chapter 16: SUICIDE

Suicide Risk Assessment and Intervention

• Suicide: Purposeful taking of one's own life, a devastating act involving intense feelings of fear, loss, anger, or despair. Suicide is preventable.
• High-Risk Factors: Individuals with previous suicide attempts, terminal illnesses, job or financial loss, and social isolation are at increased risk. Males over 50 are at a higher risk than the general population. Adolescents and young adults are another vulnerable group.
• Suicide Rates: Suicide is a significant public health concern, with varying rates across age groups and genders. Guam experiences particularly high suicide rates; in 2019, there were 31 deaths of people ages 20-30 from suicide. Illicit drug use contributes to suicide.
  • 10th leading cause of death ages 15 - 24.
  • Rates are 40% higher among the elderly population.
  • Men who are divorced or separated are more likely to commit suicide.
  • Males over 75 years old have suicide rates three times the national average.
• Suicide Myths: Common myths about suicide include that those who talk about suicide never commit it, those who are suicidal only want to harm themselves and not others, there is no way to help those who want to die, and mentioning suicide will cause a suicidal individual to commit it. These are false.

Assessing Suicide Potential

• Assessment: The assessment of suicide potential involves exploring the client's rationality, plan (how they would carry it out), and means of carrying out the plan. The SAD PERSONS scale (a tool for assessing suicide risk) guides clinical action.
• SAD PERSONS Scale: A tool (handout) used for evaluating the degree of suicide risk, scores, and proposed clinical actions are based on 10 factors. Scores of 0-2 recommend home follow-up, while scores of 7-10 indicate immediate hospitalization.

Suicide Precautions

• Safety: The priority is client safety. All potential means of self-harm—belts, razors, knives, shoelaces, bra wires, etc.—should be removed from the client's environment to prevent self-inflicting injury.
• Supervision: Continuous 1:1 observation is essential, particularly during shift changes, weekends, and night shifts.
• Medications: Carefully monitor clients taking medications; ensure they swallow pills, and avoid providing glass, metal utensils or any other potential means to harm oneself.
• Suicide Attempts: Suicide attempts are more frequent than successful suicides, and some accidents may be disguised as suicides. Women more frequently attempt suicide but men more frequently succeed.

Signs and Symptoms of Suicide

• Depression: Be alert for warning signs of depression, including sudden changes in behavior (reckless behavior, withdrawn, talking about death) and dramatic mood changes. A sudden improved mood following antidepressant therapy could indicate further risk, as medication's therapeutic effects take time.
• Possessions: Giving away possessions, financial arrangements, notes.
• Increased energy and changes to mood: An unexpected increase in energy following a depressive period could indicate a heightened risk of suicide.
• Direct/Indirect statements: Pay attention to statements about suicide or death.
• Means: Assess the client's access to means of self-harm (firearms, medications).

Suicide and Psychiatric Illness

• High Risk: Individuals with unipolar or bipolar depression, schizophrenia, and those abusing alcohol or substances have a significantly higher risk of suicide. The World Health Organization reports that 90% of people who commit suicide have a prior psychiatric diagnosis.

Suicide Survivors

• Grief Reactions: Friends and family of suicide victims may experience unique grief and anger.
• Resources: Resources are available to assist survivors of suicide.

Interventions and Prevention

• Suicide Safety Plans: Encourage the development and usage of a safety plan, which includes reasons for living, trusted contacts, and available resources.
• Risk Reduction: Reduce social isolation, lessen psychological symptoms (stress & anxiety) by taking steps to reduce social isolation and to improve psychological well-being, and establish a suicide support contract, if appropriate.
• Prevention Levels: Suicide prevention measures include tertiary prevention for those who survive attempts, secondary prevention to identify those at risk, and primary prevention to address warning signs in the general public, specifically young people.
• Crisis Intervention: If someone reveals suicidal ideations on the phone, listen carefully, try to understand their feelings and encourage them to share their thoughts and feelings; avoid offering advice and keep them talking until help arrives. Establish rapport and try to get details or if drugs have been consumed: type, amount, alcohol and food intake that may have been consumed).

Duty of Care

• Liability: Healthcare professionals have a legal duty to ensure the safety of clients at risk of suicide.

Social Media-Suicide

• Cyberbullying: Cyberbullying is a significant risk factor for suicide, especially among adolescents and young adults.
• Specific warning signs: Cyberbullying may include intentional targeting by another person/teen via text or internet with threats, harassment, humiliation.
• Cyberstalking: Adults also experience cyberstalking, which could be a factor.

Special Populations by Risk

• Military Combatants: Military combatants may be at elevated risk for suicide.
• Incarcerated Individuals: Individuals in holding facilities or local jails may need heightened monitoring.
• Elderly: The elderly may be at risk for suicide due to losses, loneliness, or alcohol abuse.

Nursing Diagnoses & Outcomes

• Nursing Diagnoses: Relevant diagnoses for suicidal clients may include spiritual distress, hopelessness, and powerlessness.
• Outcome Identification: The focus is on preventing harm, prioritizing safety, developing a suicide safety plan, creating a reduced-risk environment, and fostering hope.

NCLEX Focus

• Key Concepts: NCLEX focus on assessing client's rationality, plan, means of harm, and implementing safety measures.

Important Considerations

• Shift Changes/Weekends/Nights: Increased vigilance is needed during these periods when staff may be fewer.
• Therapeutic Responses: When a client expresses suicidal thoughts or feelings, focus should be on gaining understanding first (e.g., open-ended questions eliciting information on the client's feelings).