Suicide risk mitigation

Case history #1

A 48-year-old business owner residing in a large urban area visited his family physician 6 weeks ago. He was concerned because of weight loss over the previous 6 weeks and was worried that he may have cancer. He had no significant medical or psychiatric history, but commented that he had been seeing his religious leader due to a loss of faith, self-doubt, and worries about the future of the world. He was referred for investigation of suspected bowel cancer. Three days ago, the man attempted to end his life by hanging, but the noose was not secure. He fell, broke his arm, and contacted his wife, who took him to the local emergency department, where it was determined that he had had major depressive disorder for about 3-4 months. His work colleagues had noticed that something was wrong but were concerned about approaching him because they did not want to pry. His wife had been very concerned about his lack of interest in anything, brooding, sleep problems, and weight loss, but had attributed these changes to difficulties at work.

Case history #2

A 79-year-old woman residing in a rural village presents to her family doctor with complaints of a 3-week history of constipation, backache, headaches, and constant fatigue. She has a pre-existing cardiac condition and is taking occasional glyceryl trinitrate for exercise-induced chest pain. She also has insulin-requiring diabetes with reasonable control of her diabetic indices. She is the primary carer for her husband, who has recently been diagnosed with Alzheimer’s disease. A systems review elicits feelings of depression, hopelessness, and persistent suicidal ideation. She feels overwhelmed by the severity of her husband’s condition and the burden of caring. She has made vague suicide plans but is worried about how her death would affect her husband’s care.

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