Gaps 09 Suicide

Listen to the audio and fill in the blanks with the exact words / phrases. You can replay the audios.

It is important to realize that 83% of people who commit suicide or attempt suicide have had contact with a doctor within a year of their death, and up to (1) __________ of people who commit or attempt suicide have had such contact within (2) _________________ of their death. Therefore, with better prevention techniques, these figures could be reduced. We can divide suicide prevention into three categories, which are primary, secondary or tertiary. Secondary suicide prevention aims to decrease the (3) _________ of a suicide attempt in high risk patients. Tertiary suicide prevention occurs in response to completed suicides and attempts to (4) _________________ suicide in a particular geographical area or in a particular age group. 

I would now like to look at secondary suicide prevention in more detail. Secondary suicide prevention is particularly important, but not always given the attention that it (5) ________________, in part because research into secondary prevention is only just starting to be applied to clinical practice. Now, from a clinical perspective, suicide is often difficult to (6) ________________ due to its complex nature. The three major risk factors that contribute to suicidal behaviour are biological, psychological and (7) ________________ stresses, which are recent events that can lead to increased suicide risk. 

Firstly, there are biological risk factors for suicide, which include low blood cholesterol levels, medical or neurological illnesses such as (8) ________________, stroke, huntington disease and epilepsy and cigarette smoking. Secondly, there are psychological risk factors with a childhood history of physical or sexual abuse, (9) ________________ personality traits, low self esteem and poor access to psychiatric treatment. Thirdly, there are (10) ________________ or the recent events that can lead to increased suicide risk and these include relationship problems with (11) ________________, partner or loved one, financial troubles caused by unemployment or large amounts of (12) _________________, a family history of suicide, major depression and drug abuse. The clinical evaluation of the medical and psychiatric history of a patient and of their (13) _________________ is the crucial and essential element of the suicide assessment process. It is important because it enables the (14) _________________ of risk factors in order to determine the patient’s immediate safety and the best setting for treatment and also to develop diagnosis and treatment strategies. 

Psychiatric illness is a major contributing factor to suicide risk, with mood disorders such as major depressive disorder and (15) ________________ being associated with about 60% of suicides. Indeed, psychiatric disorders are diagnosed in more than 90% of completed suicides and more than 80% of these psychiatric disorders are (16) ________________. Thus, the recognition and treatment of individuals with psychiatric disorders, specifically mood disorders, are essential components of secondary suicide prevention. In addition, the (17) ________________ of the severity of depression is one of the most powerful predictors of future suicidal acts. Therefore, assessing and managing depression, as well as (18) _________________ of the suicide risks in psychologically, medically and neurologically (19) ________________ individuals, is an important aspect of secondary suicide prevention.

Consequently, physicians need to be taught to recognise the association between mental disorders and suicide. Additional information about the individual who may be at risk for suicide, such as medical and psychiatric treatment records and (20) ________________, should also be incorporated into the assessment. Equally importantly, clinicians and other professionals in a (21) _________________ to offer help should not hesitate to ask patients about suicidal ideation because while it may seem surprising, patients will often talk (22) _____________ about their suicidal thoughts and tendencies if given the (23) ________________. Failure to ask about suicidal ideation may be related to the health professional’s (24) ____________ with the topic, lack of time or lack of skills in this area, clinicians need to overcome these obstacles to provide appropriate care to their patients. 

What are the most effective secondary suicide prevention strategies? In a recent systematic review of suicide prevention strategies, Mann, along with other researchers, found (25) ___________ of effectiveness in five secondary suicide prevention methods, pharmacological interventions, psychological interventions, follow up care, reduced access to (26) ________________, and responsible media reporting of suicide. (27) _________________ medications are the most widely used pharmacological interventions in secondary suicide prevention, but studies of their (28) _________________ in reducing suicide attempts have had mixed results. Among adults younger than 25, the effect of antidepressants seems to be (29) _________________ on suicidal behaviour, but it seems to reduce the risk of suicidal behaviour in the (30) ______________. Thus, the relation between antidepressants and suicide needs further studies before this class of drugs can be safely used for the secondary prevention of suicide. In terms of psychological interventions, suicidal patients often benefit from therapies that address the (31) ________________ of suicidal thoughts and behaviours and other factors commonly associated with suicide.

Better psychological and pharmacological treatment of depression and (32) _________________ also appears to decrease suicide rates. Social factors that should be addressed in follow up treatment include (33) _________________ and willingness of support within the family. Support individuals who should be contacted about the suicide risk and follow up arrangements include general practitioners, private psychiatrists, family and (34) _________________. Some interventions, however, such as telephone and psychosocial follow up, have shown no difference in suicidal ideation when compared with standard (35) __________. Many studies show that suicides by particular methods, for example, firearms, domestic gas or (36) ________________, decrease after the introduction of legal restrictions that reduce access to such means. This reduction in (37) ________________ is particularly influential in regions where the specific means of restriction correlates with a common method of suicide. For example, in the UK, the reduction of (38) ________________ in domestic gas since 1958 and the reduced availability of analgesics since the mid 1990s have both decreased UK suicide rates. Finally, many studies have exposed a need for a decrease in reporting of suicide and for responsible reporting. Media (39) ________________ in reporting suicide have coincided with a decrease in suicide rates. Because reports of suicide in the media tend to (40) _________________ suicide for vulnerable individuals. The Internet is also of increasing concern, with (41) ___________ and chat rooms providing accessible instructions for suicide. For these reasons, (42) _________________ have recently been produced for the responsible reporting of suicide. Despite our increasing knowledge about secondary suicide prevention, there are still many (43) ___________ in the research and looking to the future. Thorough evaluations and appropriate treatments of patients with depressive disorders and other psychiatric illnesses should help to improve the (44) _________________ of secondary prevention of suicide. But it is also clear that more research into new approaches for the prevention and treatment of suicidal behaviour remains (45) _________________.