Suicide

Secondary levels of intervention

treatment of the actual suicidal crisis

recent theories

combination of suicidal fantasies and signficant loss

You are worried about a close friend who recently broke up with a boyfriend. She is taking the breakup very hard and seems depressed. - What are some questions you could ask to assess for suicide ideation?

Have you ever felt that life was not worth living? Have you been thinking about death recently? Did you ever think about suicide? Have you ever attempted suicide? Do you have a plan for completing suicide? If so, what is your plan for suicide?

A person with which psychiatric problem is most likely to commit suicide?

Major Depression

what is the last thing to get better on meds?

Mood. They can think better and have better motor skills to plan suicide.

Oregan's Death with Dignity Act of 1994

terminally ill patients allow physician-assisted suicide

Which method of suice has the highest lethality? - cutting one's wrists - overdose medication - self-inflicted gunshot wound

self-inflected gunshot wound

Switzerland

assisted suicide legal since 1918

Advanced practive interventions

Psychotherapy Psychobiological interventions Clinical supervision Consultation

what age group does this effect the most?

- 3rd leading cause of death in 15-24 age group - 4th in 10-14 and 25-44 -8th for 45-64 - elderly are at a high risk for suicide

verbal and nonverbal cues

- Overt statements "I'm going to kill myself" - Covert statements "You don't have to worry about me much longer" - Nonverbal - getting affairs in order - giving away prized possessions - Making amends with people

Diagnosis

- Risk for suicide - Ineffective coping - Hopelessness/ helplessness - Impaired thought process

SAD PERSONS Scale

- Sex (male) - Age 25 to 44 or 65+ years - Depression - Previous attempt (History of previous attempt = higher risk. If they abuse alcohol) - Ethanol use - Rational thinking loss - Social supports lacking or recent loss - Physical, psychological, real, perceived - Organized plan - No spouse - Sickness

Outcome Identification

- Suicide self-restraint - We hope they don't kill themselves - Cessation of suicidal thoughts

protective cultural factors

- african americans (religion, role of extended family) - hispanic americans (roman catholic relgion and importance of extended family) - Asian Americans (adherence to religions that tend to emphasize interdependence between the individual and society)

biological factors

- familial history - low serotonin levels are related to depressed mood

Risk factors:

- psychiatric disorder - alchol or substance use disorders - male gender - increasing age - race (caucasions) - religion (people who don't believe in God) - marriage (single men) - profession (health care workers because high stress job) - physical health (terminal illness or chronic pain)

Lethality of suicide plan

- talking about it can be a positive thing to not commit suicide - If they have an immediate plan, method and means, they are more worrisome and more lethal (ex: "after I get out of the hospital I am going to blow my brains out with the gun I have in my car")

Implementation

- talking to patient - seclude patient - have someone with them every single moment of the day - medication

Assessment

- verbal and nonverbal cues - lethality of suicide plan - assessment tools (SAD PERSONS scale) - self assessment - let them take the test themselves

Menninger theory

- wish to kill - with to be killed - wish to die

interventions

Teamwork and safety Counseling Health teaching and health promotion Case management Pharmacological interventions Post-vention for survivors of completed suicide

A patient is hospitalized with major depression and suicidal ideation. He has a history of several suicide attempts. For the first 2 days of hospitalization, the patient eats 20% of meals and stays in his room between groups. By the fourth day, the nurse observes that the patient is more sociable, is eating meals, and has a bright affect. Which factor should the nurse consider?

The patient may have decided to commit suicide; the nurse should reassess suicidality.

primary levels of interventation

activities that provide support, information, and education to prevent suicide

Freud's theory

aggression turned inward

Aaron Beck theory

central emotional factor is hopelessness

tertiary level of intervention

interventions with a circle of survivors left by individuals who completed suicide to reduce the traumatic after effects

Netherlands

nonterminal cases of "lasting and unbearable suffering) - could be emotional or physical

Belgium

nonterminal cases when suffering is "constant and cannot be alleviated) - similar to netherlands

Washington state

physician's can prescribe lethal medication