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Depression and Suicide

Depression and Suicide. Suicidal ideation (SI) Suicidal threat Suicidal gesture Suicide attempt. Thoughts Stated intent to end life Non-lethal self-injury Serious method with intent. Suicide: Terminology. Incidence of Suicide.

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Depression and Suicide

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  1. Depression and Suicide

  2. Suicidal ideation (SI) Suicidal threat Suicidal gesture Suicide attempt Thoughts Stated intent to end life Non-lethal self-injury Serious method with intent Suicide: Terminology

  3. Incidence of Suicide • Ninth leading cause of death in US • Third leading cause of death in the 15-35 age group • Seventy three percent of suicides are white men • Highest rate of suicide= middle-aged white males • Suicide, not homicide, is the leading cause of gun death-57% • 10-19 yr olds use a gun to kill themselves every six hours

  4. Other Risk Populations • Elderly single men with health problems • Unemployed professional workers • Women make more attempts; males more lethal • Adolescents

  5. Adolescents and Suicide • 3rd leading cause of death in teens • Rates quadrupled in 1990’s • Risk factors: depression, substance abuse, sexual or physical abuse, disruptive behavior • Psychosocial factors: Alienation, loneliness and impulsivity, sexual identity issues • Firearms most commonly used • “Copy cat” aspect

  6. Issues in Suicide • Suicidal persons are usually ambivalent • Themes are: loss, hopelessness, loneliness, psychic pain, abandonment

  7. Goals of Suicide with Examples • Escape: from abuse or intolerable situation • Relief: of physical, emotional pain or guilt • Manipulation: way to get attention, or recognition • Retaliation: revenge or punishment • Reunion: with a dead loved one • Redemption: for loss of honor, harm done to others (also, to save others from death)

  8. Issues in Suicide,cont’d • Medical illness is factor, esp. in elderly • Cultural aspects: how acceptable; role of shame

  9. Assessment: Suicidal Talk? “I’d be better off dead.” “_______ will be better off when I’m gone.” “I wish this pain I feel would just be over.” “I wish I could just get away from everything.” “I wish I just didn’t exist at all.” “I just want to be with (deceased person).”

  10. Assessment of Suicidal Potential • Is There aPlan?--the more developed, greater risk • Method—Lethality and availability • Rescue—does person try to block? • Can patient carry out plan? (energy) • Are there inhibitors? (reasons to live)

  11. Other Factors to Consider In Assessing Suicide Potential • History of previous attempts • Lives alone or feels alienated; lacks social support • Recent loss(es) and excessive guilt • Poor physical health • H/o frequent threats of self-harm or suicide • Giving away belongings • Depression • At greater risk as depression lifts • Anger • Co-existing substance abuse, or Mental Illness dx.

  12. Suicide and Mental Illness • 90% have Diagnosable Mental Conditions: Substance abuse, Bipolar depression, Major Depression, Schizophrenia What other diagnoses are also associated with risk? • Use of activating SSRI antidepressants: fluoxetine (Prozac) supply energy before the sertraline (Zoloft) depression is relieved

  13. Nurse-Client Relationship and Milieu Management • Hospitalization: Locked area, PICU • DirectlyAssess: ask pt. if they are suicidal • Remove harmful objects • 1-1 suicide watch if serious or immediate danger; restraint may be necessary • Try to “make a connection,” establish rapport • Anti-depressant, anti-anxiety medication • Have pt. sign a “No-harm Contract”

  14. NANDA Nursing Diagnoses • High Risk for Violence: directed at self • Risk for Suicide • Self esteem disturbance • Hopelessness • Powerlessness • Ineffective Individual Coping

  15. Discharge Planning and Community Resources • Careful assessment and documentation on discharge • Having a Safety Plan • Hotlines: National Suicide Prevention Hotline 1-800-273-TALK • Support: individuals and groups

  16. Nursing Process Scenario A 40 year old divorced male made a suicide attempt with his hunting rifle under the influence of alcohol and marijuana, but was intercepted by a friend. He is brought to the mental health unit with a psychiatric dx. of Major Depression with Suicidal Ideation. He says he feels he’d be better off dead, but willingly discusses what has happened recently in his life: broke up with girlfriend, furlough from his job, mother is terminally ill.

  17. In general, which behaviors indicate a risk for suicide? Able to list support system Able to state method he would use if he tries again Easily talks about feelings with nurse Has experienced recent loss Talks about future job plans   Nursing Process Scenario

  18. Scenario: Nursing Process Initial Nursing Diagnoses after interview: Problem 1: Risk for Suicide r/t hopelessness and actual or anticipated personal losses Problem 2: Ineffective Individual Coping r/t substance abuse Write a short-term goal for each of these

  19. Ethical and Legal Aspects One short term goal written for Problem 1is: Client will sign no-harm contract by end of shift • What is the value of this contract from: • an ethical standpoint? • a legal standpoint?

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