Suicide

By/ Dr. Inas Ebeid
Faculty of nursing
Taibah university

LEARNING OBJECTIVES
Upon completion of this lecture the audience will be able to:
1- Define suicide
2- Determine the incidence of suicide
3- Identify the factors that affect suicide rates
4- List modes of suicide
5- Recognize the measures of prevention for suicide
6- Assess patient with suicidal ideation
6- Identify nursing interventions for suicide

OUTLINES
1- Definition of suicide
2- Incidence of suicide
3- Risk factors of suicide
4- Modes of suicide
5- Measures of prevention for suicide
6- Assessment of patient with suicidal ideation
6- Nursing interventions for suicide

INTRODUCTION
Every year more than 800 000
people take their own life and there
are many more people who attempt
suicide. Every suicide is a tragedy
that affects families, communities
and entire countries and has long-
lasting effects on the people left
behind.

INTRODUCTION
Suicide is a serious public health
problem; however, suicides are
preventable with timely, evidence-
based and often low-cost
interventions.

DEFINITION OF SUICIDE
Originally, the word suicide, founded on Latin language
‘sui’ (oneself) and ‘caedes’ (killing)
suicide constitutes all cases of death directly or indirectly
resulting from act of a person who is aware of the consequences
of the behavior.

“SUICIDE IS A
PERMANENT SOLUTION
TO
A TEMPORARY
PROBLEM.”
If this is so obvious, then why is suicide so
distressingly common?

PREVALENCE OF SUICIDE
•Over 800 000 people die due to suicide every year.
•Stigma surrounding suicide leads to underreporting of data
•75% of global suicides occur in low- and middle-income countries.
•Ingestion of pesticide, hanging and firearms are the most common
methods of suicide globally.
•Reviewed September 2016

INCIDENCE OF SUICIDE (WHO,2014)

WHAT FACTORS AFFECT SUICIDE
RATES?

-- SEX
• Men are “better” at suicide than women. Four times as men
complete suicide, but women make more attempts.
• Male suicide attempts are more lethal because men typically use a
gun or an equally fatal method.
• Women most often attempt a drug overdose, so there’s a better
chance of help.

-- AGE
- Suicide rates increase
with advancing age.
More than half of all
suicide victims are over
45 years old.
- In fact, suicide is more
common among 15- to
24-year-olds.

-- MARITAL STATUS
Marital status is also related to
suicide rates. Married individuals
have lower rates than divorced,
widowed, or single persons.

-- HEALTH FACTORS
Mental health conditions
• Depression
• Bipolar (manic-depressive) disorder
• Schizophrenia
• Borderline or antisocial personality
disorder
• Anxiety disorders
• Substance abuse disorders
Serious or chronic health condition
and/or pain

PSYCHOLOGICAL FACTORS
• Hopelessness
is one of the strongest predictors for
suicidal behavior.
• aggression and impulsivity, lack of
reasons for living
• Feeling of worthless and helpless
• An extremely negative self-image
• cognitive rigidity (dichotomous)
(all-or-nothing thinking)
• poor problem-solving capabilities

-- ENVIRONMENTAL FACTORS
• Stressful life events which may include
a death, divorce, or job loss
• Prolonged stress
• Access to lethal means including
firearms and drugs
• Exposure to another person’s suicide
• Isolation and lack of social support

-- HISTORICAL FACTORS
Previous suicide attempts
A history of a suicide attempt is a major risk factor for both
repeated nonfatal suicidal behavior and suicide.
Family history of suicide attempts

FORMS OF SUICIDE
1- depressive ( planned).
2- impulsive .
3- away of attracting attention.

SUFFOCATION
one is more likely to commit suicide through gas
inhalation than attempting to prevent breathing all
together. Inert gases such as helium, nitrogen,
and argon, or toxic gases such as carbon
monoxide are commonly used in suicides by
suffocation due to their ability to quickly render a
person unconscious, and may cause death within
minutes.

-- SUICIDE WARNING SIGNS
Talk
•Direct statements (I will end my life)
•I can't go on," "Nothing matters anymore," "I wish I
were dead"
•Being a burden to others
•Experiencing unbearable pain
•Having no reason to live

Behavior
•Looking for a way to kill themselves
•Acting recklessly
•Isolating from family and friends
•Sleeping too much or too little
•Visiting or calling people to say goodbye
•Giving away his own possessions

Mood
•Depression
•Loss of interest
•Irritability
•Humiliation
•Anxiety
• Fear

PREVENTION
Universal prevention strategies include:
• generally improving the quality of people’s lives thereby
reducing stress
• decreasing the availability of lethal means, such as control
of guns.
• Selective strategies include in schools and institutions so
that depressed and suicidal individuals can be identified and
treated before they harm themselves
• focusing on high-risk groups those already diagnosed as
depressed
• Assert religious and cultural believes that discourage it.

