Suicide Prevention

Suicide Facts

- >90% of suicides associated with mental illness or alcohol and substance abuse - 10th leading cause of death - A suicide occurs approximately every 12 minutes in US - Mountain regions HIGHEST

How do psy factors impact suicide?

- Cognitive theories: cognitive triad: If they have a neg view of these things increased risk of suicide. 1. negative views about oneself 2. the world 3. future - Severe childhood trauma: ACES! higher ACES score higher risk of dying by suicide.

Step 1 risk factors for suicide factors enhancing suicide risk

- Vulnerability - Risk - Intent - Disinhibition

What do Patients benefit from? three things?

1. Confiding - speak openly and candidly 2.Identify their triggers 3.Find new coping techniques (cold shower, rubber band, hold ice, cube in crook of arm, chew a strong flavor, exercise vigorously)

Columbia Suicide Severity Rating Scale

1. Have you ever wished you were dead? 2. Have you actually had any thoughts of hurting yourself? 3. Have you been thinking of how (aka plan) you might do this? 4. Have you had some intention of acting on these thoughts? 5. When you have these thoughts, how long do they last? 6. How often do you have these thoughts? 7. What sorts of reasons do you have for thinking about wanting to die or killing yourself?

Suicide Assessment Five-Step Evaluation & Triage (5 Steps)

1. risk factors 2. protective factors 3. suicide inquiry - types of thoughts, how intense, the plan they might have, previous behaviors and their INTENT - ideation - plan - behaviors - intent 4. risk level/intervention 5. document

Bio factor how does genetics factor into suicide?

3-6x greater risk if first degree relative died by suicide

What is ACES?

Adverse childhood experiences encompass various forms of physical and emotional abuse, neglect, and household dysfunction experienced in childhood. ACEs have been linked to premature death as well as to various health conditions, including those of mental disorders.

Aborted attempt vs Interrupted attempt

An individual stops themselves for some reason vs. someone else stops you by interrupting like a phone call.

Step 4: Risk Assessment

Case finding Determine level of Risk

Organize using CAIPS

Chronic Factors Acute Factors Imminent warning signs Protective Factors Summary Statement

Myths and Facts about suicide?

Fact: Asking about suicide does not give people the idea for suicide. It is important to ask the question so that you understand people's thoughts and intentions. Myth: When people who are suicidal feel better, they are no longer at risk. Fact: Sometimes suicidal people feel better because they have made a decision to die, and they may feel a sense of relief that their pain is ending.

IS PATH WARM

Ideation Substance Purposelessness Anxiety Trapped Hopelessness Withdrawal Anger Recklessness Mood

What is the Cognitive triad?

If pt has a neg view of these things increased risk of suicide. 1. negative views about oneself 2. the world 3. future

Continuum of self-injurious behavior SSIB? 1. Suicidal intent 2. Suicide threat

Intent to die. 1. Suicidal intent: subjective self-destructive expectations and desire to die. 2. Suicide threat: verbal or nonverbal actions that communicate a planned suicidal act

This is not a question just info --- NSSIB more strongly associated with a history of suicide attempts than other established risk factors for suicide, such as depression, anxiety, impulsivity, and BPD

Never assume it's attention-seeking, a thorough evaluation of risk always needs to be made!!

NSSIB

Non-suicidal Self Injurious Behavior *a coping mechanism without suicidal intention

PAS

Physician Assisted Suicide

SIB

Suicide attempt - what is the intent? Self Injurious Behavior

What is key about suicide attempt?

The person's intent is key! severity comes from the INTENT Thorough assessment and evaluation are crucial !!

