Suicide PDF

11/16/23, 10:52 AM Realizeit for Student Suicide Suicide is the intentional act of killing oneself. Suicidal thoughts are common in people with mood disorders, especially depression. Each year, more than 45,000 suicides are reported in the United States; this represents just under a 30% increase i...

11/16/23, 10:52 AM Realizeit for Student Suicide Suicide is the intentional act of killing oneself. Suicidal thoughts are common in people with mood disorders, especially depression. Each year, more than 45,000 suicides are reported in the United States; this represents just under a 30% increase in the past two decades (Centers for Disease Control and Prevention [CDC], 2018). Suicide attempts are estimated to be 8 to 10 times higher than completed suicides. In the United States, men commit approximately 72% of suicides, which is roughly three times the rate of women, although women are four times more likely than men to attempt suicide. The higher suicide rates for men are partly the result of the method chosen (e.g., shooting, hanging, jumping from a high place). Women are more likely to overdose on medication. Men, young women, whites, and separated and divorced people are at increased risk for suicide. Adults older than 65 years compose 10% of the population but account for 25% of suicides. Suicide is the second leading cause of death (after accidents) among people aged 15 to 24 years. The rate of suicide is increasing most rapidly among those ages 45 to 65 years (CDC, 2018). Intentionally trying to commit suicide and self-injury behavior are often different concepts. However, it is crucial to remember that one does not exclude the other. Persons who self-injure can and do commit suicide. It is important to assess for both and never think someone is “safe” from suicide because they typically self-injure. Clients with psychiatric disorders, especially depression, bipolar disorder, schizophrenia, substance abuse, posttraumatic stress disorder, and borderline personality disorder, are at increased risk for suicide. Chronic medical illnesses associated with increased risk for suicide include cancer, HIV or AIDS, diabetes, cerebrovascular accidents, and head and spinal cord injury. Environmental factors that increase suicide risk include isolation, recent loss, lack of social support, unemployment, critical life events, and family history of depression or suicide. Behavioral factors that increase risk include impulsivity, erratic or unexplained changes from usual behavior, and unstable lifestyle (Rhimer & Pompili, 2017). Suicidal ideation means thinking about killing oneself. Active suicidal ideation is when a person thinks about and seeks ways to commit suicide. Passive suicidal ideation is when a person thinks about wanting to die or wishes he or she were dead but has no plans to cause his or her death. People with active suicidal ideation are considered more potentially lethal. Attempted suicide is a suicidal act that either failed or was incomplete. In an incomplete suicide attempt, the person did not finish the act because (1) someone recognized the suicide attempt and responded or (2) the person was discovered and rescued. Suicide involves ambivalence. Many fatal accidents may be impulsive suicides. It is impossible to know, for example, whether the person who drove into a telephone pole did this intentionally. Hence, keeping accurate statistics on suicide is difficult. There are also many myths and misconceptions about suicide of which the nurse should be aware. The nurse must know the facts and warning signs for those at risk for suicide as described in Box 17.2. BOX 17.2 Myths and Facts about Suicide Myths Facts People who talk about suicide never commit suicide. Suicidal people often send out subtle or not-so-subtle messages that convey their inner thoughts of hopelessne subtle and direct messages of suicide should be taken seriously with appropriate assessments and intervention Although the self-violence of suicide demonstrates anger turned inward, the anger can be directed toward other Physical harm: Psychotic people may be responding to inner voices that command the individual to kill others person who has decided to commit suicide with a gun may impulsively shoot the person who tries to grab the g Suicidal people only want to hurt themselves, not others. Emotional harm: Often, family members, friends, health care professionals, and even police involved in trying not realize the person’s depression and plans to commit suicide feel intense guilt and shame because of their never ending cycle of despair and grief. Some people, depressed after the suicide of a loved one, will rationaliz of the pain” and plan their own suicide to escape pain. Some suicides are planned to engender guilt and pain wants to punish another for rejecting or not returning love). There is no way to help someone who wants to kill him or herself. Suicidal people have mixed feelings (ambivalence) about the wish to die, wish to kill others, or to be killed. This cries for help evident in overt or covert cues. Intervention can help the suicidal individual get help from situation new ways to cope, and move forward in life. Do not mention the word “suicide” to a person you suspect to be suicidal because this could give him or her the idea to commit suicide Suicidal people have already thought of the idea of suicide and may have begun plans. Asking about suicide do to become suicidal. Ignoring verbal threats of suicide or challenging a person to carry out his or her suicide plans will reduce the individual’s use of these behaviors. Suicidal gestures are a potentially lethal way to act out. Threats should not be ignored or dismissed, nor should suicidal threats. All plans, threats, gestures, or cues should be taken seriously and immediate help given that foc the person is suicidal. When asked about suicide, it is often a relief for the client to know that his or her cries for help is on the way. