Suicidal Behaviors and Ideation

Self-Harm and Suicidal Behaviors (Suicidal Ideation)

• Suicide is the intentional act of taking one's own life.
• Attempted suicide is a self-destructive behavior that does not result in death, despite the expectation of death.
• Completed suicide is the self-termination of one's life, associated with despair and distress.
• Suicidal plan: Detailed planning of the suicide event, including method, location, and time.
• Suicidal ideation is thinking about or planning one's own death, and/or the wish to relieve severe emotional pain.

Suicidality and Specific Populations

• Suicide affects all age groups, social classes, and cultures.
• Globally, nearly 1 million people die by suicide annually.
• In Canada, approximately 4,000 people die by suicide per year.
• Suicide is more common among people with risk factors such as loss, unemployment, and recent life events.
• Risk factors include prepubertal children, adolescents/youth, midlife individuals, and the elderly.

Prepubertal Children

• Children under 10 years old can understand the finality of death, although it's rare for them to intentionally take their own lives.
• In 2016, suicide accounted for 19% of deaths among youth aged 10-14.
• Risk factors include body image concerns, peer pressure, challenges of sexuality, and histories of childhood abuse.

Adolescents/Youth

• More teenagers die from suicide than from various other causes combined (e.g., cancer, heart disease).
• In 2016, suicide accounted for 29% of deaths among youth aged 15-19 and 23% among young adults aged 20-24.
• Risk factors include family and social problems, insufficient coping skills, anorexia nervosa, substance abuse, chronic disease, existing mental health disorders, and interpersonal relationship problems.

Midlife

• Suicide rates are highest in midlife (ages 45-59) in Canada.
• More than half of suicides involve people aged 45 or older.
• Risk factors include issues with intimate partners, problems with job/finances, health decline, family issues, and criminal/legal problems.

Elderly

• Increased risk of suicide from age 65.
• Passive suicide (often overlooked) is a significant concern in this population.
• Risk factors include chronic illness, pain, loss of friends and significant others, and loss of independence.

Indigenous People

• Suicide rates among Indigenous populations in Canada are significantly higher than the national average (5-6 times for First Nations youth, 11 times for Inuit youth).
• Risk factors are similar to those for non-Indigenous people (depression, abuse, poverty, isolation, etc.), but are compounded by colonization, residential schools, and the forced adoption of Indigenous children.

Gender

• Worldwide, males complete suicide at a rate three times that of females, but females are four times more likely to attempt suicide.
• Men are more likely to use firearms for suicide, while women are more likely to die by poisoning.

LGBTQIA2S+

• Sexual orientation is increasingly recognized as a risk factor for suicide.
• “Coming out” can be challenging.
• Isolation and lack of support for a sexual identity are contributing factors.
• 33% of lesbian, gay, and bisexual youth have attempted suicide, compared to 7% in the general population.

DSM-5 Criteria

• The DSM-5 proposes five criteria for suicidal behavior disorder: suicide attempt within two years, no self-injurious behavior during suicide attempts, not related to preparation or ideation, not during an altered state, and not ideologically motivated.
• Two specifiers for the disorder are current (within 12-24 months of the last attempt) and in remission (more than 24 months since the last attempt).

Etiology of Suicidal Behavior

• Biologic: genetic predisposition, family history, excessive physiological stress response, medical illness, alcohol/drug use, neurotransmitter depletion (e.g., serotonin).
• Psychological: coping strategies, helplessness, hopelessness, worthlessness, guilt, negative thinking, distressed relationships, loss, and previous suicide attempts.
• Social: isolation, poverty, contagion, culture, religion, unemployment, changes in socioeconomic status, bullying, and cyberbullying.

Legal Considerations

• Counseling or assisting suicide is a criminal act.
• Involuntary vs Voluntary Hospitalization.
• Changes to legislation in Canada to allow euthanasia and physician-assisted suicide.

Nursing Care

• Family response: Families may experience guilt, anger, shame, and sadness. Nurses need to provide education about depression, substance use, etc.
• Nurse's response: A nonjudgmental approach is essential. Nurses should avoid blaming or conveying disgust.

Nursing Assessment

• The therapeutic relationship is fundamental.
• Assess for hopelessness, helplessness, and powerlessness.
• Evaluate the client's plan, access to means, and support systems.
• Assess for risk factors.
• Use questions to guide a comprehensive assessment of risk.

Nursing Diagnosis

• Examples of nursing diagnoses related to suicide: risk for suicide, risk for self-directed violence, interrupted family processes, impaired social interaction, chronic low self-esteem, ineffective coping.

Client Care and Acute Treatment

• Maintain client safety: remove means to end life, assess client's reasons for living
• Decrease suicidal ideation: explore reasons for living.
• Initiate treatment for underlying disorder
• Evaluate for substance abuse
• Reduce level of social isolation: connecting with the client and family

Client Care and Acute Treatment (Continued)

• Assessment/reassessment: suicide may be one event or continuous.
• Documentation: note assessment and interaction with client.

Nursing Interventions

• Ensure safety and remove dangerous objects.
• Engage in a therapeutic relationship.
• Observe the client regularly.
• Assist with somatic therapies, medication management, and substance abuse.
• Develop plans to prevent future suicide.

Medical Management

• Electroconvulsive therapy (ECT) is used for depressive manifestations.
• Benzodiazepines and antidepressants are options for reducing anxiety and risk.
• Lithium may reduce suicidal thoughts.
• Antipsychotics may help.

Evaluation and Treatment Outcomes

• The most desirable outcome is the client's return to the community.
• Discharge planning and ongoing follow up are crucial.
• Short-term outcomes emphasize safety and mobilization of resources.
• Long-term outcomes involve maintaining the client in psychiatric treatment.
• Prevention strategies need to be in place.

Overall Impact on Nurses

• Compassion fatigue can lead to diminished capacity to function at work and in personal life.
• Nurses might avoid the stress through absenteeism or presentism.

References

• Kunyk, D., Peternelj-Taylor, C., & Austin, W. (2022). Psychiatric and mental health nursing for Canadian practice (5th ed.). Wolters Kluwer.

Explore the complex topics of self-harm and suicidal behaviors through this quiz. Understand the definitions, risk factors, and demographic impacts of suicidality. Gain insight into the significant aspects of suicidal ideation and its effects on various populations.