Lecture Notes On Suicide PDF

🔪 Lecture 8: Suicide Pre-lecture Review Review categories of depression. Identify motivation for self-harm & suicide. Discuss statistical and demographic information related to suicide. Identify myths related to suicide....

🔪 Lecture 8: Suicide Pre-lecture Review Review categories of depression. Identify motivation for self-harm & suicide. Discuss statistical and demographic information related to suicide. Identify myths related to suicide. Recognize profundity of impact of suicide on ‘survivors’. Discuss various methods of suicide. Identify stages of suicide contemplation. Identify signs of high risk suicidal patients. Articulate therapeutic responses to the depressed and suicidal patient. Articulate appropriate interventions for the suicidal patient Post-Lecture Review: Active Recall Lecture 8: Suicide 1  Review categories of depression. Identify motivation for self-harm & suicide. Discuss statistical and demographic information related to suicide. Identify myths related to suicide. Recognize profundity of impact of suicide on ‘survivors’. Discuss various methods of suicide. Identify stages of suicide contemplation. Identify signs of high risk suicidal patients. Articulate therapeutic responses to the depressed and suicidal patient. Articulate appropriate interventions for the suicidal patient Lecture Notes Why Hurt Yourself? (From the Centre of Suicide Prevention) → So much pain; No other option → Burden to others → Looking for escape from pain & anguish Lecture 8: Suicide 2  → Self-hatred, rejection, hopelessness Suicide in Canada; Key statistics (Death & Hospitalizations) → about 11 people die by suicide each day → about 4,000 deaths by suicide per year → 1/3 of deaths by suicide are among people 45-59 years → Suicide is the second leading cause of death among youth and young adults (15-34 years) → Suicide rates are approx 3x higher among men compared to women Suicide thoughts, Plans & Attempts → Thoughts: 11.8 % report thoughts of suicide in their lifetime → 2.5% report thoughts of suicide in the past year → Plans: 4.0% report having made suicide plans in their lifetime; (7% of people in Lowest income & 3% in highest income) → Attempts: 3.1% report having made a suicide attempt in their lifetime; Suicide attempt are approx 3x higher among people born in Canada than immigrants to Canada CAD Suicide Rates 2019, all sexes → Ontario has 10.5% rates (per 100,00) - which is not bad compared to → Northwest Territories with 27.7% (per 100,00) → Nunavut 82.8% (per 100,000) - Why so high, probably due to geographical reasons ( i.e. limited to no daylight, lack of food, no jobs, high rates) Methods of Suicide in Canada (General) → Hanging = 44% Lecture 8: Suicide 3  → Poisoning = 25% → Firearm = 16% → Other = 15% Methods Of Suicide (Males Canada) → Hanging = 46% (Males tend to use more violent method) → Poisoning = 20% → Firearm = 20% → Other = 14% Methods of Suicide (Females Canada) → Poisoning = 42% (Females tend to use less violent methods = reason why there is more attempts than successful suicide) → Hanging = 37% → Firearm 3% → Other 18% Firearms → Shotgun/ rifle - large calibre → Long Gun - small calibre → Handgun → Nail gun Hanging → Material: rope, cords, wire, etc → Location rafters, staircases, tress, garages, shower rods, etc → Methods of choice - males (46%); Common in females too (37%) Lecture 8: Suicide 4  → Difficult sight for many Poisoning Drug overdoses → 10 most common (US study) 1. Alcohol 2. Acetaminophen(Tylenol) (easily accessible in large quantity; not a fast acting mechansim) 3. amitriptyline 4. doxepin 5. alprazolam 6. propoxyphene 7. heroin 8. morphine 9. codeine 10. Phenobarbital 11. diazepam → Carbon Monoxide; Cars, etc → Household chemicals; (Hydrogen sulfide popularized in 2011) → Method of choice by females (42%) vs. Males (20%) Other Methods → Jumping from height (seen frequently) → Burning → Stabbing, Cutting → Blunt force Trauma Lecture 8: Suicide 5  → Drowning → Suffocation - including helium → Electrocution → Other Other Complicating Factors → Indigenous Canadians - Much higher suicide rates, especially - males 15-24 → Elderly - Communicate less about it among most successful at completion → Teens (15 -19) - Fastest growing population of suicide in Canada