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.
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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.
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