Suicide Prevention
Suicide Facts
- >90% of suicides associated with mental illness or alcohol and substance abuse - 10th leading cause of death - A suicide occurs approximately every 12 minutes in US - Mountain regions HIGHEST
How do psy factors impact suicide?
- Cognitive theories: cognitive triad: If they have a neg view of these things increased risk of suicide. 1. negative views about oneself 2. the world 3. future - Severe childhood trauma: ACES! higher ACES score higher risk of dying by suicide.
Step 1 risk factors for suicide factors enhancing suicide risk
- Vulnerability - Risk - Intent - Disinhibition
What do Patients benefit from? three things?
1. Confiding - speak openly and candidly 2.Identify their triggers 3.Find new coping techniques (cold shower, rubber band, hold ice, cube in crook of arm, chew a strong flavor, exercise vigorously)
Columbia Suicide Severity Rating Scale
1. Have you ever wished you were dead? 2. Have you actually had any thoughts of hurting yourself? 3. Have you been thinking of how (aka plan) you might do this? 4. Have you had some intention of acting on these thoughts? 5. When you have these thoughts, how long do they last? 6. How often do you have these thoughts? 7. What sorts of reasons do you have for thinking about wanting to die or killing yourself?
Suicide Assessment Five-Step Evaluation & Triage (5 Steps)
1. risk factors 2. protective factors 3. suicide inquiry - types of thoughts, how intense, the plan they might have, previous behaviors and their INTENT - ideation - plan - behaviors - intent 4. risk level/intervention 5. document
Bio factor how does genetics factor into suicide?
3-6x greater risk if first degree relative died by suicide
What is ACES?
Adverse childhood experiences encompass various forms of physical and emotional abuse, neglect, and household dysfunction experienced in childhood. ACEs have been linked to premature death as well as to various health conditions, including those of mental disorders.
Aborted attempt vs Interrupted attempt
An individual stops themselves for some reason vs. someone else stops you by interrupting like a phone call.
Step 4: Risk Assessment
Case finding Determine level of Risk
Organize using CAIPS
Chronic Factors Acute Factors Imminent warning signs Protective Factors Summary Statement
Myths and Facts about suicide?
Fact: Asking about suicide does not give people the idea for suicide. It is important to ask the question so that you understand people's thoughts and intentions. Myth: When people who are suicidal feel better, they are no longer at risk. Fact: Sometimes suicidal people feel better because they have made a decision to die, and they may feel a sense of relief that their pain is ending.
IS PATH WARM
Ideation Substance Purposelessness Anxiety Trapped Hopelessness Withdrawal Anger Recklessness Mood
What is the Cognitive triad?
If pt has a neg view of these things increased risk of suicide. 1. negative views about oneself 2. the world 3. future
Continuum of self-injurious behavior SSIB? 1. Suicidal intent 2. Suicide threat
Intent to die. 1. Suicidal intent: subjective self-destructive expectations and desire to die. 2. Suicide threat: verbal or nonverbal actions that communicate a planned suicidal act
This is not a question just info --- NSSIB more strongly associated with a history of suicide attempts than other established risk factors for suicide, such as depression, anxiety, impulsivity, and BPD
Never assume it's attention-seeking, a thorough evaluation of risk always needs to be made!!
NSSIB
Non-suicidal Self Injurious Behavior *a coping mechanism without suicidal intention
PAS
Physician Assisted Suicide
SIB
Suicide attempt - what is the intent? Self Injurious Behavior
What is key about suicide attempt?
The person's intent is key! severity comes from the INTENT Thorough assessment and evaluation are crucial !!
