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UNIT 2 ■ Psychiatric Mental Health Nursing Interventions
Risk Factors Suicide risk factors are identified as factors that have statistically been correlated with a higher incidence of suicide. They should be differentiated from sui- cide warning signs, which are identified as factors suggesting a more immediate concern. Both are included as part of a comprehensive assessment of overall risk for suicide. Marital Status Widows and widowers, in some studies, have been identified as high risk, but a longitudinal study found that being single or widowed had no effect on sui- cide rates (Kposowa, 2000). However, the Kposowa study did find that divorced men were twice as likely as married men to die by suicide. For those who are divorced or widowed, the stresses associated with major life changes and loss are influential. Evidence has demonstrated that change in marital status increases risk for suicidal behavior, particularly in the first year after the change and par- ticularly among older people (Ro˘skar et al., 2011; Yamauchi et al., 2013). Again, it should be noted that demographics such as marital status, age, and sex may inform about populations that are statistically at higher risk, but none of these factors is predictive of immediate risk. A thorough assessment of variables, including risk factors, warning signs, and a host of other data, is essential to identifying individuals at acute risk for attempting suicide. Sex More women than men attempt suicide, but men succeed more often (about 70% of men who attempt suicide succeed, and 30% of women who attempt it succeed). This rate reflects the lethality of the means. Women tend to overdose on drugs; men use more lethal means, such as firearms. These differ- ences between men and women may also reflect dif- fering societal expectations; women are more likely than men to seek and accept help from friends or professionals. Age Suicide risk and age are, in general, positively cor- related, particularly with men. Although rates among women remain fairly constant throughout life, rates among men increase with age. The most recent sta- tistics, according to the AFSP (2021), revealed that in 2018, the highest rate of suicide occurred in the 45-to-64-year-old age-group (with the highest rates
among those 52 to 59 years of age, and men 3.56 times more often than women), and the second-highest rate was for those 85 or older. Although adolescents may statistically have a lower rate of suicide than some other age-groups, it is still important to note that it has been, over several years, the third-leading cause of death in this population, and in 2013 it jumped to the second-leading cause of death where it remained in 2019 (CDC, 2021b). Sev- eral factors put adolescents at risk for suicide, includ- ing impulsive and high-risk behaviors, untreated mood disorders (e.g., major depression and bipolar disorder), access to lethal means (e.g., firearms), and substance abuse. One study (Reyes et al., 2015) found a link between some modes of anger expres- sion in adolescents and suicide risk; in particular, hopelessness and hostility modes of anger expression were associated with an increase in suicidal tendency. Among children younger than 10 years of age, the statistics demonstrate a low number of suicides, and some have argued that younger children do not have the capacity to intentionally consider and follow through with a suicide attempt. Anecdotal evidence has shown that this is not always the case, with some therapists identifying 5- to 9-year-olds actively talking about suicide (Jobes, 2015). Research is beginning to emerge that supports real risk in young children (Duran & McGuinness, 2016). Bridge and associates (2015) studied a large sample of children ages 5 to 11 and found that an average of 33 children per year die by suicide within this age-group in the United States, predominately from suffocation and hanging. These researchers also noted that suicide was never coded as a cause of death for children under 5 years of age. When Whalen and associates (2015) studied children in the 3-to-7-year-old age-group, they found about 11% with suicidal ideation. Increased risk was correlated with male gender, psychiatric illness in their mothers, and psychiatric illness in the child. In young girls ages 10 to 14 years, the incidence of self- inflicted injury has risen 18.8% every year between 2008 and 2015, and self-inflicted injury is one of the strongest risk factors for suicide (Mercado et al., 2017). Duran and McGuinness (2016, p. 29) stress that the implications for nursing are clear; direct inquiry about suicide ideas is a “necessary com- ponent in healthcare encounters with children,” including those in primary care, emergency depart- ments, and with the school nurse. The American Association of Suicidology (2021) reports that although the overall number of suicides for 2019 (47,511) was less than it was in 2018 (48,344),
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