chapter 22: suicide prevention and intervention copyright © 2012, 2007 mosby, inc., an affiliate of...

Chapter 22:Chapter 22:

Suicide Prevention and Suicide Prevention and InterventionIntervention

Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

22Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Historic and Theoretic Historic and Theoretic PerspectivesPerspectives

Sociologic theory: DurkheimSociologic theory: Durkheim Psychoanalytic: Freud, Menninger, Jung, Psychoanalytic: Freud, Menninger, Jung,

Adler, HorneyAdler, Horney Interpersonal: SullivanInterpersonal: Sullivan


EtiologyEtiology

Suicidology is the scientific and humane Suicidology is the scientific and humane study of suicidestudy of suicide


Joiner: two categories = increase Joiner: two categories = increase risk for suicide completionrisk for suicide completion

Dysregulation in impulse controlDysregulation in impulse control Individual with suicidal ideation and attempts, Individual with suicidal ideation and attempts,

experiences intense psychologic pain experiences intense psychologic pain


Psychologic FactorsPsychologic Factors

Self-directed aggression/self-destructionSelf-directed aggression/self-destruction Death as atonementDeath as atonement Recapture lost love objectRecapture lost love object Abandonment anxiety Abandonment anxiety Response to helplessness, hopelessness, guilt, Response to helplessness, hopelessness, guilt,

and diminished self-esteemand diminished self-esteem Suicide serves as a way to end painful feeling Suicide serves as a way to end painful feeling

statesstates


Etiologic FactorsEtiologic FactorsBiologicBiologic Neurotransmitter imbalancesNeurotransmitter imbalances Serotonin irregulationSerotonin irregulation Genetic influencesGenetic influences Alterations in brain structure associated with depression Alterations in brain structure associated with depression

PsychologicPsychologic Self-directed aggressionSelf-directed aggression Unresolved interpersonal conflictsUnresolved interpersonal conflicts Negative thinking patternsNegative thinking patterns

SociologicSociologic Isolation from social groupIsolation from social group Bio-psychosocial influencesBio-psychosocial influences


Five Levels of Suicidal BehaviorFive Levels of Suicidal Behavior

1.1. Suicidal ideationSuicidal ideation Direct or indirect thoughtsDirect or indirect thoughts

2.2. SuicidalSuicidal threatsthreats Direct verbal or written messages of intentDirect verbal or written messages of intent

3.3. Suicidal gesturesSuicidal gestures Actions resulting in minor injury, no intention to dieActions resulting in minor injury, no intention to die

4.4. Suicidal attemptsSuicidal attempts Serious actions with intention to dieSerious actions with intention to die

5.5. Successful suicidesSuccessful suicides Deaths of persons who had conscious intent to dieDeaths of persons who had conscious intent to die


Risk Factors for SuicideRisk Factors for Suicide

Age Age 15 to 24 and over 6515 to 24 and over 65

SexSex Men: Men: completed completed Women: Women: attempts attempts

Race/ethnicityRace/ethnicity CaucasianCaucasian Older African AmericanOlder African American Native AmericanNative American

Symptoms Symptoms Depression, weight changes, disturbed sleep, fatigue, Depression, weight changes, disturbed sleep, fatigue,

self-depreciation, anger, hopelessness, preoccupation self-depreciation, anger, hopelessness, preoccupation with death and dyingwith death and dying


Risk Factors for Suicide, cont’d.Risk Factors for Suicide, cont’d.

Suicide planSuicide plan Assess:Assess:

• ExplicitnessExplicitness

• Lethality of methodLethality of method

• Availability of meansAvailability of means

• Provision for rescueProvision for rescue

• Alcohol/drugAlcohol/drug

• Impulse controlImpulse control



History of previous attemptsHistory of previous attempts Majority who complete have made other attemptsMajority who complete have made other attempts

Social supports and resourcesSocial supports and resources Real or perceived lack increases riskReal or perceived lack increases risk

Recent lossesRecent losses Increase risksIncrease risks



Medical problemsMedical problems Terminal illness or painful disordersTerminal illness or painful disorders

Alcohol/other drugsAlcohol/other drugs Use increases impulsivityUse increases impulsivity

Cognition and problem solvingCognition and problem solving Inability to identify problem and solutionsInability to identify problem and solutions


Severity Index for Suicide Risk Severity Index for Suicide Risk

Suicidal ideationSuicidal ideation No risk of suicideNo risk of suicide


Severity Index for Suicide Risk, Severity Index for Suicide Risk, cont’d.cont’d.

Mild thoughts of suicide:Mild thoughts of suicide: States will not make attemptStates will not make attempt Uses support systemUses support system Identifies purpose for livingIdentifies purpose for living



Moderate thoughts of suicide:Moderate thoughts of suicide: Thinks of suicide as way of problem solvingThinks of suicide as way of problem solving Wants to sleep and never awakenWants to sleep and never awaken Wants to escape more than to dieWants to escape more than to die No explicit planNo explicit plan Has support system but does not use itHas support system but does not use it Deterred by religious beliefsDeterred by religious beliefs



Advanced thoughts of suicide:Advanced thoughts of suicide: Makes gestures that may not be lethalMakes gestures that may not be lethal Has intrusive thoughts of suicideHas intrusive thoughts of suicide Tells others of suicidalityTells others of suicidality Can write own no-suicide contractCan write own no-suicide contract Gives away belongingsGives away belongings Does not use support systemDoes not use support system Rationalizes religious beliefsRationalizes religious beliefs Needs hospitalizationNeeds hospitalization



Severe thoughts of suicide:Severe thoughts of suicide: Has a suicide gestureHas a suicide gesture Wants to dieWants to die Sees no other solutionSees no other solution Develops highly specific plan with lethal methods and Develops highly specific plan with lethal methods and

low rescue potentiallow rescue potential May show increased energy and mood after deciding May show increased energy and mood after deciding

on plan to dieon plan to die Questions relationship with GodQuestions relationship with God Has highly intrusive thoughts of suicideHas highly intrusive thoughts of suicide Needs hospitalizationNeeds hospitalization


Plan of CarePlan of Care

Reduce risk of self-destruction Reduce risk of self-destruction MonitorMonitor Promote self worthPromote self worth Improve coping skillsImprove coping skills Limit isolation Limit isolation Build self-esteem Build self-esteem

chapter 22: suicide prevention and intervention copyright © 2012, 2007 mosby, inc., an affiliate of...

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