5.1 Suicide Prevention

Question 1

Suicide

Answer 1

• Suicide is not a diagnosis or a disorder, it is a behavior
• 90% of those who commit/attempt suicide have a diagnosed mental disorder

Definition
- Taking one’s own life
- Most commonly associated with depression

Question 2

Epistemological Factors of Suicide

Answer 2

• Second leading cause of death for Americans aged 10-34 years old

Question 3

Facts/Myths About Suicide

Answer 3

Myth
- People who talk about suicide do not commit suicide
- In reality 8/10 people who kill themselves have given clues/intentions about their intention

Myth
- Improvement after severe depression means risk of suicide is over
- In reality most suicides occur 3 months after beginning improvement

Myth
- Suicidal threats should be considered attention-seeking behavior
- In reality all suicidal behavior must be approached with the gravity of a potential action in mind

Myth
- Leading cause of suicide is overdose on drugs
- In reality the leading cause of suicide is gunshot wounds

Question 4

Suicide Risk Factors

Answer 4

Physical Conditions
- Traumatic Brain Disorder
- Sleep Disorders
- HIV/AIDS
- History of Psychiatric Illness

MOST COMMONLY MOOD DISORDER OR SUBSTANCE ABUSE DISORDER

• Those who have been hospitalized are at 5-10 times greater suicide risk than general population
• Half of individuals who commit suicide have had a prior attempt
• Alcohol, particularly combination of alcohol and barbiturates have increased risk of suicide. Withdrawal from stimulants are at increased risk due to “crash”. Chronic pain and disabling illness are also risks.

Question 5

Suicidal Risk Factors

Answer 5

Marital Status
- Single and never married is twice as likely then married
- Divorced men are 3x as likely than divorced women
- Widows/Widowers are also at high risk

Gender
- Women attempt suicide more (overdose) men succeed more (firearms). Transgender’s are also high risk

Age
- Highest rate is between 45-64
- Highest is 85+

Religion
- Those who follow religion are at lower risk

Socioeconomic Factors
- Low socioeconomic class are highest risk

Ethnicity
- Whites are highest risk
- Young Native Americans are also high risk

Psychiatric Illness
- Mood/Substance abuse disorders are highest risk

Others:
- Schizophrenia
- Personality Disorders
- Anxiety Disorders
- Psychosis (especially with hallucinations)

Question 6

Psychological Theory of Suicide

Answer 6

Anger turned inward
- Response to intense self-hatred. The anger originated toward a love object but ultimately turns to hate inward against self.

Hopelessness and other symptoms of depression

History of aggression/violence
- Associated with greater ideation but not necessarily attempts

Shame and humiliation
- People may view suicide as a way to prevent public humiliation following a social defeat or sudden loss of income

Question 7

Durkheim’s Three Social Categories of Suicide

Answer 7

Egoistic Suicide
- Individual feels separated from mainstream society. Integration is lacking and individual does not feel apart of any cohesive groups (family/church)

Altruistic Suicide
- Opposite of egoistic. Excessively integrated with a group governed by political/religious/cultural ties. Allegiance is so strong they are willing to sacrifice their lives.

Anomic Suicide
- Response to changes that occur in an individuals life that induce feelings of being separated and fears of losing support within their former cohesive group.

Question 8

Biological Theories of Suicide

Answer 8

Genetics
- Has to do with the gene tryptophan hydroxylase which has to do with synthesis of serotonin. Diminished serotonin is a risk factor for both depression and suicide

Neurochemical Factors
- Deficiency of CNS serotonin increases risk of suicide

Question 9

Suicidal Self Injury vs Non-Suicidal Self Injury Behaviors

Answer 9

Suicidal
- Related to wanting to die

Non-Suicidal
- Used to release emotions (cutting, scratching, burning themselves)

Question 10

Protective Behaviors to Reduce Suicide

Answer 10

• Resilient Temperament
• Social Competency
• Skills in problem solving, coping, and conflict resolution
• Perception of social support from adults/peers
• Positive expectations and optimism for the future
• Connectedness with family/school/community
• Presence of caring adults for adolescents
• Integration in social networks
• Cultural/Religious beliefs that discourage suicide
• Access to quality social services and clinical healthcare
• Support from relationships
• Restricted access to lethal means of suicide

Question 11

Suicide Assessment

Answer 11

• Identify detailed assessment of patients unique situation to figure out resources and interventions needed to ensure patient safety
• Establishing therapeutic relationship (trust through empathy and respect) to provide a safe environment is the foundation of effective suicide risk assessment
• Assessments are complex and require many different communication techniques to assess patients thoughts, feelings, and behaviors from various perspectives
• Suicide risk fluctuates (assess over time risk factors, changes in stress levels, changes in intensity of ideation, changes in support systems)
• Collaborate with other sources of information like family, peers, friends, co-workers.
• USE DIRECT LANGUAGE (use words like suicide and death instead of not happy with living or indirect sentences). This communicates that suicide is an acceptable topic to discuss
• Documentation includes warning signs, underlying themes, level of risk, clinical judgment, and recommended interventions