Suicide
Professor
Fickley, RN,MSN,CS
SCOPE of the Problem
FACTS: DEATHS BY SUICIDE!
l
11th
Leading cause of death in the US
l
8th
cause of death for males
l
19th
cause of death for females
l
30,622
suicide deaths
l
Suicides
out number homicides 3:2
l
Firearms
is the most common
l
Highest
rate : White males over 85
Child and teen stats
l
Third
leading cause of death age 15-24
l
Age
10-14 suicide rate is 272/20910440
l
Age
15-19 suicide rate 1,611/20271312
l
Age
20-24 suicide rate 2360/19711423
l
ALL AGE
GROUPS: Male have higher incidence
Attempts
l
There
is no national data on attempts but it is estimated
l
25
attempts per completed suicide
l
Highest
attempts in women an youth
l
Lower
in elderly and men
Suicidal Behaviors
l
Gestures
(unlikely to succeed)
l
Attempts
(intentionally or not intentionally the act was not fatal)
l
Completed
( act was fatal)
l
Passive
death wish
Gestures
l
Unlikely
to succeed –BUT CAN
l
Plea
for help that requires treatment
l
Scratching
wrists with a metal object
Attempts
Two types
l
Intention
is slight- vague thoughts, want to be found
l
Intention
is severe but is found early or revived
DIRECT or INDIRECT Attempts
l
Direct:
Suicidal acts
l
Indirect:
Risky behaviors, living on the edge
Passive Death Wish
l
Wanting to be dead or to die- but unable to actively hurt oneself
STATS
l
200,000
attempts/yr in the USA
l
30,000
completed
l
20% ED
visits
l
10%
medical admissions
l
More
women attempt/more men complete
l
More
single than married
l
Recent
increase in Women, adolescents
CUES
l
Nearly every individual who attempts suicide will show some warning
signs in the days, weeks or months beforehand. By identifying these risk
factors, we can help prevent suicide in the future.
CUES
l
Verbal
l
Behavioral
l
Hopeless,
helplessness
l
Ambivalence
l
Gut
feeling
l
Rigid ‘either or’ thinking
l
Command
hallucinations/delusions
l
Suicide
survivors have a 20% chance of repeating-10% of succeeding
Risk Factors
Are there factors that increase
risk?
Impulsiveness in teens
Use of alcohol and drugs
Diagnosis of depression
Biological relative who completed
suicide
Severe sexual abuse
Theories
l
Genetic-
inability to control impulsive behaviors
l
Neurobiological- Decrease Serotonin
( problem solve and resist urges)
l
Social
isolation and Loss
Men- intrapersonal
Women- interpersonal
Behavioral-
decrease anxiety; external reinforcements
Developmental-
age related
ASSESSING
l
ASK!
l
Behavior
l
Affect
l
Cognition
l
Social Factors
l
Refer to page 326 in your text for complete assessment
LETHALITY
l
Degree
of effort it takes to plan the suicide
l
Specificity
of the plan
l
Accessibility
of the weapon or method
l
The
ease by which one may or not be rescued
l
Guns-
cutting-hanging-poisons ( adults of BOTH sexes )
l
Hang-
jump ( children)
OUTCOME
l
Plan
l
Problem solving
l
No Suicide contracts
l
Crisis hotline numbers
l
Arrange support
l
Inpatient admission
Suicide Contagion
l
What is
it?
l
Can
lead to increase in Suicide
What can be done to decrease
copycats?
Family support and assessment
Limit media exposure, repetition
increases incidence
DO not discuss gruesome details
Public Debate: Rational Suicide?
l
Right
to die advocacy groups promote suicide as a rational decision( Compassionate
Friends/Hemlock Society)
l
Research
argues it is never a rational decision but more likely the result of depression, anxiety or fear of
dependency or pain or being a burden
l
More
research is needed,
Aftermath
l
Extremely painful for remaining family, friends, coworkers
l
How does a nurse intervene?
Questions
l
Mary, a
45 year old single mother of 3 teens, confides in you that she is thinking of
ending her life rather than go through chemotherapy again.
How would you, as her RN, respond?
Answer
l
Immenent
danger: NEVER LEAVE THEM ALONE’
CALL FOR HELP;
l
Hospital
setting- get a sitter, notify supervisor, MD, obtain a psych consult
l
Health
teach regarding depression , treatment options
while INSTILLING HOPE
l
Limit
access to harmful devices
True or False
l
Four
times as many men suicde than women?
l
Women
attempt suicide more often than men
l
Older
victims of suicide attempts, are less like to recover from attempts
l
The
rates for African Americans have risen in the last 20 years