1. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. Chapter 24 Suicide

2. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 2 Suicide A significant public health problem in the United StatesA significant public health problem in the United States In 2008In 2008 –Eleventh leading cause of death –32,000 completed suicides

3. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 3 Risk Factors Psychiatric disordersPsychiatric disorders Alcohol or substance use disordersAlcohol or substance use disorders Male genderMale gender Increasing ageIncreasing age RaceRace ReligionReligion MarriageMarriage ProfessionProfession Physical healthPhysical health

4. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 4 Biological Factors Suicidal behavior tends to run in familiesSuicidal behavior tends to run in families Low serotonin levels are related to depressed moodLow serotonin levels are related to depressed mood

5. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 5 Psychosocial Factors Freud – aggression turned inwardFreud – aggression turned inward MenningerMenninger –The wish to kill –The wish to be killed –The wish to die Aaron Beck – central emotional factor is hopelessnessAaron Beck – central emotional factor is hopelessness Recent theories – combination of suicidal fantasies and significant lossRecent theories – combination of suicidal fantasies and significant loss

6. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 6 Cultural Factors Protective factorsProtective factors –African Americans Religion, role of the extended familyReligion, role of the extended family –Hispanic Americans Roman Catholic religion and importance of extended familyRoman Catholic religion and importance of extended family –Asian Americans Adherence to religions that tend to emphasize interdependence between the individual and societyAdherence to religions that tend to emphasize interdependence between the individual and society

7. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 7 Societal Factors Oregon’s Death with Dignity Act of 1994 –terminally ill patients allowed physician-assisted suicideOregon’s Death with Dignity Act of 1994 –terminally ill patients allowed physician-assisted suicide Netherlands – nonterminal cases of “lasting and unbearable” sufferingNetherlands – nonterminal cases of “lasting and unbearable” suffering Belgium – nonterminal cases when suffering “constant and cannot be alleviated”Belgium – nonterminal cases when suffering “constant and cannot be alleviated” Switzerland – assisted suicide legal since 1918Switzerland – assisted suicide legal since 1918

8. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 8 Assessment: Overt Statements “I can't take it anymore.”“I can't take it anymore.” “Life isn't worth living anymore.”“Life isn't worth living anymore.” “I wish I were dead.”“I wish I were dead.” “Everyone would be better off if I died.”“Everyone would be better off if I died.”

9. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 9 Assessment: Covert Statements “It's okay, now. Soon everything will be fine.”“It's okay, now. Soon everything will be fine.” “Things will never work out.”“Things will never work out.” “I won't be a problem much longer.”“I won't be a problem much longer.” “Nothing feels good to me anymore and probably never will.”“Nothing feels good to me anymore and probably never will.” “How can I give my body to medical science?”“How can I give my body to medical science?”

10. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 10 Assessment: Lethality of Suicide Plan Is there a specific plan with details?Is there a specific plan with details? How lethal is the proposed method?How lethal is the proposed method? Is there access to the planned method?Is there access to the planned method? People with definite plans for time, place, and means are at high risk.People with definite plans for time, place, and means are at high risk.

11. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 11 Assessment Tools: SAD PERSONS Scale Uses 10 major risk factors to assess suicidal potential 1.Sex (male)6.Rational thinking loss 2. Age 25 to 44 or7. Social supports lacking 65+ years or recent loss 3.Depression8. Organized plan 4. Previous attempt9. No spouse 5. Ethanol use10.Sickness

12. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 12 Nursing Diagnoses Risk for suicideRisk for suicide Ineffective copingIneffective coping HopelessnessHopelessness PowerlessnessPowerlessness Social isolationSocial isolation

13. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 13 Levels of Intervention Primary – activities that provide support, information, and education to prevent suicidePrimary – activities that provide support, information, and education to prevent suicide Secondary – treatment of the actual suicidal crisisSecondary – treatment of the actual suicidal crisis Tertiary – interventions with the family and friends of a person who has committed suicide to reduce the traumatic aftereffectsTertiary – interventions with the family and friends of a person who has committed suicide to reduce the traumatic aftereffects

14. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 14 Basic Level Interventions Milieu therapy with suicidal precautionsMilieu therapy with suicidal precautions CounselingCounseling Health teaching and health promotionHealth teaching and health promotion Case managementCase management Pharmacological interventionsPharmacological interventions

15. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 15 Survivors of Completed Suicide: Postintervention Surviving friends and familySurviving friends and family –Overwhelming guilt, shame –Difficulties discussing the often taboo subject of suicide StaffStaff –Group support essential as treatment team conducts a thorough postmortem assessment and review

16. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 16 Advanced Practice Interventions PsychotherapyPsychotherapy Psychobiological interventionsPsychobiological interventions Clinical supervisionClinical supervision ConsultationConsultation

17. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 17 A patient is hospitalized with major depression and suicidal ideation. He has a history of several suicide attempts. For the first 2 days of hospitalization, the patient eats 20% of meals and stays in his room between groups. By the fourth day, the nurse observes the patient is more sociable, is eating meals, and has a bright affect. Which factor should the nurse consider? The patient:A patient is hospitalized with major depression and suicidal ideation. He has a history of several suicide attempts. For the first 2 days of hospitalization, the patient eats 20% of meals and stays in his room between groups. By the fourth day, the nurse observes the patient is more sociable, is eating meals, and has a bright affect. Which factor should the nurse consider? The patient:

18. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 18 a.is showing improvement and may be ready for discharge. b.may have decided to commit suicide; the nurse should reassess suicidality. c.is feeling rested, supported by the therapeutic milieu, and less depressed. d.is benefiting from the antidepressant he has been taking for 4 days.