Suicide Flashcards
Suicidality
all suicide-related behaviors and thoughts of completing or attempting suicide and suicidal ideation
Suicidal Ideation
thinking about & planning one’s own death; it includes excessive or unreasoned worrying about losing a loved one
Suicide Attempt
nonfatal, self-inflicted destructive act with explicit/implicit intent to die
Parasuicide
voluntary, apparent attempt at suicide, commonly called a suicidal gesture, in which the aim is not death
- sometimes death is the result though
- -ex: taking too many pills but not intending to commit suicide
Lethality
the probability that a person will successfully complete suicide
Epidemiology of Suicide
- Suicide is the 10th leading cause of death
- 38,000 annually in the US
- 25 attempts per suicide annually (950,000)
- Mountain regions have the highest rates
- Suicides can be disguised as vehicular accidents or homicides
- Healthy People 2020 directly targets the reduction of deaths by suicide
Who is most vulnerable to suicidality?
- Suicide of a primary family member
- Psychiatric disorder
- Previous attempt
- Loss (grief)
- Unrelenting physical illness
- Poverty
Suicide Intent
- Do they have a suicide plan and means of executing it?
- Inability to enter into a commitment to treatment contract
*Always want to assess for intent
Suicide Risk
- White or Native
- American male adult
- Non Hispanic white or Native American male adolescent
- Elderly man
- Gay, lesbian, or bisexual
- Access to firearm
- Middle aged woman
- Mental illness
- 51% abused children attempt
Suicide: Disinhibition
- Impulsivity
- Isolation
- Psychotic thoughts
- Drug or alcohol use
Special Populations: Children and Adolescents
- 15% high school students have contemplated suicide & 7% have attempted
- Suicide contagion - Adolescents -Cluster suicides (suicide pacts, copy cat syndrome), more media coverage of a celebrity suicide increases copy cat suicides
- Adolescents are influenced by prevention measures
Special Populations: Adults
- Armed services Iraq & Afghanistan a leading cause, combat exposure & for women military sexual trauma
- Ages 45-54 peak & another peak after age 75
Etiology: Genetic
runs in families, identical twin whose twin showed suicidal behavior has 11 X the risk for suicidal behavior
Etiology: Physiologic Effects on Child Abuse
constant stress, altered serotonin/dopamine metabolism
Etiology: Reaction to Surviving Suicide
if they were sorry they did not die they are more likely to attempt again
Etiology: Depression
and neurotransmitter changes
Assessment
- Look for warning signs-giving away cherished belongings, depression, talk of suicide or death
- Identification of suicidal ideation
- Elicitation of a plan
- Determination of the severity of intent
- Evaluation of availability of means
- Sudden improvement may mean the person has developed a plan
- Assess for mental illness
- When you put someone on antidepressants, they look & act better, but they don’t feel better yet
Nursing Diagnosis
- Risk for suicide
- Risk for self directed violence
- Impaired social interaction
- Ineffective coping
- Chronic low self-esteem
Interventions
- Safety
- Work on their will to live
- Commitment to treatment statement
- Physical care of self-inflicted injury - Involuntary commitment to treatment
- Referral to an appropriate clinician
- Medication management - Psychoeducation
- Changing negative thought patterns
- Developing a contingency plan
- Stigma reduction - Developing support networks
- Electroconvulsive therapy
Interventions
Treating any underlying mental illness is protective
Interventions: Depression
treat with Selective Serotonin Reuptake Inhibitors (SSRI’s) which are not generally as lethal in overdose as other antidepressants (Tricyclic antidepressants are more lethal in overdose).
Interventions: Schizophrenia & Schizoaffective
Clozapine (clozaril) is an atypical antipsychotic that is protective for suicide
Commitment to Treatment Statement
Recent research findings do not support ongoing use of No Self Harm Contracts
A Commitment to Treatment Statement may be used instead. The patient writes & signs it to commit to
- Trying new approaches
- Engage in treatment
- Access emergency services if needed
- Communicate openly & honestly in treatment about all issues including suicide
- It does not explicitly restrict the patients rights regarding suicide
Discharge Planning
- Outpatient care at level of intensity needed by the patient
- Rx prescription
- Involve the patient and significant others in plans to make the home environment safer
- Document current suicide assessment before patient leaves
Short Term Outcomes
- Maintaining the patient’s safety
- Averting suicide
- Mobilizing the patient’s resources
Long Term Outcomes
- Maintaining the patient in psychiatric treatment
- Enabling the patient and family to identify and manage suicidal crises effectively
- Widening the patient’s support network
Postvention
After a suicide…
- Work through grief with others
- Preserve treatment team integrity vs. blaming and splitting
- Community meeting with patients
- In house memorial service
- Continuous Quality Improvement
- -> “what could we have done differently?,” trying to prevent it from happening again
- Acknowledge anniversary reactions
Family Response
Undue and prolonged suffering can be caused by the sudden shock
The grieving over the way the death occurred, the social processes affecting the survivor, and the effect of the suicide on the family are unique
Coping abilities mediate grief responses
