Depression and Depression and SuicideSuicide

Suicide: TerminologySuicide: Terminology Suicidal ideation (SI)--ThoughtsSuicidal ideation (SI)--Thoughts Suicidal threats-- Stated intent to end Suicidal threats-- Stated intent to end

lifelife Suicidal gesture-- Non-lethal self-Suicidal gesture-- Non-lethal self-

injuryinjury Suicidal attempt-- Serious method withSuicidal attempt-- Serious method with

intentintent

Incidence of SuicideIncidence of Suicide Ninth leading cause of death in USNinth leading cause of death in US Third leading cause of death in the 15-35 age Third leading cause of death in the 15-35 age

groupgroup Seventy three percent of suicides are white Seventy three percent of suicides are white

menmen Highest rate of suicide: white males over age 85Highest rate of suicide: white males over age 85

Suicides, not homicide, is the leading cause Suicides, not homicide, is the leading cause of gun death-57% of gun death-57%

10-19yr olds use a gun to kill themselves 10-19yr olds use a gun to kill themselves every six hours every six hours

Adolescents and SuicideAdolescents and Suicide 33rdrd leading cause of death in teens leading cause of death in teens Rates quadrupled in 1990’sRates quadrupled in 1990’s Risk factors: depression, substance abuse, Risk factors: depression, substance abuse,

sexual or physical abuse, disruptive sexual or physical abuse, disruptive behaviorbehavior

Psychosocial factors: Alienation, loneliness Psychosocial factors: Alienation, loneliness and impulsivity, sexual identity issuesand impulsivity, sexual identity issues

Firearms most commonly usedFirearms most commonly used ““Copy cat” aspect Copy cat” aspect

Issues in SuicideIssues in Suicide Suicidal persons are usually ambivalentSuicidal persons are usually ambivalent Themes are: loss, hopelessness, Themes are: loss, hopelessness,

loneliness, psychic pain, abandonmentloneliness, psychic pain, abandonment Goals of suicide: Escape, relief, Goals of suicide: Escape, relief,

manipulation, retaliation, reunion, manipulation, retaliation, reunion, redemptionredemption

Medical illness is factor, esp. in elderlyMedical illness is factor, esp. in elderly

Risk factors for suicideRisk factors for suicide Elderly single men with health problemsElderly single men with health problems Unemployed professional workersUnemployed professional workers H/o previous attempt(s)H/o previous attempt(s) Women make more attempts; males Women make more attempts; males

more lethalmore lethal AdolescentsAdolescents Cultural aspects: how acceptable; role Cultural aspects: how acceptable; role

of shameof shame

Suicidal Talk?Suicidal Talk?

““I’d be better off dead.”I’d be better off dead.”

““_______ will be better off when I’m gone.”_______ will be better off when I’m gone.”

““I wish this pain I feel would just be over.”I wish this pain I feel would just be over.”

““I wish I could just get away from I wish I could just get away from everything.”everything.”

““I wish I just didn’t exist at all.”I wish I just didn’t exist at all.”

““I just want to be with (deceased person).”I just want to be with (deceased person).”

Assessment of Suicidal Assessment of Suicidal PotentialPotential

PlanPlan--the more developed, greater --the more developed, greater riskrisk

MethodMethod—Lethality and availability—Lethality and availability RescueRescue—does person try to block?—does person try to block? Can patient carry out plan? (energy)Can patient carry out plan? (energy) Are there inhibitors? (reasons to live)Are there inhibitors? (reasons to live) Pts. at greater risk as depression liftsPts. at greater risk as depression lifts

Suicide and Mental IllnessSuicide and Mental Illness 90% have Diagnosable mental90% have Diagnosable mental

conditions:conditions:

Substance abuse, Bipolar Substance abuse, Bipolar depression, depression, Major Depression, Major Depression, SchizophreniaSchizophrenia

