Suicide

Question 1

x

Answer 1

f

Question 2

______ can be characterized as living through an experience of suicide despite having epected or intended to die.

Answer 2

Attempt of suicide

Question 3

is the engagement of suicidal behaviour that results in death

Answer 3

Completed suicide

Question 4

• The thoughts of suicide are

Answer 4

suicide ideation

Question 5

Parasuicide?

Answer 5

is a self-injurious behavior or self-harm that may mimic suicidal behavior but the primary motivating force of action is not to kill oneself. Howveer death may occur

Question 6

Self harm =

Answer 6

exists in the suicide and parasuicide paradigms.

o It is characterized as any behaviour or act that causes harm to the body

Question 7

In which countries is suicide most common?

Where does Canada stand?

Answer 7

Show to be about equally Prevalent in low and middle income countries to high income (includes stats for ideation, plan + attempt)

• Canada ranks 41st in the world and suicide is the 9th leading cause of death overall

Question 8

IN which age groups, in men and women, is suicide the leading cause of death?
Overall?

Answer 8

men 25-29 and 40-49

woman 30-34

Is the leading cause of death for those aged 15-34 overall

Question 9

What are the most common causes of death by suicide (2000-2009)

Answer 9

hanging, suffocation, poisoning and firearms

Question 10

What is the best predictor for suicide?

Answer 10

A previous attempt

Question 11

Which youth populations in Canada are most likely to die by suicide?

Answer 11

• Second leading cause of death in youth 15-24yrs
• Young men 3X more likely to complete suicide if attempt
• 40x higher in inuit youth

Question 12

In the world, how does age affect suicide rates? In Canada

Answer 12

World: increases with age
Canada: highest at midlife (45–59)

Question 13

Most common method of suicide in youth in Canada?

Answer 13

Suffocation

Question 14

Most common psychiatric diagnosis of those that complete suicide? Other factors?

Answer 14

Depression

Other factors linked are childhood physical and sexual abuse, child hunger, and other psychosocial issues.

Question 15

*Risk factors for suicide

Answer 15

Being older
Being male
Poverty 
Being aboriginal
Being single (widowed > divorced > separated...)
Social isolation
Economic or occupational stress
Family hx of suicide
Psychiatric disorders (1/2) 
Unemployed 
Substance use/abuse (1/4) 
Sexual abuse, violence, 
Low self-esteem

Question 16

*Six community protective factors for suicide in aboriginal populations?

Answer 16

Self-government
Land claims
Education services
Police and fire services
Health services
Cultural facilities 

• In communities where there is autonomy and a strong sense of ownership, culture, and community there are lower rates of suicide

Question 17

*Protective factors

Answer 17

Access to medical and mental health resources
Intact social supports
Spirituality (religion, faith, spiritual beliefs)
Ongoing supportive relationships
Impulse control and problem-solving and coping skills
Marriage with dependent children

Individual – sense of competence, effective interpersonal skills, problem-solving, adaptive coping, self-understanding, optimism, religious affiliation

Family – sense of responsibility to family, sense of belonging

Work – sense of accomplishment, positive peer support, non-punitive environment, PD opportunities, core values are present, access to EAP programs

Community – opportunities to participate, affordable/accessible resources, hope for the future, self-determination and solidarity

Question 18

*Assessment:

IS PATH WARM

Answer 18

I-ideation
S-substance abuse
P-purposelessness
A-anxiety
T-trapped
H-hopelessness
W-withdrawal
A-anger
R-recklessness
M-mood changes

Question 19

*SAD PERSONS

What does this stand for?

Answer 19

RISK FACTORS

Sex-male?
Age-under 19, over 45
Depression-current?
Previous attempt?
Ethanol use
Rational thinking loss
Social supports lacking
Organized plan
No spouse
Sickness

Question 20

*SLAP

Answer 20

?

Question 21

What should be included in suicide risk assessment interview?

Answer 21

IS PATH WARM and SLAP
Ask directly if client is considering suicide
Interview for ideation, intent and plan(s); consider access to medications, weapons, lethality of plan, seriousness of plan, level of preparation
Explore meaning of suicidal behaviour
Identify current protective factors at individual, family, work, community level

Question 22

*Nursing Diagnoses

Answer 22

Risk for suicide
Interrupted family processes
Ineffective health maintenance
Risk of self-directed violence
Impaired social interaction
Ineffective coping
Chronic low self-esteem
Disturbed sleep pattern
Social isolation
Spiritual distress

Question 23

• Plan and goals of care for pt at risk of suicide?

