1. Self-Protective Responses and Suicidal Behavior Rochelle Roberts RN MSN Chapter 20

2. Epidemiology of Suicide 31,000 people complete the act of suicide each year Suicide outnumbers homicide in the US *The highest suicide rate for any group in this country is among people over age 65, especially white men over 85.

3. Self-Protective Responses Range from self-enhancement and growth promoting to self-destructive behavior, self- injury, and suicide. Low self-esteem leads to depression,which is present in self-destructive behavior.

4. Indirect self-destructive behavior Non-compliance: accounts for 125,000 deaths annually. Includes denial and guilt Self-injury: the act of deliberate harm to one’s own body (for tension relief)

5. Suicide Suicide ideation: the thought of self-inflicted death A suicide threat: a warning,direct or indirect, verbal or nonverbal that a person is planning to take one’s own life. Suicide attempt: any self-directed actions taken by a person that will lead to death if not stopped. Complete suicide: is death from self-inflicted injury, poisoning, or suffocation where evidence indicates the intent to kill oneself.

6. Risks for suicide Mood disorders Substance abuse Schizophrenia Anxiety disorders

7. Predisposing factors for suicide Loss Lack of social supports Negative life events Chronic medical illness Fhx of suicide

8. Personality traits Hostility Impulsivity Depression

9. Biological factors implicated in suicidal behavior Deficiency in serotonin (5-HT) Increase in one of the 5-HT post-synaptic receptors

10. Self-destructive behaviors Are an attempt to escape Are related to cultural and social factors Are influenced by chronic and painful illnesses

11. Coping mechanisms Denial Rationalization Regression Magical thinking

12. Primary nursing diagnoses Risk for suicide Self-mutilation Noncompliance Risk for self-directed violence

13. DSM-IV-TR diagnoses Anxiety disorders Bipolar disorder Major depression Non-compliance with treatment Schizophrenia Substance use disorders

14. Nursing Outcome The patient will not physically harm himself or herself

15. Nursing interventions Protecting the patient Providing for safety Communicating hope Increasing self-esteem Regulating emotions & behaviors Mobilizing social support Educating the patient Suicide prevention