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Depression and Suicide

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

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Depression and Suicide

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  1. Depression and Suicide

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

  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: white males over age 85 • Suicides, not homicide, is the leading cause of gun death-57% • 10-19yr olds use a gun to kill themselves every six hours

  4. 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

  5. Issues in Suicide • Suicidal persons are usually ambivalent • Themes are: loss, hopelessness, loneliness, psychic pain, abandonment • Goals of suicide: Escape, relief, manipulation, retaliation, reunion, redemption • Medical illness is factor, esp. in elderly

  6. Risk factors for suicide • Elderly single men with health problems • Unemployed professional workers • H/o previous attempt(s) • Women make more attempts; males more lethal • Adolescents • Cultural aspects: how acceptable; role of shame

  7. 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).”

  8. Assessment of Suicidal Potential • Plan--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) • Pts. at greater risk as depression lifts

  9. Suicide and Mental Illness • 90% have Diagnosable mental conditions: Substance abuse, Bipolar depression, Major Depression, Schizophrenia

  10. Assessing Suicide Potential • Does the Pt. have a plan? Lethality • History of previous attempts • Lives alone or feels alienated; lacks social support • Recent loss(es) and excessive guilt • Poor physical health

  11. Suicide Assessment, cont’d • Agitated depression or when it lifts • Co-existing substance abuse, or Mental Illness dx. • h/o Frequent threats of self-harm or suicide • Giving away belongings • Depression and anger

  12. Nurse-Client Relationship and Milieu Management • Hospitalization: Locked area, PICU • Directly Assess: 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”

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

  14. 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

  15. Nursing Process Scenario A 45 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 still feels he’d be better off dead, but willingly discusses stressors that contributed to his attempt: recently broke up with girlfriend, furloughs from his job, mother is terminally ill.

  16. Scenario: Nursing Process Initial Nursing Diagnoses after interview: • Risk for Suicide r/t hopelessness and actual or anticipated personal losses • Ineffective Individual Coping r/t substance abuse What is a short term goal for each of these?

  17. Ethical and Legal Aspects • The nurse writes this as one short term goal: • Client will sign no-harm contract within 12 hrs • What is the value of this contract from: an ethical standpoint? a legal standpoint?

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