This document discusses suicide and its management. It defines suicide and provides historical and epidemiological context. Key points include that 95% of those who commit or attempt suicide have a diagnosed mental disorder. Risk factors include psychiatric illnesses, loss, access to lethal means. Nursing interventions aim to ensure safety, allow expression of feelings, enhance coping skills and self-esteem, and provide counseling, education and social support. Evaluation assesses changes in mood, thinking and social engagement over time.

1. SUICIDAL CLIENT
BY:- KAJAL CHANDEL

2. INDEX
S.R NO CONTENT
1. INTRODUCTION OF SUICIDE
2. HISTORICAL PERSPECTIVE OF SUICIDE
3. DEFINITION OF SUICIDE
4. CONCEPTS OF SUICIDE
5. EPIDEMIOLOGICAL FACTORS
6. INCIDENCE OF SUICIDE
7. RISK FACTORS OF SUICIDE
8. PREDISPOSING FACTORS OF SUICIDE
9. MANAGEMENT OF SUICIDE
10. NURSING DIAGNOSIS OF SUICIDE
11. BASIC LEVEL INTERVENTION

3. INTRODUCTION
 Suicide is one of the important psychiatric emergencies
which need immediate intervention. It is one of the most
common cause of death.

4. HISTORICAL PERSPECTIVE
 Approximately 95 percent of all person who commit or attempt to
suicide have diagnosed as mental disorders. In ancient Greece suicide
was an offense against the state and individual who committed
suicide were denied burial in community sites. In middle ages,
suicide was viewed as a selfish or criminal act. Individual who
committed suicide were often denied cementary burial and their
property was confiscated and shared by the crown and courts.

5. DEFINITION
“ The conscious of self- induced annihilation as a multidimensional malaise in a needful individual who
defines an issue for which the act is perceived as the best solution” .
Edwish Shncidman, (1985)
 “Ultimate act of self destruction”.
Clayton, (1985)
“ Aggression toward the self following the internalization of frustration or disappointment related to loved
one”.

6. CONCEPTS OF SUICIDE
 SUICIDE: act of intentionally ending one’s own life and
opting for nonexistence
 SUICIDE ATTEMPT: Includes all willful, self-inflicted
life- threatening attempts that have not led to death.
 SUICIDE IDEATION: Person is thinking about self-harm

7. EPIDEMIOLOGICAL FACTORS
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

8. INCIDENCE
 Worldwide suicide rate have increased by 60% in the past 50 years,
mainly in the developing countries. Most suicides in the world occur
in Asia, Which is estimated to the world health Organization, China,
India and Japan may account for 40% of all world suicides.
 Suicide rate in India was 11.2 per 100,000 in 2002. The rate vary
across the country with states such as Kerala having the highest
suicide rate of 30.8 per lakh in 2002.Suicide rate in Army, Air Force
and Naval personal were 0.04, 0.11 and 0.12 per thousand
respectively.

9. CONTINUE……
Rate are higher in urban in rural settings. Studies of completed
suicides show that 90-94% of the patients are mentally ill while
committing the act. Depression accounts for nearly half the
number of patients committing suicide followed by alcohol
abuse (34%) and Schizophrenia(13%).
Highest suicide rate is in the age group of 18-30 years. The ratio
of attempted suicide to completed suicide is 10:1.The highest
rates of suicide in India –Pondicherry, West Bengal, Kerala,
Chennai and Bangalore.

10. GENDER AND SUICIDE
 In the western world, males die much more often by
means of suicide than do female, although females
attempts suicide more often. This pattern has held for
at least a century. Some medical professionals believe
this stems from the fact that males are more likely to
end their lives through effective violent means (guns,
knives, hanging, etc.), while women primarily use
more failure-prone methods such as overdosing on
medications.

11. CONTINUE….
AGE AND SUICIDE
In the USA, males over the age of seventy die by suicide more
often than younger males. There is no such trend for females. It is
vary from developing countries like India. Adolescence and
adulthood more common in suicide.

12. SEASON AND SUICIDE
People die by suicide more often during spring and
summer. The idea that suicide is more common during
Christmas is a common misconception. There is also
potential risk of suicide in some people experiencing
seasonal affective disorder. Some studies have found that
elderly people are more likely to commit suicide around
their birthdays.

13. 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.

14. CONTINUE….
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.
Religion
Affiliation with a religious group decreases risk of suicide.

15. CONTINUE…..
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.

16. OTHER….
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
• Depressive disorders

17. CONTINUE….
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 other

18. CONTINUE…..
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.

19. PREDISPOSING FACTORS: THEORIES OF SUICIDE
Psychological theories
 Anger turned inward
 Hopelessness
 Desperation and guilt
 History of aggression and violence
 Shame and humiliation
 Developmental stressors

20. Sociological theory
Durkheim’s four social categories of suicide
 Egoistic suicide: is the response of the individual who feels
separate and apart from the mainstream of society.
 Altruistic suicide : opposite of egoistic suicide. Individual is
prone to altruistic suicide is excessively integrated into the
group.
 Anomic suicide : occurs in response to changes that occurs
in an individual’s life. (e.g. divorce, loss of job)

21. CONTINUE….
Fatalistic suicide : occurs when individuals are kept under tight regulation. These individuals are placed
under extreme rules or high expectations are set upon them, which removes a person’s sense of self or
individuality.

