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

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

3. Etiology
Suicidology is the scientific and humane study of suicide

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

5. 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

6. 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

7. 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

8. 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

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

10. 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

11. 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

12. Severity Index for Suicide Risk
Suicidal ideation
No risk of suicide

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

14. 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

15. 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

16. 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

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