Suicide prevention and crisis intervention

Question 1

suicide placement on leading cause of death among americans in 2020

Answer 1

12th leading cause

Question 2

appr how many people died by suicide in 2020

Answer 2

46,000

Question 3

at highest risk for completing suicide

Answer 3

Single, never-married individuals
Divorce
Widows and widowers
Women attempt suicide more often than men
Men are more likely to complete suicide
Women more likely to overdose
Men more likely to use more lethal means, such as firearms

Question 4

high school students and suicide

Answer 4

More than 17% (approximately 2.5 million ninth through twelfth graders) have seriously considered suicide
More than 13% have made a suicide plan
More than 8% have attempted suicide

Question 5

Age risk factor for suicide

Answer 5

Risk of suicide increases with age
-Especially among men
Highest rate of suicide
-Aged 75 or older

Question 6

religion and socioeconomic status risk factors for suicide

Answer 6

Higher among very highest and lowest social classes
More completed suicides among unemployed
Affiliation with a religious group decreases risk of suicide

Question 7

highest ethnic group at risk for suicide

Answer 7

native american males

Question 8

other risk factors for suicide

Answer 8

Individuals hospitalized for a psychiatric illness have 5-10x greater suicide risk
Early in treatment with antidepressants
Severe insomnia
Use of alcohol and barbiturates
Psychosis with command hallucinations
Affliction with a chronic, painful, or disabling illness
Family history of suicide
Loss of a loved one through death or separation
Lack of employment

Question 9

bullying statistics

Answer 9

41% of youth are victims of physical bullying (most often boys)
17% are victims of cyberbullying
Girls are more likely to be victims of psychological bullying

Question 10

psychological theories for suicide

Answer 10

Anger turned inward
Hopelessness and other symptoms of depression
Desperation and guilt
History of aggression and violence
Shame and humiliation

Question 11

3 factors elevating active risk for attempt

Answer 11

1. Pain combined with hopelessness
2. When pain and hopelessness exceed one’s sense of connectedness to others
3. When strong, active suicide ideation is present, it leads to an attempt only if one has capacity to make an attempt (availability of lethal means)

Question 12

biological theories involved with suicide

Answer 12

Genetics
-Twin studies have shown a much higher concordance rate for monozygotic (identical) twins than for dizygotic twins
Neurochemical factors
-Deficiency of serotonin
–Recent meta-analysis examining biologic factors found they are weak predictors of a future suicide attempt/death

Question 13

assessment for suicide

Answer 13

Identify (thoughts), plans (intentions), and attempts (behavior)
Distinguish between suicidal self-injury and non-suicidal self-injury
Risk level

Question 14

screnning for depression and passive SI

Answer 14

PHQ2
PHQ9

Question 15

screening for suicide

Answer 15

Columbia-Suicide Severity Rating Scale (C-SSRS)
-Assesses passive and active SI
-Method, plan, intent to act upon plan, suicidal behavior
Ask Suicide Screening Questions (ASQ)
-4 yes/no screening questions
-Toolkit
SAFE-T
-Identify risk factors and protective factors
-Conduct a suicide inquiry
-Determine risk level and interventions
-Document a treatment plan

Question 16

factors to consider with pt history in suicide

Answer 16

Age
Gender
Ethnicity
Marital status
Socioeconomic status
Occupation
Religion
Family history of suicide
Military history
Interpersonal support system
Analysis of the suicidal crisis
-Precipitating stressor
-Risk factors
-Relevant history
-Life-stage issues
Psychiatric/medical/family history
Previous psychiatric treatment
Medical history
Coping strategies/past strategies

Question 17

diagnoses examples for suicide

Answer 17

Risk for suicide related to feelings of hopelessness and desperation
Hopelessness related to absence of support systems and perception of worthlessness

Question 18

outcomes of the client for suicide risk

Answer 18

Has experienced no physical harm to self
Sets realistic goals for self
Expresses some optimism and hope for the future

