241
CHAPTER 11 ■ Suicide Prevention
Evaluation Evaluation of the client who is suicidal is an ongoing process accomplished through continuous reassess- ment and determination of goal achievement. Once the immediate crisis has been resolved, extended psychotherapy may be indicated. The long-term goals of individual or group psychotherapy for the suicidal client would be to: ■■ Develop and maintain a more positive self-concept and a sense of hopefulness. ■■ Learn more effective ways to express feelings to others. ■■ Achieve successful interpersonal relationships. ■■ Feel accepted by others and achieve a sense of belonging. A person contemplating suicide feels worthless, hope- less, and oftentimes numb. These goals are directed toward promoting a sense of self-worth while offer- ing a measure of hope and a purpose for living. Summary and Key Points ■■ The majority of all persons who attempt or die by suicide have a diagnosed mental disorder. ■■ The highest current rates of suicide occur between the ages of 45 and 64 years (with the highest rates among those 52 to 59 years of age, and men 3.56 times more often than women). The second- highest rate was for those 85 or older. Suicide is the second-leading cause of death among young Americans ages 15 to 44 years and the eighth- leading cause of death for those ages 45 to 64. ■■ Evidence supports that recent change in relation- ship status (such as breakups, divorce, and widow- hood) is a proximal risk factor. ■■ More women than men attempt suicide, but men succeed more often. ■■ Depressed men and women who consider them- selves affiliated with a religion are less likely than their nonreligious counterparts to attempt suicide. ■■ Financial strain and unemployment are identified as risk factors for suicide. ■■ Among ethnic/racial groups the highest rates of suicide occur in white populations with the second-highest rate among American Indians and Alaska Natives. Much lower and roughly similar rates were found among black populations, Asians, and Pacific Islanders. ■■ Psychiatric disorders that are associated with higher risk for suicide include mood disorders, substance use disorders, schizophrenia, anorexia nervosa, borderline and antisocial personality
disorders, anxiety disorders, and attention deficit- hyperactivity disorder. ■■ Predisposing factors include internalized anger, hopelessness and other symptoms of severe depres- sion, history of aggression and violence, shame and humiliation, developmental stressors, sociological influences, genetics, and neurochemical factors. ■■ Suicide risk assessment should be a patient- centered, collaborative process in the context of a therapeutic relationship and should chronolog- ically explore presenting suicide events, recent events, past events, and immediate intentions. ■■ Assessment of the level of intervention needed includes identifying the number of proximal or potentiating risks as well as the number of warn- ing signs. ■■ It is important for the nurse to determine the seri- ousness of the patient’s suicidal intentions, the existence of a plan, and the availability and lethal- ity of the method. ■■ Many tools exist to screen for risk factors and warning signs for suicide. The Columbia Suicide Severity Rating Scale is an evidence-based tool for assessing the degree of risk and making clinical judgments about what level of treatment is needed to help the patient remain free from self-injury or death by suicide. Risk assessment scales should not be used alone but in combination with a compre- hensive psychosocial assessment. ■■ The suicidal person should not be left alone. ■■ A safety plan is developed with the patient follow- ing a comprehensive suicide risk assessment and includes assisting the patient to recognize warn- ing signs, identify and employ coping strategies, engage family members and friends as available support persons, identify people and social set- tings that can be used to distract from suicidal thoughts or urges, identify resources and contact information for crisis intervention, and problem- solve ways to restrict access to lethal means. ■■ Once the crisis intervention is complete, individ- uals may require long-term psychotherapy, during which they work to: ■■ Develop and maintain a more positive self- concept. ■■ Learn more effective ways to express feelings. ■■ Improve interpersonal relationships. ■■ Achieve a sense of belonging and a measure of hope for living. ■■ Evidence-based psychological interventions include dialectical behavior therapy, cognitive behavior therapy, and the Collaborative Assessment and Management of Suicidality (CAMS) approach.
Powered by FlippingBook