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUZWdjLO5UHpukqIHual8pZRZOPKGxj61nPC0Rzizzdwuu… 1/2 11/16/23, 10:52 AM Once a suicide risk, always a suicide risk. Realizeit for Student Although it is true that most people who successfully commit suicide have made attempts at least once before, can have positive resolution to the suicidal crisis. With proper support, finding new ways to resolve the problem emotionally secure and have no further need for suicide as a way to resolve a problem. Family Response Suicide is the ultimate rejection of family and friends. Implicit in the act of suicide is the message to others that their help was incompetent, irrelevant, or unwelcome. Some suicides are done to place blame on a certain person, even to the point of planning how that person will be the one to discover the body. Most suicides are efforts to escape untenable situations. Even if a person believes love for family members prompted his or her suicide—as in the case of someone who commits suicide to avoid lengthy legal battles or to save the family the financial and emotional cost of a lingering death, relatives still grieve and may feel guilt, shame, and anger. Significant others may feel guilty for not knowing how desperate the suicidal person was, angry because the person did not seek their help or trust them, ashamed that their loved one ended his or her life with a socially unacceptable act, and sad about being rejected. Suicide is newsworthy, and there may be whispered gossip and even news coverage. Life insurance companies may not pay survivors’ benefits to families of those who kill themselves. Also, the one death may spark “copycat suicides” among family members or others, who may believe they have been given permission to do the same. Families can disintegrate after a suicide. Nurse’s Response When dealing with a client who has suicidal ideation or attempts, the nurse’s attitude must indicate unconditional positive regard not for the act but for the person and his or her desperation. The ideas or attempts are serious signals of a desperate emotional state. The nurse must convey the belief that the person can be helped and can grow and change. Trying to make clients feel guilty for thinking of or attempting suicide is not helpful; they already feel incompetent, hopeless, and helpless. The nurse does not blame clients or act judgmentally when asking about the details of a planned suicide. Rather, the nurse uses a nonjudgmental tone of voice and selfmonitors his or her body language and facial expressions to make sure not to convey disgust or blame. Nurses believe that one person can make a difference in another’s life. They must convey this belief when caring for suicidal people. Nevertheless, nurses must also realize that no matter how competent and caring interventions are, a few clients will still commit suicide. A client’s suicide can be devastating to the staff members who treated him or her, especially if they have gotten to know the person and his or her family well over time. Even with therapy, staff members may end up leaving the health care facility or the profession as a result. Legal and Ethical Considerations Assisted suicide is a topic of national legal and ethical debate, with much attention focusing on the court decisions related to the actions of Dr. Jack Kevorkian, a physician who has participated in numerous assisted suicides. Oregon was the first state to adopt assisted suicide into law and has set up safeguards to prevent indiscriminate assisted suicide. Many people believe it should be legal in any state for health care professionals or families to assist those who are terminally ill and want to die. Others view suicide as against the laws of humanity and religion and believe that health care professionals should be prosecuted if they assist those trying to die. Groups, such as the Hemlock Society, and people who were in alignment with Dr. Kevorkian, are lobbying for changes in laws that would allow health care professionals and family members to assist with suicide attempts for the terminally ill. Controversy and emotion continue to surround the issue. Often, nurses must care for terminally or chronically ill people with a poor quality of life, such as those with the intractable pain of terminal cancer or severe disability or those kept alive by life support systems. It is not the nurse’s role to decide how long these clients must suffer. It is the nurse’s role to provide supportive care for clients and families as they work through the difficult emotional decisions about if and when these clients should be allowed to die; people who have been declared legally dead can be disconnected from life support. Each state has defined legal death and the ways to determine it. Elder Considerations Depression is common among the elderly and is markedly increased when elders are medically ill. Older adults tend to have psychotic features, particularly delusions, more frequently than younger people with depression. Suicide among persons older than 65 years is doubled compared with suicide rates of persons younger than 65. Late-onset bipolar disorder is rare (Gatchel, Wilkins, Forester, Kelly, & Alexopoulos, 2017). Older adults are treated for depression with ECT more frequently than younger persons. Elder persons have increased intolerance of side effects of antidepressant medications and may not be able to tolerate doses high enough to effectively treat the depression. Also, ECT produces a more rapid response than medications, which may be desirable if the depression is compromising the medical health of the elder person. Because suicide among the elderly is increased, the most rapid response to treatment becomes even more important (Heijnan et al., 2018). https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUZWdjLO5UHpukqIHual8pZRZOPKGxj61nPC0Rzizzdwuu… 2/2