Suicide Prevention Study Notes

Suicide Prevention

CHAPTER OUTLINE

  • Objectives

  • Historical Perspectives

  • Epidemiology

  • Risk Factors

  • Predisposing Factors: Theories of Suicide

  • Application of the Nursing Process in the Care of Patients With Suicidal Ideation and Suicidal Behavior

  • Key Terms

  • Summary and Key Points

  • Review Questions

  • Clinical Judgment Questions

  • Communication Exercises

  • Movie Connections

KEY TERMS

  • collaborative safety plan

  • suicide

  • suicide risk factors

  • suicide warning signs

OBJECTIVES

After reading this chapter, the student will be able to:

  1. Discuss the epidemiology and risk factors related to suicide.

  2. Describe the predisposing factors implicated in the development of risk for suicidal behavior.

  3. Differentiate between facts and myths regarding suicide.

  4. Apply the nursing process in the care of patients exhibiting suicidal thoughts and behaviors.

CORE CONCEPTS

  • Caring: Therapeutic relationship, patient-centered care

  • Safety: Suicide risk assessment, suicide prevention

  • Collaboration: Suicide prevention

  • Evidence-Based Practice: Suicide prevention

  • Health Promotion: Suicide risk assessment

  • Professional Behavior: Nursing process in the care of patients with suicidal thoughts and behaviors

CLINICAL JUDGMENT

  • Definition: Suicide is not a diagnosis or a disorder but a behavior. It is the act of taking one's own life, derived from Latin words meaning "one's own killing."

  • Cultural Impact: Many religions consider suicide a sin, influencing societal attitudes. Some populations, like American Indians, veterans, and LGBTQ+ individuals, are at higher risk.

  • Interactions: Factors like mental illness, substance abuse, losses, exposure to violence, and social isolation increase risks.

  • Legal Perspective: The legality of physician-assisted suicide varies by state, with currently 10 states and D.C. having legalized it (as of 2022).

  • Psychiatrical View: Many view suicide as irrational, linked to mental illness, although not all suicides stem from mental disorders.

HISTORICAL PERSPECTIVES

  • Ancient Greece and Rome: Suicide was viewed as an offense against the state or a means to escape humiliation.

  • Middle Ages: Condemned as selfish or criminal; grave punishments were often imposed.

  • Renaissance: More philosophical discussions began, but condemnation persisted.

  • 17th-18th Century Views: Some philosophers recognized connections between suicide and extreme mental disturbances.

  • Legal Changes: England legalized suicide in 1961 and Ireland in 1993.

EPIDEMIOLOGY

  • Statistics (2020): 45,979 suicides in the U.S., with firearms (63%) as the leading means.

  • Demographics: Males have higher rates than females, though female rates are increasing, particularly in younger ages.

  • Suicide as Cause of Death: Spike due to other causes (COVID-19, chronic liver disease) shifted suicide from the 10th to the 12th leading cause of death in 2020.

RISK FACTORS

  • Identified suicide risk factors are statistically correlated with increased incidences, differentiated from immediate warning signs.

  • Marital Status: Divorce significantly raises risks.

  • Sex: Females more frequently attempt suicide; males often complete.

  • Age: Rates generally increase with age; especially high among older men.

  • Religion: Variable impacts; often considered protective, but exceptions exist.

  • Socioeconomic Status: Financial strain is a key factor, with (rural) settings showing higher suicide rates.

  • Ethnicity: Higher rates in Whites and American Indians, particularly among young adults.

  • Mental Health Conditions: Major mental illnesses significantly elevate risk factors.

PREDISPOSING FACTORS: THEORIES OF SUICIDE

  • Psychological Theories:
       - Freudian View: Anger turned inward results in self-harm.
       - Hopelessness: Recognized as a significant predictor for suicidal behavior.

  • Sociological Theories:
       - Durkheim’s Theory: Cohesive societies decrease suicide risk; identifies egoistic, altruistic, and anomic suicides.
       - Joiner's Interpersonal Theory: Emphasizes connectedness and perceived burdensomeness as central to suicidal ideation and attempts.
       - Klonsky and May's Three-Step Theory: Explains the transition from pain and hopelessness to active ideation and attempts.
     

APPLICATION OF THE NURSING PROCESS

  • Assessing suicidal ideation involves a detailed risk assessment through effective communication and documentation of findings.

  • Assessment Aspects:
       - Ideas, plans, and attempts to self-harm should be evaluated.
       - The patient's interpersonal support system should be assessed.
       - Acknowledge underlying stressors and psychological history.

  • Safety Plans: Developed collaboratively, must be comprehensive, covering coping strategies, triggers, and support networks.

  • Ongoing Evaluation: Suicide risk is dynamic; assessments must adjust to changes in patient behavior and circumstances.

SUMMARY AND KEY POINTS

  • The majority of individuals attempting or dying by suicide have a diagnosed mental disorder.

  • Suicide is the second-leading cause of death among young Americans aged 10 to 14 and 25 to 34 years.

  • More women attempt suicide, while men succeed more often.

  • Identify risk and protective factors through a comprehensive assessment
     of patients during risk evaluation, focusing on evidence-based practices and preventative measures.

REVIEW QUESTIONS

  1. Which individual demonstrates the highest number of risk factors for suicide?

  2. What considerations are important for suicide risk assessment in the ED?

  3. How would Freudian theory explain a suicide attempt following a breakup?

  4. What interventions are appropriate for a client on suicide precautions?

  5. How can success of therapy for a suicidal client be measured?

CLINICAL JUDGMENT QUESTIONS

6-10 Various scenarios assessing suicide ideation, response, and intervention strategies.

COMMUNICATION EXERCISES

  • Practice empathetic communication and effective assessment techniques in hypothetical scenarios.

MOVIE CONNECTIONS

  • Explore how films like Dead Poet's Society and The Perks of Being a Wallflower tackle themes of suicide and mental health.

REFERENCES

  • Detailed resource section with guidelines for prevention, assessment tools, and support organizations.