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SUICIDE
øIdeation-
øGesture-
øAttempt-
- -thinking about suicide ranging to planning eventually including intent
- -an attempt in order to control the external environment, a cry for help
- -a nonfatal self destructive, self inflictive act
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Examples of indirect self-destructive behavior, it ranges on a continuum
- smoking, drinking, j walking, getting involved in a relationship right after another
- relationship.
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Social variables for people not getting help when thinking about suicide
øEthics
øIgnorance
øEmbarrassment
øShame
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CLINICAL VARIABLES
%of individuals who commit suicide have a psychiatric illness
%are under active psychiatric or mental health care
2 reasons for committing suicide
ø90
ø50
- øLack
- of close relationships
- øLack
- of personal freedoms
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Who is most at risk for suicide?
Age group?
Race?
- YYoung
- adults 20-24- 3rd
- leading cause
- YNon-Hispanic
- whites twice as likely as blacks or hispanics
- YNon-Hispanic
- white men over 65
- YDivorced
- and widowed men more likely
- YSingle
- men twice as likely
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What are the different axises?
Axis 1- clinical syndromes
- Axis 2- learning disabilities, challenges in intellectual functioning, personality
- disorders, chronic, maladaptive relationship
- Axis 3-
- medical problems… hypothyroid… diabetes
- Axis 4-
- stressor… lost job, move
- Axis 5- global
- assessment of functioning… scale from 0-100… the lower the score the more
- likely to need inpatient care. <40= inpatient care
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Reasons for committing suicide:
- øSecondary
- to terminal illness
- øFeeling
- like a burden to others
- øAn
- untenable family situation
- øAn
- untenable personal situation
- øSelf-punishment
- for unacceptable behavior
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Relationship between depression and committing suicide?
Higher risk as depression is lessening because you get more energy to actually do it.
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THEORIES
Sociocultural-
Interpersonal-
Bioloogic
Cognitive-
- -loss of job, religion
- -percieved or real rejection, abandonment, guilt
- - hormones, serotonin
- -black and white thinking, constriction of thought (narrow view of the world,
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SUICIDE ASSESSMENT
Verbal:
Bahavioral:
Somatic:
Emotional:
- YOvert-
- “I wish I were dead”, “life isn’t worth living”
- YCovert-
- “things are never going to work out for me”
-giving away possessions, putting affairs in order
- -social withdraw, then pulling away isolates them and
- makes it more difficult to get better alone.
-helplessness, hopelessness, irritability, exhaustion.
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When is the risk of a second suicide attempt highest?
first 2 years, especially 3 months.
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What makes them more prone reguardless of the answer to any other questions?
Psychosis and command hallucinations.
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Risk factors to assess when dealing with suicide:
øGender; age
øPrevious attempts
øPresenting symptoms
øPsychiatric illness
øSevere life events
øPoor impulse control
øFamily history
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Risk factors in hospitalized depressed pts:
- •First
- month after discharge
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Risk factors in older pts:
Death of a loved one
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Minimum precautions:
Moderate precautions:
Maximum precautions:
- someone in arms distance at all time
- must be in your eyesight at all time
see them every 15 minutes- this is if they say they will come find someone if they are feeling like doing something
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Risk factors for patients with alcoholism:
- •Loss
- of a close relationship in the previous 6 weeks
- •Concurrent
- use of other drugs
- •Late
- in the course of illness
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Risk factors in depressed adolescents:
- •Family
- history of major depression
- •Previous
- antidepressant treatment
- •History
- of legal problems
- •Handgun
- available in the house
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Sample protocalls for suicide precaution:
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Suicide prevention
- zTake any threat
- seriously
- zTalk openly and
- directly
- zInstitute appropriate
- level of precautions
- zBe mindful of objects
- that can be used for self-harm
- zDetermine if contract
- is needed*
- zConsistently observe
- client
- zDevelop a care plan
- zEncourage hope and
- self-care
- zPerform
- physical assessment- look for any other obvious injuries
- zMindful
- of family and client needs
- zMonitor
- personal feelings-
- zHelp
- client identify and develop protective factors*
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No suicide/harm contracts: 
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Protective factors against suicide:
- •Effective
- and appropriate clinical care for mental, physical, and substance abuse disorders
- •Easy
- access to a variety of clinical interventions and support for help-seeking
- •Restricted
- access to highly lethal methods of suicide
- •Family
- and community support
- •Support
- from ongoing medical and mental health care relationships
- •Support
- from ongoing medical and mental health care relationships
- •Learned
- skills in problem solving, conflict resolution, and nonviolent handling of
- disputes
- •Cultural
- and religious beliefs that discourage suicide and support self-preservation
- instincts
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Possible nursing diagnoses:
- øRisk
- for violence, self-directed
- øIneffective
- individual coping
øHopelessness
øPowerlessness
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Counceling- on the basic level
effective intervention
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Information to convey:
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- YUnbearable
- pain can be survived
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