VSED
Voluntarily stopped eating and drinking
Case finding
identifying people who are at risk for suicide to initiate proper treatment
Anhedonia
inability to experience pleasure
suicide attempt
nonfatal, self-inflicted destructive act with explicit or implicit intent to die
Terminal sedation
occurs when sufficient pain relief requires a dosage that likely will also kill the patient
Lethality
the probability that a person will successfully complete suicide
suicidal ideation
thinking about and planning one's own death
Nursing Interventions: Intermediate and long-term risk psy domain
•Challenging the suicidal mindset •Developing new coping strategies •Committing to treatment •Crisis plan & safety contract (when appropriate)!! Not appropriate for patients with cognitive impairment not
Determine level of Risk
•Degree and lethality of suicidal ideation and behaviors •Determination of the severity of intent •Degree and lethality plan •Evaluation of availability of means •Identification of imminent warning signs •Identification of exacerbating factors that can precipitate a person toward acting on their thoughts (impulsivity, hopelessness, feeling trapped, withdrawal, anger, etc.)
Nursing Interventions: Intermediate and long-term risk social domain
•Development of support networks •Crisis plan evaluation & communication with social support system
Step 5: Documentation and Reporting must include?
•History: suicide history, hospitalizations, treatment history, recent diagnoses, risk factors •Presence or absence of suicidal thoughts, intent, plan, and available means •Use of drugs, alcohol, or prescription medications •Level of the patient's judgment •Prescribed medications, dosages, and the number of pills dispensed Plan for ongoing treatment
Step 3: Suicide Inquiry
•Ideation: frequency, severity and duration of suicidal thoughts • including worst ever, •Ameliorating factors •Aggravating factors •Intent: degree to which the person expects that they will carry out the plan & how lethal the plan may be (lethal plan vs. self-injury) •Plan: timing, location, availability of means to execute the plan, preparatory behaviors, •Behaviors: past attempts, aborted attempts, rehearsals, acquisition of means
Nursing Interventions for suicide precautions
•Imminent risk: Ensuring safety!!! •Implement suicide precautions: 1. 1:1 if inpatient 2. Remove safety hazards (sharps, chords, etc) 3. Staff communication 4. Get pscyh consult • Instill hope
Family response to suicide
•Increased risk for suicide death in another family if suicide death in a family occurs •Survivors with increased grief, anxiety, depression, guilt, shame, self-blame, and family dysfunction * ensure safety
Eval and treatment LONG-term outcomes:
•Maintaining the patient in psychiatric treatment •Enabling the patient and family to identify and manage suicidal crises effectively •Maintains updated crisis plan and safety contract
Eval and treatment SHORT-term outcomes:
•Maintaining the patient's safety!!!! •Mobilizing the patient's resources 1.Has self-inflicted injury been avoided? 2.Have self-inflicted harm tendencies (thought, plan, intent) decreased? 3.Has client utilized coping mechanisms and/or stated safety plan?
Step 1 risk factors?
•Medical illnesses, new diagnoses /exacerbation •Psychological: hopelessness indicator > depression •Social: social isolation, (ask about living situation) •Gender: females attempt 4x more than males, males have higher lethality (males 3x more likely than women to be lethal) •Elderly white men > 85 have highest lethality rate •High ACE = higher risk •Race and ethnicity: whites > than other groups •Antidepressants in teens increase suicidal ideation, but no clear increase in actual suicidal behaviors.
Nursing Interventions: Intermediate and long-term risk bio domain
•Physical care of self-inflicted injury •Medication management •Electroconvulsive therapy
Nursing Diagnoses for suicide precautions
•Risk for Suicide •Risk for Self-directed Violence •Social Isolation •Spiritual Distress
Interpersonal-psychological theory of suicidal behavior Social theories
•Suicide contagion - When someone notable rich and famous is successful, there is an increase of others completing suicide too.
Step 2: PROTECTIVE FACTORS
•Supportive relationships •Access to interventions / support •Family / community connectedness •Married and with children for adults •Pregnancy for women •Skills in problem-solving, conflict resolution and nonviolent ways of handling disputes •Religiosity/spirituality
Nurses reflections
•Understand your feelings/reactions •Know procedures & resources •You WILL encounter suicide attempts, suicidal ideation & suicidal behaviors •Be aware of assisted suicide & death with dignity concepts •Death with Dignity Act, was signed into law in Maine June 2019
Functions of NSSIB can be divided into 2 categories:
•intrapersonal-self-focused - Ex] emotion regulation and self-punishment • interpersonal-other-focused - Ex] influencing others