Question 19

planning and implementation for suicide

Answer 19

Establish rapport and promote a trusting relationship
Address client’s feelings in a nonjudgmental manner
Be direct and listen actively
Talk openly and matter-of-factly about suicide and encourage expression of feelings
Discuss the current crisis situation in the client’s life using the problem-solving approach
Help the client identify areas of life that are within his or her control and those that cannot be controlled
DBT and CBT

Question 20

information for family and friends of individuals with SI

Answer 20

Take any hint of suicide seriously
Do not keep secrets
Be a good listener
Stress that the person’s life is important to you and to others
Express concern for individuals who express thoughts about killing themselves
Familiarize yourself with suicide intervention resources
Restrict access to firearms or means of self-harm
Communicate caring and commitment to provide support

Question 21

suggestions for families and friends of individuals with SI

Answer 21

Try to give them hope
Do not leave him or her alone
Show love and encouragement
Seek professional help
Do not judge or show anger toward the person or provoke guilt in him or her

Question 22

strategies for assisting survivors of suicide victims

Answer 22

Encourage him or her to talk about the suicide
Discourage blaming and scapegoating
Listen to feelings of guilt and self-persecution
Talk about personal relationships with the victim
Recognize differences in styles of grieving
Assist with development of adaptive coping strategies
Identify resources that provide support

Question 23

long-term goals of psychotherpy for clients with SI

Answer 23

Develop and maintain a more positive self-concept
Learn more effective ways to express feelings to others
Achieve successful interpersonal relationships
Feel accepted by others and achieve a sense of belonging

Question 24

as sudden event that disturbs homeostasis in one’s life

Answer 24

crisis

Question 25

characteristics of a crisis

Answer 25

Crisis occurs in all individuals
Precipitated by specific identifiable events
Personal by nature
Acute, not chronic
Potential for psychological growth or deterioration

Question 26

4 steps of development of crisis

Answer 26

1. Exposure to precipitating stressor
2. Previous problem-solving techniques do not relieve the stressor and anxiety increases
3. All possible resources are called on to resolve the problem and relieve the discomfort
4. If resolution does not occur in previous phases, the tension mounts beyond a further threshold or its burden increases to a breaking point

Question 27

factors influencing a crisis

Answer 27

The individual’s perception of the event
Availability of situational supports
The availability of adequate coping mechanisms

Question 28

crisis intervention

Answer 28

Structured activities focused on change
Problem-solving
Through adaptive change, crises are resolved and growth occurs
Individual in crisis must experience some degree of relief almost from the initial interaction
Using crisis situation to restore functioning and at most to enhance personal growth

Question 29

crisis intervention phase 1: assessment

Answer 29

Gather information regarding the precipitating stressor and crisis
Ask individual to describe the event that precipitated crisis
Determine when it occurred
Assess the individual’s mental and physical status
Determine if the individual has experienced this stressor before
If previous coping methods were tried, what was the result?
Assess suicide or homicide potential, plan, and means
Assess adequacy of support systems
Determine level of pre-crisis functioning
Assess individual’s perception of strengths and limitations

Question 30

crisis intervention for phase 2: planning of therapeutic intervention

Answer 30

Select appropriate nursing actions for the identified nursing diagnoses
Considerations in planning interventions:
Type of crisis
Individual’s strengths
Desired choices
Available resources for support

Question 31

crisis interventions phase 3: intervention

Answer 31

Reality-oriented approach
Focus of the problem is on the here and now
Remain with individuals experiencing panic anxiety
Could foster working relationship through unconditional acceptance, active listening, and attending to immediate needs
Discourage lengthy explanations or rationalizations of the situation
Promote atmosphere for verbalization of true feelings
Set firm limits on aggressive, destructive behaviors
Establish at the beginning what is acceptable and what is not

Question 32

crisis intervention phase 4: evaluation

Answer 32

Nurse and client summarize what has occurred during the intervention
Review what the individual has learned and anticipate how he or she will respond in the future
Make determination regarding follow-up therapy
If needed, provide referral information