4 Suicide - Lecture notes 4 PDF

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Notes on suicide...

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Week 5: Suicide & Self Harm

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At-risk individual - person who has been identified as having certain suicide risk factors (e.g. previous suicide attempt) and/or has been exposed to certain suicide risk conditions (e.g. recent suicide of a close peer)

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Contributing factors - factors which act to intensify an existing risk for suicide (e.g. substance abuse)

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Risk factor - refers to an individual trait (e.g. hypersensitivity) or demographic factor (gay or lesbian youth) which potentially elevates the risk for suicide and suicidal behaviours (include prior attempts, mood disorders, physical disabilities, and substance abuse)

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Self-injury - deliberate self-injurious behaviour with low intent to die, generally resulting in visible injuries (e.g. wrist cutting) which may be part of a repetitive or chronic pattern

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Suicide - death caused by self-inflicted, intentional injury (may be used interchangeably with completed suicide). An attempt to solve a problem of intense emotional pain with impaired problem-solving skills.

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Suicide attempt - potentially self-injuring behaviour motivated by an intent to die with a non-fatal outcome

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Suicide-related behaviours - a broad spectrum of behaviours which encompass suicidal gestures, threats, and attempts (may be used interchangeable with non-fatal suicidal behaviours)

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Suicide contagion - process by which one suicide, suicide attempt, or suicide-related behaviour may facilitate another person to attempt, threat, or complete suicide

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Suicide ideation - thoughts about suicide

Causes: -

Biopsychosocial: Biopsychosocial causes account for most suicides and attempted suicides. These causes include: o Depression o bipolar disorder o schizophrenia

o anxiety disorders o personality disorders o substance abuse o childhood abuse or trauma o family history of suicide o previous suicide attempts o having a chronic disease -

Environmental: Environmental factors that increase the risk for suicide often occur due to a stressful life event such as: o social loss, such as the loss of a significant relationship o access to lethal means, including firearms and drugs o being exposed to suicide o being a victim of harassment, bullying, or physical abuse

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Sociocultural: One of the main sociocultural causes of suicide is the feeling of being isolated or of not being accepted by others. Feelings of isolation can be caused by sexual orientation, religious beliefs, and gender identity:

o difficulty seeking help or support

o lack of access to mental health or substance abuse treatment

o following belief systems that accept suicide as a solution to personal problems

o exposure to suicidal behavior

Signs of Depression in Youth -

Oversensitivity to criticism

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Risk-taking, hyperactivity

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Low self-esteem

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Indecision, withdrawal, inactivity

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Somatic symptoms and complaints

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Aggression, hostility

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Sleep disturbances

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Eating disorders

S: Sex. Men are more likely to commit suicide than women. Males kill themselves about four times more often, although females make far more attempts. A: Age. The ages which are most dangerous for suicide vary over time. You should consult current statistics. As this is being written in 2006 individuals 1524 have an elevated risk. Suicide is the third leading cause of death in this age group. However, estimates exist which suggest that people this age making attempts outnumber actual suicides by a ratio of 100400 times. Males over age 75 are also known to be at high risk. Current demographics suggest that women in the 4554 age group are highest, but females in older or younger age ranges are not that different. After age 65 individuals as a whole have an attempt to completed suicide rate of about 2:1. Up to age 65, it is about a 7:1 ratio. D: Depression. The suicide rate for those who are clinically depressed is about 20 times greater than for the general population. Hopelessness is one aspect of depression that has a close tie to suicide. These two issues, depression and hopelessness, are the strongest predictors of wishes for a hastened death. P: Prior History. Roughly 80% of completed suicides were preceded by a prior attempt. E: Ethanol abuse. Alcohol and/or drug abuse increase risk.