22. CONTINUE….
Biological theories
Genetics : much higher concordance rate for monozygotic
twins than for dizygotic twins.
Neurochemical factors : deficiency of serotonin in
depressed client who attempted suicide. Some changes in
noradrenergic system.

23. SUICIDE WARNING SIGNS

24. CONTINUE…..
TALK
Direct statements (I will end my life).
I can’t go on, “ Noting matters anymore,” “I wish I were dead”.
Being a burden to others.
Experiencing unbearable pain.
Having no reason to live.

25. CONTINUE…..
BEHAVIOR
 Looking for a way to kill themselves.
 Isolating from family and friends.
 Sleeping too much or too little.
 Visiting or calling people to say goodbye.

26. CONTINUE…..
MOOD
 Depression
 Loss of interest
 Irritability
 Humiliation
 Anxiety
 Fear

27. MODE OF SUICIDE

28. MODES OF SUICIDE
1. BLEEDING WRIST CUTTING

29. CONTINUE…..
2. DROWNING

30. CONTINUE…..
3. JUMPING FROM HEIGHT

31. CONTINUE…..
4. ELECROCUTION

32. CONTINUE
5. FIREARMS

33. CONTINUE…..
6. POISON

34. CONTINUE…..
7. DRUG OVERDOSE

35. CONTINUE…..
8. HANGING

36. MANAGEMENT
 MLC:(MEDICO LEGAL CASE) Sec.309 of IPS,
states that “ whoever attempts to commit suicide and
does any act towards the commission of such offense,
shall be punishable with simple imprisonment for a
team which may extend to one year and shall also be
liable to fine”.

37. PREVENTABLE
This management lies in preventing the act. This can be done at
suicide prevention centers. Crisis intervention centers, Psychiatric
emergency services, medical emergency services, social welfare
centers, even at home.
Important steps for preventing suicide are:-
 Take all suicidal threats; gestures to attempts seriously and
notify a psychiatrist.
 Inspect physical surrounding and remove all means of
committing suicide, like sharp objects, ropes, drugs, etc.

38. CONTINUE….
 Acute psychiatric emergency interview.
Counseling and Guidance.
Treatment of psychiatric disorder with medication of
ECT.
Follow up care- is very important to prevent future
suicidal attempts or suicide.

39. WORLD SUICIDE PREVENTION DAY 10 SEPTEMBER BY WHO
World suicide prevention day is an opportunity for people worldwide
to unite in commitment and action to ensure that suicides and
prevented, that people living with mental illness receive adequate
treatment, that community-based care and close follow-up are
available to people who attempts suicide, that access to common
methods of suicides is restricted, and that media reports of suicides
are more measured.
Every 40 seconds, the loss of a person who killed themselves shatters
the lives of family and friends. For every person who completes a
suicide, 20 or more may attempts suicide. For family and friends
affected by suicides or attempted suicide, the emotional impact can
last for many years.

40. CONTINUE….
World Suicide Prevention Day not only offers an opportunity to ensure that suicides are prevented , but
also that people living with mental illness, in particular depression and alcohol use disorders, receive
adequate treatment, that community-based care and close follow-up are available to people who attempt
suicide, that access to common methods of suicides is restricted, and that media reports of suicides are
more measured.

41. CHALLENGES AND OBSTACLES
Worldwide the prevention of suicide has not been adequately addressed due to basically a lack of awareness
of suicide as a major problem and the taboo in many societies to discuss openly about it. In fact, only a few
countries have included prevention of suicide among their priorities. Reliability of suicide certification and
reporting is an issue in great need of improvement.
It is clear that suicide prevention requires intervention also from outside the health sector and calls for an
innovative, comprehensive multi-sectoral approach, including both health and non-health sectors, e.g.
education, labour, police, justice, religion, low, politics, the media.
The 2013 international theme for would suicide prevention day is stigma: A major barrier to suicide
prevention.

42. ASSESSMENT
The following items should be considered when conducting a suicidal assessment. It include
 Demographic assessment
• Age
• Gender
• Ethnicity
• Marital status
• Occupation
• Religion
• Family history

43. CONTINUE….
 Presenting symptoms / medical –psychiatric
diagnosis
• What are the major physical or psychological
symptoms and treat the symptoms.
 Suicidal act or ideas
• How serious the intent and plan, means, is the first
time or second
 Interpersonal support system

44.  Analysis of the suicidal crisis likes
• Precipitating events
• Relevant history
• Life stage issues
Psychiatric/ medical/ Family history
The individual should be assessed with regards previous psychiatric treatment
SAD person scale is a simple, clear cut, and practical guide for gauging suicide potential. Ten categories
are described in the assessment tool, and the person being evaluated is assigned on point for each
applicable characteristics

45. NURSING DIAGNOSIS
 Risk for suicide related to prior suicidal attempts.
Ineffective coping mechanism related to disease condition as evidenced by poor problem solving skills.
Disabled family coping mechanism related to changing family environment as evidenced by poor
problem solving skills.
 Poor self-esteem related to depressive thoughts as evidenced by hopelessness.

