Prevention of Suicide (Sherpath)

An 86-year-old African-American female patient recently lost her spouse. The patient has a history of cancer and is receiving treatment that includes medication for pain control. Which factors place her at high risk for suicide?

Age Suicides are increasing at the fastest rate among males who are 85 years of age and older. Disease process Persons with chronic diseases such as cancer and pain syndromes are more vulnerable to suicide. Recent loss of spouse Significant losses, such as losses due to divorce or death, can increase risk for suicide.

Prevalence of Suicide

Age and Gender Middle-aged adults and youths between the ages of 15 and 24 are the age groups most at risk for suicide (Fortinash, 2012 Ethnicity Caucasians complete suicide. The second most at-risk group is Native Americans and Alaska Natives Socioeconomic Levels Suicide knows no socioeconomic boundaries.Both those living in economic comfort and those living in poverty can experience circumstances that cause feelings of hopelessness and lead to suicide.

Which factors are associated with increased risk for suicidal behavior? Select all that apply.

Alcohol abuse Alcohol and/or other substance abuse may lead to an increased risk for suicidal behavior. Pain syndromes People with pain syndromes are particularly at risk for suicidal behavior. Terminal cancer People with cancer are particularly at risk for suicidal behavior.

An older adult patient who is a veteran has a history of depression and takes serotonin. Which type of risk factor for suicidality is associated with serotonin deficiency?

Biological Serotonin deficiency is a biological risk factor for suicide.

Which group is at greatest risk for suicide associated with post traumatic stress disorder (PTSD)?

Combat veterans Combat veterans have an increased risk for suicide related to PTSD due to trauma endured during combat.

Which behavior is associated with parasuicidal behavior?

Inflicting superficial skin cuts Inflicting superficial skin cuts is a parasuicidal behavior. Parasuicidal behavior involves unsuccessful attempts that are unlikely to be lethal.

Sociological Factors for Suicide

Isolation and alienation from social groups Biopsychosocial influences

Which group is most at-risk for suicide?

Middle-aged adults, aged between 45-54 Middle-aged adults and youths between the ages of 15 and 24 are the age groups most at-risk for suicide.

Which protective factors may mitigate Ms. Kaplan's risk of committing suicide? Select all that apply.

Optimistic outlook An optimistic outlook is a positive personal trait that can mitigate the risk of suicide. Gainful employment Employment is an example of a social support system that can mitigate the risk of suicide. Ongoing health care support Ongoing support through medical health care relationships can mitigate the risk for suicide. Child-rearing responsibilities Child-rearing responsibilities indicate a social support system, which can mitigate the risk of suicide.

Indications that a person is at high risk for suicidal behavior.

Physical and emotional symptoms such as serious depression, significant weight changes, serious sleep disturbances, extreme fatigue and loss of energy, self-depreciation, anger, feelings of hopelessness, and preoccupation with themes of death and dying lack of social support, recent loss, abuse, medical problems, abuse of alcohol or other drugs, and cognitive difficulties. Veterans and military personnel also have specific risk factors. Emotional Factors and Abuse Real or perceived loss, separation, or abandonment is a major emotional factor that can contribute to suicide risk Medical Conditions Individuals experiencing pa Alcohol and Substance Abuse Cognitive Difficulties Veteran Status Military and veteran populations have specific risk factors for suicide.

A patient experiencing both poor concentration and hallucinations is assessed as being a high risk for destructive behavior. Which form of mental health disturbance is the cause for this concern?

Poor impulse control Poor impulse control can result when an individual is experiencing problems with concentration and hallucinations, and may increase potential for self-harm.

What information can the nurse obtain by performing a mental status examination?

Potential for self-harm A mental status exam can assist the nurse in determining the patient's potential for self-harm.

What is the most critical risk factor for the nurse to consider when determining the seriousness of suicide risk?

Presence of a lethal suicide plan One of the most critical factors indicating imminent suicide risk is the presence of a suicide plan.