R: Rational thinking loss. Psychosis (‘I heard a voice saying I should kill myself’) increases risk. Some estimates suggest that 2040% of schizophrenics make an attempt at some point, and the risk is highest early on in the illness. S: Support System Loss. Loss of support can vary tremendously. With kids and adolescents it can be the break up of their first ‘puppy love’ which they can take very seriously even though others like parents may view it as a trivial event. Other lost relationships for adolescents can include parents divorcing and remarrying someone else. Even a parent who is divorced or separated and living with a new person can be a trigger for adolescent suicide. The death of a relative, such as grandparents, can be another trigger for kids. Loss of a spouse can be devastating to some. Loss of a parent within the past 35 years increases risk of suicide. Among older individuals, men who are widowed, and women who are divorced or separated are at increased risk O: Organized Plan. This speaks for itself. Having a method in mind creates more risk. N: No Significant Other. See ‘S’ above. S: Sickness. Terminal illness, such as cancer and AIDS, also carries with it a 20 fold increase in risk of suicide compared to the general population. Scoring System 1 point for each positive answer on the above. Score Risk 02 No real problems, keep watch 34 Send home, but check frequently 56 Consider hospitalization involuntary or voluntary, depending on your level of assurance patient with return for another session 710 definitely hospitalize involuntarily or voluntarily

Responding to Suicidal Client •

Engage through acceptance, concern, and support

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Explore to understand what contributing factors or precipitating events

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Listen for client’s experience of “part of you wants to live and part of you wants to die”

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Begin shift towards life (position client to delay decision, safety contract)

Suicide Risk Assessment (Adults) •

Current suicidal thoughts, intent, and plan

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History of suicide attempts (e.g. lethal method, situation)

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Family history of suicide

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History of violence (e.g. weapon use, circumstances)

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Intensity of current depressive symptoms

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Current treatment regimen and response

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Recent life stressors (e.g. marital separation, job loss)

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Alcohol and drug use patterns

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Psychotic symptoms

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Current living situation (e.g. social supports, availability of weapon)

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Assess whether risk is low/moderate/high

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Is there a suicide plan?

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Has there been previous attempts?

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Is the plan doable at home or in community?

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Is the chosen method lethal?

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Does client have access to method?

Suicide Risk Assessment (Children) •

Did you ever feel so upset that you wished you were not alive or wanted to die?

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Did you ever do something that you knew was so dangerous that you could get hurt or killed?

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Did you ever try to hurt yourself or kill yourself?

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Did you tell anyone that you wanted to die or were thinking about killing yourself?

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Did you do anything to get ready to kill yourself?

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Did you think that what you did would kill you?

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Do you think about killing yourself more than once or twice a day?

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Have you tried to kill yourself since last summer/since school began?

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What would happen if you died? What would that be like?

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How do you remember feeling when you were thinking about trying to kill yourself?

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How is the way you felt then different from the way you feel now?

Kanel’s Crisis Intervention Model A. “People don’t care what you know, until they know that you care.” - Develop rapport-building communication - Not advice or therapeutic interpretation - Get a glimpse of client’s emotional pain - Behaviours that convey to client that you are present and interested in their point of view on the crisis - Threefold process; listen to content, observe client processes and nonverbal cues, pay close attention to your responses (not reactions) - Use cultural variations with client groups B. Problem Definition/Impact - Internal client perceptions easier to change and build hope than external circumstances - Identify ‘the straw that broke the camel’s back’ - Over 6 questions to find cognitive key and client meaning perception - What are the four general areas of stress? - Explore Internal Distress and Impairments in Functioning

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Review symptoms from last lecture Establish what is the nature of precrisis quality of lifestyle “ I can’t play piano now that I’m injured. How much did you play before the accident? Oh, I don’t know how to play piano.”

C. Coping Behaviors - What has client tried? - What worked in the past? - Identify healthy versus unhealthy patterns? - Encourage the risk of trying new COPING. - Suggesting alternatives, what info does counsellor need? - Give client practical/concrete plan to take home - Provide opportunities for follow-up and evaluation of plan

Robert’s Seven-Stage Model -

Develop and Practice Action Plan Brainstorm various alternatives Client chooses and invests energy in alternate manner of coping Rehearse and practice advantages and disadvantages of change

Question A patient is hospitalized with major depression and suicidal ideation. He has a history of several suicide attempts. For the first 2 days of hospitalization, the patient eats 20% of meals and stays in his room between groups. By the fourth day, the nurse observes that the patient is more sociable, is eating meals, and has a bright affect. Which factor should the nurse consider? A. The patient is showing improvement and may be ready for discharge. B. The patient may have decided to commit suicide; the nurse should reassess suicidality. C. The patient is feeling rested, supported by the therapeutic milieu, and less depressed. D. The patient is benefiting from the antidepressant he has been taking for 4 days....