PSYCHIATRIC ASSESSMENT
Suicidal behaviors are frequently symptoms of underlying
mental health problems. Therefore, a suicide risk assessment
cannot be undertaken in isolation from an overall mental health
assessment.

INTERVIEW PROCESS
Unlike medical interviews, where the patient and parents may
be interviewed together, a psychiatric interview must include
some time alone with each party, especially when assessing
the patient’s potential dangerousness, to obtain a complete
picture of the problem.

DIRECT QUESTION …???
Contrary to popular myth, children and adolescents do not
become suicidal when asked about suicidal thoughts. It is
extremely important that the physician ask about suicidal
ideation, plans, or attempts openly and frankly:
A patient who answers no to these questions is probably not
telling the full story.

HISTORY OF SUICIDAL BEHAVIORS
• Has the person harmed himself or herself before?
• What were the details and circumstances of the
• previous attempt/s?
• Is there a history of suicide of a family member
or friend?

CURRENT SUICIDAL THOUGHTS
• Are suicidal thoughts and feelings present?
• What are these thoughts (determine the content, eg guilt or
delusions)?
• When did these thoughts begin?
• How frequent are they?
• How persistent are they?
• What has happened since these thoughts started?
• Can the person control them?
• What has stopped the person from acting on their thoughts so
far?

LETHALITY/INTENT
• What is the person’s degree of suicidal intent?
• Was their attempt carefully planned or impulsive?
• Has the person finalized personal business, eg
given away their possessions and said their
goodbyes?*

PRESENCE OF A SUICIDE PLAN
• How far has the suicide planning process
proceeded?
• Specific method, place, time?
• How long has the person had the plans?
• How realistic are the plans?

ACCESS TO MEANS AND KNOWLEDGE
• Has the person made a special effort to find out
information about methods of suicide or do they have
particular knowledge about using lethal means?
• Is there any item or aspect of the in-patient environment
that may be used as a means to self-harm?
• Type of occupation? For example, police officer (access
to gun), health worker (access to drugs).

SAFETY OF OTHERS
• Have the person’s thoughts ever included harming
someone else as well as himself or herself?
• Has the person harmed anyone else?
• What is the person’s rationale for harming another
person?
• Is there a risk of murder-suicide?

COPING POTENTIAL OR CAPACITY
• Does the person possess the capacity to enter into
a therapeutic alliance?
• personal strengths or effective coping strategies:
How have they managed previous life events and
stressors?
• Are there social or community supports (eg family,
friends, church, general practitioner)?

nursing observation
during hospitalization

NURSING OBSERVATION LEVELS
• On admission, the doctor, in consultation with the senior nurse,
is to determine the category of nursing observation.
• A clear explanation is to be given to the patient about the
reason for the particular observation level.
• Levels are to be reviewed throughout each shift by the treating
team & report to senior nurse to minimize the level of
unnecessary restriction to the patient’s rights

-- HIGH LEVEL OF IMMEDIATE RISK
Patient is to be contained in a locked facility.
■ Patient is to be nursed on a 1:1 basis.
■ Nurse is to be in close proximity to patient .
■ Patient is to be checked for signs of life (eg respiration) each
10 minute interval throughout the night and these are to be
documented.
■ There is no leave to be granted.
■ Individual observations chart kept as part of patient’s medical
record.

PATIENT IS ASSESSED AS A LOWER LEVEL OF
RISK OF SUICIDE OR SELF-HARM.
• Patient is checked every 30 minutes throughout
the day and night.
• Patient is confined to the ward.
• Patient must be with a member of staff when out of
the unit.
• Individual observations chart kept as part of
patient’s medical record.

PATIENT IS NOT CURRENTLY IN SELF-HARM
RISK.
Patient is checked every 2 hours and at change of
shift.

NURSING INTERVENTION
• The client’s room should be near the nurses’ station and
within view of the staff, not near to an exit, elevator, or stairs.
• Be alert to the possibility of the client saving up his or her
medications or obtaining medications or dangerous objects
from other clients or visitors. You may need to check the
client’s mouth after medication administration or use liquid
medications to ensure that they are ingested.

• Convey that you care about the client and that you believe the
client is a worthwhile human being.
• Give the client support for efforts to remain out of his or her
room, to interact with other clients, or to attend activities.
• Encourage and support the client’s expression of anger.
(Remember: Do not take the anger personally.)
• Involve the client as much as possible in planning his or her
own treatment.

Examine with the client his or her home environment and
relationships outside the hospital.

TYPES OF THERAPY
Family therapy .
Cognitive Behavioral Therapy (CBT)
Problem-Solving Therapy
Group Therapy
Medications

Suicide

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