The Suicidal Client
Chapter 16
Introduction
▪ Suicide is not a diagnosis or a disorder; it is a
behavior.
▪ More than 90% of individuals who attempt or
commit suicide have a diagnosed mental
disorder.
Suicide Statistics
▪ Suicide is the 10th leading cause of
death in the US
▪ Each year 44,193 Americans die by
suicide
▪ For every suicide - 25 attempts are
made
▪ Suicide costs the US $ 51 Billion annually
(American Foundation for Suicide Prevention, 2017)
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Epidemiological Factors
The annual age-adjusted suicide rate is 13.26
per 100,000 individuals.
Men die by suicide 3.5x more often than
women.
On average, there are 121 suicides per day.
White males accounted for 7 of 10 suicides in
2015.
Firearms account for almost 50% of all
suicides.
The rate of suicide is highest in middle age —
white men in particular.
(American Foundation for the Prevention of Suicide, 2017)
Risk Factors
▪ Marital status
▪ The suicide rate for single persons is twice
that of married persons.
▪ Gender
▪ Women attempt suicide more often, but
more men succeed.
▪ Men commonly choose more lethal
methods than women.
Risk Factors
▪ Age -Suicide risk and age are positively
correlated.
▪ Risk of suicide increases with age,
particularly among men.
▪ Suicidal rates rise sharply during
adolescence.
▪ White men older than 80 years are at the
greatest risk of all
age/gender/race groups.
Risk Factors
▪ Religion
▪ Affiliation with a religious group decreases
risk of suicide.
▪ Catholics have lower rates than Protestants
or Jews.
▪ Socioeconomic status
▪ Individuals in the very highest and lowest
social classes have higher suicide rates
than those in the middle class.
Risk Factors
▪ Ethnicity
▪ Whites are at highest risk for suicide,
followed by Native Americans, African
Americans, Hispanic Americans, and
Asian Americans.
Other Risk Factors
▪ Psychiatric illness: mood disorders are the
most common psychiatric illnesses that
precede suicide.
Other psychiatric disorders that account for
suicidal behavior include:
▪ Substance-related disorders
▪ Schizophrenia or psychosis with command
hallucinations
▪ Personality disorders
▪ Anxiety disorders
Other Risk Factors
▪ Severe insomnia
▪ Affliction with a chronic painful or disabling
illness
▪ Homosexual individuals have a higher risk of
suicide than their heterosexual counterparts
▪ Personal stressors
▪ Losses (personal or financial)
▪ Bullying (perpetrators and victims)
Higher Risk Factors
▪ Family history of suicide
▪ Having attempted suicide previously
increases the risk of a subsequent attempt
▪ About half of those who ultimately
commit suicide have a history of a
previous attempt
Predisposing Factors:
Psychological Theories of Suicide
▪ Anger turned inward
▪ Hopelessness
▪ Desperation and guilt
▪ History of aggression and violence
▪ Shame and humiliation
▪ Developmental stressors
Nursing Process: Assessment
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Age
Gender
Ethnicity
Martial status
Socioeconomic status
Occupation
Lethality and availability of method
Religion
Family history of suicide
Chronic and terminal physical illnesses
Nursing Process: Assessment
▪ Presenting symptoms/medical-psychiatric
diagnosis
▪ Suicidal ideas or previous attempts
▪ Seriousness of intent
▪ Plan
▪ Means
▪ Verbal and behavioral clues
▪ Interpersonal support system
Nursing Process: Assessment
▪ Analysis of the suicidal crisis
▪ The precipitating stressor
▪ Relevant history
▪ Life-stage issues
▪ Psychiatric/medical/family history
▪ Coping strategies
Nursing Process: Diagnosis /
Outcome Criteria
Nursing diagnoses for the suicidal patient
may include:
▪ Risk for suicide
▪ Hopelessness
Outcome Criteria – The patient:
▪ 1. Has experienced no physical harm to
self.
▪ 2. Sets realistic goals for self.
▪ 3. Expresses some optimism and hope for
the future.
Nursing Process:
Planning/Implementation - Inpatient
▪ Ask client directly: “Have you thought about
harming yourself in any way?
▪ Create a safe environment.
▪ Formulate a short term verbal or written
contract for safety.
▪ Maintain close observation.
▪ Maintain special care with medication
administration.
▪ Make rounds at frequent, irregular intervals.
▪ Encourage expression of honest feelings.
Nursing Process:
Planning/Implementation
Guidelines for treatment of the suicidal
patient on an outpatient basis:
▪ Do not leave the person alone.
▪ Establish a no-suicide contract with the
person.
▪ Enlist the help of family or friends.
▪ Schedule frequent appointments.
▪ Establish rapport and promote a trusting
relationship.
Nursing Process:
Planning/Implementation
Guidelines for treatment of the suicidal patient
on an outpatient basis
▪ Ask patient directly if they are having
thoughts about harming themselves in any
way.
▪ Discuss the current crisis situation in the
patient’s life.
▪ Identify areas of self-control.
▪ Antidepressant medications may be
prescribed.
Nursing Process:
Planning/Implementation
Crisis counseling with the suicidal client:
▪ Focus on the current crisis and how it can
be alleviated.
▪ Note client’s reactivity to the crisis and
how it can be changed.
▪ Work toward restoration of the client’s
self-worth, status, morale, and control.
▪ Introduce alternatives to suicide
▪ Rehearse more positive ways of thinking.
Nursing Process:
Planning/Implementation
▪ Crisis counseling with the suicidal client
▪ Identify experiences and actions that
affirm self-worth and self-efficacy.
▪ Encourage movement toward the new
reality.
▪ Be available for ongoing therapeutic
support and growth.
Nursing Process:
Planning/Implementation
Information for family and friends of the
suicidal patient:
▪ Take any hint of suicide seriously.
▪ Do not keep secrets.
▪ Be a good listener.
▪ Communicate to the person the importance
of having them in your life.
▪ Know about suicide intervention resources.
▪ Restrict access to firearms or other means of
self-harm.
Nursing Process: Evaluation
▪ Develop and maintain a more positive
self-concept.
▪ Learn more effective ways to express
feelings to others.
▪ Achieve successful interpersonal
relationships.
▪ Feel accepted by others and achieve
a sense of belonging.
Nursing Process:
Planning/Implementation
Information for family and friends of the
suicidal patient:
▪ Acknowledge and accept the person’s
feelings.
▪ Provide a feeling of hopefulness.
▪ Do not leave him or her alone.
▪ Show love and encouragement.
▪ Help them seek professional help.
▪ Assess the safety of children in the home.
▪ Do not judge or show anger toward
the person, or provoke guilt in him or her.
Nursing Process:
Planning/Implementation
Interventions with family and friends of suicide
victims
▪ Encourage the person to talk about the
suicide.
▪ Assess emotional reaction.
▪ Discourage blaming and scapegoating.
▪ Listen to feelings of guilt and self-persecution.
▪ Talk about personal relationships with the
victim.
▪ Recognize differences in styles of grieving.
▪ Assist with development of adaptive coping
strategies.
▪ Identify resources that provide support.
References
American Foundation for Suicide Prevention. (2017). Suicide statistics.
Retrieved from https://afsp.org/about-suicide/suicide-statistics/
Townsend, M. C. (2015). Psychiatric mental health nursing: Concepts of
care in evidenced-based practice (8th ed.). Philadelphia: F.A. Davis
Company