Suicidal Behaviors and Ideation

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Questions and Answers

Which of the following factors is most directly associated with the initiation of suicidal behavior according to the etiology discussed?

Social support from peers

Unmanageable stressors exceeding typical coping efforts (correct)

Coping strategies employed by the individual

Family history of mental illness

Which statement reflects a psychosocial factor affecting suicide risk among LGBTQ+ youth?

LGBTQ+ youth report lower rates of suicidal thoughts compared to their heterosexual peers.

Peer acceptance has no significant effect on LGBTQ+ youth's mental health.

Economic deprivation is unrelated to suicidal behavior in LGBTQ+ populations.

Isolation due to inability to disclose sexual identity contributes to higher suicide risk. (correct)

Which of the following DSM-5 criteria for suicidal behavior disorder states a critical condition to establish the diagnosis?

The individual must not have accessed mental health support.

The individual has made a suicide attempt within the past two years. (correct)

The act must be ideologically motivated.

The individual must have experienced suicidal ideation previously.

What is the most significant impact of family responses on an at-risk individual’s suicide risk?

Families that deny mental health issues increase isolation. Signup and view all the answers

Which group displays the highest suicide attempt rate, as suggested in the content?

Transgender individuals Signup and view all the answers

How does economic deprivation relate to suicide risk among genders according to the provided content?

Men experience higher suicide rates than women when economic deprivation is present. Signup and view all the answers

Which of the following is an essential consideration for nursing care when managing individuals at risk of suicide?

Developing a plan that includes coping mechanisms for identified stressors Signup and view all the answers

What is a critical psychosocial factor that should be assessed in clients experiencing suicidal ideation?

Family relationships and support Signup and view all the answers

Which of the following statements reflects the nurse's role in suicide prevention?

Nurses are generally the first health care professionals to assess suicidal clients. Signup and view all the answers

What demonstrates the importance of a therapeutic relationship in nursing care for suicidal clients?

It allows for open communication about distress and hopelessness. Signup and view all the answers

Which legal consideration is vital when assessing suicide risk in clients?

Documenting the assessment findings and actions taken. Signup and view all the answers

What aspect of a client's life should be explored to identify possible precipitating factors for suicidal behaviour?

Recent changes related to loss Signup and view all the answers

In terms of family responses, which aspect can significantly affect the mental health of a suicidal client?

Family members encouraging discussion about feelings. Signup and view all the answers

How should nurses convey support to clients at risk of suicide?

By maintaining a nonjudgmental tone and open body language. Signup and view all the answers

Which of the following describes a common misconception regarding clients who attempt suicide?

They often seek attention and do not truly want to die. Signup and view all the answers

What impact can a client's suicide have on the healthcare staff involved?

Staff members may experience feelings of failure and devastation. Signup and view all the answers

Which factor is least likely to contribute to the etiology of suicidal behavior?

Strong familial support system Signup and view all the answers

What should a nurse primarily focus on when providing care for individuals at risk of suicide?

Promoting family educational sessions Signup and view all the answers

Which statement regarding legal considerations in suicide prevention is accurate?

Confidentiality must be overridden if the client poses a risk to others. Signup and view all the answers

What emotional responses might significant others experience in relation to a suicidal individual?

Guilt, anger, and sadness Signup and view all the answers

Which is an example of a psychosocial factor that increases suicide risk?

Poverty Signup and view all the answers

Which coping strategy is identified as maladaptive and can increase the risk of suicidal behavior?

Alcohol and drug use Signup and view all the answers

What aspect of nursing care is crucial when interacting with clients who are suicidal?

Using a calm and non-blaming approach Signup and view all the answers

Following a suicide attempt, what is a priority intervention for nursing care?

Provide education on coping strategies Signup and view all the answers

What legislation permits medical assistance in dying in Canada?

Both Bill C-14 and Bill C-7 Signup and view all the answers

Study Notes

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.

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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.