PowerPoint Presentation

SuicideRISKSAWARENESSINTERVENTIONSDr Bernreuter

Hallmark College1Unit ObjectivesDescribe demographics related to suicideDiscuss the meanings and motivation for suicideIdentify risk factors for suicideDiscuss suicide as it relates to levels of interventionDescribe critical parts of a suicide assessmentApply the SAD PERSONS scale to a patientList emotions of suicide survivors

23SuicideA significant public health problem in the United StatesEvery 15 minutes suicide ends a lifeEleventh leading cause of death (34.000 a year)For every two murders there are three suicides32,000 completed suicides; 45% had contact with primary care provider in previous 5 monthsMany suicides are not reported as such so numbers probably higherWe are missing opportunities to prevent suicide!Not all who attempt suicide really want to die3The Common Emotion in Suicide is a sense of HOPELESSNESSThe Common Emotion in Suicide is a sense of The Common Emotion in Suicide Is

SEEKING A SOLUTION TO WHAT APPEARS TO BE AN INSOLUBLE PROBLEM4Suicide Rates in the US

5Motivation for SuicideTerminal illness or unbearable painBeing a burden to othersUntenable family situationUntenable personal situationPunishment or exposure of socially or personally unacceptable behavior67Risk Factors

Psychiatric disorders 90% of suicides have psychiatric illnessAlcohol or substance use disordersMale genderIncreasing ageRace American/Alaskan natives highest, followed by whitesDichotomous thinking Marriage Especially with children reduces riskProfessionals have higher ratesPhysical health About half have physical illnessesFamily history of suicideSee p 515 for more risk factors78Psychosocial FactorsFreud aggression turned inward Menninger - The wish to kill; the wish to be killed; the wish to dieAaron Beck central emotional factor is hopelessnessRecent theories combination of suicidal fantasies and significant loss

Biological FactorsLow serotonin levels are related to depressed moodSuicidal behavior tends to run in families

89Cultural FactorsProtective factorsAfrican Americans; men more than women Religion, role of the extended familyHighest rate among adolescent and young adultsHispanic AmericansRoman Catholic religion and importance of extended familyHowever, Hispanic females grades 9-12 have more attempts than blacks or whites of same ageAsian AmericansAdherence to religions that tend to emphasize interdependence between the individual and society, seen as selfish or disrespectful to group910Societal FactorsOregons Death with Dignity Act of 1994 terminally ill patients allowed physician-assisted suicideNetherlands nonterminal cases of lasting and unbearable sufferingBelgium nonterminal cases when suffering constant and cannot be alleviatedSwitzerland assisted suicide legal since 1918Islam does not condone, but suicide bombers may believe it is an honor to die for their faith; that real happines lies beyond this world1080% Signal Intent

1112Assessment: Overt Statements and ActionsI can't take it anymore.Life isn't worth living anymore.I wish I were dead.Everyone would be better off if I died.ActionsGiving away prized possessionsMake or change a willTake out or add to insurance policyPlan funeralHave sudden unexplained recovery from depression1213Assessment: Covert StatementsIt'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?1314Assessment: Lethality of Suicide PlanThree parts you must be concerned with:IdeasPlansIs there a specific plan with details?How lethal is the proposed method?MeansIs there access to the planned method?

The further down the Ideas, Plans, Means, the higher riskPeople with definite plans for time, place, and means are at high risk.1415Assessment Tools:SAD PERSONS ScaleUses 10 major risk factors to assess suicidal potential1.Sex (male)6.Rational thinking loss2. Age 25 to 44 or7. Social supports lacking65+ years or recent loss3.Depression8. Organized plan4. Previous attempt9. No spouse5. Ethanol use10.Sickness

Patient gets 1 point for each positive: Score 0-2: send home with follow-up, 3-4: Follow closely, consider in-patient care; 5-6: Strongly consider hospitalization; 7-10: Hospitalize 1516Nursing DiagnosesRisk for suicide/injury/self or other directed violenceIneffective coping/disabled family coping/impaired social interactionHopelessness/chronic sorrowPowerlessness/low self esteemSocial isolation /lonelinessSpiritual distress1617Levels of InterventionPrimary activities that provide support, inform, and educate to prevent suicideSecondary treatment of the actual suicidal crisisTertiary interventions with the family and friends of a person who has committed suicide to reduce the traumatic after effects1718Basic Level InterventionsMilieu therapy with suicidal precautionsVerbal or written contracts to report feelingsCounselingHealth teaching and health promotionCase managementPharmacological interventions1819Survivors of Completed Suicide: PostventionEmotions of Surviving friends and familyOverwhelming guilt, shame, often leads to depression and possible suicidal ideationDifficulties discussing the often taboo subject of suicide; only about 25% seek treatment despite painNeed to talk about loss; reach out; refer to local SOS groupStaffGroup support essential as treatment team conducts a thorough postmortem assessment and review of what was missed, what happened, etc.1920A 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: 2021is 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.21