Suicide Prevention PPT Pt. 1

Describe epidemiological statistics and risk factors related to suicide. Describe predisposing factors implicated in the etiology of suicide. Differentiate between facts and myths regarding suicide. Apply the nursing process to individuals exhibiting suicidal behavior.

____ of people who attempt or commit suicide have a diagnosed mental illness

90%

More ______ attempt, but more ____succeed

women; men

•The nurse should ____________ or words, plan, lethality of the plan and possibility of carrying it out

determine the seriousness of the signs

DO NOT leave a suicidal person _________.

alone (unless unsafe)

Develop a _______ for those not actively suicidal

safety plan

There are _____________ for suicide.

risk factors and protective factors

define suicide

• not a diagnosis or a disorder; it is a behavior.

• the act of taking one’s own life and it derives from the Latin words for “one’s own killing.” Many religions believe that suicide is a sin and it is strictly forbidden.

what’s suicide considered in the field of psychiatry?

an irrational act associated with mental illness and most commonly with depression. More than 90 percent of all persons who commit or attempt suicide have a diagnosed mental disorder.

what does suicide acceptance vary by?

religion, culture, and individual

what type of person are those who commit suicide?

More than 90 percent of suicides are by individuals who have a diagnosed mental disorder.

what was suicide considered throughout hx?

• an offense against the state and was viewed as a selfish or even criminal act.

• they were often denied cemetery burial and their property was confiscated and shared by the crown and the courts.

when did the issue of suicide change hx?

during the period of the Renaissance and intellectuals began to discuss the issue more freely (Suicide was illegal in England until 1961, and only in 1993 was it decriminalized in Ireland.)

what’s is suicide in the death list?

the 9th leading cause of death in the US for adults

review slide 6 for epidemiological factors

review slide 6 for epidemiological factors

what are the individual protective factors for suicide?

•Effective coping and problem-solving skills

•Reasons for living (for example, family, friends, pets, etc.)

•Strong sense of cultural identity

what are the relationship protective factors for suicide?

•Support from partners, friends, and family

•Feeling connected to others

what are the community protective factors for suicide?

•Feeling connected to school, community, and other social institutions

•Availability of consistent and high quality physical and behavioral healthcare

what are the societal protective factors for suicide?

•Reduced access to lethal means of suicide among people at risk

•Cultural, religious, or moral objections to suicide

what’s the suicide rate for single, never married infividuals?

• twice that of married persons and divorce increases risk for suicide particularly among men, who are three times more likely to take their own lives than divorced women.

• Widows and widowers also have high risk.

who are more likely to commit suicide (m/f)?

• Men’s suicide rate was 4 times women’s rates.

• Women attempt suicide more often, but more men succeed.

what age group is suicide the highest risk for men?

From 2000 through 2020, male suicide rates were consistently highest in those aged 85 and over

what are the suicide stats for trans?

have 41% lifetime prevalence

what are the recent trends for female suicide?

rates have declined recently for all age groups over age 25, but have generally increased for those aged 10–14 and 15–24

Although adolescents may statistically have a lower rate of suicide than some other age groups, what is still important to note?

that it has been, over several years, the third leading cause of death in this population

what put adolescents at an increased risk of suicide?

impulsive and high-risk behaviors, untreated mood disorders, and substance abuse.

what are the age trends of suicide ?

• Risk of suicide increases with age, particularly among men.

• Ages 45-54, especially men, had highest completion rate.

• White men older than 85 years are at greatest risk of all age, gender, and race groups. 

• Suicide rates declined last year by 8% in the 10-24 age group.

what specific demographic is at the greatest risk for suicide?

White men older than 85 years are at greatest risk of all age, gender, and race groups.

slide 9 (leading causes of death by age range)

slide 9 (leading causes of death by age range)

what does religion do as a risk factor for suicide (personally)?

it decreases the risk of suicide. Catholics have lower rates than do Protestants or Jews.

what does socioeconomic status do as a risk factor for suicide (personally)?

Individuals in the very highest and lowest social classes have higher suicide rates than those in the middle class.  Higher in rural areas. 

what does ethnicity do as a risk factor for suicide (personally)?

Non-Hispanic American Indian/Alaska Native have the highest rates followed by Non-Hispanic Whites.  Non-Hispanic Asians have the lowest rates.   

what are the general risk factors (psychological) for suicide?

psychiatric illnesses, severe insomnia, and LGBTQIA

what are the most common psychiatric illnesses that precede suicide?

Mood (depression/bipolar) and substance use disorders

what are some Other psychiatric disorders (other than Mood (depression/bipolar) and substance use disorders) that account for suicidal behavior include?

•Schizophrenia (command hallucinations)

•Personality disorders

•Anxiety disorders

•Eating disorders

•Substance use

what’s severe insomnia associated with?

increased risk of suicide.

Prevention identified that in a study of youth, grades 7 to 12, LGB youth were _____ more likely to attempt suicide than their heterosexual peers.

two times

what are the following exemplifying:

–Having attempted suicide previously increases the risk of a subsequent attempt. About half of those who ultimately commit suicide have a history of a
previous attempt.

