Suicide

Question 1

Suicide general

Answer 1

A behavior; not a diagnosis or disorder
30,000 persons in the U.S.
95% who attempt or commit have a diagnosed mental disorder
Major depression and bipolar (80%)
Substance abuse, schizophrenia, personality and anxiety disorders.

Question 2

Active vs Passive

Answer 2

Active:
Direct action by the suicidal person to end his/her own life. It is not an accident or a mistake.
Passive:
The goal is to allow an accident or neglect to be the cause of death.
(Don’t get hung up on the difference!)

Question 3

Levels of suicidal behaviors

Answer 3

Ideation: Frequent and specific thoughts of death and ways to die.
Planning: A logical and well prepared suicide plan with a good likelihood of success.
Gesture: Behavior or activity that is dangerous
Attempt: Clear, self-destructive actions with a good probability or expectation of lethality that did not result in death.
Successful Suicide

Question 4

Suicide and age

Answer 4

Men: Sharp increase in adolescence, peak between 40 and 50, levels off to age 65 where it rises again for the remaining years*
Women: Fairly constant throughout life, declines after age 65.
15-19 years: 7.4 per 100,000 (firearms 49%)
Elderly: 15.6 per 100,000. White men over 80 are at greatest risk (firearms)

Question 5

Suicide and gender

Answer 5

Women attempt more, men succeed more often.

Men 70%, women 30% . Women tend to overdose; men tend to use more lethal means such as firearms.

Question 6

Suicide and ethnicity

Answer 6

Whites are at highest risk, followed by Native American, African Americans, Hispanic Americans, and Asian Americans.

Question 7

Suicide and marital status

Answer 7

The suicide rate for single persons is twice that of married.
Divorced, separated, or widowed have rates 4 to 5 times higher than married.

Question 8

Suicide and SES

Answer 8

Persons in the highest and lowest classes are at higher risk than the middle classes

Question 9

Suicide and religion

Answer 9

Depressed men and women who consider themselves affiliated with a religion are less likely to attempt suicide.

Question 10

Suicide - other risk factors

Answer 10

Higher risk with a family history, esp. same-sex parent.
Persons who have a prior attempt.(50%)
Loss of a loved one through death or separation, lack of employment, financial worries also increase risk.
Suicide risk may increase early in treatment with antidepressants due to increase in energy level.
Severe insomnia
Alcohol
Psychosis with command hallucinations
Chronic painful or disabling illness

Question 11

Suicide myths

Answer 11

People who talk about suicide don’t commit suicide
Suicidal persons are fully intent on dying
Once suicidal, always suicidal
Improvement after severe depression means risk is over
Suicide is inherited
Suicide is psychotic
Once a person has attempted suicide, he/she will not do it again.

Question 12

Suicide facts

Answer 12

8/10 people give a warning
Ambivalence!
With help, they can go on to lead normal lives
Most suicides occur within beginning of “improvement”
Family member suicide is a risk factor, not a guarantee
Most suicidal patients do have a mental health diagnosis, but not usually psychosis. Some patients do not have any mental illness background.
If a person has attempted suicide, he/she is at greater risk for attempting again.

Question 13

Psychological Theories of suicide

Answer 13

Anger turned Inward
Hopelessness
Desperation and Guilt
Hx of Aggression and Violence
Shame and Humiliation
Developmental Stressors

Question 14

Suicide in hospitals

Answer 14

Patients on medical-surgical units and emergency rooms also are at risk for suicidal thoughts and behaviors.
We have a mandate from The Joint Commission to assess our patients for suicide risk

Question 15

Suicide - hospital assessment

Answer 15

Medical / Psychiatric symptoms or diagnosis
Suicidal ideas or acts-
Intent, means, lethality, history
Verbal or behavioral cues
Interpersonal support system
Coping Strategies
(Meds)

Question 16

Suicide interventions

Answer 16

Ask client directly
Create safe environment (How?)
Formulate written or verbal contract (contract for safety)
Maintain close observation –
1:1, eye contact, q 15 min.,etc.
Room close to station, not private, accompany off-unit
Special care with meds
Frequent, irregular rounds
Encourage expression of feelings