Self-Protective Responses and Suicidal Behavior

1. Self-Protective Responses and Suicidal Behavior Rochelle Roberts RN MSN Chapter 20

2. Epidemiology of Suicide • 31,000 people complete the act of suicide each year • Suicide outnumbers homicide in the US • *The highest suicide rate for any group in this country is among people over age 65, especially white men over 85.

3. Self-Protective Responses • Range from self-enhancement and growth promoting to self-destructive behavior, self-injury, and suicide. • Low self-esteem leads to depression,which is present in self-destructive behavior.

4. Indirect self-destructive behavior • Non-compliance: accounts for 125,000 deaths annually. Includes denial and guilt • Self-injury: the act of deliberate harm to one’s own body (for tension relief)

5. Suicide • Suicide ideation: the thought of self-inflicted death • A suicide threat: a warning,direct or indirect, verbal or nonverbal that a person is planning to take one’s own life. • Suicide attempt: any self-directed actions taken by a person that will lead to death if not stopped. • Complete suicide: is death from self-inflicted injury, poisoning, or suffocation where evidence indicates the intent to kill oneself.

6. Risks for suicide • Mood disorders • Substance abuse • Schizophrenia • Anxiety disorders

7. Predisposing factors for suicide • Loss • Lack of social supports • Negative life events • Chronic medical illness • Fhx of suicide

8. Personality traits • Hostility • Impulsivity • Depression

9. Biological factors implicated in suicidal behavior • Deficiency in serotonin (5-HT) • Increase in one of the 5-HT post-synaptic receptors

10. Self-destructive behaviors • Are an attempt to escape • Are related to cultural and social factors • Are influenced by chronic and painful illnesses

11. Coping mechanisms • Denial • Rationalization • Regression • Magical thinking

12. Primary nursing diagnoses • Risk for suicide • Self-mutilation • Noncompliance • Risk for self-directed violence

13. DSM-IV-TR diagnoses • Anxiety disorders • Bipolar disorder • Major depression • Non-compliance with treatment • Schizophrenia • Substance use disorders

14. Nursing Outcome • The patient will not physically harm himself or herself

15. Nursing interventions • Protecting the patient • Providing for safety • Communicating hope • Increasing self-esteem • Regulating emotions & behaviors • Mobilizing social support • Educating the patient • Suicide prevention