–Loss of a loved one through death or separation

lack of employment or increased financial burden

– Family history of suicide

–Chronic pain or illness

risk factors for suicide

what are the overarching psychological theories of suicide?

–Anger turned inward (self-hatred)

–Hopelessness (no other way out)

–History of aggression and violence (impulsive)

–Shame and humiliation (to save-face or reduce family embarrassment)

what are the characteristics of “anger toward inward”, a psychological theory of suicide

• self hatred

• Freud: suicide was a response to the intense self-hatred that an individual possessed.

• anger had originated toward a love object but was ultimately turned inward against the self.

• He interpreted suicide to be an aggressive act toward the self that often was really directed toward others.

what are the characteristics of “hopelessness”, a psychological theory of suicide

• no other way out

• hopelessness= a sign of depression and…

• an underlying factor in the predisposition to suicide.

• While many of the symptoms that are identified in suicide assessment tools attempt to assess for seriousness of suicide ideation, current research is attempting to glean which symptoms might be more predictive of the move from ideation to attempts.

what are the characteristics of “History of aggression and violence”, a psychological theory of suicide

• impulsive

• a hx of this is associated w increased suicide risk tho recent evidence says impulsive traits are higher in people w suicide ideation NOT necess. attempts

what are the characteristics of “Shame and humiliation”, a psychological theory of suicide

• to save-face or reduce family embarrassment

• Some individuals have viewed suicide as a “face-saving” mechanism—a way to prevent public humiliation following a social defeat such as a sudden loss of status or income.

• Often these individuals are too embarrassed to seek treatment or other support systems

what’s a sociological theory of suicide?

Durkheim’s three social categories of suicide

what’re Durkheim’s three social categories of suicide?

•Egoistic suicide (feels separate and different)

•Altruistic suicide (sacrifices self for group)

•Anomic suicide (response to change)

what is Durkheim’s three social categories of suicide?

a Three-step theory (pain, with hopelessness, hopelessness greater than connection, energy to make an attempt)

what’re the general biological theories of suicide?

–Genetics

–Neurochemical factors

what’re the characteristics of “Egoistic suicide”, which is a Durkheim social category of suicide?

• feels separate and different

• it is the response of the individual who feels separate and apart from the mainstream of society.

• Integration is lacking and the individual does not feel a part of any cohesive group (such as a family or a church).

what’re the characteristics of “altruistic suicide”, which is a Durkheim social category of suicide?

• sacrifices self for group

• the opposite of egoistic suicide.

• The individual who is prone to altruistic suicide is excessively integrated into the group.

• The group is often governed by cultural, religious, or political ties, and allegiance is so strong that the individual will sacrifice his or her life for the group.

what’re the characteristics of “anomic suicide”, which is a Durkheim social category of suicide?

• response to change

• occurs in response to changes that occur in an individual’s life that disrupt feelings of relatedness to the group.

• An interruption in the customary norms of behavior instills feelings of “separateness,” and fears of being without support from the formerly cohesive group.

order the following for most concerning for suicide:

•A. 70-year-old widowed White Non-Hispanic male

•B. 55-year-old male CEO of successful financial company, recently divorced. 

•C. 29-year-old postpartum female with PPD, good support system

•D. 82-year-old male Native American with new terminal diagnosis

•E. 29-year-old female with a previous suicide attempt using medications

1. E. 29-year-old female with a previous suicide attempt using medications

2. D. 82-year-old male Native American with new terminal diagnosis

3. A. 70-year-old widowed White Non-Hispanic male

4. B. 55-year-old male CEO of successful financial company, recently divorced. 

5. C. 29-year-old postpartum female with PPD, good support system

what does the joint commission require in a suicide risk assessment?

using therapeutic relationship, trust, and open communication

what should be considered when conducting a suicidal assessment?

demographics, presenting symptoms/medical-psychiatric diagnosis, suicidal ideas or acts, interpersonal support system, analysis of the suicidal crisis, psychiatric/medical/family history, and coping strategies.

what are the most common disorders that precede suicide?

Mood disorders (major depression and bipolar disorders) (also: Individuals with substance use disorders are also at high risk)

what are some other psychiatric disorders in which suicide risks have been identified include

anxiety disorders, schizophrenia, anorexia nervosa, and borderline and antisocial personality disorders.

what may individuals leave as to the intent of their act with regards to suicide?

they may leave both behavioral and verbal clues

what are some behavioral clues that someone may leave behind that they have intention to act?

giving away prized possessions, getting financial affairs in order, writing suicide notes, or sudden lifts in mood (may indicate a decision to carry out the intent).

what can lack of a meaningful network of satisfactory relationships indicate?

an individual as a high risk for suicide during an emotional crisis.

what should we specifically ask about in the case of suicide risk?

–Seriousness of intent – Are you talking/thinking about killing yourself?

–Plan – specificity  Do you have a plan?

