Suicide Prevention - Ch. 11

Question 1

Define: Adverse Childhood Experiences (ACE) Questionnaire. What score increases the likelihood of childhood/adult suicide attempts?

Answer 1

First conducted in the mid 1990s. Examined the long-term health effects of trauma exposure, violence and loss in childhood. ACE data link childhood trauma with suicide risk factors and suicide attempts later in life.

A score of 7 or higher greatly increases childhood-adolescent suicide attempts as well as adult suicide attempts.

Question 2

What is the leading cause of death among suicide victims?

Answer 2

Gunshot wounds are the leading cause of death among suicide victims.

Question 3

Risk factors for suicide: Marital status

Answer 3

The suicide rate for single persons is twice that of married persons.

Question 4

Risk factors for suicide: Gender

Answer 4

Women attempt suicide more often, but more men succeed.

Men commonly choose more lethal methods than do women.

Question 5

Risk factors for suicide: Age

Answer 5

Risk of suicide increases with age, particularly among men.

Suicide is the second-leading cause of death of Americans aged 15 to 34 years of age.

The highest suicide rate by age is adults between 45 and 54 years of age.

Second highest rate is 85 years or older.

White men older than 80 are at the greatest risk of all age, gender, and race groups.

Question 6

Risk factors for suicide: Religion

Answer 6

Affiliation with a religious group decreases risk of suicide.

Catholics have lower rates than do Protestants or Jews.

Question 7

Risk factors for suicide: Socioeconomic status

Answer 7

Individuals in the very highest and lowest social classes have higher suicide rates than those in the middle class.

Question 8

Risk factors for suicide: Ethnicity

Answer 8

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

Question 9

Risk factors for suicide: Psychiatric illness

Answer 9

Mood and substance use disorders are the most common psychiatric illnesses that precede suicide. Other psychiatric disorders that account for suicidal behavior include:
Schizophrenia
Personality disorders
Anxiety disorders

Question 10

Risk factors for suicide: Insomnia

Answer 10

Severe insomnia is associated with increased risk of suicide.

Question 11

Risk factors for suicide: Sexual/Gender Orientation

Answer 11

LGBTQ individuals have a higher risk of suicide
Transgender individuals at much higher risk; studies have reported 40% + attempt

Question 12

Risk factors for suicide: Other risk factors

Answer 12

Use of alcohol and barbiturates

Psychosis with command hallucinations

Affliction with a chronic, painful, or disabling illness

Family history of suicide

Having attempted suicide previously increases the risk of a subsequent attempt. About half of those who ultimately die by suicide have a history of a previous attempt.

Loss of a loved one through death or separation

Bullying

Question 13

Predisposing factors of suicide: Psychological theories

Answer 13

Hopelessness *

Anger turned inward

Desperation and guilt

History of aggression and violence

Shame and humiliation

Question 14

Predisposing factors of suicide: Biological theories

Answer 14

Genetics

Neurochemical factors (deficiencies in CNS serotonin)

Question 15

Assessment for Suicide Risk: 9 types of demographic information to gather

Answer 15

Age
Gender
Ethnicity
Martial status
Socioeconomic status/Occupation
Lethality and availability of method
Religion
Family history of suicide
Military history

Question 16

Assessment for Suicide Risk: other information to gather

Answer 16

Presenting symptoms/medical-psychiatric diagnosis

Suicidal ideas or acts: Seriousness of intent, Plan, Means, Verbal and behavioral clues

Interpersonal support system

Analysis of the suicidal crisis: Precipitating stressor, Relevant history, Life-stage issues

Psychiatric/medical/family history

Coping strategies

Question 17

What is the Columbia-Suicide Severity Rating Scale (C-SSRS)?

Answer 17

Questionnaire used for suicide assessment developed by multiple institutions, including Columbia University, with support from NIMH.

Question 18

POTENTIAL QUESTIONS TO ASK A PERSON WHO MAY BE SUICIDAL (14):

Answer 18

• Have your problems been getting you down so much lately that you’ve been thinking of harming yourself?
• How would you harm yourself?
• How frequently do you have these thoughts? (The more often, the higher the risk.)
• How intensely do you feel this and how do you behave?
• How much do you want to live? (The fewer the reasons, the higher the risk.)
• How much do you want to die? (The more reasons, the higher the risk.)
• How long do the periods last? (The longer, the higher the risk.)
• Do you have the means available?
• Have you ever attempted suicide? If so, how serious was the means chosen? (or just How did you attempt)
• What has happened that makes life not worth living?
• Have you had any recent losses of important persons or things?
• What has been keeping you alive so far?
• Do you use alcohol or drugs?
• Is there anyone who could stop you? Whom do you trust the most? (Get the name & phone # of that person—ask as many times as needed to find out the name of significant person in the patient’s life.

Question 19

What is the priority nursing intervention for the actively suicidal patient?

Answer 19

Placing the client on suicide precautions with one-to-one observation provides a safe environment for an actively suicidal client. Maintaining client safety should always be a priority nursing intervention.

Question 20

Guidelines for treatment of the suicidal client on an outpatient basis:

Answer 20

Do not leave the person alone.
Establish a no-suicide contract with the client.
Enlist the help of family or friends.
Schedule frequent appointments.
Establish rapport and promote a trusting relationship.
Be direct and talk matter-of-factly about suicide.
Discuss the current crisis situation in the client’s life.
Identify areas of self-control.
Consider antidepressant medications.

Question 21

Information for family and friends of the suicidal client:

Answer 21

Take any hint of suicide seriously.
Do not keep secrets.
Be a good listener.
Express feelings of personal worth to the client.
Know about suicide intervention resources.
Restrict access to firearms or other means of self-harm.
Acknowledge and accept the person’s feelings.
Provide a feeling of hopefulness.
Do not leave him or her alone.
Show love and encouragement.
Seek professional help.
Remove children from the home.
Do not judge or show anger toward the person or provoke guilt in him or her.

Question 22

The long-term goals of individual or group psychotherapy for the suicidal client would be for him or her to:

Answer 22

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 23

Interventions with family and friends of suicide victims:

Answer 23

SUPPORT
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.