Warning Signs of Suicide

Risks (Acute) Individuals at risk for suicidal behavior commonly demonstrate one or more of the following warning signs, commonly referred to as expressed or communicated ideation: Talking or making threats about wanting to kill oneself Looking for ways to complete suicide by seeking access to firearms, pills, or other means Talking or writing about death, dying, or suicide when these actions are out of the ordinary Warnings Additional warning signs include the following: Increasing alcohol or drug use Talking about having no reason for living, no future, or no sense of purpose in life Feeling anxiety and agitation, being unable to sleep, or sleeping all the time Feeling trapped and believing there is no way out Withdrawing from friends, family, and society Feeling rage and uncontrolled anger or seeking revenge Acting reckless or engaging in risky activities, seemingly without thinking Exhibiting dramatic mood changes Giving away belongings and/or items of personal value

Psychological Factors for Suicide

Self-directed aggression Hopelessness Unresolved personal conflicts Negative thinking patterns Reduced positive reinforcement Problem-solving difficulties

What is the nurse primarily trying to determine when assessing a patient's intent for suicide and the imminence of the suicide risk?

Severity of risk When the nurse assesses a patient's intent to complete suicide and the imminence of the patient's risk, the nurse is attempting to determine how severe the risk of suicide is for that patient.

Which warning sign displayed by Mr. Steiner could be an indication of suicidal ideation? Select all that apply.

Sleeping until late afternoon every day Sleeping all of the time could be a warning sign of suicide. Ignoring his son's attempts to visit him Withdrawing from friends, family, and society could be a warning sign of suicidal ideation. Yelling at his son for telling the nurse Mr. Steiner is ignoring social obligations Feeling rage and uncontrolled anger could be a warning sign of suicidal ideation.

Which findings from the physical exam would cause the nurse to suspect that a patient is a high-risk for suicide?

Track marks Scars on the wrists Chronic medical condition

When conducting a suicide risk assessment, why would the nurse decide to interview the patient's family separately?

Family may be hesitant to speak in front of the patient. The nurse may interview the family separately in case they are hesitant to speak openly in front of the patient.

The nurse requests to assess Mr. Steiner and his son, both together and then individually. What is the nurse's primary reason for conducting the assessments in this manner?

The son may be hesitant to speak about his father's behavior in Mr. Steiner's presence. Rationale: Interviewing Mr. Steiner and his son both together and separately is a therapeutic approach the nurse should use in case the son is hesitant to speak openly in front of Mr. Steiner.

Which factor contributes to a high risk of suicide in the veteran population?

Disciplinary actions Depression related to disciplinary actions may increase risk for suicide. Changes in fitness for duty Career-threatening changes in fitness may be related to an increase in suicide risk in military and veteran populations. Trauma related to combat experiences Trauma related to deployment and combat experiences increases risk for suicide.

Biological Factors for Suicide

*Levels and actions of neurotransmitters (serotonin, norepinephrine, and γ-aminobutyric acid) linked to emotional responses. For example, serotonin helps regulate mood and thus has an influence on feelings of depression and suicidality *Genetics *Alterations in brain structure that correlate with dimensions of depression (mood, affect, motivation, cognitive content)

An adolescent male reaches out to a teacher at school when he begins to have thoughts of suicide. Which internal protective factor may mitigate risk of suicide in this patient?

Help-seeking Help-seeking is an internal protective factor that can mitigate suicide risk. The young man demonstrates this factor by reaching out to a teacher.

Which assessment finding for Ms. Kaplan is most predictive of her risk for completing suicide?

History of suicide attempts The majority of people who complete suicides have made previous attempts.

Levels of Suicidal Behavior

Suicidal Ideation = Direct or indirect thoughts or fantasies about suicide with no definite intent expressed. Thoughts may be conveyed verbally or written. Suicide Threats = Actual written or verbal expressions of intent to commit suicide, but without action. Suicide Gestures = Self-directed acts by persons who do not intend to end their lives; result in no injury or in minor injury to person. Are done in such a way that others interpret acts as suicidal Suicide Attempts = Self-directed acts by persons who intend to end their lives or cause serious self-harm; result in minor or major injury to person. Completed Suicide = Death caused by intentional infliction of harm to end one's life. Intent may be unconscious, such as in individuals who engage in high-risk activities.

Match each level of suicide behavior to the appropriate description.

Suicidal ideation = Direct or indirect thoughts or fantasies about suicide Suicide threats = Actual written or verbal expression of intent to commit suicide Suicide gestures = Self-directed actions that result in no injury or minor injury Suicide attempts = Serious self-directed actions that result in minor or major injury