21. Suicide Flashcards
person is thinking about suicide
suicide ideation
includes willful, self-inflicted life threatening attempts that have not led to death
suicide attempt
act of intentionally ending one’s own life and opting for nonexistence
suicide
voluntary apparent attempt at suicide where the aim is not death (intent varies)
parasuicide
probability that a person will die by suicide; likelihood that a method of death will succeed
lethality
myths of suicide
- people who talk about suicide don’t die by it
- suicide happens without warning
- people who die by suicide are fully intent on dying-
suicides occur more frequently during holidays - improvement after suicide crisis means risk of over
a bodily lesions resulting from acute overexposure to energy (mechanical, thermal, electrical, chemical, or radiant)
physical injury
examples of physical injury
- suffocation
- poisoning or overdose
- lacerations
- gunshot wounds
examine factors that identify whose who are most likely to attempt suicide
ideation of action theories
3 interactive factors that indicate a high risk of suicide
- thwarted belongingness: feelings of loneliness or isolation
- perceived burdensomeness: feelings of being a burden to others
- acquired capability for suicide: heightened sense of fearlessness and a high pain threshold (develops over time)
progression from suicide ideation to suicide attempt
volitional factors
4 volitional factors
- acquired capability
- access to lethal means
- planning
- impulsivity
a lack of social connection that contributes to suicide thoughts and actions
social distress
examples of social distress
- single
- separated or widowed
- homeless w/o religious affiliations
- interpersonal conflict
- sexual minorities
- bullying
suicide behavior that occurs after the suicide death of a known other
suicide contagion
T/F: poverty and economic disadvantage is associated w/ suicide
True
protective factors from suicide
- family and community support
- skills in problem solving, conflict resolution, and non-violent ways of handling disputes
- cultural and religious beliefs
- easy assess to clinical care
marital status risk factors for suicide
single 2x more likely than married people
gender risk factors for suicide
women attempt suicide more often but men succeed more (more lethal methods)
age risk factors for suicide
- risk of suicide increases w/ age
- highest risk group: males 22-44 years old and white males over age 75
ethnicity risk factors for suicide
- American Indian/Native Alaska have highest risk
- Caucasian is second highest
social risk factors for suicide
- no religious affiliation
- highest and lowest social classes have higher risk than middle class
- unemployment or increased financial burden
physical risk factors for suicide
- psychiatric illness (mood disorders most common)
- severe insomnia
- alcohol and barbiturate use
- psychosis w/ command hallucinations
- chronic painful or disabling illness
- family Hx of suicide
- loss of loved one through death or separation
largest risk factor of suicide
previous suicide attempt (about half of those who die by suicide have hx of attempts - usually within years)
3 areas of suicide assessment
- thoughts or ideation
- intention
- behavior
2 important questions to aks pt to establish suicide ideation
- over the past month, have you wished you were dead or wished you could go to sleep and not wake up?
- over the past month, have you had any actual thoughts of killing yourself
- answer “yes” to either question = risk (learn intent)
how to establish suicidal intent
past or present evidence (explicit or implicit) that a person
- wishes to die
- means to kill him/herself
- understands probable consequences of his/her actions or potential actions
questions to ask to assess suicidal intent
over the past month have you
- been thinking how you might do this
- had these thoughts and some intention of action on them
- started to work out the details of how to kill yourself
- if yes, did you intend to carry out this plan
thought of at least one method w/ no intent on acting on thoughts and has not worked out details
intent; method
thought of method but would never go through with it
suicide thoughts w/ no intent
thought about method but not sure if would go through with it (possible)
some intent; no plan
thoughts of killing oneself with plan fully or partially worked out and some intent to carry it out
suicidal thoughts with specific plan and intent
how to assess suicidal behavior
Have you ever done anything started to do anything or prepared to do anything to end your life in the past 3 months?
acts or preparation towards self-directed violence; before potential for injury has begun; anything beyond verbalization or thought
preparatory behavior
examples of preparatory behavior
- collecting pills
- obtaining gun
- giving away valuables
- writing a will
- went to a bridge but didn’t jump
- tried to shoot or hang self
behavioral cues of potential suicide
- giving away possessions
- writing farewell notes
- making a will or putting affairs in order
- sudden improvement after being depressed/withdrawn (more energy to carry out suicide)
- neglecting personal hygiene
interventions for crisis period
- hospitalization w/ suicide precautions or observations
- keep accurate records of pt; document activity every 15 minutes (per protocol)
- encourage pt to discuss feelings/problem-solving alternatives
- support or develop safety plan
interventions for outpatient setting
- don’t leave person alone
- refer for a comprehensive assessment
- enlist help of family or friends
- schedule frequent appointments
- establish rapport and promote trusting relationship
prioritized written list of coping strategies and sources of support for anyone who has had a suicidal crisis; collaborated on by clinicians and patient
safety plan
3 characteristics of safety plan
- brief
- in patient’s own words
- easy to read
steps of safety plan
- warning signs: when to use safety plan
- internal coping strategies: problem-solving strategies that can be done on their own
- social contacts who may distract from crisis: places that help person feel safe
- family member or friends who may offer help: prioritize list
- professionals and agencies to contact for help
- making environment safe: remove firearms, prescriptions etc.
- write down 1 thing important to person and worth living for
safety plan followup
- assess likelihood of following safety plan
- where safety plan is kept and can be accessed
- evaluate format
- review periodically
education for family and friends of suicidal patient
- take any hint of suicide seriously
- don’t keep secrets
- be a good listener
- express to patient feelings of personal worth
- restrict access to firearms or other means of self-harm
