Suicide

What is pathology of suicide?

Serotonin depletion, inflammation, HPA axis dysregulation (connected to anxiety and stress response), BDNF, genetics + epigenetic, brain structure and function

Biological risk factors

Genetic predisposition, neurochemical imbalances (low serotonin imbalances in other neurotransmitters), HPA axis dysregulation, epigenetic changes, neuroinflammation, structural brain abnormalities (reduced prefrontal cortex)

Sociological risk factors

social isolation/lack of support, socioeconomic adversity, exposure to violence/trauma, cultural/societal norms, high-risk population, media influence and suicide contagion

Psychological risk factors

Mental health disorders, cognitive factors, behavioral factors, psychological stressors

Cultural risk factors

Cultural beliefs/practices, acculturative stress (lack of connectedness to those with similar values), high-risk groups (immigrants, refugees, older adults)

Spiritual risk factors

Lack of spiritual support, religious teachings

Common patterns

• Rates in men increase steadily with age

• Native Americans and Alaskan Natives high risk

• Women more at risk

• Caucasian, single/divorced/widowed men at highest risk

Assessment risk considerations

• past attempts

• substance use

• serious health condition

• serious mental health condition

• family history of suicide

Nursing assessment steps

• Main question: “are you having thoughts of killing yourself?”

• Follow up: ""do you have thoughts or plans on how you would kill yourself?”

• Protective factors: things that stop people from committing suicide

• historical assessment: “Have you ever had thoughts of killing yourself in the past?”

Role of nurse

Create a safe environment, provide support

What meds are known to decrease suicidal ideations?

1) Esketamine (Spravato) - treatment-resistant depression

2) Lithium - primarily used for bipolar disorder

3) Clozapine - antipsychotic used for treatment-resistant schizophrenia