Suicide, LGBTQ+ Experiences, and Stress Management

Suicide Data and Statistics

• Definition of suicide is provided in the lecture.
• 2020 data indicates that approximately 12.2 million people seriously considered suicide.
• Age-related suicide statistics:
  • Ages 15-24: 19 deaths per 100,000 people.
  • Ages 10-14: Approximately 3.1 deaths per 100,000 people.
  • Suicide rates among active duty military members have been increasing to an all-time high over the past five years.
  • A 2021 study in Colorado surveyed 72 soldiers about the reasons for their suicide attempts.
  • The primary reason cited was a desire to end intense emotional distress.
  • Soldiers are trying to end intense psychological suffering and pain.

Risk Factors for Suicide

• General risk factors include genetics, shame, and humiliation.
• Specific populations at higher risk:
  • LGBTQ+ individuals.
  • LGBTQ+ youth are 3.5 times more likely to attempt suicide compared to their heterosexual peers.
  • A 2023 survey indicated that less than 40% of transgender and non-binary youth do not think about committing suicide.

Personal Experience and LGBTQ+ Issues

• Personal narrative of concealing identity to fit societal norms and avoid judgment.
• Sacrificing authenticity to minimize feelings of shame and fear of rejection.
• Living a lie to gain acceptance, resulting in a protective facade.
• Coming out in early thirties after years of pretense.
• Growing up queer involves constant navigation of societal norms, religious beliefs, and familial expectations, leading to suicidal ideation.
• Call to action against silence and indifference towards the LGBTQ+ community.
• Emphasis on unconditional love for children, regardless of their sexual orientation or gender identity.
• Forty percent of homeless youth are displaced due to rejection by their families.
• Importance of allyship and speaking out in support of the LGBTQ+ community.
• Positive experience working at Cedars Sinai where colleagues were accepted and respected for their abilities, not their sexual orientation.
• Desire to be straight to avoid the challenges and discrimination faced as a gay individual.
• Concern over the erosion of rights for marginalized populations and the silence surrounding it.
• Frustration with religion and the concept of conversion therapy, which can exacerbate suicide rates.
• Fear of discrimination based on sexual orientation and gender identity, particularly in certain states.
• Discussion of Pride Month as a means of showing support, love, and kindness towards each other, and advocating for LGBTQ+ rights.

Recognizing and Evaluating Suicide Risk

• Warning signs include withdrawing from friends and family, expressing a lack of purpose, and making comments about worthlessness.
• The importance of evaluating the lethality of a suicide plan to determine the degree of suicidal risk.
• Three main elements in evaluating suicide risk:
  1. Specific plan with details.
  • If someone acknowledges thoughts of self-harm, ask about their plans.
  1. Lethality of the proposed method.
  • Distinguish between high-risk, potentially instantaneously lethal methods and lower-risk methods.
  1. Access to the planned method.
  • A definite plan, time, and place indicates a higher risk of suicide.
• Example of a student with access to their father's gun seeking help, highlighting the importance of intervention.

Suicide Assessment and Intervention

• The Columbia Suicide Severity Rating Scale is used in psychiatry to assess suicide risk.
• Statements indicating suicidal ideation include:
  • Feeling like a burden.
  • Believing loved ones would be better off without them.
  • Needing an escape from negative thoughts.
  • Seeing no desirable future.
• If such statements are made, directly ask about thoughts of self-harm.
• Intervention for suicide becomes the top priority in nursing care.
  • Adopting an authoritative role to ensure the client feels safe.
  • Denying requests to be alone and requiring presence in a common area.
• No-suicide contracts are not a guarantee of safety and are sharply criticized.
• Creating a safe environment is crucial.

Pharmacological Interventions and Monitoring

• The use of antidepressants to raise serotonin levels.
• Increased energy levels from SSRIs after a few weeks can be a dangerous period as the thoughts still remain.
• Monitor clients closely when severe depression begins to lift, as they may now have the energy to act on their suicide plan.
• One-to-one monitoring is the safest intervention when a client expresses suicidal thoughts and has a plan.
• Fifteen-minute checks and close observation are important.

Suicide Crisis Hotline

• 988 is a suicide crisis hotline number.
• There are concerns about defunding the hotline, which provides crucial support, especially for the LGBTQ+ community.
• Importance of asking patients about suicide as part of the Mental Status Examination (MSE).
  • If they express suicidal thoughts, inquire about their plan.

Quiz Information

• Quiz number two will cover:
  • Therapeutic and non-therapeutic communication.
  • Bipolar disorders.
  • Depressive disorders.
  • Suicide.
  • Mental Status Examination (MSE).
• Exam number one will carry over with anxiety-related disorders, depression, and bipolar II disorder.

Stress Definition

• Stress is the brain's response to any demand.
• Exposure to high levels of stress in childhood increases the likelihood of developing mental illness as an adult.

Types of Stressors

• Stressors can be physical or psychological and perceived as good or bad, leading to a biological response.
  • Physical Stressors: Events or conditions that place physical strain on the body.
  • Examples include work, environmental conditions, injury, illness, lack of sleep, and substance abuse.
  • Psychological Stressors: Conditions that cause emotional or mental strain, challenging coping mechanisms.
  • Examples include work-related stress, school-related stress, financial stress, social stress, and life changes.

Fight or Flight Response

• Involves the sympathetic nervous system.
• Women tend to respond to stress by tending and befriending rather than fighting or fleeing.
  • This is related to their larger limbic region, which is associated with emotions and social support.

Types of Stress

• Distress: Negative stress that drains energy and results in anxiety, depression, confusion, helplessness, and hopelessness.
• Eustress: Beneficial, positive stress that brings happiness and hopefulness.
• Excessive stressors can lead to distress.

Gender Differences in Stress Response

• Women seek emotional support due to increased emotional needs associated with a larger limbic region.
• Men are often less likely to discuss their stress due to societal expectations of masculinity.
• Toxic masculinity and patriarchal norms discourage men from expressing emotions.

General Adaptation Syndrome (GAS)

• Occurs in three phases and is the body's response to stress.
• Triggered by psychological or physiological stress such as financial troubles, family breakdown, or trauma.
  1. Alarm Stage
  • The hypothalamus sends distress signals.
  • Glucocorticoids are released, triggering adrenaline and cortisol.
  • The sympathetic nervous system activates, leading to physiological responses such as dilated pupils and constricted veins.
  1. Resistance Stage (Adaptation Stage)
  • The parasympathetic nervous system attempts to return the body to normal.
  • Hormone Production of cortisol decreases, and heart rate and blood pressure normalize.
  • If the stressor remains, the body adapts to the stressor.
  1. Exhaustion Stage
  • Prolonged stress depletes the body's energy resources.
  • The body struggles to maintain normal function, leading to weariness and anxiety.
  • If stress is not managed, it can lead to health problems.
• The GAS system serves as a warning sign to find coping mechanisms.

Responses to Stress or Trauma

• Fight: Confronting and overcoming challenges to prevent illness.
• Prayer: Provides aid in healing and comfort during stressful times.
• Coping strategies such as prayer can help manage stress before tests.