Answer 23

• Mobilize continuing sources of social support
• Establish the out-patient care plan
  (Include names, schedule, ongoing supervision, etc.) –> most suicides occur during first week after discharge

Set short term outcomes

• Maintain safety
• Avert suicide
• Mobilize patient resources
• Reduce stress

Long-term Outcome
- Maintain treatment , manage crises, widen social network

Question 24

More goals of nursing care…

Answer 24

Demystify
Prevent stigma of at-risk people
Cries for help need to be heard
Preventive – develop protective factors
Proactive – collaboratively develop safety plan/contract
Clients at high or imminent risk – immediate evaluation for protective secure environment or hospitalization

Question 25

*What is a no harm contract?

Answer 25

Have the patient agree and commit, in writing, to no self-harm for an agreed upon period of time.
Only done after a thorough assessment and the patient is deemed competent…in other words…is not a candidate for involuntary admission or a high risk for suicide. Used with caution.
Patients who are not good candidates may be psychotic, under the influence of substances, prior suicide attempts, isolated, or have multiple risk factors.
Not a well researched strategy, and may not be effective.

Question 26

*Prevention strategies

Answer 26

Education
Suicide risk screening 
Depression screening 
Accessibility to resources – outpatient care plan 
Reduction of stigma
Promoting hope
Familiarity with Mental Health Act

Question 27

*Educate client and family on…

Answer 27

Depression, suicidal behaviour & treatments
Origins of suicidal behaviour
Effective treatment for depression
Access to ongoing seamless out-patient support
Development of a plan for managing future suicidal ideation & contacting “help”
Supportive others in the community
Benefit of meds and abstinence of alcohol, etc.

Question 28

Regional variations in suicide risk in Canada?

What sort of factors involved here?

Answer 28

• Eastern and central regions of the far north have some of the highest mortality rates in Canada (Nunavut, NWT, quebec)
• D/t combo of factors: live in rural or semirural env’t where hunting is common; social isolation can occur due to low population per square km, and populatin is predominantly aboriginal

Question 29

DO people usually really want to do die when they attempt suicide?

Answer 29

• Suicidal acts tend to be seen as cries for help rather than overt expressions of a desire to die

Question 30

• Suicidal ideation and self-harm are more common among ____

Why do teens self harm?

Answer 30

adolescents than other age groups

• Self-harm behavior in adolescents is often a way to communicate needs or wants and often the need is for attention or care.
• Para suicidal behavior (cutting or self-mutilation) may relieve or release certain emotions and feelings and produce a tangible, physical pain to substitute for unfamiliar, unbearable psychological suffering

Question 31

What biological factors are seen in risk for suicide?

Answer 31

• Recognize and interpret physiologic, neurophysiologic and hormones changes
• Psychopathologic changes are evident
• MDD (depression), sometimes comorbid with other psychiatric illness is prevealent
• Genetic predisposition
• Excessive physiologic stress responsiveness
• Neurotransmitter depletion
• Early significant childhood trauma
• Inc suicide risk among those who have experienced sexual abuse
• MDD tends to develop when a person who is vulnerable to it (bc of genetic factors is subjected to repeated or unsustained stress
• Stress responsiveness- changes neurotransmitter and hormoneal functioning to affect a depressed state
• Those who complete suicide have low levels of serotonin, 5-HT, and dopamine

Question 32

What evidence is there for genetic link in suicide risk?

Answer 32

• Genetic link is evident in twins. Inc risk 11-fold for other twin if one twi shoes behavior
• Adults that experience mood disorders and were adopted as children, the suicide rate among the biologic relatives of the adoptees is much higher than the rate among the adoptive relatives.
• Genetic abnormalities in the serotonergic neurotransmitter system may be responsible for the inc familial risk for suicide

Question 33

What biological explanation is there for risk of suicide and childhood abuse?

Answer 33

• Enhanced vulnerability to MDD and suicide associated with child abuse are attributable to changes in the hypothamic-pituitary-adrenal axis caused by irritable stress and altered serotonin and dopamine metb
• Child abuse- specific vulnerability for psychopathology and suicide
• Link between childhood sexual abuse and biologic alternations contribute to psychopathology may be independent of other environmental influences.

Question 34

How do mental health issues and substance abuse contribute to suicide risk?

Answer 34

• MDD, generalized anxiety, personality disorders and pther psychiatric illness are present in suicidal persons
• Alcohol and substance use are found in 25% of suicides, similar to those associated with depression
• Anxiety and comorbid depression and substance use account for more suicides than schizophrenia and other psych disorders (but these later ones also contribute
- Psychological disorders + substance abuse = greatest risk for suicide

Question 35

What sort of psychological theories are there about suicide?

