in the time leading up to a suicide. The study authors reported that family members were specifically aware of suicide warning signs in 90% of the cases, while doctors were aware 44% of the time.

This makes sense, given that patients spend more time with their families than with their doctors, and thus family members are more likely to notice changes in mood or behavior. It was not always clear whether family members were reaching out to the doctor for a purely medical, rather than a psychiatric, issue. It is not typical that coherent patients who have the ability to contact their own doctors would have family members reach out to the doctor. So, an unusual increase in contacts to the doctor from the family could be a red flag when it comes to patient well-being. When put into patient-specific context, preventative measures such as a psychiatry consultation can be obtained.

External influence on suicide

Another study analyzed social media data to evaluate how the social and economic climate could influence suicide rates.³ The researchers were able to predict suicide rates based on factors such as economic indicators, the stock index, celebrity suicides, and daily sunlight duration 7 days in advance. While these results should not be used to place blame on employers, the government, world events, or seasonal changes, it could potentially be used in a public health effort to alert physicians that risk is higher when the indicators that correlate with suicide are on the rise.

Neurologists and patient suicide

Neurologists take care of patients who may have comorbidities that increase the risk of suicide. Given that suicide is increasing as a public health concern, better identification of warning signs could assist in directing preventative strategies to the right people.

References:

1. Centers for Disease Control and Prevention. Suicide Rates Rising Across the US. June 7, 2018. https://www.cdc.gov/media/releases/2018/p0607-suicide-prevention.html. Accessed July 10, 2018.

2. Draper B, Krysinska K, Snowdon J, De Leo D. Awareness of Suicide Risk and Communication Between Health Care Professionals and Next-of-Kin of Suicides in the Month Before Suicide. Suicide Life Threat Behav. 2017; June 22. [Epub ahead of print].

3. Lee KS, Lee H, Myung W, et al. Advanced Daily Prediction Model for National Suicide Numbers with Social Media Data. Psychiatry Investig. 2018;15:344-354.