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A significant public health problem in the US
- Psychiatric D/O
- ETOH or substance abuse D/O
- Male gender
- Increasing Age
- Physical Health
- Suicidal Behavior tends to run in families
- Low serotonin levels are r/t depressed mood
- Freud- Aggression turned inward
- Menninger: Wish to kill, Wish to be killed, Wish to die
- Aaron Beck- Central emotional factor is hopelessness
- Recent theories- combination of suicidal fantasies and significant loss
- Protective Factors:
- African Americans: Religion, role of the extended family
- Hispanic Americans: Roman Catholic religion and importance of extended family
- Asian Americans: Adherence to religions that tend to emphasize interdependence between the individual and society
- Oregon's Death with Dignity Act: terminally ill pt allowed MD assisted suicide
- Netherlands- Nonterminal cases of "lasting and unbearable" suffering
- Belgium- Non terminal cases when suffering is constant and cannot be alleviated
- Switzerland- Assissted suicide legal since 1918
Assessment: Overt (Open) Statements
- "I can't take it anymore."
- "Life isn't worth living anymore."
- "I wish I were dead."
- "Everyone would be better off if I died."
Assessment: Covert (Concealed) Statements
- "It's okay, now. Soon everything will be fine."
- "Things will never work out"
- "I won't be a problem much longer."
- "Nothing feels good to me anymore and probably never will."
- "How can I give my body to medical science?"
Assess: Lethality of Suicide Plan
- Is there a specific plan with details?
- How lethal is the proposed method?
- Is there access to the planned method?
- People with definite plans for time, place and means are at high risk.
Assessment Tools: SAD PERSONS Scale: p 554
- Uses 10 major risk factors to assess suicidal potential
- 1. Sex (male)
- 2. Age 25-44 or >65
- 3. Depression
- 4. Previous Attempt
- 5. Ethanol Use
- 6. Rational thinking loss
- 7. Social support lacking or recent loss
- 8, Organized plan
- 9. No spouse
- 10. Sickness
- Risk for suicide
- Ineffective Coping
- Social Isolation
Levels of Interventions
- Primary: Activites that provide support, info, and education to prevent suicide (Beginning)
- Secondary: Tx of the actual suicidal crisis. (Middle)
- Tertiary: Interventions with the family and friends of a person who has committed suicide to reduce the traumatic aftereffects. (End)
Basic Level Interventions
- Milleu therapy with suicidal precautions
- Health teaching and Health Promotion
- Case Management
- Pharmacological Interventions
Survivors of Completed Suicide: Post-Intervention
- Surviving Friends and Family have overwhelming shame and guilt
- Difficulties discussing the taboo subject of suicide
- Staff: Group support essential as Tx team conducts a thorough postmortem assessment and review