Answer 35

• Suicide can be conceptualized psychologically as an excessive reaction arising from intense preoccupation with humiliation and disappointment
• Can be driven by intolerable aloneness and isolation
• Attachment theory explains social isolation and interpersonal relationships as being a part of the spectrum of suicide—in this theory adult behavior is shaped by early interacions with the primary caregiver during infancy
• Disturbed attachments results in the individuals inability to form meaningful relationships or in a constant concern about the viability of a lasting relationship
• Few or maladaptive coping strategies
• Helplessness
• Hopelessness
• Worthlessness
• Guilt
• Negative thinking
• Distressed significant relationships
• loss

Question 36

Relationship between religion + suicide?

Answer 36

• Greater omral objections to suicide may be protective against attempts
• However social scientists do not finding that not believing in God is a causative factor to suicide, rather it is the belief that suicide is wrong that is a strong deterrent to the act

Question 37

What is suicide contagion?

Answer 37

one teenager takes their life and others follow
• Occurrence of this can result in development of “suicide cluster” which is defined as multiple suicidal behaviours or suicides that fall within a specific time frame and often specific geographical area

Question 38

What are “point clusters”

“mass clusters” associated with?

Answer 38

are suicides that occur close in time and space and often occur in settings such as hospitals, schools, prisons and specific communities

mass cluster is associated with media reports related to suicide of celebrities or other completed suicides with overwhelming attention (Marilyn MOnroe, Amanda todd)…have to be very careful in how to report suicides!

Question 39

4 types of bullying?

Answer 39

physical, verbal, relational, and cyber

Question 40

Link between spirituality + suicide risk?

Answer 40

• Source of of resilience and coping

* Those with spiritual involvement are at a dec risk of substance abuse, addiction and suicide

Question 41

What responsibilities does a nurse have when child states they may harm themselves?
What should a nurse always do before conducting a suicide assesssment?

Answer 41

• Nurse must always consider informing parents of a child who has suicidal intent
• The parents of a minor retain the privilege to determine the right care for their child
• Before beginning any suicide assessment, nurses must let a child know that disclosure of self-harm may be shared with aprents

Question 42

When is physical restraint + hospitalizing pt against will “ok”?

Answer 42

Only when under threat of imminent suicide or status in “noncompetene” under mental healht act and is risk for self and/or others.

Question 43

The CNA outlines pt has right to confidentiality unless?

Answer 43

• Risk for harming self or others

- Discloses any form of abuse to minors (neglect, sexual, psychological, emotional, etc…)

Question 44

What effect does a nurse disclosing limitations of confidentiality have with nruse=patient relationship?

Answer 44

Greater trust formed, more therapeutic relationship…this is true with children too.
(always be very honest with all ages about limitations)

Question 45

What kind of restrictive environment does a suicidal pt have a right to? What does a nurse need to communicate with the pt around this?

Answer 45

• Nurses must inform suicidal patients about limits to their self-determination and make efforts to obtain their cooperation
• From the time that the nurse encounters a suicidal patient until a suitable placement is made in consultation with other members of the interprofessional team, the nurse must share with the pt his or her right to be placed on the least restrictive env’t to ensure safety
o It is the setting that puts the fewest constraints on the patients rights while still ensuring the p safety
o Informing a patient about their choices helps the nurse gain trust and dec likihood of involuntary hospitalization

Question 46

Importance of documentation with suicidal pt’s?

Answer 46

• Nurse must thoroughly document encounters with patients
• Action is for the patients ongoing treatment and nurses protection
• Nursing notes must reflect that the nruse took every reasonable action to provide for the paitents safety
• If is a no self-harm contract that has been instituted, the record must contain specific aspects of the contract

Question 47

Comprehension Assessment of risk

Answer 47

• Assessment includes collection of adequate data to provide a clear picture of the patients life and relevant stressors from the patients perspective
• Includes a good understanding of the patients family, peers and social relationships
• Changes related to loss and abuse need to be explored
• symp of depression- isolation, sleep and eating disturbances, not participating in activities
• risky behaviors
• Assessed for other psychiatric disorders,
• Aolescents- key question is if any other family member completed suicide
• Alcohol use
- Stressors (what’s troubling)
- Symptoms (eating, sleeping, enjoyment?)
- Prior behavior (thoughts or actions of self harm?)
- Current plan?
- Resources and support?

Question 48

• Those who impulsively decide to end their lives are usually

Answer 48

adolescents, people who abuse alcohol or drugs, people with personality disorders, pt with psychoses (may respond to voices in their head)

Question 49

WHo are not good candidates for self harm contract?

Answer 49

if on medication, under the influence of alcohol or other drugs, previous suicide attempts or extremely isolated

Question 50

Goals of inpatient care?

