module - 1 Suicide

Suicide and adolescent

*Second leading* cause of deaths in youths *10 - 24 years old* CDC study (2014): Within last 12 months - 16% of adolescents considered suicide; - 13% created a plan; - 8% attempted suicide Risk Factors: - Depression or mental illness - Mental Health changes - History of previous suicide attempt - Poor school performance - Family disorganization - Substance abuse - *Homosexuality* - *Giving away(누설하다) valued possessions* - Being a loner/having no close friends - *Changes in behavior* Healthy People 2020: Reduce suicide attempts by adolescents. Nursing significance/interventions: - *Screen* teens at all encounters for indications of *depression* - *Screen* teens at all encounters for indications of *violent behaviors* - *Encourage alternative appropriate methods for dispelling(없애다) anger* - *Provide education r/t decreasing school violence in middle and high schools*.

Legal and Ethical Considerations for suicide

Assisted suicide Caring for terminally or chronically ill people - Provide supportive care for clients and families - Participate within interdisciplinary team to set goals for care - Work within scope of practice and state Nursing Act Assisted suicide is national ethical and legal debate. Dr Jack Kevorkian - Oregon first state to adopt assisted suicide into law. *Palliative Care not considered euthanasia*.

Assessment: Lethality(치사) Assessment for suicide

Does the client have a plan? What is the plan? Does the client have the means to carry out the plan? Will the plan be lethal if carries out as described? Has the client made preparations for death? - Suicide note - Talking to friends one last time - Giving away items Where and when does the client intend to carry out the plan? Is the intended time a special date or anniversary that has meaning? Believing a method to be lethal(치명적인) poses a significant risk.

Family response to suicide

Families grieve; feel guilt, shame, and anger - Most suicides are efforts to escape unavoidable situations. - Ultimate rejection of family and friends: their love or attempt to help was not enough. - *Some suicides are done out of blame*. - *Guilt* may come due to *not knowing how desperate the person was*. - *Anger* towards *victim* cause *they did not use resources or get help*. - *Sad for being rejected*. - *Ashamed of socially unacceptable act*.

Assessment for suicide

History of previous suicide attempts History of increases risk for suicide First 2 yrs after an attempt is highest risk period, esp *first 3 months* Suicide is associated w/ energy spurts(분출) - *Antidepressant treatment: Gives client new energy....ability to think clearly about attempt and plan* - *Sunlight: more suicide in April or spring* - *Beginning of the week: More suicides happen on Monday mornings*, when most people return to work. Warnings: - Direct or indirect signals/cues to others about thoughts or plan. - The nurse must never ignore any hint of suicidal ideation regardless of how trivial or subtle it seems and the clients intent or emotional status. - Ask the client directly about thoughts of suicide! *Risky behavior* - *Approach carries high risk to clients and bystanders*(방관자) - *Allows client to feel brave by repeatedly confronting death and surviving*.

Myths and facts about suicide

Myths - *People who talk about suicide never commit suicide*. Facts - Suicidal people often send out subtle or not-so-subtle messages that convey their inner thoughts of hopelessness and self-destruction. Both subtle and direct messages of suicide should be taken seriously with appropriate assessments and interventions. Myths - *Suicidal people only want to hurt themselves, not others*. Facts - Although the self-violence of suicide demonstrates anger turned inward, the anger can be directed toward others in a planned or impulsive action. - Physical harm: Psychotic people may be responding to inner voices that command the individual to kill others before killing the self. A depressed person who has decided to commit suicide with a gun may impulsively shoot the person who tries to grab the gun in an effort to thwart(좌절시키다) the suicide. - Emotional harm: Often, family members, friends, health-care professionals, and even police involved in trying to avert(회피하다) a suicide or those who did not realize the person's depression and plans to commit suicide feel intense guilt and shame because of their failure to help and are "stuck" in a never-ending cycle of despair and grief. Some people, depressed after the suicide of a loved one, will rationalize that suicide was a "good way out of the pain" and plan their own suicide to escape pain. Some suicides are planned to engender(발생시키다) guilt and pain in survivors, e.g., as someone who wants to punish another for rejecting or not returning love. Myths - *There is no way to help someone who wants to kill himself or herself*. Facts - Suicidal people have mixed feelings (ambivalence) about their wish to die, wish to kill others, or to be killed. This ambivalence often prompts the cries for help evident in overt or covert cues. Intervention can help the suicidal individual get help from situational supports, choose to live, learn new ways to cope, and move forward in life. Myths - *Do not mention the word suicide to a person you suspect to be suicidal, because this could give him or her the idea to commit suicide*. Facts - Suicidal people have already thought of the idea of suicide and may have begun plans. Asking about suicide does not cause a nonsuicidal person to become suicidal. Myths - *Ignoring verbal threats of suicide or challenging a person to carry out his or her suicide plans will reduce the individual's use of these behaviors*. Facts - Suicidal gestures are a potentially lethal way to act out. Threats should not be ignored or dismissed, nor should a person be challenged to carry out suicidal threats. All plans, threats, gestures, or cues should be taken seriously and immediate help given that focuses on the problem about which the person is suicidal. When asked about suicide, it is often a relief for the client to know that his or her cries for help have been heard and that help is on the way. Myths - *Once a suicide risk, always a suicide risk*. Facts - Although it is true that most people who successfully commit suicide have made attempts at least once before, most people with suicidal ideation can have positive resolution to the suicidal crisis. With proper support, finding new ways to resolve the problem helps these individuals become emotionally secure and have no further need for suicide as a way to resolve a problem.

