suicide prevention

suicide data

•In the US in 2023, 49,000 people died by suicide.

•The suicide rate was 4 times higher in males than the rate among females.

•People aged 85 and older had the highest suicide rate in 2023.

10^th leading cause of death overall

2^nd leading cause of death in 10-34 year old’s in 2019

comorbidities

Severe mood disorders– particularly Major Depression

Schizophrenia

Substance abuse

Borderline and Antisocial Personality Disorders

Panic Disorder

Suicidal ideations

Thoughts of injury or demise of self but without a plan

Suicidal intent

Degree to which the person intends to act on his suicidal ideations

Suicidal threat

Verbalization of an  imminent self-destructive action

Suicidal gesture (Parasuicide)

Acts that result in little or no injury but communicate a message of suicidal intent

suicidal plan

Refers to organization of a time frame and method for killing one self

self mutilation

Cause deliberate harm to body without intent to suicide

cause tissue damage (e.g.: cutting)

Other types of self-mutilation : Biting nails and/or cuticles, Injurious masturbation, Head banging or Rocking

2. Increase in adolescent self-mutilation parallels prevalence of depression, hostility, and anxiety

3. May be coping mechanism to cope with despair, hopelessness, distress, low self-esteem, and intense emotional states

4. Uses scissors, razors, knives or other sharp objects to cut, or may burn self

direct patterns

•Suicide

•Anorexia

•Alcohol and substance abuse

•Self-mutilation

indirect patterns

•Unsafe sexual practices

•Abusive relationships

•Dangerous sports

•Compulsive gambling

Medical Conditions Associated with Suicide

•HIV/AIDS

•Cancer

•Cardiovascular Disease

•Cerebrovascular Disease

•Chronic Renal Failure with Dialysis

•Cirrhosis

•Dementia

•Head Injury

•Multiple Sclerosis

•Epilepsy

risk factors

•Prior suicide attempts

•Family history of suicide

•Misuse and abuse of alcohol and other drugs

•Mental disorders, particular depressions and other mood disorders

•Access to lethal means

•Social isolation

•Chronic disability and disease

•Lack of access to behavioral health care

•History of child and sexual abuse

environmental risk factors

•Job or financial loss

•Relational or social loss

•Easy access to lethal means

•Local clusters of suicide that have a contagious influence

•Natural disasters

•Veterans returning from war with PTSD

sociocultural risk factors

•Lack of social support and sense of isolation

•Stigma associated with help-seeking behavior

•Barriers to accessing health care, especially mental health and substance abuse treatment

•Certain cultural and religious beliefs (for instance, the belief that suicide is a noble resolution of a personal dilemma)

•Exposure to, including through the media, and influence of others who have died by suicide

at risk groups:

•Youth

•Elderly

•Military

•Native American-Indigenous and White

•LGBTQI

protective factors

•Positive family relationships

•Circle of Friends/peer supports

•Connectedness to others

•Coping and problem-solving skills

•Religious and cultural supports

•Alliances with peer mentors, teachers, therapists, guidance counselors, and clergy

•Mental and physical health

psychoeducation checklist

•Emotional connections to family and friends

•Instill hope

•Discouraging SI

•Self validation

•Distress management

•Alternatives

•Safety plan

•Re-establishing a social network

•Therapy treatment plan-psychotherapy, self-help, survivor’s group, psychopharmacology

•What will you bring to your practice as an RN?

•Listen

•Teach our partners how to communicate

•Be open

•Families are so important

•Help survivors

language

•Avoid stigmatized language

•Out with “committed suicide” ⇢ sensitive language is “died by suicide or ended his/her/their life

assessmet clues

Almost all suicidal persons send out clues

Overt Statements

“I wish I was dead.”

Covert Statements

“You won’t have to worry about me anymore.”

Non-verbal's – Sudden brightening of mood with more energy

asking someone if they are thinking of comitting suicide…

ASKING SOMEONE IF THEY ARE THINKING OF SUICIDE WILL NOT GIVE THAT PERSON IDEAS

•When assessing the risk for suicide, always determine:

•Intent to die

•Severity of ideation

•Availability of means

•Degree of planning

ASSESSING LETHALITY

Do you have plans for the time, place and method for suicide?

Do you own a gun or have access to firearm?

Do you have access to potentially harmful medications?

Have you imagined your funeral and how people will react to your death?

Have you "practiced" your suicide? (e.g., put the gun to your head or held the medications in your hand)?

Have you changed your will or life insurance policy or given away your possessions?

If person psychotic, assess for command hallucinations ordering him/her to kill him/her self

History of attempts

Need to complete full mental status evaluation

nursing diagnosis

•Risk for suicide

•Powerlessness

•Hopelessness

•Chronic low self-esteem

•Ineffective coping

primary intervention

preventing

secondary intervention

Treating acute suicidal crisis

tertiary intervention

lnterventions with family and friends of those who have committed suicide

Milieu Therapy suicide precautions:

SAFETY

1:1 Observation within arm’s reach

Document verbalizations & behaviors every 15 to 30 minutes

Carefully watch client swallow medications

No unsafe objects around patient (sharp or dangerous objects

Remove clothing that could be used as a tourniquet (i.e.: belt, stockings, etc.)

Counseling:

Commitment to treatment statement (CTS)

No-Suicide Contract

Therapeutic communication- develop rapport

Interventions for underlying disorder

health teaching

Teach about underlying disorder

Coping skills

Appropriate expressions of anger

survivors of those who died by suicide:

Ascertain how the loss has affected them

Encourage survivors to get counseling or survivor support groups

Loss of a loved one by suicide is not the same as the loss of a loved one to a physical health problem or even an accidental death

evaluation

Development of coping alternatives

Denial of desire to suicide

Support system in place

When a Client Ends Their Life

Can be devastating to nurses, other health professionals, and families

Feelings of guilt, helplessness, inadequacy and anger are common staff and family responses

Family may project anger on healthcare professionals.

Self-anger and guilt for failing to prevent the suicide is common

recommendations in nursing practice

Include material in basic nursing education

Make the topic a mandatory education piece for licensing

Ask at each encounter with each patient (5th vital sign)-TPR BP, SI

Look at prevention of brain diseases associated with suicide

Annual Physical and Mental Wellness Check