–Means  (determine: Is it achievable?)

–Previous attempts

–Verbal and behavioral clues

what’s a genetic risk factor for suicide?

monozygotic twins

what are some analysis components of the suicidal crisis?

–Precipitating stressor (life event/trigger)

–Relevant history (failure/rejections)

–Life-stage issues (ability to cope with developmental issues)

what is the Columbia Suicide Severity Rating Scale

a scale that indicates risk of suicide

what is “is path warm”?

a pneumonic for assesing suicidal risk

what does “is path warm” mean?

•I – ideation current and active

•S – Substance abuse

•P – Purposelessness

•A – Anger, uncontrolled or rage

•T – Trapped with no way out

•H – Hopelessness

•W – Withdrawal from others

•A – Anxiety, agitation, sleep changes

•R – Recklessness or impulsive

M – Mood (dramatic shifts)

assesses for suicidal risk

what is the “dangerous person” scale used for?

assessing an individuals risk of injury to self or others 

what is the “dangerous person” pneumonic?

Depression/suicidal

Anger/agitation, aggressive

Noncompliance with requests/taking medication

General appearance/inappropriate dress/poor hygiene

Evidence of self-inflicted injury

Responding/reacting to delusions or hallucinations

Owns/displays weapon(s)

Unorganized thoughts/appearance/behavior

Speech pattern/substance/rate (too fast, too slow, jumps all over)

Paranoid

Erratic or fearful behavior

Recent loss of job/loved one/home

Substance abuse

Orientation (Lack of) to date/time/location/situation/insight into illness

Number and type of previous contacts with police, mental health, or crisis workers

what do the Nursing concerns for the suicidal client include?

• risk for suicide

• hopelessness

what’re the Nursing diagnoses for the suicidal client?

•Risk for suicide related to feelings of hopelessness and desperation.

•Hopelessness related to absence of support systems and perception of worthlessness.

what is the following exemplifying:

•Keep the client safe

•Assess current ideation/desire

•Remove all potentially dangerous items (belts, shoelaces, strings, perfume/cosmetics, plastic bags, hand sanitizer and other cleaning agents, medications, weapons)

•Place with roommate near nurse’s station (a safe keeping action — roommate can report)

•Supervise at appropriate level (one on one, line of sight, etc)

•Stay with the client

•Monitor sleep and nutrition

•Allow and encourage expression of emotion

•Encourage medication and therapy

•Teach problem solving and coping when client is ready

Nursing Actions for Inpatient Clients

what’s the following exemplifying:

–Do not leave the person alone if actively suicidal.

–Establish a no-suicide contract with the client if no other options.

–Enlist the help of family or friends.

–Schedule frequent appointments.

–Establish rapport and promote a trusting relationship.

–Be direct and talk matter-of-factly about suicide.

–Discuss the current crisis situation in the client’s life.

–Identify areas of self-control.

–Give antidepressant medications (only a few days).

Nursing Actions for Outpatient Clients

what criteria may be used for measurement of outcomes in the care of suicidal client?

The Client:

1.Has experienced no physical harm to self.

2.Sets realistic goals for self.

Expresses some optimism and hope for the future

what is the NUMBER ONE nursing priority for suicidal pts?

Keep the client safe

what are the key nursing actions for inpatient suicide clients? (memorize)

•Keep the client safe

•Assess current ideation/desire

•Remove all potentially dangerous items (belts, shoelaces, strings, perfume/cosmetics, plastic bags, hand sanitizer and other cleaning agents, medications, weapons)

•Place with roommate near nurse’s station (a safe keeping action — roommate can report)

•Supervise at appropriate level (one on one, line of sight, etc)

•Stay with the client

•Monitor sleep and nutrition

•Allow and encourage expression of emotion

•Encourage medication and therapy

•Teach problem solving and coping when client is ready

what are the Nursing Actions for Outpatient Clients?

–Do not leave the person alone if actively suicidal.

–Establish a no-suicide contract with the client if no other options.

–Enlist the help of family or friends.

–Schedule frequent appointments.

–Establish rapport and promote a trusting relationship.

–Be direct and talk matter-of-factly about suicide.

–Discuss the current crisis situation in the client’s life.

–Identify areas of self-control.

–Give antidepressant medications (only a few days).

for an outpatient client, what must be arranged for sleep situations?

Arrangements must be made for the client to stay with family or friends. If this is not possible, hospitalization should be reconsidered.

when can a no suicide contract be made for outpatient clients?

only as an adjunct to other interventions. The focus of this intervention is to formulate a written or verbal contract that the client will not harm himself or herself in a stated period of time.

why would you enlist the help of friends/family for outpatient clients?

to ensure that the home environment is safe from dangerous items, such as firearms or stockpiled drugs. Give support persons the telephone number of the counselor, or an emergency contact person in the event that the counselor is not available.

what should you establish w the outpatient client?

rapport and promote a trusting relationship. It is important for the suicide counselor to become a key person in the client’s support system at this time.