VSED

Voluntarily stopped eating and drinking

Case finding

identifying people who are at risk for suicide to initiate proper treatment

Anhedonia

inability to experience pleasure

suicide attempt

nonfatal, self-inflicted destructive act with explicit or implicit intent to die

Terminal sedation

occurs when sufficient pain relief requires a dosage that likely will also kill the patient

Lethality

the probability that a person will successfully complete suicide

suicidal ideation

thinking about and planning one's own death

Nursing Interventions: Intermediate and long-term risk psy domain

•Challenging the suicidal mindset •Developing new coping strategies •Committing to treatment •Crisis plan & safety contract (when appropriate)!! Not appropriate for patients with cognitive impairment not

Determine level of Risk

•Degree and lethality of suicidal ideation and behaviors •Determination of the severity of intent •Degree and lethality plan •Evaluation of availability of means •Identification of imminent warning signs •Identification of exacerbating factors that can precipitate a person toward acting on their thoughts (impulsivity, hopelessness, feeling trapped, withdrawal, anger, etc.)

Nursing Interventions: Intermediate and long-term risk social domain

•Development of support networks •Crisis plan evaluation & communication with social support system

Step 5: Documentation and Reporting must include?

•History: suicide history, hospitalizations, treatment history, recent diagnoses, risk factors •Presence or absence of suicidal thoughts, intent, plan, and available means •Use of drugs, alcohol, or prescription medications •Level of the patient's judgment •Prescribed medications, dosages, and the number of pills dispensed Plan for ongoing treatment

Step 3: Suicide Inquiry

•Ideation: frequency, severity and duration of suicidal thoughts • including worst ever, •Ameliorating factors •Aggravating factors •Intent: degree to which the person expects that they will carry out the plan & how lethal the plan may be (lethal plan vs. self-injury) •Plan: timing, location, availability of means to execute the plan, preparatory behaviors, •Behaviors: past attempts, aborted attempts, rehearsals, acquisition of means

Nursing Interventions for suicide precautions

•Imminent risk: Ensuring safety!!! •Implement suicide precautions: 1. 1:1 if inpatient 2. Remove safety hazards (sharps, chords, etc) 3. Staff communication 4. Get pscyh consult • Instill hope

Family response to suicide

•Increased risk for suicide death in another family if suicide death in a family occurs •Survivors with increased grief, anxiety, depression, guilt, shame, self-blame, and family dysfunction * ensure safety

Eval and treatment LONG-term outcomes:

•Maintaining the patient in psychiatric treatment •Enabling the patient and family to identify and manage suicidal crises effectively •Maintains updated crisis plan and safety contract

Eval and treatment SHORT-term outcomes:

•Maintaining the patient's safety!!!! •Mobilizing the patient's resources 1.Has self-inflicted injury been avoided? 2.Have self-inflicted harm tendencies (thought, plan, intent) decreased? 3.Has client utilized coping mechanisms and/or stated safety plan?

Step 1 risk factors?

•Medical illnesses, new diagnoses /exacerbation •Psychological: hopelessness indicator > depression •Social: social isolation, (ask about living situation) •Gender: females attempt 4x more than males, males have higher lethality (males 3x more likely than women to be lethal) •Elderly white men > 85 have highest lethality rate •High ACE = higher risk •Race and ethnicity: whites > than other groups •Antidepressants in teens increase suicidal ideation, but no clear increase in actual suicidal behaviors.

Nursing Interventions: Intermediate and long-term risk bio domain

•Physical care of self-inflicted injury •Medication management •Electroconvulsive therapy

Nursing Diagnoses for suicide precautions

•Risk for Suicide •Risk for Self-directed Violence •Social Isolation •Spiritual Distress

Interpersonal-psychological theory of suicidal behavior Social theories

•Suicide contagion - When someone notable rich and famous is successful, there is an increase of others completing suicide too.

Step 2: PROTECTIVE FACTORS

•Supportive relationships •Access to interventions / support •Family / community connectedness •Married and with children for adults •Pregnancy for women •Skills in problem-solving, conflict resolution and nonviolent ways of handling disputes •Religiosity/spirituality

Nurses reflections

•Understand your feelings/reactions •Know procedures & resources •You WILL encounter suicide attempts, suicidal ideation & suicidal behaviors •Be aware of assisted suicide & death with dignity concepts •Death with Dignity Act, was signed into law in Maine June 2019

Functions of NSSIB can be divided into 2 categories:

•intrapersonal-self-focused - Ex] emotion regulation and self-punishment • interpersonal-other-focused - Ex] influencing others