Suicide

Suicide, derived from the Latin term sui caedere (intentionally killing oneself), can be defined as self-inflicted death with evidence (either explicit or implicit) that the person intended to die (1,2).

A suicide attempt can be described as self-injurious behaviour with a nonfatal outcome accompanied by evidence (either explicit or implicit) that the person intended to die. The suicidal act may have been abandoned, interrupted, or was unsuccessful (1,2).

It is important that clinicians to identify the intent behind a potentially self injurious behaviour.

• for behaviours that are suicidal – the person, at least in part, intent to end one’s life e.g. – a 16 year old boy takes a small overdose of paracetamol intending to kill himself, although he does not succeed (suicide attempt)
• non suicidal self injurious (NSSI) behaviour - self-destructive acts without suicidal intent e.g. – a 14 year old boy takes a large overdose of paracetamol because he was angry and upset, he did not want to end his life
  • however some NSSI behaviours may lead to death – by ignorance or miscalculation e.g. - the above mentioned 14 year old boy was unaware about the toxic effects of the dose and actually died as a result (1)

Lack of uniform definitions has created a major obstacle for clear communication among clinicians, adolescents and families regarding suicidal ideation and behaviours. The Columbia Classification Algorithm for Suicide Assessment (C-CASA) which was created as a research instrument may be used to standardise the terminology in clinical practice (1).

Reference:

• (1) Rey JM. IACAPAP e-Textbook of Child and Adolescent Mental Health.  Geneva. International Association for Child and Adolescent Psychiatry and Allied Professions 2015.
• (2) Practice guideline for the assessment and treatment of patients with suicidal behaviors. Am J Psychiatry. 2003;160(11 Suppl):1-60