MH Chpt 11

Verbal cues

"I want to die" "Im going to kill myself" "This is the last time youll see me" "I wont be around much longer for the doctor to have to worry about" "I dont have anything worth living for anymore"

Risk factors

- use of alcohol or barbiturates - psychosis with command hallucinations - affliction with a chronic, painful, or disabling illness - family history of suicide - homosexual individuals are at higher risk - previous suicide attempts - loss of a loved one through death or separation

Examples of Protective Factors

-Resilient temperament, social competence -Skills in problem solving, coping, and conflict resolution -Perception of social support from adults and peers -Positive expectations, optimism for the future; identification of future goals - Connectedness to family, school, community - Presence and involvement of caring adults - Cultural and religious beliefs that discourage suicide and encourage preservation of life - Access to quality social services and clinical healthcare for mental, physical, and substance use disorders - Restricted access to highly lethal means of suicide

Precipitating stressor:

Adverse life events in combination with other risk factors, such as depression, may lead to suicide.

Risk factors: religion

Affiliation with a religious group decreases risk of suicide. Catholics have lower rates than Protestants or Jews.

Young children 5-12 cannot be suicidal

Annually, 30-35 children younger than 12 take their own lives and not all are clinically depressed

Theories: Hopelessness

Both a symptom of depression and an underlying factor in the predisposition to suicide. *although hopelessness is identified as a contributing factor, the strength of a persons intention to die may be more significant in triggering an attempt

Theories: Sociological theory- Durkheim's three social categories

Durkheim believed the more cohesive the society and the more that the individual felt and integrated part of society, the less likely he or she was to carry out suicide. He described 3 social categories: Egotistical siucide, altruistic suicide, anomic suicide

Risk factors: secere insomnia

Even in the absence of depression, this is associated with increased risk of suicide

MYTH: People who talk about suicide do not act on their ideas. Suicide happens without warning

FACT: 8 out of 10 people who kill themselves have given definite clues and warnings about their suicidal intentions. Very subtle clues may be ignored or disregarded by others.

MYTH: Suicidal thoughts and attempts should be considered manipulative or attention seeking behavior and should not be taken seriously.

FACT: All suicidal behavior must be approached with the gravity of the potential act in mind. Attention should be given to the possibility that the individual is issues a cry

MYTH: All suicidal individuals are mentally ill, and suicide is the act of a psychotic person

FACT: Although a majority of people who attempt suicide are extremely unhappy, or clinically depressed, they are not necessarily psychotic. They are merely unable at that point in time to see and alternative solution to what they consider an unbearable problem.

MYTH: If an individual has attempted suicide they will not do it again

FACT: Between 50 and 80% of all people who ultimately kill themselves have a history of at least one previous attempt

MYTH: Suicide is inherited or "runs in the family"

FACT: Family history and genetics may contribute to an increased risk for suicide. Many mental illnesses like depression. bipolar disorder, and substance abuse runs in families and confer an increased risk but suicidal behavior does not.

MYTH: People usually take their own lives by taking an overdose of drugs

FACT: Gunshot wounds are the leading cause of death among suicide victims

MYTH: You cannot stop a suicidal person. He or she is fully intent on dying.

FACT: Most suicidal people are very ambivalent about their feelings regarding living or dying. Most are "gambling with death" and see it as a cry for someone to save them.

MYTH: Improvement after severe depression means that the suicidal risk is over

FACT: Most suicides occur within about 3 months after the beginning of "improvement" when the individual has the energy to carry out suicidal intentions

MYTH: Suicide always happens in an impulsive moment

FACT: People who are suicidal often contemplate, imagine, plan strategies, write notes, post things on the internet. The importance of indepth exploration and assessment cannot be overstated

MYTH: Once a person is suicidal, he or she is suicidal forever.

FACT: Suicidal ideation and risk fluctuate over time and may be time limited. If provided adequate support and resources, a suicidal person can go on to lead a normal life. However, multiple suicide attempts may reflect greater chronicity of suicidal ideation. Reassessment over time is important to identify current risks

Theories: Anger turned inward

Freud believed that suicide was a response to the intense self hatred that an individual possessed. The anger is first directed toward a love object but is ultimately turned inward against the self

Leading cause of death among suicide victims

Gunshot wounds

Relevant history

Has the individual experienced numerous failures or rejections that would increase his or her vulnerability for a dysfunctional response to the current situation?

Theories: Aggression and violence

History of violent acts or impulsive behavior has been associated with increased risk for suicide

IS PATH WARM

I deation: has suicide ideas that are current and active, especially with an identified plan S ubstance abuse: has current and or excessive use of alcohol or other mood altering drugs P urposelessness: expresses thoughts that there is no reason to continue living A nger: expresses uncontrolled anger or feelings of rage T rapped: expresses the belief that there is no way out of current situation H opelessness: expresses lack of hope and perceives little chance of positive change W ithdrawl: expresses desire to withdraw from others or has begun withdrawing A nxiety: expresses anxiety, agitation, and/ or changes in sleep patterns R ecklessness: engages in reckless or risky activities with little thought of consequences M ood: expresses dramatic mood shifts

Suicide risk factors

Identified as factors that have statistically been correlated with a higher of incidence of suicide

Anomic suicide

In response to changes in an individuals life (divorce, loss of job) that disrupts feelings of relatedness to the group. Disruption instills feelings of separateness.

Risk factors: socioeconomic status

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

Risk factors: psychiatric illness

Mood and substance use disorders are the most common psychiatric illnesses that precede suicide. Other psychiatric disorders that accounts for suicidal behavior include: - schizophrenia, personality disorders, anxiety

What is a common misconception about suicide?

Most individuals commit suicide by taking an overdose of drugs

Egotistic suicide

Response of a person who feels separate from mainstream of society. Integration is lacking. The person does not feel a part of a cohesive group ie: church or family

Risk factors: age

Risk increases with age- especially men 70% of all suicides are white men 2nd leading cause of death amongst adolescents White men 80+ are at the greatest risk of all age, gender, and race groups. 15% of all suicides

Theories: Shame and humiliation

Some view suicide as a "face saving" mechanism- a way to prevent public humiliation following a social defeat. Can also interrupt ones self of connectedness with others, and these things are considered protective against suicide

Epidemiological Factors

Suicide is: - The third leading cause of death among Americans 15 to 34 years of age - The fourth leading cause of death for ages 35 to 44 - The fifth leading cause of death for ages 45 to 64 - Tenth leading cause of death overall

Life stage issues

The ability to tolerate losses and disappointments is often compromised if those losses and disappointments occur during various stages of life in which the individual struggles with developmental issues (e.g., adolescence, midlife)

Altruistic suicide

The opposite of egoistic suicide. The individual who is prone to altruistic suicide is excessively integrated into the group. The group is often governed by cultural, religious, or political ties, and allegiance is so strong that the individual will sacrifice his or her life for the group.

Risk factors: marital status

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

Risk factors: ethnicity

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

Risk factors: gender

Women attempt suicide more often but men succeed (70%) Men commonly choose more lethal methods than women do. (firearms vs drugs) *Transgender individuals are also at a higher risk

Suicide warning signs

factors suggesting a more immediate concern