Mental Health Chapter 11 Suicide Prevention PDF

Chapter 11 Suicide Prevention Copyright ©2019 F.A. Davis Company Introduction § Suicide is not a diagnosis or a disorder; it is a behavior. § More than 90% of suicides are by individuals who have a diagnosed mental disorder. Copyright ©2019 F.A. Davis Company Historical Perspectives § In ancient Gre...

Chapter 11 Suicide Prevention Copyright ©2019 F.A. Davis Company Introduction § Suicide is not a diagnosis or a disorder; it is a behavior. § More than 90% of suicides are by individuals who have a diagnosed mental disorder. Copyright ©2019 F.A. Davis Company Historical Perspectives § In ancient Greece, suicide was an offense against the state, and individuals who committed suicide were denied burial in community sites. § In the culture of the imperial Roman army, individuals sometimes resorted to suicide to escape humiliation or abuse. § In the Middle Ages, suicide was viewed as a selfish or criminal act. Copyright ©2019 F.A. Davis Company Historical Perspectives (continued) § During the Renaissance, the view became more philosophical, and intellectuals could discuss suicide more freely. § Most philosophers of the 17th and 18th centuries condemned suicide, but some individuals began to associate suicide with mental illness. Copyright ©2019 F.A. Davis Company Epidemiological Factors § Suicide is: The second-leading cause of death among Americans 10 to 34 years of age The fourth-leading cause of death for ages 35 to 54 The eighth-leading cause of death for ages 55 to 64 The tenth-leading cause of death overall Copyright ©2019 F.A. Davis Company Discuss the epidemiological factors of suicide. § § § More than 42,000 people committed suicide in 2014, the latest year for which statistics have been recorded. It had the highest rate of suicide in 30 years. These recent statistics have established suicide as the second-leading cause of death among young Americans ages 10 to 34 years, the fourth-leading cause of death for ages 35 to 54, the fifth-leading cause of death for individuals age 55 to 64, and the tenth-leading cause of death overall. With a steady incline in rates of suicide, it has become a major healthcare problem in the United States today. Reports of dramatic rises in suicide rates among military personnel since 2008 have led to greater public awareness, concern, and interest in research on this topic. Confusion exists over the reality of suicide. Some of the more commonly accepted myths relating to suicide include: The idea that people who talk about suicide do not commit suicide. In reality, 8 out of 10 people who kill themselves have given clues and warnings about their intentions. Improvement after severe depression means that the risk of suicide is over. In reality, most suicides occur within 3 months after the beginning of improvement. Suicidal threats should be considered attention-seeking behavior. In reality, all suicidal behavior must be approached with the gravity of the potential act in mind. Copyright ©2019 F.A. Davis Company Clicker Question 1 1. Which is a misconception about suicide? A. Eight out of ten individuals who commit suicide give warnings about their intentions. B. Most suicidal individuals are ambivalent about their feelings regarding suicide. C. Most individuals commit suicide by taking an overdose of drugs. D. Initial mood improvement can precipitate suicide. Copyright ©2019 F.A. Davis Company Clicker Question Answer 1 Correct Answer: C It is a misconception that individuals usually commit suicide by taking an overdose of drugs. Gunshot wounds are the leading cause of death among suicide victims. Copyright ©2019 F.A. Davis Company Risk Factors § Marital status The suicide rate for single persons is twice that of married persons. § Gender Women attempt suicide more often, but more men succeed. Men commonly choose more lethal methods than do women. Copyright ©2019 F.A. Davis Company Risk Factors (continued_1) § Age Risk of suicide increases with age, particularly among men. White men older than 80 years are at the greatest risk of all age, gender, and race groups. § Religion Affiliation with a religious group decreases the risk of suicide. Catholics have lower rates than do Protestants or Jewish people. Copyright ©2019 F.A. Davis Company § The most recent statistics revealed that in 2013 the highest rate of suicide occurred in the 45–64 age group and the second highest rate was for those 85 or older. A high rate of suicide in these age groups has been a consistent trend from 2000 to 2013, but the 45–64 age group has shown a steady incline in suicide rates over the same period. § Although adolescents may statistically have a lower rate of suicide than some other age groups, it is still important to note that it has been, over several years, the third-leading cause of death in this population. Several factors put adolescents at risk for suicide, including impulsive and high-risk behaviors, untreated mood disorders, and substance abuse. § Among children under 10 years of age, the statistics demonstrate a low number of suicides, and some have argued that younger children don’t really have the capacity to intentionally consider and follow through with a suicide attempt. Anecdotal evidence has shown this is not always the case, with some therapists identifying 5- to 9-year-olds actively talking about suicide. § While the elderly make up just over 13% of the population, they account for almost 15% of all suicides. In general, 70% of all suicides are among white males, but white males