Student Assessment: Suicidal Ideation PDF

11/16/23, 10:54 AM Realizeit for Student Assessment A history of previous suicide attempts increases risk for suicide. The first 2 years after an attempt represents the highest risk period, especially the first 3 months. Those with a relative who committed suicide are at increased risk for suicide...

11/16/23, 10:54 AM Realizeit for Student Assessment A history of previous suicide attempts increases risk for suicide. The first 2 years after an attempt represents the highest risk period, especially the first 3 months. Those with a relative who committed suicide are at increased risk for suicide; the closer the relationship, the greater the risk. One possible explanation is that the relative’s suicide offers a sense of “permission” or acceptance of suicide as a method of escaping a difficult situation. This familiarity and acceptance is also believed to contribute to “copycat suicides” by teenagers, who are greatly influenced by their peers’ actions. Many people with depression who have suicidal ideation lack the energy to implement suicide plans. The natural energy that accompanies increased sunlight in spring is believed to explain why most suicides occur in April. Most suicides happen on Monday mornings, when most people return to work (another energy spurt). Research has shown that antidepressant treatment can actually give clients with depression the energy to act on suicidal ideation. Warnings of Suicidal Intent Most people with suicidal ideation send either direct or indirect signals to others about their intent to harm themselves. The nurse never ignores any hint of suicidal ideation regardless of how trivial or subtle it seems and the client’s intent or emotional status. Often, people contemplating suicide have ambivalent and conflicting feelings about their desire to die; they frequently reach out to others for help. For example, a client might say, “I keep thinking about taking my entire supply of medications to end it all.” (direct) or “I just can’t take it anymore.” (indirect) Box 17.3 provides more examples of client statements about suicide and effective responses from the nurse. BOX 17.3 Suicidal Ideation: Client Statements and Nurse Responses Client Statement Nurse Responses “Specifically just how are you planning to sle “I just want to go to sleep and not think anymore.” “By ‘sleep,’ do you mean ‘die?’” “What is it you do not want to think of anym “I wonder if you are thinking of suicide.” “I want it to be all over.” “What is it you specifically want to be over? “Are you planning to end your life?” “It will just be the end of the story.” “You have been a good friend.” “How do you plan to end your story?” “You sound as if you are saying goodbye. Ar “Are you planning to commit suicide?” “Remember me.” “What is it you really want me to remember “Here is my chess set that you have always admired.” “What is going on that you are giving away t “If there is ever any need for anyone to know this, my will and insurance papers are in the top drawer of my dresser.” “I appreciate your trust. However, I think the giving me. Are you thinking of ending your li “How do you plan to end the pain?” “I can’t stand the pain anymore.” “Tell me about the pain.” “Sounds like you are planning to harm yours “Everyone will feel bad soon.” “Who is the person you want to feel bad by https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUZWdjLO5UHpukqIHual8pZRZOPKGxj61nPC0Rzizzdwuu… 1/2 11/16/23, 10:54 AM Realizeit for Student “What is it you cannot bear?” “I just can’t bear it anymore.” “How do you see an end to this?” “Who is one person you believe would be be “How do you plan to eliminate yourself, if yo “Everyone would be better off without me.” off without you?” “What is one way you perceive others would “You seem different today. What is this abou Nonverbal change in behavior from agitated to calm, anxious to relaxed, depressed to smiling, hostile to benign, from being without direction to appearing to be goal directed. “I sense you have reached a decision. Share Asking clients directly about thoughts of suicide is important. Psychiatric admission assessment interview forms routinely include such questions. It is also standard practice to inquire about suicide or self-harm thoughts in any setting where people seek treatment for emotional problems. Risky Behaviors A few people who commit suicide give no warning signs. Some artfully hide their distress and suicide plans. Others act impulsively by taking advantage of a situation to carry out the desire to die. Some suicidal people in treatment describe placing themselves in risky or dangerous situations such as speeding in a blinding rainstorm or when intoxicated. This “Russian roulette” approach carries a high risk for harm to clients and innocent bystanders alike. It allows clients to feel brave by repeatedly confronting death and surviving. DRUG ALERT Antidepressants and Suicide Risk Depressed clients who begin taking an antidepressant may have a continued or increased risk for suicide in the first few weeks of therapy. They may expe the antidepressant but remain depressed. This increase in energy may make clients more likely to act on suicidal ideas and make them capable of carrying antidepressants take several weeks to reach their peak effect, clients may become discouraged and act on suicidal ideas because they believe the medic reasons, it is extremely important to monitor the suicidal ideation of depressed clients until the risk has subsided. Lethality Assessment When a client admits to having a “death wish” or suicidal thoughts, the next step is to determine potential lethality. This assessment involves asking the following questions: Does the client have a plan? If so, what is it? Is the plan specific? Are the means available to carry out this plan? (e.g., If the person plans to shoot himself, does he have access to a gun and ammunition?) If the client carries out the plan, is it likely to be lethal? (e.g., A plan to take 10 aspirin is not lethal, while a plan to take a 2-week supply of a tricyclic antidepressant is.) Has the client made preparations for death, such as giving away prized possessions, writing a suicide note, or talking to friends one last time? Where and when does the client intend to carry out the plan? Is the intended time a special date or anniversary that has meaning for the client? Specific and positive answers to these questions all increase the client’s likelihood of committing suicide. It is important to consider whether the client believes his or her method is lethal even if it is not. Believing a method to be lethal poses a significant risk. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUZWdjLO5UHpukqIHual8pZRZOPKGxj61nPC0Rzizzdwuu… 2/2