Transcript Suicide PPT
Case Finding and Care in Suicide: Children, Adolescents and Adults Chapter 36 Suicide Terminology • Suicide - act of killing oneself • Parasuicide - failed attempt to kill oneself, varies by intent, self-harm • Suicide ideation - thinking about or planning one’s own death • Lethality - degree of probability that an individual will be successful in completing suicide Suicide • Highly stigmatized • Stimulates fear in others • Directs consequences of certain mood disorders • Highly preventable Suicide: Epidemiology • • • • • Ninth leading cause of death in the U.S. Lifetime rate - 10% chance for suicide Men more likely than women to attempt Lethality increases with age Suicide - most prevalent in the 15-24 aged group and over 75 age group • Whites more likely than nonwhites • Comorbid with depression and schizophrenia Epidemiology • 56% - succeed first suicide attempt • 25% - hospitalized for a failed suicide attempt within three months • Handguns most common method • Prepubertal children: increase in rates • Adolescents: higher than in children Risk Factors • • • • • White man Older adulthood Adolescence Gay, lesbian or bisexual orientation Access to firearm Other Risk Factors • Vulnerability – Family member who competed suicide – Psychiatric disorder – Previous attempt • Intent – Plan and execution – Loss – Unrelenting physical illness • Disinhibition – Impulsivity – Isolation – Psychotic thought – Drug or alcohol abuse Etiology of Suicide • Biologic – Most have MDD – Low levels of serotonin – Higher among those who significantly reduce their fat intake, low cholesterol levels – Familial tendencies • Psychological – Psychodynamic - anger and aggression turned inward – Stress-diathesis model – Cognitive model of depression • Social – Lack of social support – Interpersonal stress Effects of Suicide • Estimated medical cost of suicide per person - $5,700 • Estimated lost productivity - $844,184 • Grief of family and friends Legal Considerations • Confidentiality (Explain limits.) • Informed consent (Explain limits of right to selfdetermination and least restrictive environment.) • Competence (Must judge.) • Beneficence • Documentation and reporting • Involuntary hospitalization Assessment • Case-finding – Primary care settings - should be screened for depression – Variety of scales available • Determining risk (Text Box 36.3) – Intent to die – Severity of ideation – Degree of planning – Lethality – Availability Nursing Diagnoses • • • • • • • • Risk for suicide Interrupted family processes Ineffective health maintenance Impaired social interaction Chronic low self-esteem Disturbed sleep pattern Social isolation Spiritual distress No-Suicide Contract • Written or verbal agreement between health care professional and the patient • States that patient will not engage in suicidal behavior for a specific period of time • Patient must be competent to enter a contract • Must help patient dismantle suicide plan • Must refrain from use of substances Inpatient Care • Protect patient from suicide and establish treatment of underlying psychiatric disorder • Objectives of hospitalization: – Maintain patient’s safety. – Decrease the level of suicidal ideation. – Initiate treatment for underlying disorder. – Evaluate for substance abuse. – Reduce level of social isolation. Inpatient Management • • • • Confidentiality No-suicide contract Reporting in the medical record Inpatient suicides – 1% in general hospitals – .03% in psychiatric hospitals – High risk times • Precautions • Prepare for discharge – No guns, no means in the house – A plan to call someone Biologic Interventions • Ensuring safety – – – – Hospital protocol for safety Observing patient regularly Removing dangerous objects Providing outlets for expression of patient’s feelings – No-suicide contract • Somatic therapies – Medications – ECT • Substance abuse treatment Psychological Interventions • Evaluating patient’s ways of thinking about problems and generating solutions • Cognitive interventions • Developing plans to prevent future suicide attempts Social Interventions • Help patient develop social skills that can be used in engaging others. • Identify family and friends who are willing to help. Discharge Planning and Outpatient Care • Educating patient and family • Identifying continuing sources of social support • Establishing an outpatient care plan – Have enough medication to last until first outpatient visit – Plan for ongoing supervision Avoiding Secondary Trauma • Nurses’ emotional reaction to patient’s circumstances or to repeated stress of coping with suicidal crises • Nurse who experiences it may develop early stages of PTSD. • Nurses must engage in active program of self-care.