Suicide Prevention and Intervention Chapter 22: Suicide Prevention and Intervention Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Historic and Theoretic Perspectives Sociologic theory: Durkheim Psychoanalytic: Freud, Menninger, Jung, Adler, Horney Interpersonal: Sullivan

Etiology Suicidology is the scientific and humane study of suicide

Joiner: two categories = increase risk for suicide completion Dysregulation in impulse control Individual with suicidal ideation and attempts, experiences intense psychologic pain

Psychologic Factors Self-directed aggression/self-destruction Death as atonement Recapture lost love object Abandonment anxiety Response to helplessness, hopelessness, guilt, and diminished self-esteem Suicide serves as a way to end painful feeling states

Etiologic Factors Biologic Neurotransmitter imbalances Serotonin irregulation Genetic influences Alterations in brain structure associated with depression Psychologic Self-directed aggression Unresolved interpersonal conflicts Negative thinking patterns Sociologic Isolation from social group Bio-psychosocial influences

Five Levels of Suicidal Behavior Suicidal ideation Direct or indirect thoughts Suicidal threats Direct verbal or written messages of intent Suicidal gestures Actions resulting in minor injury, no intention to die Suicidal attempts Serious actions with intention to die Successful suicides Deaths of persons who had conscious intent to die

Risk Factors for Suicide Age 15 to 24 and over 65 Sex Men:  completed Women:  attempts Race/ethnicity Caucasian Older African American Native American Symptoms Depression, weight changes, disturbed sleep, fatigue, self-depreciation, anger, hopelessness, preoccupation with death and dying

Risk Factors for Suicide, cont’d. Suicide plan Assess: Explicitness Lethality of method Availability of means Provision for rescue Alcohol/drug Impulse control

Risk Factors for Suicide, cont’d. History of previous attempts Majority who complete have made other attempts Social supports and resources Real or perceived lack increases risk Recent losses Increase risks

Risk Factors for Suicide, cont’d. Medical problems Terminal illness or painful disorders Alcohol/other drugs Use increases impulsivity Cognition and problem solving Inability to identify problem and solutions

Severity Index for Suicide Risk Suicidal ideation No risk of suicide

Severity Index for Suicide Risk, cont’d. Mild thoughts of suicide: States will not make attempt Uses support system Identifies purpose for living

Severity Index for Suicide Risk, cont’d. Moderate thoughts of suicide: Thinks of suicide as way of problem solving Wants to sleep and never awaken Wants to escape more than to die No explicit plan Has support system but does not use it Deterred by religious beliefs

Severity Index for Suicide Risk, cont’d. Advanced thoughts of suicide: Makes gestures that may not be lethal Has intrusive thoughts of suicide Tells others of suicidality Can write own no-suicide contract Gives away belongings Does not use support system Rationalizes religious beliefs Needs hospitalization

Severity Index for Suicide Risk, cont’d. Severe thoughts of suicide: Has a suicide gesture Wants to die Sees no other solution Develops highly specific plan with lethal methods and low rescue potential May show increased energy and mood after deciding on plan to die Questions relationship with God Has highly intrusive thoughts of suicide Needs hospitalization

Plan of Care Reduce risk of self-destruction Monitor Promote self worth Improve coping skills Limit isolation Build self-esteem