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UNIT 2 ■ Psychiatric Mental Health Nursing Interventions
a rational act? Most people in our society do not yet believe that it can. In the field of psychiatry, suicide is considered an irrational act associated with mental illness and most commonly, but not exclusively, with depression. How- ever, not everyone who dies by suicide has a mental illness. Individuals in non-psychiatric health-care settings and in the community may also be at risk. This chapter explores suicide from an epidemiolog- ical and etiological perspective. Care of the suicidal patient is presented in the context of the nursing process. Historical Perspectives In ancient Greece, individuals were said to have “com- mitted” suicide because it was an offense against the state, and individuals who did so were denied burial in community sites (Minois, 2001). In the culture of ancient Rome, individuals sometimes resorted to sui- cide to escape humiliation or abuse. In the Middle Ages, suicide was viewed as a selfish or criminal act (Minois, 2001). Individuals who “com- mitted suicide” were often denied cemetery burial and their property was confiscated and shared by the crown and the courts (MacDonald & Murphy, 1991). The issue of suicide changed during the Renaissance period. Although condemnation was still expected, the view became more philosophical, and intellectu- als could discuss the issue more freely. Most philosophers of the 17th and 18th centuries condemned suicide, but some writers recognized a connection between suicide and melancholy or other severe mental disturbances (Minois, 2001). Suicide was illegal in England until 1961, and only in 1993 was it decriminalized in Ireland. With the decriminalization of suicide, many have advanced the idea that the term committed suicide should be removed from our vocabulary because it is inaccu- rate and potentially maintains a stigmatizing attitude toward this population. Most religions consider suicide as a sin: Judaism, Christianity, Islam, Hinduism, and Buddhism all con- demn suicide. The Catholic Church still teaches that suicide is wrong, that it is in opposition to proper love of self and love of God, and that it wrongs oth- ers through the experience of loss and grief (Byron, 2016). But as Byron points out, some of the church’s condemnation may have been rooted in a “denial of the responsibility to understand the pain” that pro- duces such an act, and he stresses the importance of encouraging those who “are hurting to open up,”
which, it is hoped, will remove some of the taboos of discussing suicide within the church. Likewise, replacing the term committed suicide (which has per- sisted long since its decriminalization) may also help to reduce the stigma and taboo that has historically been associated with discussing suicide. Epidemiology In 2019, the most recent year for which statistics have been recorded, 47,511 people died by suicide in the United States (Centers for Disease Control and Pre- vention [CDC], 2021a). Most of those deaths were firearm suicides. These statistics have established sui- cide as the second-leading cause of death (behind unintentional injuries) among young Americans ages 10 to 24 (19.2% of deaths) and 25 to 44 (10.9%), the eighth-leading cause for those ages 45 to 64 (3.1% of deaths), and the 10th-leading cause of death overall (CDC, 2019a). (While suicide has been the 10th-leading cause of death for several years, provi- sional statistics for 2020 indicate suicide as the 11th- leading cause of death for a year where COVID-19 deaths became the third-leading cause of death over- all in the United States [Ahmad et al., 2021].) Many more people attempt suicide than succeed (about 12:1), and countless others seriously contemplate the act without carrying it out. With a steady incline in rates of suicide over the period from 2000 to 2018, suicide has become a major health-care problem in the United States today. Not only have the number of suicides been on the incline but the demographics have changed. Histor- ically, the highest rates of suicide were among the elderly. However, the current highest rates of suicide are among individuals ages 45 to 54 and the second- highest are those over 85 years of age (American Foundation for Suicide Prevention [AFSP], 2021). Historically, the suicide rate has been lower among military personnel than among the general popula- tion. However, in some time periods since the Iraq War began—including in 2010 and 2011—more soldiers died by suicide than died in combat (Nock et al., 2013). The Department of Defense reports that among all military populations, the 2018 rate of suicide was consistent over the last two years but rates from the active military component were statis- tically higher than the last five years (Lopez, 2019). See Chapter 28, “Military Families,” for further discussion. Research is being conducted to better under- stand the best methods for assessment of suicide
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