Quiz #2: Suicidal Behavior Flashcards
Epidemiology of Suicide
-10th leading cause of death, outnumbering homicide
-Highest suicide rate for any group in the U.S. is among people older than 80 years
-3rd leading killer of young people
-Incidence varies among cultural groups
(More common among Whites than Blacks at all ages. Certain groups at higher risk, such as LGBTQ)
-Women attempt more than men but men are more successful
-Guns account for half of all suicides
Risk Factors for Suicide Include
-Past suicide attempts (strongest predictor!)
-Psychiatric diagnosis (mood disorders, substance abuse, schizophrenia, and anxiety disorders)
-Personality traits/disorders (Hostility, impulsivity, depression, and hopelessness)
-Psychosocial factors and physical illness
(Loss, lack of social supports, negative life events, and chronic physical illness)
-Genetic and Familial Variables (Family history of suicide)
-Biochemical (Low levels of serotonin (5-HT))
-Demographic factors (Males, persons who are unmarried, elderly, adolescent & young people, White race)
-Precipitating Stressors (any overwhelming stress)
Suicide Protective Factors Include
- Ability to cope w/ stress
- Access to care and medications
- Restricted access to highly lethal methods of suicide
- Support
- Skills in problem solving
- Cultural/religious beliefs against suicide
- Sense of hope
Suicidal verbal and nonverbal cues
- Overt Statements (i.e “I wish I were dead”, “life isn’t’ worth living anymore”)
- Covert Statements (i.e “It’s okay now. Soon everything will be fine.”, “Things will never work out.”, “Nothing feels good to me anymore and probably never will.”)
Suicide: Assessment - Specific Questions
- Have you ever felt that life was not worth living?
- Have you been thinking about death recently?
- Did you ever think about suicide?
- Have you ever attempted suicide?
- Do you have a plan for completing suicide?
- If so, what is your plan for suicide?
Asking direct questions about suicide
- Does NOT make the patient more prone to suicide!
- Most people want to talk about their depressed and/or suicidal thoughts, but are too scared/ashamed to seek out help.
Assessment - Lethality of Suicide Plan
- Evaluating suicide plan is extremely important in determining degree of suicidal risk
- People who have definite plans for the time, place, and means are at high risk
- **People who are psychotic are at high risk regardless of specificity of plan
Main elements that need to be considered when evaluating lethality of suicide plan
- Is there a specific plan with details?
- How lethal is the proposed method?
- Is there access to the planned method?
“High Risk” suicide plans include
- Gun
- Jumping
- Hanging
- CO poisoning
- Staging car crash
“Low risk” suicide plans include
- Cutting wrists
- Inhaling natural gas
- Ingesting pills
Implementation for those at risk for suicide
- Protection and safety (highest priority!): Adequate suicide assessment; safe environment of care; adequate and competent staff; adequate supervision; adequate medication management
- Increasing self-esteem: Reinforce reasons for living and promote patient’s strengths
- Regulating Emotions and Behaviors: Encourage socialization; Physical activity; Relaxation; Process feelings
- Social Support
- Patient Education: Medication regimens; handling future crises
- Suicide Prevention: Telephone services; Find support groups
Environmental guidelines for minimizing suicidal behavior
- No private rooms and ensure doors are open
- Jump-proof and hang-proof bathrooms
- Keep electrical cords to minimal length
- Take all potentially harmful gifts from visitors
- Remove all potentially harmful objects from patient (use plastic utensils, unbreakable glass)
- Ensure that staff and visitors do not leave potentially harmful objects
- Lock all utility rooms, kitchens, stairwells and offices.