Four Stages of Suicide Contemplation Stage 1. - Unmet needs = frustration → Anger, hostility turns inward → Response(EMT): help identify unmet needs & source of frustration Stage 2 - Situation unbearable = panic → Looking for escape or help → Response: be a resource, listen carefully, try to move them to stage 1 Stage 3 - Person (may) communicate helplessness → Response: show concern; listen well; ‘they’re not alone’ Stage 4 - Person unable to help themselves → Plan developed → Response; intervention (Form 1, try your best to Potential Warning Flags → Situational Risk Factors: Relationships issues, divorce, health problems, jobs/ work related issues, financial difficulties → Depression, mental illnesses or substance use disorders Lecture 8: Suicide 6  → Prior suicide attempts (40x likely to attempt again) → Exposure to suicide, mental illnesses or substance us disorders within the family → Trauma or suicide of a friend, associate or important person → Conviction for serious crime (i.e. your going to jail, or gonna be imprisoned for a long time) → Victim of family violence or sexual abuse Possible Indicators of Suicidal Thoughts → Talking about death or suicide (could be talking in general) → Talking about feeling like they are in a hopeless situation → Increases use of alcohol/ drugs → Sudden change or withdrawal from normal social activities or interests → Excessive complaining about responsibilities → Extreme mood swings, possibly violent → Planning: Putting things in order SAD PERSON checklist Sex: males more likely to succeed Age: Highest risk 15-24 years old (interms of teens & young adults the rate of overall suicide is not different from middle aged people. but percentage of death is high) Depression: Most common factor Previous attempt: increase risk Ethanol or drug abuse Rational thinking: impaired thinking = increase risk Social support: little support = increase risk Organized plan: well developed plan = increased risk Lecture 8: Suicide 7  No spouse or significant other = increased risk Sickness: illness or injury, especially chronic = Increased risk The Therapeutic Response → Prevention! (only significant intervention) → Listen Well - Clues? → Every threat or attempt is serious → Be upfront → Be supportive → No ‘pat’ answers or easy advice, but explore reasons for living ( if they don’t wanna talk, don’t force them. Give them support and listen when they do talk) → Acknowledge suffering → Once they have communicated ideation, can’t leave them. Prevention: Warning Signs (another mnemonic to remember warning signs) IS PATH WARM? I = Ideation (idea is formed) S = Substance abuse P = Purposelessness A = Anxiety T = Trapped H = Hopelessness W = Withdrawal A = Anger R = Recklessness M = Mood Changes Lecture 8: Suicide 8  Communicating Suicide Plans → Indirect: “What would you do if I weren’t around here to clean up after you”? → Direct: “I wonder what it’s like to die.” “ I just want to sleep” → Coded Verbal messages: “ I hate autumn - everything is dying” Intervention (from program ASIST) (Doesn’t neatly apply to EMS but use it to guide our conversation) 1. Explore ‘invitations’ (situations, behaviours, thoughts, things that indicate you to suspect suicide) 2. Ask about suicide (involves being tactful, but unambiguous & inquiring if the person is thinking about suicide) 3. Listen to reason for dying & living 4. Review risk 5. Contract ‘Safeplan’ (make a verbal contract you & the person that you agree, involves actions & commitments on both parties behalf to keep the person out of immediate danger of completing suicide) (if your with someone, not EMS, that you think there gonna do it call 911- as a paramedic you take them to the hospital) 6. Follow up on commitments (calling the person to see if they kept their promise, etc) Training Living work → SafeTALK → ASIST Survivor Reaction (Samra) → Unique Grief Lecture 8: Suicide 9  → Extremely intense emotional response → Haunting ‘WHY?’ → Difficulty discussing (consider culture too) → Initially: Shock, numbness → Later: anger, shame, guilt (family member my feel angry, or guilt) Paramedic Reaction to Suicide → Shocked, grossed out - normal → Disturbed afterward - normal → Informally debrief with colleagues → Trained or professional help as required Lecture 8: Suicide 10