- Self imposed death stemming from depression.
- Theories of Suicide
- Anger turned inward: anger that was previously directed at someone else is turned inward.
- Hopelessness, depression, and guilt: desperate feelings of the client.
- A history of aggression and violence: rage and violent behavior is correlated with suicides.
- Shame and humiliation: suicide viewed as a “saying face” or saving the family name following a suicidal defeat.
- Developmental stressors: certain stressors at developmental stages have been identified as precipitating factors to suicide.
- Biological theories
- Generic tendency: Twin studies have indicated a predisposition toward suicidal behavior.
- Neurochemical factors: Postmortem studies have revealed a decreased serotonin level in the brainstem and spinal fluid.
Signs and Symptoms
- Self mutilation
- Unexplained decrease in daily functioning
- Isolation and withdrawal, decreased social interaction
- Channeling of anger and hostility towards self
- Inability to discuss the future
- Destructive coping mechanisms
- Express anger toward self
- Previous suicide attempts
- Low self-esteem
- Anxious and apprehensive
- Non-verbal cues such as giving away possessions
- Suicidal Assessment: Question to ask the client to assess how realistic the client’s plan is.
- Do you have thoughts of harming or killing yourself?
- Do you have a plan to harm or kill yourself?
- What is the plan?
- Is it possible to implement the plan?
- When do you plan to do it?
- A person is considered at a high-risk for suicide if the plan could be carried out within 24-48 hours. Other issues in determining risk include the lethality of the method and the plan of discovery after death.
- High risk for violence, self-directed or directed at others
- Risk for self mutilation
- Ineffective individual coping
- Ineffective family coping
- Spiritual distress
Therapeutic Nursing Management
- Establish a therapeutic relationship
- Talk directly with the client about suicide and plans
- Communicate the potential for suicide to team members and family
- Stay with the client
- Accept the person. Listen to the person.
- Secure a “no suicide/harm” contract
- Give the person a message of hope based on reality
- When client is able, encourage gradual increase in activities
- Maintain suicide precautions, be particularly concerned with personal items the client may used to harm self, remove all dangerous and potentially dangerous items (belts, glass, sharps).