over the age of 80 are at the greatest risk of all age/gender/race groups. § Historically, suicide rates among Protestants and Jews have been higher than Roman Catholic or Muslim populations, but the degree of orthodoxy and affiliation with one’s religion may be an important variable. Copyright ©2019 F.A. Davis Company Risk Factors (continued_2) § Socioeconomic status Individuals in the very highest and lowest social classes have higher suicide rates than those in the middle class. § Ethnicity Whites are at the highest risk for suicide, followed by Native Americans, African Americans, Hispanic Americans, and Asian Americans. Copyright ©2019 F.A. Davis Company Risk Factors (continued_3) § Psychiatric illness: More than 90% of people who kill themselves have a diagnosable mental disorder Mood and substance use disorders are the most common psychiatric illnesses that precede suicide. Other psychiatric disorders that account for suicidal behavior include: Schizophrenia Personality disorders Anxiety disorders § Severe insomnia is associated with increased risk of suicide. § Individuals who have been hospitalized for a psychiatric illness have a 5 to 10 times greater suicide risk than others with a psychiatric illness in the general population. Copyright ©2019 F.A. Davis Company Risk Factors (continued_4) § Use of alcohol and barbiturates § Psychosis with command hallucinations § Affliction with a chronic, painful, or disabling illness § Family history of suicide § L G B T individuals have a higher risk of suicide than do their heterosexual counterparts. Copyright ©2019 F.A. Davis Company Risk Factors (continued_5) § Having attempted suicide previously increases the risk of a subsequent attempt. About half of those who ultimately commit suicide have a history of a previous attempt. § Loss of a loved one through death or separation § Bullying Copyright ©2019 F.A. Davis Company Predisposing Factors: Theories of Suicide § Discuss the psychological theories on suicide. § Anger Turned Inward. Freud believed that suicide was a response to the intense selfhatred that an individual possessed. The anger had originated toward a love object, but was ultimately turned inward against the self. He interpreted suicide to be an aggressive act toward the self that often was really directed toward others. § Hopelessness and Other Symptoms of Depression. Hopelessness has long been identified as a symptom of depression and as an underlying factor in the predisposition to suicide. While many of the symptoms that are identified in suicide assessment tools attempt to assess for seriousness of suicide ideation, current research is attempting to glean which symptoms might be more predictive of the move from ideation to attempts. § History of Aggression and Violence. A history of violent behavior or impulsive acts has been associated with increased risk for suicide, although recent evidence suggests that impulsive traits are higher in individuals with suicide ideation but are not necessarily associated with more attempts. § Shame and Humiliation. Some individuals have viewed suicide as a “face-saving” mechanism—a way to prevent public humiliation following a social defeat such as a sudden loss of status or income. Often, these individuals are too embarrassed to seek treatment or other support systems. Copyright ©2019 F.A. Davis Company Predisposing Factors: Theories of Suicide (continued_1) § Interpersonal theory Durkheim’s three social categories of suicide ‒ Egoistic suicide is the response of the individual who feels separate and apart from the mainstream of society. Integration is lacking, and the individual does not feel a part of any cohesive group (such as a family or a church). ‒ Altruistic suicide is the opposite of egoistic suicide. The individual who is prone to altruistic suicide is excessively integrated into the group. The group is often governed by cultural, religious, or political ties, and allegiance is so strong that the individual will sacrifice his or her life for the group. ‒ Anomic suicide occurs in response to changes that occur in an individual’s life that disrupt feelings of relatedness to the group. An interruption in the customary norms of behavior instills feelings of “separateness,” and fears of being without support from the formerly cohesive group. Joiner’s interpersonal-psychological theory The Three Step Theory Copyright ©2019 F.A. Davis Company Predisposing Factors: Theories of Suicide (continued_2) § Biological theories § Genetics. Twin studies have shown a much higher concordance rate for monozygotic twins than for dizygotic twins. Some studies with suicide attempters have focused on the genotypic variations in the gene for tryptophan hydroxylase, with results indicating significant association to suicidality. Tryptophan hydroxylase is an enzyme associated with the synthesis of serotonin, and diminished serotonin has implications for both depression and suicidal behavior. These findings suggest the potential for genetic predisposition toward suicidal behavior. § Neurochemical Factors. A number of studies have revealed a deficiency of serotonin (measured as a decrease in the levels of 5-hydroxyindole acetic acid [5-HIAA] in the cerebrospinal fluid of depressed clients who attempted suicide. These studies, as well as postmortem studies, have supported the hypothesis that deficiencies in CNS serotonin are associated with suicide. Copyright ©2019 F.A. Davis Company Nursing Process: Assessment § Demographics Age Gender Ethnicity/race Marital status Socioeconomic