Chapter 25
When is a person at highest risk of suicide?
Adolescents are especially at high risk, people who have definite plans for the time, place, and means. When people are experiencing psychotic episodes Higher risk methods involve methods that are more lethal, often referred to as hard methods (guns, hanging, staged car crash) Lower risk referred to as soft methods: slashing one's wrists, inhaling natural gas, ingesting pills.
tertiary intervention
Also known as postvention. Refers to interventions with the circle of survivors of a person who has completed suicide. This is done to both reduce the traumatic aftereffects and explore effective means of addressing survivor problems using primary and secondary interventions.
suicide attempt
Any willful, self-inflicted, life-threatening attempt at suicide that did not lead to death.
How does a nurse know a person might be contemplating suicide?
Ask questions like: •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?
no-suicide contract
A contract made between a nurse or counselor and a patient, outlined in clear and simple language, in which the patient states that he or she will not attempt self-harm and in which specific alternatives are given for the person instead.
SAD PERSONS scale
A simple and practical assessment tool to evaluate potentially suicidal patients.
copycat suicide
A suicide that follows a highly publicized suicide of a public figure, idol, or peer in the community.
primary intervention
Interventions that include activities to provide support, information, and education to prevent or reduce the rate at which new cases of a disorder develop.
non-suicidal self-injury
Manifested by deliberate and direct attempts to cause bodily harm with no intent to cause death.
Interventions for families after a loved one commit suicide.
Provide knowledge regarding grief and loss counseling, consult, and collaborate in the best interests of friends and family.
secondary intervention
Providing immediate intervention in times of crisis or acute illness.
psychological autopsies
Retrospective review of a deceased person's life within several months of the death to establish likely diagnoses at the time of death.
parasuicide
Self-injury with clear intent to cause bodily harm or death. Most people who eventually commit suicide have engaged in parasuicidal behaviors in the past.
suicidal ideation
Thoughts a person has regarding killing himself or herself.
Secondary Interventions
Treatment of the actual suicidal crisis. Practiced in clinics, hospitals, jails, and on telephone hotlines.
Primary Interventions
includes activities that provide support, information and education to prevent suicide.
Tertiary Interventions
interventions with the circle of survivors of a person who has completed suicide. Done in efforts to reduce the traumatic aftereffects and explore effective means of addressing survivor problems using primary and secondary interventions
What type of nursing intervention would you implement for someone at high risk of suicide?
primary intervention patients who are suicidal are observed continuously by nursing staff. 1a.Assess suicide status. 1b.Even if Kaitlin denies suicidal ideas, make a future plan. 1c.Monitor efficacy of antidepressant therapy and assess for side effects. 2a.Remain neutral in face of anger. 2b.Refocus attention back to Kaitlin and the emotions underlying her anger. 2c.Give frequent opportunities for discussion of feelings through verbal invitation
lethality
The relative deadliness of a chosen suicide method. For example, superficial cuts have a low degree of lethality, and a shotgun has a high degree of lethality.
suicidal
The ultimate act of self-destruction in which a person purposefully ends his or her own life.
postvention
Therapeutic interventions with the significant others of an individual who has committed suicide.
Appropriate nursing diagnosis/focus for a person who has attempted suicide.
"Patient with suicidal ideation or delusions of self-mutilation who, according to assessment by unit staff, presents clinical symptoms that suggest a clear intent to follow through with the plan or delusion" Assessment guidelines - suicide: 1. Assess risk factors, including history of suicide (in family, friends), degree of hopelessness and helplessness, and lethality of plan. 2. Assess protective factors that may be built upon. 3. If there is a history of suicide attempt, assess intent, lethality, and injury. 4. Determine whether the patient's age, medical condition, psychiatric diagnosis, or current medications put the patient at higher risk. 5. A change from sad or depressed to happy and peaceful may be a red flag. Often a decision to commit suicide gives a feeling of relief and calm. 6. If the patient is to be managed on an outpatient basis, also assess social supports and helpfulness of significant others. Objective data • Reported first suicide attempt in a 23-year-old female • Self-medicating with alcohol and substances (denies chronic use) • Isolated without social support systems • Recent failure at work and subsequent loss of job • Mounting debt at holiday season • No history of bipolar disorder or related behaviors Subjective data • "I love my boyfriend, but I don't like to talk about my problems." • "I have a lot of friends, but they don't really know me; I keep secrets from everyone." • "I just feel so down and depressed." • "I'm constantly getting in over my head and screwing up." • "I don't want my family to find out what a mess I've made of things .... again." Diagnosis 1. Risk for suicide related to feeling overwhelmed and depressed secondary to loss of job and mounting debt, as evidenced by suicide attempt
Risk factors
Gender: Men commit suicide four times more likely than females Increasing age: For men, suicide rates peak after the age of 45; for women, rates peak after 55. (Risk Factors pulled from Table 25-2) Suicidal ideation with intent •Lethal suicide plan •History of suicide attempt •Co-occurring psychiatric illness •Co-occurring medical illness •History of childhood abuse •Family history of suicide •Recent lack of social support (isolation) •Unemployment •Recent stressful life event (e.g., death, other loss) •Hopelessness •Panic attacks •Feeling of shame or humiliation •Impulsivity •Aggressiveness •Loss of cognitive function (e.g., loss of impulse control) •Access to firearms and other highly lethal means •Substance abuse (without formal disorder) •Impending incarceration •Low frustration tolerance •Sexual orientation issues Risk factors associated with suicide attempts include the following: •Past suicide attempts remain the strongest consistent predictor of suicide attempts and completed suicide. •Comorbid psychiatric diagnosis is a greater risk with substance, mood, and personality disorders. •Single diagnoses of eating disorders and substance abuse disorders have the greatest risk. •Severity of mental disorder, regardless of the disorder, may be a risk factor. •Psychological vulnerabilities, including aggressiveness/impulsivity, anxiety, and depressive symptoms, increase the risk. •Genetic markers; 5-HTT serotonin-gene is a moderate risk factor. •Demographic factors convey risk, albeit inconsistently. At higher risk are males (who complete more suicides), persons who are unmarried, the elderly, adolescent and young adult age groups, and Caucasian race. •Diathesis-stress models may confer greater risk where underlying genetic and psychological vulnerabilities may be triggered by environmental stressors.
What types of questions might a nurse ask to evaluate a persons' risk of suicide?
Have you wished you were dead or wished you could go to sleep and not wake up? Have you actually had any thoughts of killing yourself? Have you been thinking about how you might kill yourself
completed suicide
Suicide attempts that result in death.
What kind of tools is available for evaluating a person's risk of suicide?
The Columbia-Suicide Severity Rating Scale (C-SSRS)