Psych: Suicide and Suicide risk: Free MSRA Podcast

⚕️ FREE MSRA PODCAST – Suicide
🎧 A sensitive but essential breakdown of Suicide as a medical and public health topic – ideal for MSRA preparation and clinical practice.

🧠 Key Learning Points

📌 Definition
• Suicide is defined as an intentional act of self-inflicted harm resulting in death.
• It exists on a spectrum from suicidal ideation, planning, attempts, to completed suicide.
• It is a multifactorial and deeply complex issue involving emotional, psychological, social, and medical dimensions.

📌 Risk Factors
• Mental illness (especially depression, bipolar, schizophrenia)
• Substance misuse – drugs or alcohol
• Previous suicide attempts – strongest predictor of future risk
• Family history of suicide
• Access to lethal means
• Chronic illness, pain, recent stressors (e.g., bereavement, relationship breakdown)
• Social isolation, trauma, or marginalisation
• Demographics: Higher suicide completion in middle-aged men
• Mnemonic: "SAD PERSONS" for common risk indicators

📌 Protective Factors
• Family support and strong personal relationships
• Having children or dependents
• Religious or cultural beliefs against suicide
• Access to mental health services and community connection

📌 Pathophysiology
• Based on a biopsychosocial model
• Biological: Imbalances in serotonin and other neurotransmitters
• Psychological: Hopelessness, feeling trapped or burdensome
• Social: Stigma, poverty, lack of access to care

📌 Epidemiology
• ~5,821 suicides in the UK in 2017
• Higher completion in men (esp. aged 45–49), more attempts in women
• WHO: Over 800,000 deaths/year globally
• Geographic and socioeconomic variations noted within the UK

📌 Common Methods
• Hanging
• Poisoning (including overdose)
• Many had prior contact with healthcare professionals – key intervention point

📌 Clinical Features (Warning Signs)
• Expressing hopelessness, withdrawal from others
• Giving away possessions
• Mood changes, reckless behaviour
• Talking or writing about death or suicide
• Important note: Some individuals show no signs at all

📌 Mental Health Links
• 90% of those who die by suicide have an underlying mental illness• 25% had recent contact with mental health services• Most common diagnoses:

• Depression, bipolar, schizophrenia

• Personality disorders

• Alcohol or drug misuse

📌 Assessment• No reliable scoring system recommended – e.g., NICE does not endorse SAD PERSONS scale• Emphasis on clinical interview:

• Suicidal ideation? Intent? Planning?

• Mental state exam

• Past attempts

• Access to means• Multidisciplinary input: healthcare, mental health, sometimes police or social services• Always assess intent + access + protective factors

📌 Management•

Episode Transcript

(00:00):
OK, let's dive in. We all know that feeling, right?
You've got this pile of dense notes.
Maybe for revision, maybe just trying to really get your head
around a difficult subject. Yeah, and making sense of it
all, turning those facts into something you can actually
remember and more importantly, use.
That's tough. Especially with the topic as

(00:20):
critical and, let's be honest, as sensitive as suicide.
Exactly. So you shared your revision
notes on this, and that's what we're going to tackle today.
Our mission really is to help you unpack this material.
Find those key Nuggets of information.
Yeah, the really high yield stuff and structure it
conversationally so it sticks, you know, not just reading off a
page. We'll work through everything

(00:40):
that's in your notes. Definition causes the risk
factors, the sort of medical understanding, the number.
Clinical features assessment management.
Right all the way through to prognosis and the wider impact.
We'll approach it carefully given the subject, but focus
squarely on the facts presented in your material.
OK, so where do the notes suggest we start?

(01:01):
Definition seems logical. Yes, they kick off with that
core definition. Intentional self-inflicted harm
that leads to death. Pretty clear.
It is, but the notes immediatelyadd that crucial layer of
complexity. They frame it not just as an
act, but as a well, a deeply complex issue.
Emotional. Social.

