The Suicidal Client

1. The Suicidal Client Nursing 202

2. The Suicidal Client • Approximately 30,000 persons in the United States end their lives each year by suicide. • Suicide is the 3rd leading cause of death among Americans 15 to 24 years of age 5th leading cause of death for ages 25 to 44 8th leading cause of death for ages 45 to 64

3. 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. • Age • Risk of suicide increases with age, particularly among men. • White men older than 80 years are at the greatest risk of all age/gender/race groups.

4. Religion • Affiliation with a religious group decreases risk of suicide • Socioeconomic status • Individuals in the very highest and lowest social classes have higher suicide rates than those in the middle class. • Ethnicity • Whites are at highest risk for suicide, followed by Native Americans, African Americans, Hispanic Americans, and Asian Americans.

5. 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 * personality disorders * anxiety disorders • Severe insomnia is associated with increased risk of suicide. Use of alcohol and barbiturates • Psychosis with command hallucinations • Affliction with a chronic painful or disabling illness • Family history of suicide

6. 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. • Loss of a loved one through death or separation is a risk factor. • Lack of employment or increased financial burden increases the risk of suicide.

7. Psychological theories • Psychological theories • Anger turned inward • Hopelessness • Desperation and guilt • History of aggression and violence • Shame and humiliation • Developmental stressors

8. Sociological theory • Durkheim’s three social categories of suicide • Egoistic suicide • Altruistic suicide • Anomic suicide • Biological theories • Genetics • Neurochemical factors

9. Assessment

10. Diagnosis

11. Guidelines for Treatment of the Suicidal Client on an Outpatient Basis • Do not leave the person alone. • Establish a no-suicide contract with the client. • Enlist the help of family or friends. • Schedule frequent appointments. • Establish rapport and promote a trusting relationship. • Do not leave the person alone. • Establish a no-suicide contract with the client. • Enlist the help of family or friends. • Schedule frequent appointments. • Establish rapport and promote a trusting relationship.

12. Information for Family and Friends of the Suicidal Client • Take any hint of suicide seriously. • Do not keep secrets. • Be a good listener. • Express to the client feelings of personal worth. • Know about suicide intervention resources. • Restrict access to firearms or other means of self-harm.

13. Interventions with Family and Friends of Suicide Victims • Encourage them to talk about the suicide. • Discourage blaming and scapegoating. • Listen to feelings of guilt and self-perception. • 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.