Suicidal Thoughts and Behavior 20 Chapter

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Concepts of Suicide Suicide: act of intentionally ending one’s own life and opting for nonexistence Suicide attempt –Includes all willful, self-inflicted life-threatening attempts that have not led to death Suicide ideation –Person is thinking about self-harm Physician-assisted suicide (PAS) –Movement supporting right of mentally competent adults to humanely end their own suffering –Strict guidelines apply, few jurisdictions legally sanction this “right to die”

Cultural Considerations Related to Suicide In U.S., European Americans have twice the rate of minority groups –Exception is Native Americans (rate equal to European Americans) African Americans –Men more than women; peak rate in adolescence/young adult –Protective factors include family/religion Hispanic Americans –Protective factor: Roman Catholic religion/family Asian Americans –Rate increases with age. ---Protective factor: belief that individual and society are interdependent

The Suicidal Client Approximately 30,000 persons in the United States end their lives each year by suicide. Suicide is the 3 rd leading cause of death among Americans 15 to 24 years of age 5 th leading cause of death for ages 25 to 44 8 th leading cause of death for ages 45 to 64

Risk Factors Marital status – The suicide rate for single persons is twice that of married persons. Gender – Women attempt suicide more often, but more men succeed. – Men commonly choose more lethal methods than women. Age – Risk of suicide increases with age, particularly among men. – White men older than 80 years are at the greatest risk of all age/gender/race groups.

Religion – Affiliation with a religious group decreases risk of suicide Socioeconomic status – Individuals in the very highest and lowest social classes have higher suicide rates than those in the middle class. Ethnicity – Whites are at highest risk for suicide, followed by Native Americans, African Americans, Hispanic Americans, and Asian Americans.

Psychiatric illness - Mood disorders are the most common psychiatric illnesses that precede suicide. Other psychiatric disorders that account for suicidal behavior include * substance-related disorders * schizophrenia * personality disorders * anxiety disorders – Severe insomnia is associated with increased risk of suicide. Use of alcohol and barbiturates – Psychosis with command hallucinations – Affliction with a chronic painful or disabling illness – Family history of suicide

–Having attempted suicide previously increases the risk of a subsequent attempt. About half of those who ultimately commit suicide have a history of a previous attempt. – Loss of a loved one through death or separation is a risk factor. – Lack of employment or increased financial burden increases the risk of suicide.

Psychological theories –Anger turned inward –Hopelessness –Desperation and guilt –History of aggression and violence –Shame and humiliation –Developmental stressors

Sociological theory –Durkheim’s three social categories of suicide Egoistic suicide Altruistic suicide Anomic suicide Biological theories –Genetics –Neurochemical factors

Nursing Process: Assessment Guidelines Use suicide assessment tools (SAD Persons Scale) Recognize verbal clues –Suicide threats need to be taken seriously, including overt and covert statements Recognize behavioral clues –Sudden changes: giving away possessions, writing farewell notes, making one’s will/putting affairs in order –Sudden improvement after being depressed/withdrawn –Neglecting personal hygiene

Nursing Process: Assessment Guidelines Always ask person suspected of being at risk, “Are you thinking about killing yourself?” Assess precipitating events/risk and protective factors Assess suicide history (family/friends)

Common nursing diagnoses –Risk for suicide, Ineffective coping, Hopelessness, Social isolation, Spiritual distress Outcomes identification –Crisis intervention aimed at optimizing events and environmental factors to minimize self-destructive acts –Specific goals: help explore alternatives to suicide, increase coping skills, minimize social isolation Nursing Process: Diagnosis and Outcomes Identification

Nursing Process: Planning and Implementation Planning directed toward: –Crisis intervention –Long-term treatment of any co-occurring mental illness Implementation –Lack of evidence to support any particular approach to suicide prevention –Protective factors: social supports, treatment for mental illness, restricted access to means of suicide, cultural/religious beliefs, learned skills for problem solving

Nursing Interventions for Crisis Period Follow institutional protocol –Suicide precautions –Suicide observation Keep accurate records of patient behavior, documenting activity q 15 minutes or as per protocol Establish no suicide contract Encourage patient to discuss feelings/problem-solving alternatives

Nursing Interventions Postcrisis Period Arrange for patient to stay with family/friends; if no one available, hospitalization Weapons/pills removed by family/friends Encourage patient to discuss feelings Encourage patient to avoid decisions during crisis Activate links to community supports (self-help groups) If medication used for anxiety/depression: –1-3 day supply only –Monitored by family/significant other

Guidelines for Treatment of the Suicidal Client on an Outpatient Basis Do not leave the person alone. Establish a no-suicide contract with the client. Enlist the help of family or friends. Schedule frequent appointments. Establish rapport and promote a trusting relationship. Do not leave the person alone. Establish a no-suicide contract with the client. Enlist the help of family or friends. Schedule frequent appointments. Establish rapport and promote a trusting relationship.

Information for Family and Friends of the Suicidal Client Take any hint of suicide seriously. Do not keep secrets. Be a good listener. Express to the client feelings of personal worth. Know about suicide intervention resources. Restrict access to firearms or other means of self- harm.

Interventions with Family and Friends of Suicide Victims Encourage them to talk about the suicide. Discourage blaming and scapegoating. Listen to feelings of guilt and self-perception. Talk about personal relationships with the victim. Recognize differences in styles of grieving. Assist with development of adaptive coping strategies. Identify resources that provide support.

FACTS AND FABLES ABOUT SUICIDE Indicate with a T or F whether each of the following statements is true or false. _____ 1. Suicide is an inherited trait. _____ 2. Gunshot wounds are the leading cause of death among suicide victims. _____ 3. Most people give clues and warnings about their suicidal intentions. _____ 4. If a person has attempted suicide, he or she will not do it again. _____ 5. Suicide is the act of a psychotic person. _____ 6. Once a person is suicidal, he or she is suicidal forever. _____ 7. Most suicides occur when the severe depression has started to improve. _____ 8. Most suicidal people have ambivalent feelings about living and dying. _____ 9. If a suicidal person is intent upon dying, he or she cannot be stopped. _____ 10. People who talk about suicide don’t commit suicide.