(01:21):
And a major public health concern.
Absolutely. It's not just one thing.
And the notes are clear. When we say suicide, it's
actually a spectrum, isn't it? It covers the thoughts,
ideation, then attempts and thencompleted suicide, right?
It's a process, potentially. It always involves that
self-inflicted harm with the intent to end life.
And crucially, the notes point out, it can be multifaceted.

(01:44):
It might even result from patterns or difficulties over
many years. That longer perspective is
important. OK, so that's the what.
What about the why and The Who ideology and risk factors?
The section in the notes looks quite detailed it.
Really does, and it frames the causes well, highlighting that
it's usually this complex mix, isn't it?
Individual things, relationships, even wider
societal factors. It's rarely just one single

(02:05):
cause, and the notes list specific risk factors.
Mental health conditions and substance abuse are right up the
top. Yeah, absolutely.
Critical points there. And history plays a big part
too. A family history of suicide is
mentioned as increasing risk. And previous attempts seem
really significant. Hugely significant, the notes
rightly highlight that previous suicide attempts are one of the

(02:27):
strongest predictors of future attempts.
That recurrence idea is key for revision.
Access to lethal means is also listed a stark point, but it
shows how opportunity can intersect with intent.
Yeah, definitely. And then there are the social
and health dimensions. Social isolation, Chronic
illness, both listed as risk factors.

(02:48):
You can imagine the burden of feeling alone or constantly
battling a health problem. Recent life stressors, too, the
notes mention things like money troubles, relationship
breakdowns, things that can feeloverwhelming.
Exposure is another one, being exposed to suicidal behaviours
in your community or social circle.
It suggests perhaps a kind of clustering effect sometimes.
And specific demographics are highlighted.

(03:08):
Yes, the notes mentioned middle-aged men and individuals
from marginalised communities aspotentially being at higher
risk, according to the data theypresent.
It's quite a heavy list of risks, but I noticed the notes
immediately follow up with protective factors, things that
can actually help. Which is just as important to
remember, especially for revision.
Things like strong family support, having children,

(03:30):
religious belief. They're explicitly mentioned as
protective. It highlights connection
responsibility. Belief systems?
Yeah, Things that anchor people.So, moving from risks to the
underlying mechanisms, the pathophysiology section, the
notes seem to describe this using that biopsychosocial
model. That's right, it brings together
biological, psychological, and social elements.

(03:51):
Biologically, the notes mentioned neurotransmitter
imbalances. Serotonin is given as an
example. And psychologically.
They point to those really powerful internal states,
hopelessness, deep despair, feeling trapped with, you know,
no. Way out and socially.
Things like the stigma around mental health which can stop
people seeking help, limited access to care, isolation, all

(04:17):
contributing factors. Right now, shifting slightly,
but really important when a death has occurred, differential
diagnosis, the notes stress, ruling out other possibilities.
Yes, absolutely essential. Was it accidental?
Was it natural causes? Or tragically, was it harm
caused by someone else? You have to establish the manner
of death accurately. And the process describes sounds

(04:39):
thorough medical exams, toxicology, a psychological
assessment. Understanding the context, the
person's state of mind leading up to it.
Mental health professionals playa key role in that, according to
the notes for an accurate determination.
OK, let's look at the numbers. Epidemiology The notes call
suicide a significant UK public health issue and mention
increasing rates in some age groups.

(05:01):
Yeah, and a really key point from the data presented is that
gender difference, men tend to have higher completed suicide
rates, while women have more attempts.
That's a classic distinction to be aware.
Of and it varies across the country.
It does. The note suggests regional
variations linked to social, economic and cultural factors.
Are there specific figures we should pull out?
Well, the notes mentioned 5821 suicides recorded in the UK in

(05:25):
2017. They also note a general
declining trend since 1981, which is positive, though it
does fluctuate. But within that there are peaks.
Yes, for that 2017 data point, the highest rates were noted in
men aged 4549 and women aged 5054.
That age bracket is worth remembering.

