suicidal thoughts and behaviors Flashcards
suicidal ideation
thinking about killing oneself
suicide attempt
engaging in potentially self-injurous behavior with the intention of death
suicide
intentional act of killing oneself by any means
nonsuicidal self-injury
intentional damage to ones own body tissue, without conscious suicidal intent, and for purposes not socially or culturally sanctioned
epidemiology of suicide
10th leading cause of US for all ages; 2nd leading cause of death for 10-34 year olds; 4th leading cause of death for 35-54 year olds; age-adjusted suicide rate has increases 33% from 1999-2017
comorbidities of suicide
46% of those who die by suicide have a diagnosed mental illness such as depressive disorder, substance use, psychosis; suicide is a behavior not a diagnosis; very important to treat coexisting psychiatric disorder
those at an increased risk for suicide
anxiety disorders, personality disorders, eating disorders, trauma-related disorders
biological risk factors for suicide
family tendency- higher among monozygotic twins (identical), genetic and epigenetic factors; low serotonin levels with depressed mood- low serotonin in CSF, brainstem, and frontal cortex
cognitive factors for suicide
freud- unacceptable aggression turned inward; menningers three parts to suicide hostility- wish to kill (revenge), wish to be killed (guilt), wish to die (hopelessness); aaron beck- central emotional factor is hopelessness, cognitive styles contributing to risk are rigid all or nothing thinking and inability to see different options and perfectionism
environmental factors to suicide risk
family conflict- adverse childhood experiences increase risk by 2.7x; clusters of suicide or copycat suicides- teens at risk due to immature prefrontal cortex
cultural factors to suicide risk
religious beliefs, family values, sexual orientation, gender identity, bullying behavior, attitude toward death (S. korea has 10th highest suicide rate- familial honor vs shame), climbing rates of suicide in US
social factors to suicide risk
relationship problems, recent or imminent crises, substance use, health problems, financial problems, legal problems, loss of housing
other risk factors to consider to suicidie risk
family HX of suicide, ACEs, previous suicide attempts, HX of mental disorders, HX or alcohol/substance use, hopelessness, impulsiveness, isolation, easy access to lethal methods, unwillingness to seek help due to stigma around mental health
protective factors related to suicide risk
effective mental healthcare: easy access to variety of clinical interventions; strong connections to individuals, fam, community, social institutions; safe and happy marriage; having children; problem-solving and conflict resolution skills; contact with provides
nursing process- assessment of suicide
verbal and nonverbal cues: overt statements- “life isnt worth living anymore”; covert statements- “its ok now. soon everything will be fine”; nonverbal cues- giving away possessions, writing letters, mood lift following antidepressants (may give enough energy to follow through); lethality of plan- high risk vs low risk; HX of attempts; family HX; social support; presence/absence of psychosis
high risk suicide plans
using gun, jumping off bridge, hanging, CO poisoning, staging car crash
low risk suicide plans
cutting wrists, inhaling natural gas, ingesting pills
potential screening questions for suicidal ideation
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 you have a plan, what is it?
nursing self-assessment
may experience fear, grief, anger, puzzlement, condemnation of suicidal feelings or intent; acknowledge feelings to team member to avoid countertransference
possible nursing problems/diagnoses
risk for suicide (highest priority), self-care deficit, impaired sleep, impaired nutritional intake, anxiety
outcome identification of suicide
suicide self-restraint- remaining free from injury, describing self-worth, reaching out to others for help
planning for those who are suicidal
depends on pt condition; interventions could target underlying condition of depression, anxiety, psychosis
nursing implementation for suicidal pt
psychosocial- safety planning, careful med admin (mouth checks; only day by day supply); health teaching/promotion- prevention efforts; case management- aftercare referrals; milieu therapy- observational checks (highest risk during first few days and on shift rotation); documentation of care; suicide survivors; evaluation is ongoing
examples of ongoing evaluations
changes in mood, thinking, and behavior; increases in expression of emotions, thoughts, or feelings; widening of social network
suicidal environmental guidlines
plastic utensils (count when collected), no private room (door open), jump/hang-proof bathroom, minimal length electrical cords, unbreakable windows, locked windows, locked doors to non-patient areas, monitor/remove potentially harmful gifts, assess pt belongings in their presence, search pt for harmful objects
suicidal treatment modalities
biological treatment- pharmacotherapy for underlying conditions, brain stim therapy for decreasing ideation (ECT/TMS); psychological therapies- talk therapy
nonsuicidal self-injury epidemiology
15% of adolescents; 17-35% of college students; peak is between age 20-29; female to male ratio 3:1
nonsuicidal self-injury comorbidities
other mental health disorders such as depression, anxiety, eating disorders, substance use disorders; 70% of females with borderline personality disorder are affected by NSSI
risk factors for nonsuicidal self-injury
biological- increased stress vulnerability; cognitive- positive reinforcement (attention by someone) or negative reinforcement (reduction of anxiety); environmental- parental harsh punishment, limited monitoring by parent, poor quality of attachment; societal- phenomenon (social media), can be very isolating
NSSI nursing process assessment
be empathetic; assess type of injury, triggers, frequency, motivation; watch for transference and set boundaries early
nursing process diagnosis NSSI
risk for self-mutilation, self-mutilation
nursing process outcomes identification for NSSI
coping, social support, adherence (meds)
nursing process for planning for NSSI
6 step approach: limit setting for safety, developing self-esteem, discover motive and its role, discovery of self-control, replacement with coping skills, entering maintenance phase
nursing process implementation for NSSI
caring for injuries, establishing therapeutic alliance, teach coping skills, promote reflective dialogue
nursing process evaluation NSSI
continue to evaluate pt communication and perception
treatment modalities for NSSI
biological treatment or psychological treatment
biological treatment for NSSI
pharmacotherapy for comorbid conditions before targeting NSSI: evidence of using meds to target serotonergic, dopaminergic, and opioid systems- SSRIs/SNRIs, second gen antipsychotics, opioid antagonist
psychological therapies
advanced practice roles- CBT, DBT, group therapy; DBT aka dialectical behavior therapy focused on distress tolerance
dialectical behavioral therapy
focuses on helping individuals accept the reality of their lives and behaviors and helps to change their lives and unhelpful behaviors