46. PLANNING
INTERVENTION
Level of intervention
Nursing interventions for suicide takes place in three levels
 Primary intervention
It includes activities that provide support, information an
education to prevent suicide
 Secondary intervention
It is the treatment of actual suicidal crisis
 Tertiary intervention
It refers to the intervention with the family and friends of
aperson who committed suicide to reduce the traumatic after
effects.

47. NURSING INTERVENTION
1. Risk for suicide related to prior suicidal attempts.
Intervention:-
◦ Closely supervise the patient by sustaining observation or awareness of the patient at all times.
◦ Provide a safe environment to the patient.
◦ Give opportunities to the patient to express thoughts, and feelings in a nonjudgmental environment.
◦ Stay with the patient more often.

48. CONTINUE…..
2. Ineffective coping mechanism related to disease condition as evidenced by poor problem solving
skills.
Intervention:-
◦ Assist patient set realistic goals and identify personal skills and knowledge.
◦ Provide chances to express concerns, fears, feeling, and expectations.
◦ Use empathetic communication.
◦ Encourage the patient to recognize his or her strengths and abilities.

49. CONTINUE…..
3. Disabled family coping mechanism related to changing family environment as evidenced by poor
problem solving skills.
Intervention:-
◦ To assess the causative and contributing factors: ascertain preillness behavior/ interaction of the family
◦ Established rapport with family members who are available and promotes therapeutic relationship and
support for problem solving solutions.
◦ Allow free expression of feelings, including frustration, anger, hostility and hopelessness.
◦ Provide time for private interaction between client/family.

50. CONTINUE…..
4. Poor self-esteem related to depressive thoughts as evidenced by hopelessness.
Intervention:-
◦ Develop a trust relationship with patient.
◦ Encourage the patient to participate in self-care activities.
◦ Enhance sense of self by being attentive through
- Listening
- Validating your interpretation of what is being said or experienced.
- Helping the patient verbalize what he/she is experiencing non- verbally.

51. BASIC LEVEL INTERVENTION
 In the hospital or community setting the basic level
registered nurse utilizes counseling, health teaching, case
management, and psychobiological interventions.

52. MILIEU THERAPY WITH SUICIDAL PRECAUTIONS
 In accordance with the unit policies and procedures,
client in continuously observed by nursing staff.
Monitoring flow sheets for suicide precautions are more
clinically useful if they include a description of affect as
well as behavior. Nurse should monitor the environment
for safety hazards.

53. COUNSELLING
 Counselling skill including interviewing, crisis care, and
problem solving techniques are used in both the inpatient
and outpatient setting.
 The key element is establishing a working alliance to
encourage the client to engage in more realistic problem
solving. One particular aspect of counselling. One
particular aspect of counselling is the use of no-suicidal
contract.

54. HEALTH TEACHING
 The nurse teaches the client about any psychiatric diagnosis
present and about medications, age related crisis, community
resources, coping skills and communication skills especially
the expansion of anger.

55. CASE MANAGEMENT
 Case management is an important aspect of nursing care
of suicidal client. The clients perception of being alone
without support after blinds the person to the real support
figure who are present.

56. PSYCHOBIOLOGICAL INTERVENTIONS
 A significant nursing intervention to assist the
suicidal client in regaining self control is the careful
administration of medication. All medication should
give to high risk clients are monitored carefully.

57. EVALUATION
 Evaluation of suicidal clients is an ongoing part of assessment.
The nurse must be constantly alert to the changes in the suicidal
patients mood, thinking, and behavior. In evaluation the nurse
also look for indications that the client is communicating
thoughts and feelings more readily and that the clients social
network is widening.

58. SUMMARIZATION
Suicide is the taking of one's own life. It is a death that happens when someone harms themselves because
they want to end their life. A suicide attempt is when someone harms themselves to try to end their life, but
they do not die. Suicide is a major public health problem and a leading cause of death. The effects of suicide
go beyond the person who acts to take his or her life. It can also have a lasting effect on family, friends, and
communities.

59. CONCLUSION
Youth suicide constitutes a major public mental health problem. Young people and especially adolescents
are by nature a vulnerable group for mental health problems. While suicide is relatively rare in children, its
prevalence increases significantly throughout adolescence.

60. BIBLIOGRAPHY
BOOK REFRENCES
 Raj Bhaskara Elakkuvana D., Debr’s Mental Health (Psychiatric Nursing), EMMESS, edition 2, Pp-
315-322.
INTERNET REFRENCES
 https://pt.slideshare.net. Net. Suicidal client (viewed on March 5, 2022).
 https://www.Wikipedia.com-suicide (viewed on March 10,2022).