Chapter 23: Suicide and Non-

Suicidal Self-Injury

PROFESSOR STANFORD
 Clinical Picture

 Suicide: The intentional act of killing oneself by

any means
 Prior attempts put the individual at greater
probability of completing suicide in the future
 After an attempt, the next 2 years are especially high risk
 Epidemiology

 10th leading cause of death in the United States

 Risk Factors

 Suicidal Ideation: Manifestation of inner pain,

hopelessness, and helplessness suffered by
individuals
 Psychiatric Disorders accompany 90% of completed
suicides
 Estimated that 2/3 of those that commit suicide are
experiencing depression at the time
 Studies indicate that about 50% of those that end
their life by suicide have alcohol in their blood at the
time of death
 Risk Factors

 Men commit suicide four times more often than women

 Suicide risk for men peaks after age 45
 Suicide risk for women peaks after age 55
 Race: White males commit 2 out of every 3 suicides
 Religiosity is associated with decreased rates of suicide
 Being married, especially with children decreases the risk
of suicide
 Law enforcement, dentists, artists, mechanics, insurance
agents, and lawyers are at higher risk
 About half of those that commit suicide have a physical
illness
 Loss of mobility, disfigurement, and chronic pain are correlated with
suicide
 Etiology

 Biological Factors
 There appears to be a genetic component to suicide

 Postmortem exams of those that commit suicide show

low serotonin levels in the brainstem and frontal cortex
 Etiology

 Psychosocial Factors
 Cognitive factors that seem to be associated with suicide:
 Hopelessness
 Rigid all-or-nothing thinking
 Inability to see different options
 Perfectionism

 Copycat suicide
 Follows a highly publicized suicide of a public figure, an idol, or a
peer in the community
 Adolescents at higher risk for copycat suicide
 Etiology

 Cultural Factors
 Religious beliefs, family values, sexual orientation, and
attitude toward death all have an impact on suicide rates

 Societal Factors
 Assisted suicide for the terminally ill is a moral and
ethical issue
 Must define terminal illness

 Is the individual depressed?

 Assessment

 The nurse must talk openly t an individual experiencing

suicidal ideation
 This decreases isolation and can increase problem-solving
 The nurse may ask the following types of assessment
questions:
 Have you ever felt that life was not worth living?
 Have you been thinking about death recently?
 Did you ever think about suicide?
 Have you ever attempted suicide?
 Do you have a plan for completing suicide?
 If so, what is your plan for suicide?
 Assessment

 The presence of a therapeutic alliance may be a protective

factor
 The absence of a therapeutic alliance may be a risk factor for
suicide
 Lethality of Suicide Plan
 Three main elements must be considered:
 Is there a specific plan with details?

 How lethal is the proposed method?

 Is there access to the planned method?

 Those who have definite plans for the time, place, and means are
at high risk
 Assessment Tools & Diagnosis

 Assessment Tools
 Multiple evidence-based assessment tools exist to screen for
suicidality
 Diagnosis
 Highest priority is Risk for Suicide diagnosis
 Other Diagnoses:
 Self-care deficit
 Sleep pattern disturbance
 Altered nutrition
 Anxiety
 Intervention

 Primary Intervention
 Activities that provide support, information, and education to
prevent suicide

 Secondary Intervention
 Treatment of the actual suicidal crisis

 Tertiary Intervention
 Interventions with the circle of survivors of a person who has
completed suicide
 Suicide Precautions & Counseling

 Suicide Precautions
 Observed frequently, generally every 15 minutes
 Charting on these individuals is most useful if it includes affect
and behavior

 Counseling
 No-suicide contracts are formed
 No literature exists to verify the effectiveness of these contracts
 Does establish good intent and resource availability
 Pharmacologic Interventions & ECT

 Pharmacologic Interventions
 Overdose is nearly impossible with SSRIs
 Overdose can occur with Tricyclic antidepressants and MAOIs
 Mouth checks may be used to ensure that the patient is swallowing
medications and not pocketing them to hoard for potential
overdose

 Electroconvulsive Therapy (ECT)

 May be used to decrease acute suicidal ideation
 Non-Suicidal Self-Injury

 Deliberate and direct attempts to cause bodily harm

that does not result in death
 Most of the time these acts are done to alleviate
psychic pain, pierce psychic numbness, self-
punishment, to get attention, or to avoid a situation