Self-Protective Responses And Suicidal Behavior

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Self-destructive behavior may be

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direct or indirect

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Low self-esteem leads to

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depression, always present in self-destructive behavior

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suicidal activity with intent to cause death

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direct self-destructive behavior

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suicide ideation, threats, attempts, completed suicide

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direct self-destructive behavior

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any activity detrimental to person's physical well-being that may result in death

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indirect self-destructive behavior

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The age group that has highest suicide rate

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people over age 80

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Suicide is ____ of young people

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third leading killer

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___ commit overwhelming majority of completed suicides

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males

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____ attempt three times as often

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women

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____ account for half of all completed suicides

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guns

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Women use means of ____ in suicide attempts

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mediations, wrist slashing

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Highest ethnicity of suicide rates

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natives ages 15 to 34

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Hispanic females and suicide rates

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grades 9 to 12 higher in attempt rates

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The types of suicidal behaviors

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1. Suicidal ideation
2. Suicide threat
3. Attempted suicide
4. Completed suicide

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Floats around as an idea in our mind

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ideation

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action or statement

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threat

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Attempt at suicide

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attempt

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completed suicide

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death

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Accounts for 125,000 deaths annually

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noncompliance

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___ people generally aware they have chosen to not care for themselves

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noncompliant

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act of deliberate harm to one's own body, done to oneself, without aid of another person

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self-harm

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cutting and burning skin, banging head and limbs, picking at wounds, chewing fingers

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injury severe enough to cause tissue damage

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-People with mental retardation
-Psychotic pts as response to command hallucinations or delusions
-Prison populations
-Character disorders, especially borderline personality disorders

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Categories of self-injurious pts

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thought of self-inflicted death: self reported or reported to others

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ideation

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Only thoughts of suicide

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passive suicide ideation

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plans of causing one's own death

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active suicide ideation

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verbal or nonverbal warning (direct or indirect) that person is planning to take his or her own life

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suicide threat

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All suicide behavior is

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serious, whatever the intent

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Suicide ideation, threats, and attempts all

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require the nurse's highest priority

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any self-directed action that will lead to death if not stopped

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suicide attempt

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when assessing suicidal behavior, place

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emphasis on lethality of method threatened or used

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Although all suicide threats and attempts must be taken seriously, vigilant attention

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indicated when person is planning or tries highly lethal method

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Most suicidal person is one who has

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-Highly lethal method (gunshot to head)
-Specific plan (as soon as wife goes shopping)
-Means available (loaded gun in desk drawer)

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Person exhibit ____ as compared with someone "asking for help"

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little ambivalence

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death from self-inflicted injury, poisoning, or suffocation with evidence that decedent intended to kill self

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completed suicide

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Most people want to be prevent from carrying out self-destruction;

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relieved to be asked about it

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Merely asking a pt if he or she is suicidal

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does not meet the standard of care

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self-injury learned and reinforced in childhood or adolescence

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behavior theory

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problems in early stages of ego development may provoke episodes of self-injury

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psychological theory

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self-injury may result from interactions that leave child feeling guilty and worthless

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interpersonal theory

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-Psychiatric dx
-Personality traits and disorders
-Psychosocial factors
-Physical illness
-Genetic and familial variables, biochemical factors
-Biopsychosocial model for understanding self-destructive behavior over life cycle

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Predisposing factors to self-injury

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Over 90% who complete suicide have psychiatric illness

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-Mood disorders
-Substance abuse
-Schizophrenia
-Anxiety disorders

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Hostility, impulsivity, depression, hopelessness associated

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with increased risk of suicide

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Suicidal people are more

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socially withdrawn, have lower self-esteem, are less trusting of others, expect bad things to happen, have rigid and inflexible way of thinking

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-Loss, lack of social supports, neg life events, chronic physical illness
-Humiliating events: personal, public embarrassment, job loss, threat of jail
-More vulnerable to self-destructive behavior from knowing someone who attempted suicide or media exposure
-Strength and quality of social supports improve compliance with treatment

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Predisposing factors - Psychosocial

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Suicide rate in recently discharged hospital patients

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3x higher than general population

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Chronic, debilitating disorders most often associated with suicide

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Cancer, Huntington chorea, epilepsy, MS disorders, peptic ulcer disease, HIV/AIDS

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Explained by ____ with an _____ of family member who has committed suicide, family stress, transmission of genetic factors

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identification; imitation

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The offspring of mood-disordered suicide attempters are at a

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markedly greater risk for suicide attempts themselves

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Growing evidence of association between suicide or suicidal tendencies and low level of brain neurotransmitter

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serotonin

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-Self-destructive behavior: from overwhelming stress
-Stressors individualized, as is person's ability to tolerate stress
-All self-destructive behaviors may be seen as attempts to escape from uncomfortable or intolerable life situations, related anxiety
-Suicide implies loss of ability to value self

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Precipitating stressors

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When sense of self-worth is extremely low, self-destructive behavior

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peaks

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In alcoholism, losing close relationship in _____, concurrent use of other drugs, physical illness

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6 weeks

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-Comorbid substance abuse
-Prior suicide attempts
-Family history of major depression
-Previous antidepressant tx
-History of legal problems
-Handgun available in house

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Significant predictors in depresses adolescents

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Social isolation may lead to loneliness

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increased vulnerability

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People involved with others in their communities are

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more able to tolerate stress

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Social activities and religious involvement

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supportive to many people

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-Clinical care for mental, physical, substance abuse disorders
-Easy access to clinical interventions
-Restricted access to lethal methods
-Family and community support and supportive relationships in ongoing medical/mental health care
-Learned skills in problem-solving, conflict resolution, nonviolent handling of disputes
-Cultural and religious beliefs give sense of hope that discourages suicide

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Protective factors against suicide

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The best predictor of suicide is

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a previous suicide attempt

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Denial, rationalization, regression, magical thinking, defend from strong emotional responses to life events that seriously threaten ego

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Coping mechanisms

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In the case of self-destructive behavior,

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caution is the recommended in determining the level of risk

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It is better to overestimate the patient's level of risk

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than allow serious injury to occur

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-Anxiety disorders
-BPD
-Major depressive disorder
-Noncompliance with treatment
-Schizophrenia
-Substance use disorders

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Medical dx r/t suicidal behavior

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Expected outcomes

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-Patient will not physically harm himself or herself
-First priority is to prevent actively suicidal person from acting on impulses
-Give highest priority to preservation of life

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Nursing care plan must focus first

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on protecting patient from harm

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Suicide precautions require checking pt at least

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q15minutes to ensure safety

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-Inadequate suicide assessment of the pt at intake, absent or incomplete reassessment, and lack of assessment at discharge
-Unsafe environment of care
-Insufficient orientation or training, incomplete competency review or credentialing, and inadequate staffing levels
-Incomplete communication among caregivers
-Inadequate care planning or care provision

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Common avoidable causes of suicide in hospitals

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Suicidal patients may appear to be feeling much better before

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immediately before making attempt

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Agreement not to inflict self-harm specified period and contact nurse if tempted to act on self-destructive impulses

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contracting with suicidal pt

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Estimated that each suicide intimately affects

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at least six other people

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Survivors are

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also at risk of suicide following a relative/close relationship's suicide