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Depression and Suicide

Depression and Suicide. Suicidal ideation (SI) Suicidal threat Suicidal gesture Suicide attempt. Thoughts Stated intent to end life Non-lethal self-injury Serious method with intent. Suicide: Terminology. Incidence of Suicide.

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Depression and Suicide

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  1. Depression and Suicide

  2. Suicidal ideation (SI) Suicidal threat Suicidal gesture Suicide attempt Thoughts Stated intent to end life Non-lethal self-injury Serious method with intent Suicide: Terminology

  3. Incidence of Suicide • Ninth leading cause of death in US • Third leading cause of death in the 15-35 age group • Seventy three percent of suicides are white men • Highest rate of suicide= (no longer white males over age85)middle-aged white males • Suicide, not homicide, is the leading cause of gun death-57% • 10-19 yr olds use a gun to kill themselves every six hours

  4. Adolescents and Suicide • 3rd leading cause of death in teens • Rates quadrupled in 1990’s • Risk factors: depression, substance abuse, sexual or physical abuse, disruptive behavior • Psychosocial factors: Alienation, loneliness and impulsivity, sexual identity issues • Firearms most commonly used • “Copy cat” aspect

  5. Issues in Suicide • Suicidal persons are usually ambivalent • Themes are: loss, hopelessness, loneliness, psychic pain, abandonment • Goals of suicide: escape, relief, manipulation, retaliation, reunion, redemption

  6. Issues in Suicide,cont’d • Medical illness is factor, esp. in elderly • Cultural aspects: how acceptable; role of shame

  7. Suicidal Talk? “I’d be better off dead.” “_______ will be better off when I’m gone.” “I wish this pain I feel would just be over.” “I wish I could just get away from everything.” “I wish I just didn’t exist at all.” “I just want to be with (deceased person).”

  8. Assessment of Suicidal Potential • Is There a Plan?--the more developed, greater risk • Method—Lethality and availability • Rescue—does person try to block? • Can patient carry out plan? (energy) • Are there inhibitors? (reasons to live)

  9. Other Factors to Consider In Assessing Suicide Potential • History of previous attempts • Lives alone or feels alienated; lacks social support • Recent loss(es) and excessive guilt • Poor physical health • H/o frequent threats of self-harm or suicide • Giving away belongings • Agitated type of depression • Greater risk as depression lifts • Anger • Co-existing substance abuse, or Mental Illness dx.

  10. Suicide and Mental Illness • 90% have Diagnosable Mental Conditions: Substance abuse, Bipolar depression, Major Depression, Schizophrenia What other diagnoses are also associated with risk? • Use of activating SSRI antidepressants: fluoxetine (Prozac) supply energy before the sertraline (Zoloft) depression is relieved

  11. Nurse-Client Relationship and Milieu Management • Hospitalization: Locked area, PICU • DirectlyAssess: ask pt. if they are suicidal • Remove harmful objects • 1-1 suicide watch if serious or immediate danger; restraint may be necessary • Try to “make a connection,” establish rapport • Anti-depressant, anti-anxiety medication • Have pt. sign a “No-harm Contract”

  12. NANDA Nursing Diagnoses • High Risk for Violence: directed at self • Risk for Suicide • Self esteem disturbance • Hopelessness • Powerlessness • Ineffective Individual Coping

  13. Discharge Planning and Community Resources • Careful assessment and documentation on discharge • Having a Safety Plan • Hotlines: National Suicide Prevention Hotline 1-800-273-TALK • Support: individuals and groups

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