status / Occupation Lethality and availability of method Religion Family history of suicide Military history Copyright ©2019 F.A. Davis Company Nursing Process: Assessment (continued_1) § Presenting symptoms/medical-psychiatric diagnosis § Suicidal ideas or acts Seriousness of intent Plan Means Verbal and behavioral clues § Interpersonal support system Copyright ©2019 F.A. Davis Company Nursing Process: Assessment (continued_2) § Interpersonal support system § Analysis of the suicidal crisis Precipitating stressor Relevant history Life-stage issues § Psychiatric/medical/family history § Coping strategies § Presenting symptoms Copyright ©2019 F.A. Davis Company § Ideation: Has suicide ideas that are current and active, especially with an identified plan § Substance abuse: Drinks alcohol, perhaps excessively, or uses other moodaltering drugs § Purposelessness: Expresses thoughts that there is no reason to continue living § Anger: Expresses uncontrolled anger or feelings of rage § Trapped: Expresses the belief that there is no way out of the current situation § Hopelessness: Expresses lack of hope and perceives little chance of positive change § Withdrawal: Expresses desire to withdraw from others or has begun withdrawing § Anxiety: Expresses anxiety, agitation, and/or changes in sleep patterns § Recklessness: Engages in reckless or risky activities with little thought of consequences § Mood: Displays dramatic mood shifts Copyright ©2019 F.A. Davis Company Nursing Process: Diagnosis/Outcome Identification § Nursing diagnoses for the suicidal client may include Risk for suicide Hopelessness § Outcome criteria: Has experienced no physical harm to self. Sets realistic goals for self. Expresses some optimism and hope for the future. Copyright ©2019 F.A. Davis Company Clicker Question 2 2. The nurse is caring for an actively suicidal client on the psychiatric unit. What is the nurse’s priority intervention? A. Discuss strategies for the management of anxiety, anger, and frustration. B. Provide opportunities for increasing the client’s self-worth, morale, and control. C. Place client on suicide precautions with one-to-one observation. D. Explore experiences that affirm self-worth and self-efficacy. Copyright ©2019 F.A. Davis Company Clicker Question Answer 2 Correct Answer: C Placing the client on suicide precautions with one-to-one observation provides a safe environment for an actively suicidal client. Maintaining client safety should always be a priority nursing intervention. Copyright ©2019 F.A. Davis Company Guidelines for Treatment of the Suicidal Client on an Outpatient Basis § Ensure access to support systems and tie to a system of care. § Develop a detailed safety plan. § Establish a no-suicide contract with the client. § Enlist the help of family or friends. § Schedule frequent appointments. § Establish rapport and promote a trusting relationship. Copyright ©2019 F.A. Davis Company Guidelines for Treatment of the Suicidal Client on an Outpatient Basis (continued) § Be direct and talk matter-of-factly about suicide. § Discuss the current crisis situation in the client’s life. § Identify areas of self-control. § Give antidepressant medications. Copyright ©2019 F.A. Davis Company Clicker Question 3 3. A client with a history of a suicide attempt has been discharged and is being followed in an outpatient clinic. At this time, which is the most appropriate nursing intervention for this client? A. Provide the client with a safe and structured environment. B. Isolate the client from all stressful situations that may precipitate a suicide attempt. C. Observe the client continuously to prevent self-harm. D. Assist the client to develop more effective coping mechanisms. Copyright ©2019 F.A. Davis Company Clicker Question Answer 3 Correct Answer: D Assisting the client to develop more effective coping mechanisms is a nursing intervention that can and should be implemented in outpatient settings as ongoing follow-up. Copyright ©2019 F.A. Davis Company Information for Family and Friends of the Suicidal Client § Take any hint of suicide seriously. § Do not keep secrets. § Be a good listener. § Express feelings of personal worth to the client. § Know about suicide intervention resources. § Restrict access to firearms or other means of self-harm. Copyright ©2019 F.A. Davis Company Information for Family and Friends of the Suicidal Client (continued) § Acknowledge and accept the person’s feelings. § Provide a feeling of hopefulness. § Do not leave him or her alone. § Show love and encouragement. § Seek professional help. § Remove children from the home. § Do not judge or show anger toward the person or provoke guilt in him or her. Copyright ©2019 F.A. Davis Company Interventions with Family and Friends of Suicide Victims § Encourage him or her to talk about the suicide. § Discourage blaming and scapegoating. § Listen to feelings of guilt and selfpersecution. § Talk about personal relationships with the victim. Copyright ©2019 F.A. Davis Company Interventions with Family and Friends of Suicide Victims (continued) § Recognize differences in styles of grieving. § Assist with development of adaptive coping strategies. § Identify resources that provide support. Copyright ©2019 F.A. Davis Company Nursing Process: Evaluation § Develop and maintain a more positive selfconcept. § Learn more effective ways to express feelings to others. § Achieve successful interpersonal relationships. § Feel accepted by others and achieve a sense of belonging. Copyright ©2019 F.A. Davis Company