Suicidal Clients Etiology Genetic and Biologic Theories Genetic Markers o DNA analysis showed that the 102T/C

C polymorphism in 5-HT2a receptor gene is significantly associated with major depression. Relationship of Neurochemical Binding Sites o The relationship among serotonin and postsynaptic frontal cortices' binding sites, 5-HIAA (a metabolite of serotonin normally found in spinal fluid), and serum cholesterol Twin and Adoption Studies Egoistic suicide refers to suicide by individuals who are not strongly integrated into any social group (eg, a divorced male, who has no children and who lives alone, commits suicide). Altruistic suicide describes suicide by persons who believe sacrificing their lives will benefit society. Anomic suicide refers to suicide that occurs when an individual has difficulty relating to others, adapting to a world of overwhelming stressors, or adjusting to expected normal social behavior. Psychological Theories: suicide was a result of anger turned inward. Theory of Parasuicidal Behavior: parasuicide describes individuals who engage in self-injury (eg, self-inflicted wounds) but usually do not wish to die. Other Psychological Factors A reunion wish or fantasy: A way to end one's feelings of hopelessness and helplessness: A cry for help: An attempt to save face or seek a release to a better life Individuals at Risk for Self-Destructive Behavior Verbal suicidal clues include talking about death, making comments that significant others would be better off without the person, and asking questions about lethal dosages of drugs. Behavioral suicidal clues include writing forlorn love notes, directing angry messages at a significant other who has rejected the person, giving away personal items, or taking out a large life-insurance policy. Situational suicidal clues describe events or situations that present themselves either around or within the person, such as the unexpected death of a loved one, divorce, job failure, or diagnosis of a malignant tumor. 1. Clients With a Psychiatric Disorder: major depression, bipolar disorder, schizophrenia, schizoaffective disorder, personality disorders, eating disorders, and alcoholism or drug abuse 2. Clients With Alexithymia: having no word for emotions. This construct is useful for characterizing clients who seem not to understand the feelings they experience and who seem to lack the words to describe their feelings to others. 3. Clients With Medical Illnesses 4. High-Risk Population Group a. ethnic minorities

homosexuals incarcerated elderly. persons who are divorced, separated, widowed, unemployed, or socially isolated Individuals whose occupations require selfless public service and dedication and who work under pressure g. Persons who engage in masochistic sexual acts by using devices to enhance autoerotic feelings, and daredevils h. individuals who have a history of previous suicide attempts, and who have not developed adequate coping skills or who lack sufficient support systems, are at risk each time they experience increased stress. b. c. d. e. f. Assessment

Suicidal ideation, or vague, fleeting thoughts about wanting to die Suicidal intent, or thoughts about a concrete plan to commit suicide Suicidal threat, or the expression of a person's desire to end his or her life Suicidal gesture, or intentional self-destructive behavior that is clearly not lifethreatening but does resemble an attempted suicide Suicidal attempt, or self-destructive behavior by which an individual responds to ambivalent feelings about living (Badger, 1995) Talks about death, suicide, and wanting to be dead, and appears to be in deep thought Asks suspicious questions such as, How often do the night personnel make rounds? How many of these pills would it take to kill a person? How high is this window from the ground? How long does it take to bleed to death? and so forth Fears being unable to sleep and fears the night Is depressed and cries frequently Keeps away from others due to self-imposed isolation, especially in secluded areas or behind locked doors Is tense and worried and has a hopeless, helpless attitude Imagines he or she has some serious physical illness such as cancer or tuberculosis. (The person may want to end the suffering or decrease the imagined burden to the family.) Feels very guilty about something real or imaginary or feels worthless. (The person may feel she or he is not worthy to live.) Talks or thinks about punishment, torture, and being persecuted Is listening to voices. (The voices may tell the person to try to take his or her life.) Suddenly seems very happy, without any apparent reason, after being very depressed for some time. (The person may be happy now that she or he has figured out a method of committing suicide.) Collects and hoards strings, pieces of glass, a knife, or anything else sharp that might be used for self-harm Is very aggressive or very impulsive, acting suddenly and unexpectedly Shows an unusual amount of interest in getting his or her affairs in order Gives away personal belongings Has a history of suicide attempts

SAD PERSONS Assessment Scale

Sex: Men commit suicide more frequently than women do; however, women make more suicide attempts. Age: Those at greater risk of suicide are younger than 19 and older than 45. Depression: The risk of suicide increases with depresssion. Previous attempts: The rate of suicide increases among people with a history of suicide attempts. Ethanol or alcohol abuse: The rate of suicide is higher among alcoholics than among the general population. Rational thinking: Individuals who experience impaired judgement (eg, psychosis, substance abuse, neurologic disorder) are at greater risk. Social support: Individuals who lack support systems are at greater risk. Organized plan: The more organized the plan for committing suicide, the greater the risk. No spouse: Single, divorced, widowed, or separated individuals are at greater risk for suicide than those who are married. Sickness: Individuals who experience a chronic or debilitating illness are at greater risk. NANDA Nursing Diagnoses: Suicide

Risk for Injury related to a recent suicide attempt and the verbalization, Next time I won't fail. Risk for Suicide related to stated desire to end it all and recent purchase of a handgun Risk for Violence: Self-directed related to multiple losses secondary to retirement Hopelessness related to diagnosis of terminal cancer as evidenced by the statement, I'd rather be dead. Impaired Social Interaction related to alienation from others secondary to depressive behavior Ineffective Coping related to inadequate psychological resources as evidenced by impulsive, suicidal behavior Chronic Low Self-Esteem related to feelings of failure secondary to marital discord

Implementation Establishment of a Safe Environment Suicide Prevention Suicide Precautions Suicide Contract Seclusion and Restraint o Establish a supportive relationship, aligning oneself with the part of the client that wishes to live. o Monitor the client closely, using suicidal precautions according to agency protocol. o Question the client directly about suicide, including asking about a specific plan and a means to accomplish the plan. o Remove dangerous and potentially lethal materials or objects, according to agency protocol. o Encourage the client to discuss stressors, feelings of pain, anger, and anguish. o Encourage the client to agree to a no-suicide contract as part of behavioral agreement.

o Assist the client with the problem-solving process when specific problems are identified. Evaluation

Evaluation is an ongoing process that considers the client's progress in attaining expected outcomes as stated in the inpatient or outpatient plan of care and continuum of care.