Chapter 24

1. Chapter 24 Suicide

2. Suicide • A significant public health problem in the United States • In 2008 • Eleventh leading cause of death • 32,000 completed suicides

3. Risk Factors Psychiatric disorders Alcohol or substance use disorders Male gender Increasing age Race Religion Marriage Profession Physical health

4. Biological Factors • Suicidal behavior tends to run in families • Low serotonin levels are related to depressed mood

5. 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

6. Cultural Factors • Protective factors • African Americans • Religion, role of the extended family • Hispanic Americans • Roman Catholic religion and importance of extended family • Asian Americans • Adherence to religions that tend to emphasize interdependence between the individual and society

7. Societal Factors Oregon’s Death with Dignity Act of 1994–terminally ill patients allowed physician-assisted 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

8. Assessment: Overt Statements • “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.”

9. Assessment: Covert Statements • “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?”

10. Assessment: Lethality of Suicide Plan • Is there a specific plan with details? • How lethal is the proposed method? • Is there access to the planned method? • People with definite plans for time, place, and means are at high risk.

11. 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

12. Nursing Diagnoses • Risk for suicide • Ineffective coping • Hopelessness • Powerlessness • Social isolation

13. Levels of Intervention • Primary–activities that provide support, information, and education 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 aftereffects

14. Basic Level Interventions • Milieu therapy with suicidal precautions • Counseling • Health teaching and health promotion • Case management • Pharmacological interventions

15. Survivors of Completed Suicide: Postintervention • Surviving friends and family • Overwhelming guilt, shame • Difficulties discussing the often taboo subject of suicide • Staff • Group support essential as treatment team conducts a thorough postmortem assessment and review

16. Advanced Practice Interventions • Psychotherapy • Psychobiological interventions • Clinical supervision • Consultation

17. 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:

18. 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.