Answer 50

are to maintain the patients safety, reduce or eliminate the suicidal crisis, dec level of suicidal ideation, initiate treatment for the underlying disorder, evaluate substance abuse and reduce the patients level of social isolation

Question 51

Methods nurses use to ensure safety of suicidal pt?

Answer 51

• Most important way to reduce stress
• Observing patient regularly for suicidal behaviour
• Remove dangerous objects
• Provide counseling opportunities
• Help them to reestablish personal control by including them in decisions about their care
• Patients often feel shaky in the first few hours of hospitalization and it is comforting to know that a caring person is nearby
• Observational periods can be used to help the patients express a broad range of feelings ands strengthen their belief in their own abilities to keep themselves safe.
• Nurse might help at the beginning and then reinforce the safety behaviour next time
• Seclusion and restraint are two modalities sometimes used

Question 52

Effects of seclusion + restraints?

Answer 52

• Interferes with develoing trusting relationships
• Reinforces sense of hopelessness and helplessness
- Enhance pt’s feelings that they are “crazy” and can’t control impulses
- Takes away pt’s ability to control own anxiety symptoms etc

Question 53

What must be done before a nurse can leave an acutely suicidal patient’s side (event for a moment)

Answer 53

Must determine what is necessary to ensure the safety of that pt
(this is nurse’s top priority!!)

Question 54

What sort of somatic therapies may be used for those with suicidal ideation?

When is ECT useful?

Answer 54

• Antidepressants and Electroconvulsive therapy (ECT)
• ECT may be useful for selected patients with intractable suicidal ideation and severe depression or do not respond to meds
• Objective of medication is to raise serotonin level rapidly to redice suicide risk

Question 55

Why should 3rd generation and newer anti-depressant medications should be used instead of 1st and 2nd gen?

Answer 55

1st + 2nd gen = tricyclic + MAOI’s = equally effective but much more toxic (so can use more easily to die by suicide..)

Question 56

How does substance abuse and depression play into suicidal ideation for men and women differently?

Answer 56

• For men, substance use may be the primary psych disorder with depression a side feffect
• For women, depression is commonly a primary psych disorder

Question 57

Interventions for psychological domain

Answer 57

• Identify stressors that are experienced by the patient to determine ways for the patient to avoid these or cope with them better in the future
• Identify what needs to change in their lives to prevent further suicidal behaviour –> this involves instilling hope in pt that this change is possible and there is hope in the future

Question 58

Interventions for the Social Domain

Answer 58

1) Improving Communication
• Most patients do not want to burden their family and/or are not comfortable sharing their concerns with them
• Nurse must identify who in their life is supportive and make appropriate referrals to professionals

2) Networking and discharge planning
• Through education the nurse should destigmatize the situation for both the patient and significant other, as they are embarrassed

3) Educating the patient and the family
• Inc pt understanding of the origins of her suicidal behaviour,
• Establish effective treatment for depression,
• Provide for ongoing seamless outpatient treatment,
• Devise a plan for managing future suicidal ideation, identify supportive others in the community,
• Establish a plan to make contact with these people and community resources and
• Continue with drug and alcohol treatment
• Educate about depression, suicidal, behaviour and treatments
• Include significant other

Question 59

Interventions for the spiritual domain

Answer 59

• Important to be open to the patients concept of spirituality, his or her thoughts and feelings around the meaning of suicide and what it is like to contemplate killing onself.
• Provide the patient with the time and space to explore the meaning of life, their spirituality and their concept of death and dying bc it might give insight into the factors the precipitate the patients thoughts and behaviours

Question 60

WHen do most suicides occur after discharge?

Answer 60

during first week of discharge and many within first 24 hours

Question 61

What should be included in establishing outpatient plan for suicidal pt?

Answer 61

• Concrete plan must be in place. Includes:
o Scheduling an apt for outpatient care
o Continuing medication until the first outpatient treatment visit
o Ensuring postrelease contact between the patient and significant others
o Access to emergency psych care
o Arranging the patients env’t so that it provides both structure and safety
• Very unstable patients may need 2 or 3 outpatient visits per week
• Patient and significant other should have plan for patients ongoing supervision
• Family members must feel they have resources. Not just on them

Question 62

What sort of symptoms are seen in caregiver with compassion fatige?

Answer 62

ntrusive thoughts or images of pt situations or trauma, difficulty separating work from personal life, lower frustration tolerance, hypervigilance, dec feelings of confidence, diminished sense of purpose or enjoyment of career and sleep disturbances
• The nurse maybegin to avoid the stress through absenteeism or presenteeism