Nurse response to suicide

Nurses role: - *Indicate unconditional(무조건의) positive regard for person and their desperation*. - Convey belief that person can be helped. - Does not blame, act judgmentally, make client feel guilty. - Use nonjudgmental tone of voice, body language, & facial expressions. *Nurses believe that one person can make a difference in another's life!* Some clients will commit suicide no matter what. Suicide is devastating to nurses as well. Can cause them to consider leaving profession.

Age groups and ethnicity with suicide

Older adults: - Suicide rates for middle-aged adults and older adults have comparable levels (ages 24-62). - Among those *age 65+*, white males comprise(...을 구성하다) *over 80 percent of all late-life suicides*. Among ethnicities: - Highest rates: *American Indians and Alaska Natives* (AI/AN) - Followed by *non-Hispanic Whites* older adults were the demographic group with the highest suicide rates for decades, Hispanics, African Americans, and Asian/Pacific Islanders each have suicide rates that are about half their White and AI/AN counterparts.

The main risk factors for suicide

Psychiatric disorders, esp. *depression, bipolar d/o, schizophrenia*, or substance abuse disorder; *PTSD, Borderline personality d/o* A prior suicide attempt Family history of a mental disorder or substance abuse Family history of suicide Family violence, including physical or sexual abuse Having guns or other firearms in the home Incarceration(투옥), being in prison or jail Being exposed to others' suicidal behavior, such as that of family members, peers, or media figures. Chronic medical illnesses: cancer, HIV/AIDS, diabetes, CVAs, head and spinal cord injury. Environmental factors: Isolation, recent loss, lack of social support, unemployment, critical life events Behavioral Factors: - *Impulsivity(충동성)* - *Erratic or unexplained changes from usual behavior* - *Unstable Lifestyle*

Mental health promotion for suicide

Screen for early detection Talk with children and adolescents about bullying Refer people with sign and symptoms of depression to primary health care provider or clinic If you or someone you know are in crisis: Call the toll-*free National Suicide Prevention* *Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week*. The service is available to anyone. All calls are confidential. Nurses are first line staff: Recognize behavior consistent w/ mood disorders. Can screen for early detection: family strife(갈등), parental alcoholism or mental illness, history of fighting, access to weapons in the home. Suicide is leading cause of death among adolescents, prevention, early detection, and treatment are important. To decrease youth victimization and prevent suicide, watching out for bullying and cyberbullying is important for parents, teachers, schools.

Suicide intro

Suicide: Intentional act of killing oneself; Sign of extreme distress Men commit @ 72% of suicides in US - Methods: shooting, hanging, jumping from a high place *Women 4 times more likely to attempt suicide* - Method: Overdose on medication; poisoning Suicide Ideation: Thinking about killing oneself - Active: Thinks about it and seeks ways to commit suicide - Passive: Thinks and wishes of death, or wants to die but has no plans. Suicide does not discriminate. People of all genders, ages, and ethnicities can be at risk for suicide. But people most at risk tend to share certain characteristics.

Intervention for suicide

Using an authoritative role: - Safety is primary concern and takes precedence(선행) Providing a safe environment: - Remove sharp objects, shoelaces, belts, lighters, matches, pens, etc. - One-to-one observation by staff person - No suicide or no-self-harm contracts Creating a support system list: - List of specific names and agencies for client Authoritative role: - Safety becomes primary concern - Safety takes precedence over other needs or wishes - Client cannot be left alone Safe environment: - Direct sight of and no more than 2-3 feet away from staff member for all activities, including going to BR - Paper scrubs Support system: Who will be there for them? If nobody else be sure they have National Suicide Prevention Lifeline 1-800-273-TALK