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SUICIDE

RISKS
AWARENESS
INTERVENTIONS

Dr Bernreuter
Hallmark College

Unit Objectives

Describe demographics related to suicide


Discuss the meanings and motivation for
suicide
Identify risk factors for suicide
Discuss suicide as it relates to levels of
intervention
Describe critical parts of a suicide
assessment
Apply the SAD PERSONS scale to a
patient
List emotions of suicide survivors

Suicide

A significant public health problem in the


United States
Every 15 minutes suicide ends a life
Eleventh leading cause of death (34.000 a
year)
For every two murders there are three
suicides
32,000 completed suicides; 45% had
contact with primary care provider in
previous 5 months
Many suicides are not reported as such so
numbers probably higher
We are missing opportunities to prevent

The Common Emotion in Suicide


is a sense of

HOPELESSNESS
The Common Emotion in Suicide Is

SEEKING A SOLUTION TO WHAT


APPEARS TO BE AN INSOLUBLE
PROBLEM

Su
ici
de
Ra
te
s
in
th
e
US

Motivation for Suicide

Terminal illness or unbearable


pain
Being a burden to others
Untenable family situation
Untenable personal situation
Punishment or exposure of
socially or personally
unacceptable behavior

Risk Factors

Psychiatric disorders 90% of suicides have


psychiatric illness
Alcohol or substance use disorders
Male gender
Increasing age
Race American/Alaskan natives highest,
followed by whites
Dichotomous thinking
Marriage Especially with children reduces risk
Professionals have higher rates
Physical health About half have physical
illnesses
Family history of suicide
See p 515 for more risk factors

Psychosocial Factors

Freud aggression turned inward


Menninger - The wish to kill; the wish to be
killed; the wish to die
Aaron Beck central emotional factor is
hopelessness
Recent theories combination of suicidal
fantasies and significant loss

Biological Factors
o
o

Low serotonin levels are related to depressed


mood
Suicidal behavior tends to run in families

Cultural Factors

Protective factors
African Americans; men more than women
Religion, role of the extended family
Highest rate among adolescent and young
adults
Hispanic Americans
Roman Catholic religion and importance
of extended family
However, Hispanic females grades 9-12 have
more attempts than blacks or whites of same
age
Asian Americans
Adherence to religions that tend to emphasize
interdependence between the individual and
society, seen as selfish or disrespectful to group

Societal Factors
Oregons Death with Dignity Act of 1994
terminally ill patients allowed physicianassisted suicide
Netherlands nonterminal cases of lasting
and unbearable suffering
Belgium nonterminal cases when suffering
constant and cannot be alleviated
Switzerland assisted suicide legal since
1918
Islam does not condone, but suicide
bombers may believe it is an honor to die
for their faith; that real happines lies
beyond
this
world
10

80% Signal Intent

Assessment: Overt Statements and


Actions

I can't take it anymore.


Life isn't worth living anymore.
I wish I were dead.
Everyone would be better off if I died.
Actions
Giving away prized possessions
Make or change a will
Take out or add to insurance policy
Plan funeral
Have sudden unexplained recovery from
depression

12

Assessment: Covert Statements

13

It's okay, now. Soon everything will be


fine.
Things will never work out.
I won't be a problem much longer.
Nothing feels good to me anymore and
probably never will.
How can I give my body to medical
science?

Assessment: Lethality of
Suicide Plan

Three parts you must be concerned with:


Ideas
Plans
Is there a specific plan with details?
How lethal is the proposed method?

Means

Is there access to the planned method?

The further down the Ideas, Plans, Means, the higher risk
People with definite plans for time, place, and means are
at high risk.
14

Assessment Tools:
SAD PERSONS Scale
Uses 10 major risk factors to assess
suicidal potential
1. Sex (male) 6. Rational thinking loss
2. Age 25 to 44 or 7. Social supports lacking
65+ years
or recent loss
3. Depression 8. Organized plan
4. Previous attempt 9. No spouse
5. Ethanol use 10. Sickness
Patient gets 1 point for each positive: Score 0-2: send
home with follow-up, 3-4: Follow closely, consider inpatient care; 5-6: Strongly consider hospitalization; 715
10:
Hospitalize

Nursing Diagnoses

16

Risk for suicide/injury/self or other


directed violence
Ineffective coping/disabled family
coping/impaired social interaction
Hopelessness/chronic sorrow
Powerlessness/low self esteem
Social isolation /loneliness
Spiritual distress

Levels of Intervention

17

Primary activities that provide support,


inform, and educate to prevent suicide
Secondary treatment of the actual
suicidal crisis
Tertiary interventions with the family and
friends of a person who has committed
suicide to reduce the traumatic after
effects

Basic Level Interventions

Milieu therapy with suicidal precautions

Verbal or written contracts to report


feelings

Counseling

Health teaching and health promotion

Case management

Pharmacological interventions

18

Survivors of Completed
Suicide: Postvention

Emotions of Surviving friends and family

Staff

19

Overwhelming guilt, shame, often leads to


depression and possible suicidal ideation
Difficulties discussing the often taboo subject of
suicide; only about 25% seek treatment despite
pain
Need to talk about loss; reach out; refer to local
SOS group
Group support essential as treatment team
conducts a thorough postmortem assessment
and review of what was missed, what happened,
etc.

20

A patient is hospitalized with major


depression and suicidal ideation. He has a
history of several suicide attempts. For the
first 2 days of hospitalization, the patient
eats 20% of meals and stays in his room
between groups. By the fourth day, the
nurse observes the patient is more
sociable, is eating meals, and has a bright
affect. Which factor should the nurse
consider? The patient:

a.

b.

c.

d.

21

is showing improvement and may be


ready for discharge.
may have decided to commit suicide;
the nurse should reassess suicidality.
is feeling rested, supported by the
therapeutic milieu, and less depressed.
is benefiting from the antidepressant he
has been taking for 4 days.