How Do You Talk About Suicide with Patients with TBI and PTSD?

[Lt. Col. Jeffrey Yarvis] When you're dealing with suicidality, I think the key is that any person who has these symptoms could be suicidal whether they tell you or they don't tell you. That this is definitely one of those where there's smoke, there should be fire or potential for fire. And I personally believe that we need to get all providers thinking about this topic and adding it to their algorithms. So somebody has chronic pain, "Has the pain ever reached a point where you've had thoughts about wanting to die or kill yourself?" If the person has anxiety and depression, people usually don't kill themselves when they're happy. So—you know—when you have something like post-traumatic stress disorder, one of the research projects show that if you have PTSD or you actually meet the cutoff for the disorder that you're 44 times more likely to be depressed. And if you're 44 times more likely to be depressed, there's a percentage of those depressed individuals who might consider suicide as an option. And suicide is actually not a crazy behavior, it's a very logical one. Usually there's a pretty good reason why people consider it— unbearable emotional pain, they don't see a solution to their problem, and this seems like a choice in that moment that they can take. So one of the keys is that we're there when those moments happen. I think we can prevent a lot of suicides, but I don't think we can prevent all of them. There will always be some people who have made a decision to die. However, I think when we're recognizing some of the problems at a sub-clinical level, when we talk about depression and suicidality very open, when we do what the surgeon generals have called for where commanders are involved in the questioning of their people, and really saying, "Are you sure, this seems a little off for you," that you take time to really know your people, you're making a huge impact on this process. And then also means reduction and that we encourage people to not have the things around that might contribute to suicide. We know that you're on prescription medications, we know that you have a firearm, and when we know somebody is having problems that we monitor their access to those things, or we work with them to talk about where those things are when their symptoms spike. And how can we help, and we're involved in the lives of our warriors. I think when somebody comes in for a primary care visit, and somebody endorses even the most subtle of symptoms, that that's a question that's always asked. And it's asked very comfortably. I would rather have somebody go, no, of course not, why would you ask me such a thing, than not ask it. And we ask right now, "What's your scale on a scale of zero to 10 your pain symptoms right now today?" And that was something that was institutionalized. I would love to see us do the same for suicidality, and I think more and more that is the case that our provides are making this something comfortable to talk about because the vast preponderance of us won't endorse it, but when they do, then we're saving lives.

How do you talk about suicide with patients with TBI and PTSD?


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Jeffrey Yarvis

Lt. Col. Jeffrey Yarvis, PhD is the first integrated service chief of the Fort Belvoir Community Hospital. He is an assistant professor of Family Medicine and director of Social Work at the Uniformed Services University of the Health Sciences.

Posted on BrainLine May 14, 2013.

Produced by Victoria Tilney McDonough and Erica Queen, BrainLine.