Assessing Suicide PotentialAssessing Suicide Potential Does the Pt. have a plan? LethalityDoes the Pt. have a plan? Lethality History of previous attemptsHistory of previous attempts Lives alone or feels alienated; lacks Lives alone or feels alienated; lacks

social support social support Recent loss(es) and excessive guiltRecent loss(es) and excessive guilt Poor physical healthPoor physical health

Suicide AssessmentSuicide Assessment, cont’d, cont’d Agitated depression or when it liftsAgitated depression or when it lifts Co-existing substance abuse, or Mental Co-existing substance abuse, or Mental

Illness dx.Illness dx. h/o Frequent threats of self-harm or h/o Frequent threats of self-harm or

suicidesuicide Giving away belongingsGiving away belongings Depression and angerDepression and anger

Nurse-Client Relationship Nurse-Client Relationship and Milieu Managementand Milieu Management

Hospitalization: Locked area, PICUHospitalization: Locked area, PICU DirectlyDirectly Assess: ask pt. if they are suicidal Assess: ask pt. if they are suicidal Remove harmful objects Remove harmful objects 1-1 suicide watch if serious or immediate 1-1 suicide watch if serious or immediate

danger; restraint may be necessarydanger; restraint may be necessary Try to “make a connection,” establish Try to “make a connection,” establish

rapportrapport Anti-depressant, anti-anxiety medicationAnti-depressant, anti-anxiety medication Have pt. sign a “No-harm Contract” Have pt. sign a “No-harm Contract”

NANDA Nursing DiagnosesNANDA Nursing Diagnoses High Risk for Violence: directed at High Risk for Violence: directed at

selfself Risk for SuicideRisk for Suicide Self esteem disturbanceSelf esteem disturbance HopelessnessHopelessness PowerlessnessPowerlessness Ineffective Individual CopingIneffective Individual Coping

Discharge Planning and Discharge Planning and Community ResourcesCommunity Resources

Careful assessment and Careful assessment and documentation on dischargedocumentation on discharge

Having a Safety PlanHaving a Safety Plan Hotlines: Hotlines: National Suicide PreventionNational Suicide Prevention

Hotline Hotline 1-800-273-TALK1-800-273-TALK Support: individuals and groupsSupport: individuals and groups

Nursing Process ScenarioNursing Process Scenario

A 45 year old divorced male made a suicide A 45 year old divorced male made a suicide attempt with his hunting rifle under the attempt with his hunting rifle under the influence of alcohol and marijuana, but was influence of alcohol and marijuana, but was intercepted by a friend. He is brought to intercepted by a friend. He is brought to the mental health unit with a psychiatric the mental health unit with a psychiatric dx. of Major Depression with Suicidal dx. of Major Depression with Suicidal Ideation. He says he still feels he’d be Ideation. He says he still feels he’d be better off dead, but willingly discusses better off dead, but willingly discusses stressors that contributed to his attempt: stressors that contributed to his attempt: recently broke up with girlfriend, furloughs recently broke up with girlfriend, furloughs from his job, mother is terminally ill.from his job, mother is terminally ill.

Scenario: Nursing ProcessScenario: Nursing Process

Initial Nursing Diagnoses after interview:Initial Nursing Diagnoses after interview: Risk for Suicide r/t hopelessness and Risk for Suicide r/t hopelessness and

actual or anticipated personal lossesactual or anticipated personal losses Ineffective Individual Coping r/t Ineffective Individual Coping r/t

substance abusesubstance abuse

What is a short term goal for each of What is a short term goal for each of these?these?

Ethical and Legal AspectsEthical and Legal Aspects

The nurse writes this as one short The nurse writes this as one short term goal: term goal: Client will sign no-harm contract within Client will sign no-harm contract within

12 hrs12 hrs

What is the value of this contract from: What is the value of this contract from:

an ethical standpoint?an ethical standpoint?

a legal standpoint?a legal standpoint?