(05:45):
Methods. Hanging and poisoning are listed
as common methods and this is really critical.
The notes state a significant number of those who died by
suicide had prior contact with health professionals.
That flags up potential points for intervention, doesn't it?
It really does. It suggests the healthcare
system is often involved at somepoint beforehand.
The notes also mention the global picture.
Briefly, yeah. Citing The Who estimate of over

(06:07):
800,000 suicides annually worldwide puts the UK figures in
context. So if that's the data landscape,
how might suicide risk actually,you know, present itself
clinical features? The notes say Signs vary hugely.
They do. There's no single checklist, but
the notes give potential indicators, things like
expressions of hopelessness. Talking or writing about death

(06:28):
or suicide. Withdrawing socially.
Changes in mood? Maybe behaviour?
Giving away belongings. Increased use of alcohol or
drugs. Engaging in reckless or risky
behaviours. OK, quite a list, but there's a
massive caveat here, isn't there?
Absolutely massive and vital, the notes stress this.
Not everyone shows clear warningsigns.

(06:49):
Some people conceal their intentions incredibly well.
You just can't rely on seeing these signs.
Which leads straight into the section on mental disorders and
suicide risk. Yeah, and the link is stark.
The notes state individuals withmental disorders have a
significantly higher risk, maybe5 to 15 times higher, compared
to the general population. Wow, and the stat about
underlying mental illness. Around 90% of individuals who

(07:12):
die by suicide are estimated to have an underlying mental
illness, according to the sourcematerial.
And specific to the UK notes. About a quarter, 25%, of those
who die by suicide had been in contact with mental health
services prior to their death, again highlighting that contact
point. The notes also list common
diagnosis found in UK victims. Yes, affective disorders,

(07:33):
especially depression, schizophrenia, personality
disorders and histories of alcohol or drug misuse.
You can maybe group them from memory.
Effective psychotic personality substances.
Good way to frame it. OK, so given all this
complexity, how do we investigate after death and
crucially, assess risk in someone living?

(07:54):
The notes cover both for investigations after death.
They talk about a comprehensive approach.
Which means. Looking at everything,
circumstances, interviews with family, medical records,
toxicology, that psychological assessment we talked about.
Needs collaboration. Definitely law enforcement,
medical teams, mental health experts working together.
And for assessing risk in a living person, this is all about

(08:15):
prevention. Exactly.
Not about predicting perfectly you can't, but about
understanding the level of risk to guide what you do next.
The notes give clear steps. Start with open questions, build
rapport. Trust is foundational.
Then you explore those risk factors.
We discussed mental health history, depressive symptoms,
medication, substance use, theircurrent mental state as you see

(08:36):
it. Previous self harm or attempts.
Crucial remember that recurrencerisk also age, gender, social
situation, relationships and importantly, do they have access
to lethal methods. But the real core seems to be
assessing current intent. Absolutely.
This is where you explore. Have they made plans?
How specific are they? When?
Where? How do they feel right now?

(08:59):
Hopeless. Trapped.
Any regret? What do they think will happen?
That ES pathworm mnemonic you mentioned earlier could be
useful here, even if not explicitly in these notes, just
to cover those bases. Ideations.
Substance use Purposelessness. Anxiety, trapped, hopelessness,
withdrawal, anger, recklessness,mood changes.
That covers the key domains the notes are pointing towards.

(09:20):
And the notes list specific red flags, things that really
increase concern. Yes, strong feelings of
hopelessness or being trapped, having well formed plans,
lacking social support, experiencing psychotic phenomena
like hearing voices telling themto harm themselves and
significant physical pain or chronic illness.
Now there's a really important point about scoring systems.

