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Course: Mental Health Nursing

Topic: Suicide Part I

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Module Goals

Learners will be able to

Define suicidal ideation.
Discuss the various etiologies of suicide.
Discuss the characteristics of an individual with suicidal ideation.

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Suicidal Ideation (SI)

Often called suicidal thoughts or ideas.

A broad term used to describe a range of contemplations, wishes, and preoccupations with death and suicide.

Hamer et. al., 2021

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Suicidal Ideation (SI)

The magnitude and characteristics of SI vary in intensity, duration, and character.

Present in a “waxing and waning manner”.

Hamer et. al., 2021

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Active Suicidal Ideation

Denotes experiencing current, specific, suicidal thoughts.

Example of an active SI assessment

Miller et al. (1991) Modified Suicidal Ideation Scale.

"Over the past day or two, when you have thought about suicide, did you want to kill yourself? How often? A little? Quite often? A lot? Do you want to kill yourself now?"

Hamer et. al., 2021

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Passive Suicidal Ideation

A general wish to die, but no plan of inflicting lethal self-harm

Examples of passive SI assessment items

Miller et al. (1991) Modified Suicidal Ideation Scale

"Would you deliberately ignore taking care of your health? Do you feel like trying to die by overeating (or eating too little), drinking too much (or too little), or not taking needed medications?"

Hamer et. al., 2021

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Case Study

Discuss the differences between active and passive SI.

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Etiology

Diathesis-Stress Models of Suicide

Suggests that variations and interactions between biological and psychological risk factors predispose some individuals to a vulnerability of suicide.

There are five broad categories of risk factors for SI and suicidal behaviors.

Hamer et. al., 2021

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Five Broad Risk Factors for Suicide and Suidical Behaviors

Internal psychopathology
Prior suicidal thoughts and behaviors
Risk Factors
External psychopathology
Social factors

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Risk Factors: Internal Psychopathology

Anxiety disorders
Mood disorders
Hopelessness
Emotional dysregulation
Sleep disturbances

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Etiology

B. Risk factors

Advanced age
Chronic illness (Continuous pain)
A family history of suicides
Financial difficulties
Negative life experiences
Loss of job
Marital status divorced

O'Rourke, Jamil, & Siddiqui, 2021

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For individuals aged 15–44 years, suicide ranks as one of the top three leading causes of death

Compared to younger populations, older adults are more apt to endorse passive SI and less inclined to express active SI or seek mental health care

Overall, the highest risk for suicide is in men over the age of 65.
White males over the age of 85 have a very high rate of suicide.
Suicide is the third leading cause of death in adolescents and teens between ages 15 to 24.
Men have a much higher rate of suicide completion than women.
Women tend to have a much higher rate of attempts.
Seventy-five percent of all suicides are seen in white males.
In men, suicide risk is highest for those between ages 50 to 85 (30 deaths per 100,000).
In women, the suicide risk is highest between ages 60 to 65 (5 to 7 deaths per 100,000).
Among ethnic groups, the highest risk of suicide is in Alaskan natives, American Indians, and non-Hispanic whites. While the highest risk of suicide among Alaskan natives is in adolescents, in non-white Hispanics, the risk of suicide continues to increase with advancing age.
In the United States, the highest suicide rates are among whites, followed by American Indians and Alaskan natives. Suicide rates are much lower in African Americans, Asians, and Pacific Islanders

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Etiology

C. Prior suicidal thoughts and behaviors

Prior deliberate self-harm
Nonsuicidal self-injury
Suicide attempt
Suicide ideation

D. External psychopathology

Aggressive behaviors
Impulsivity
Incarceration history
Antisocial behaviors
Substance abuse

(Hamer et. al., 2021)

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Etiology

E. Social factors

History of abuse
Family problems
Isolation
Peer problems
Stressful life events

Hamer et. al., 2021

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Case Study

Discuss the risk factors for suicidal Ideation.

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Suicide-related Characterisrics

Suicidal characteristics

A preoccupation with death
A sense of isolation and withdrawal
Few friends or family members
An emotional distance from others
Distraction and lack of humor

They often seem to be "in their own world" and lack a sense of humor (anhedonia)

Focus on the past
Haunted and dominated by hopelessness and helplessness

Soreff, Basit & Attia, 2021

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Activities Intent to Commit Sucide

Several activities that have been associated with an intent to commit suicide.

Buying a weapon like a gun, rope, or chemicals
Getting the house and family affairs together
Going to the emergency room or visiting a healthcare provider
Making a will
Seeing friends and family unexpectedly
Writing a suicide note

O'Rourke, Jamil, & Siddiqui, 2021

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Common Expressions of Suicidal Individuals

Cry for help
Escape: “I can not put up with this mess any longer” (Embarrassing or traumatic situations)
Heroic: To gain respect, some cultures view suicide as an accepted alternative to failure
Loss of self-esteem
Manipulation: The coercive measure “you better come back to me, or I will kill myself”
Martyrdom: “Nobody cares for me and everyone would be better off without me”
Rebirth: Fantasy of new life

Keltner, Schweeke, & Bostrom, 2003

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Common Expressions of Suicidal Individuals

Redemption: An attempt to make up for some wrong.

Relief of pain: “I can not stand the pain” (Physical or emotional).

Retaliatory: Suicide is viewed as getting even: “I will show them”.

Reunion: Joining the loved on in heaven: “I can not live without them”.

Keltner, Schweeke, & Bostrom, 2003

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Red Flags

Buying a weapon like a gun, rope, or chemicals
Getting all the house and family affairs together
Going to the emergency room or visiting a healthcare provider
Making a will
Seeing friends and family unexpectedly
Writing a suicide note
Visiting a primary care physician

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Cultural Considerations

To gain respect some cultures view suicide as an accepted alternative to failure.

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References

Harmer B, Lee S, Duong TvH, et al. [Updated 2021 Aug 6]. Suicidal Ideation. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK565877/

Keltner, NL., Schweeke, LH., & Bostrom, CE. (2003). Depression. Psychiatric Nursing. 4th Ed. Mosby.

O'Rourke MC, Jamil RT, Siddiqui W. [Updated 2021 Jun 15]. Suicide Screening and Prevention. In: StatPearls [Internet]. StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK531453/

Soreff SM, Basit H, Attia FN. Suicide Risk. [Updated 2021 Jul 25]. In: StatPearls [Internet]. StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441982/

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