Veteran’s – Suicide Rates 248 completed suicides in one year: 3x the rate of non-dependent vets. 63% of outpatient vets were alcohol dependent. 1/3 of those with alcohol dependence were also “other” drug dependent. 770 reported suicide attempts in same year. Kausch, 2001
Veteran’s – Suicide Risk Factors The longer they were alcohol dependent, the greater the risk. Most were male in the third decade of life, which is approximately 10 years younger than non-veteran suicides. Mood and Personality Disorders increased risk. Kausch, 2001
Opioid Dependence & Suicidality Maloney, 2007
Opioid Dependence and Suicide Rates 66% lifetime prevalence of suicide ideation. 31% had attempted suicide 19% had attempted suicide more than once. 63% indicated a severe intent to die. Both cases and controls were more likely than the general population to suffer from substance abuse issues and psychological disorders. Maloney, 2007
Opioid Dependence and Suicide Risk Factors Childhood Maltreatment – including physical, emotional, sexual & neglect Axis II Disorders, esp. Borderline Personality Disorder DSM-IV Diagnosis of PTSD Depressive Episode Other drug dependency (sedatives, stimulants) Unemployment Maloney, 2007
What can we do as nurses?
Non-physicianAssessment and Service Planning Bartels, 2005
Evaluating Provider Assessments Survey conducted of NON-physician community mental health providers: 13 agencies, 44 clinicians, & 100 consumers. Bartels, 2005 33% failed to screen for substance use. Over 40% failed to screen for suicide risk and dangerous behaviors. Over 75% failed to screen for caregiver burden & risk of neglect or abuse.
Integrated Assessment, Planning and Evaluation Multi-disciplinary team of clinicians, consumers, administrators, and clinical outcomes researchers developed an integrated system of clinical assessment, service planning, and outcome measurement. Compare to nursing process: Assessment, Diagnosis, Planning, Intervention and Evaluation (ADPIE) Bartels, 2005
The Non-physician Intervention Included 4 elements: Selecting key domains of functioning and symptoms Identification of valid, brief assessment and outcome measures Development of decision-support materials for selecting appropriate treatments Pilot-testing in community settings. Bartels, 2005
Symptom-specific Domains Axis I – Behavioral Issues Axis IV – Social/Environmental Axis V – Global Functioning Bartels, 2005 Depression, suicide, mania, anxiety, suspiciousness, hallucinations, substance abuse, hostile and dangerous behaviors, and memory. Daily living skills, personal care skills, social skills, leisure activities, work and education, health status, and treatment, self-management. Social supports, caregiver burden, residential risk, safety, neglect and abuse, and residential status.
Outcomes and Evaluation Increased comprehensiveness of assessments and specificity of treatment planning. Major gains made in routine clinical assessment practices as described through clinician interviews, and reflected in medical record reviews. Improvements also found in the specificity of service plans. Bartels, 2005
Nurses can make a difference Major gap between knowledge and routine clinical practice. Promote use of standardized methods that guide the clinician (nurse) through the process of assessment, outcome measurement, and treatment planning. Demonstrated effectiveness. Bartels, 2005
Suicide,Chemical Dependency and Mental Health IssuesGo Hand in Hand We can be the ones who ask…
References Bartels, S.J., Miles, K. M., VanCitters, A.D., Forester, B.P. & Cohen, M.J. (2005). Practices for older adults: A controlled comparison study. Mental Health Services Research, 7 ,213-223. Kausch, O., McCormick , R.A., (2001). Suicide prevalence in chemical dependency programs: preliminary data from a national sample, and an examination of risk factors. Journal of Substance Abuse Treatment,2,97–102. Maloney, E., Degenhardt, L., Darke, S., Mattick, R.P., & Nelson, E., (2007). Suicidal behaviour and associated risk factors among opioid-dependent individuals: A case–control study. Society for the Study of Addiction, 102, 1933–1941.