(09:42):
Yes, critical for practise and revision.
The notes highlight that NICE guidelines specifically state
that risk predicting score systems are not recommended for
assessing suicidal intent. Though no relying on just a
number. Exactly.
The emphasis is on a thorough clinical interview.
It's about the conversation, exploring all those factors, not
ticking boxes on a scale that's the gold standard, according to

(10:05):
this material. OK, that makes sense.
So understanding the risks, assessing it, what about
management? How do we?
Help The notes outline a multi faceted approach.
It starts broad crisis helpline,support groups, counselling, all
valuable. And specific treatments.
Psychotherapy is mentioned prominently, particularly CBT
and DBT medication, 2 antidepressants, mood

(10:26):
stabilisers, the notes even briefly mentioned ketamine
Research is something being explored and sometimes
hospitalisation is necessary. The Notes layout general
management steps. Yeah, a kind of framework.
First pull together your summaryand risk assessment, then tailor
the plan. It has to fit the individual
specific level of risk. Maintain that supportive

(10:48):
relationship. Crucial and practical steps like
helping remove access to means where it's safe and possible.
Consider their willingness to engage.
Think about referrals, maybe even a Mental Health Act
assessment if needed. Right.
If the criteria and significant risk due to a mental state, then
work with them, if possible on acollaborative care plan.

(11:09):
What goes in that? Short and long term goals,
strategies to manage risk and a clear crisis plan.
Who do they call? What steps do they take if
things get tough again? And follow up is key.
Essential the notes particularlystress this after starting
antidepressants, as that initialperiod can be a bit tricky
sometimes. What about someone deemed high
risk right now? The notes suggest ensuring 24

(11:30):
hour support is available, maybethrough a local crisis team.
Psychiatric evaluation should beconsidered.
And potentially Mental Health Act detention.
If necessary, yes, if the criteria are met.
But important point from the notes, this isn't just for being
drunk or high on drugs, There needs to be an underlying mental
disorder contributing to the risk.

(11:52):
And safety planning is part of this whole process.
Definitely writing down those coping strategies and contacts,
it's a tangible tool for the individual.
Looking further ahead, what about prognosis?
The notes say it really varies. It depends heavily on getting
support, getting it quickly, andhow well the treatment works for
that person. But early intervention helps.
Yes, the notes are clear. Early identification, prompt

(12:14):
help, and ongoing support genuinely improve outcomes.
It makes a difference. But it's individual.
Always depends on our circumstances and response.
Lastly, complications. This isn't just about one
person, is it? No, the notes emphasise the
ripple effect. There's a huge emotional and
social impact on the individual if they survive an attempt, but

(12:35):
also profoundly on family, friends, the whole community.
Especially for those bereaved bysuicide.
Immense emotional trauma for those left behind, often called
survivors of suicide loss, and the notes mentioned stigma
complicates that grief terribly.And that can lead to more mental
health challenges in the community.
It can, which underlines why we need not just prevention but

(12:57):
also postvention dedicated support for those bereaved.
OK. Well we've really worked through
the layers presented in your notes.
Definition, causes, risks, the medical side stats, signs,
assessment, management impact. It's a lot to take in.
It is, We hope that talking it through like this, breaking it
down, has helped make those dense notes a bit more, well,
manageable and memorable for your revision.

(13:19):
Absolutely. And maybe a final thought to
leave you with, based on everything we've discussed from
these notes, considering all those complex factors,
individual, interpersonal, societal, and also the
protective ones like connection and support, how can you perhaps
in your future clinical role or even just as a person in your
community best contribute? How can we help spot risk and

(13:42):
actively build those protective connections?
Something to really reflect on. Thanks for joining us for this
deep dive into such an important, though difficult,
topic. We hope it's been a useful
session for your learning. And if you find this way of
breaking down information helpful, especially if you are
revising for something like the MSRA, you might want to check
out Path m-sra.com for more structured revision content.

(14:03):
Yeah, and for free resources, question banks and the like,
definitely take a look at freemissray.com as well.
Good luck with all your revisionefforts.