Suicide
In 2012, Suicide: ______ leading cause of death >38,364 completed suicides _____ leading casue of death in 15 to 24 year olds Highest risk age group ______ 1 in 5 had contact with a mental health provider 45% had contact with PCP a month prior
10th third 65 years and older
IN ASSISTED SUICIDE, you must have ____ sign off saying they are terminal
2 physicians
There is one suicide for every ____ attempted suicides
25
Religion, role of the extended family
African Americans
What are the protective, cultural factors?
African Americans Hispanic Americans Asian Americans
Adherence to cultural beliefs that tend to emphasize interdependence between the individual and society Suicide may be preferable to shame
Asian Americans
. Which of the following is a misconception about suicide? A) Eight out of ten individuals who commit suicide give warnings about their intentions. B) Most suicidal individuals are very ambivalent about their feelings about suicide. C) Most individuals commit suicide by taking an overdose of drugs. D) Initial mood improvement can precipitate suicide.
C - most individuals commit suicide by taking an overdose of drugs Gunshot wounds are the leading cause of death among suicide
The nurse is caring for an actively suicidal client on the psychiatric unit. What is the nurse's priority intervention? A) Discuss strategies for the management of anxiety, anger, and frustration. B) Provide opportunities for increasing the client's self-worth, morale, and control. C) Place client on suicide precautions with one-to-one observation. D) Explore experiences that affirm self-worth and self-efficacy.
C - place the client on suicide percautions with one to one observation
Develop rapport Avoid note-taking Provide eye contact How do you ask?
Communication techniques
"It's okay, now. Soon everything will be fine." "Things will never work out." "I won't be a problem much longer." "Nothing feels good to me anymore and probably never will." "How can I give my body to medical science?"
Covert statements
A client, with a history of a suicide attempt, has been discharged and is being followed in an outpatient clinic. At this time, which is the most appropriate nursing intervention for this client? A) Provide the client with a safe and structured environment. B) Isolate the client from all stressful situations that may precipitate a suicide attempt. C) Observe the client continuously to prevent self-harm. D) Assist the client to develop more effective coping mechanisms.
D
Separate from the mainstream of society. EX: don't feel like they belong
Egoistic
Strategies for the immediate crisis
Encourage them to talk & share memories Discuss family dynamics Listen Recognize individual grieving patterns Discuss coping strategies Identify supportive resources
Take any hint of suicide seriously Do not keep secrets Be a good listener Let them know they are important Express concern Get rid of firearms Get them help Do not judge
Family education
Using a gun Jumping off a high place Hanging oneself Poisoning with carbon monoxide Staging a car crash
Hard methods of suicide
Roman Catholic religion and importance of extended family
Hispanic Americans
Sense of guilt Anger, resentment Helplessness, despair "If only..." Confusion Inner injury Strained relationships Vulnerable to illness
Immediate crisis
Should not be left alone Establish a "no-suicide contract" Enlist help of family & friends Daily contact Be direct Use problem solving approach/Control Antidepressants
Interventions with Out patient
Suicide occurs more frequently among those with:
Major depression Bipolar Schizophrenia Alcohol/substance abuse borderline and antisocial personality disorders panic disorder
People who talk about it don't do it You cannot prevent it from happening Improvement after depression means the risk is over It is just manipulation
Myths of suicide
"I am going to kill myself." "Life isn't worth living anymore." "I wish I were dead." "Everyone would be better off if I died."
Overt statements
How do you analyze the suicidal crisis?
Precipitating stressors Relevant history life-stage issues past psychiatric/medical history coping strategies
What are occupations with the highest risk of suicide?
Professionals with change in status Physicians, architects, engineers, lawyers, nursing and social work
Anger turned inward Hopelessness Desperation and guilt History of aggression and violence Shame and humiliation Developmental stressors
Psychological theories
What are types of nursing diagnosis?
Risk for suicide Hopelessness Ineffective coping Powerlessness Social isolation
Slashing one's wrists Inhaling natural gas Ingesting pills
Soft methods
Patient safety plan
What are your warning signs? What can you do to de-esculate? What places/Social settings can you go to? Who can you call to ask for help? How can you make your environment safe? Find out if there are weapons in the home
What are primary levels of intervention?
activities that provide support, information, and education to prevent suicide
Nonsuicidal self-injury = parasuicide Prevalence: 13-20% _____; 10-15 y/o, peaking late teans Comorbidity: depression, non-heterosexual orientation, BPD Etiology: Biological factors _____ Cultural factors _____ Societal factors_____
adolescents monoamines nothing significant social media sites
Excessively integrated into a group. EX: cult
altruistic suicide
response to change fear of loss of support
anomic suicide
Risk factors of suicide: Religion _____ Family hx ______ Other ______
decreased rates higher risk gay men and lesbians
______ attempt suicide less often but have a higher completion rate because their methods are more lethal
elderly
suicides outnumber homicides by 3:2 Suicide by ____ is the most common method for men and _____ is most common for women
firearm poisoning
_____ are the most commonly used suicide method in youth
firearms
Risk factors of suicide: Age _____ Gender ______ Ethnicity Marital status _____
increases with age; adolescents also men 4x more often than women white males 2 out of 3 suicides sing, divorce, widowed
Most adolescent suicide attempts are precipitated by _____
interpersonal conflicts
Tertiary levels of intervention?
interventions with the family and friends of a person who has committed suicide to reduce the traumatic aftereffects
Biological theories: Suicidal behavior _____ in families Gene variants Low levels of ____ may be a factor _____ is considered a factor in 11% to 51% of suicides Low _____ levels in post suicidal autopsies
runs serotonin Physical illness cholesterol
A significant public health problm in the US. A human life ends about every _____ minutes
suicide 14 minutes
Secondary levels of intervention
treatment of the actual suicidal crisis