SUICIDE
is the deliberate self-injury with the intent to end ones life.
Successful suicide occurs more frequently in males, although more Females attempt suicide.
The higher rate of attempted suicide in women is attributed to the elevated rate of mood disorders among females.
Women are more likely than men to have stronger social supports and to seek psychiatric and medical intervention, which may contribute to their lower rate of completed suicide
Suicide ranks third as the cause of death in the 15-19 year old group.
Incest, abuse, increased chemical dependency, marital instability in the family and poor problem-solving ability. Drugs and alcohol may contribute to suicide by further impairing judgment.
Some degree of depression may be present in most adolescents due to growing apart from parents and losing their carefree childhood.
Events such as school failure, loss of a loved one, competition and self-esteem may trigger suicide.
The loss of a girlfriend or boyfriend is particularly significant because it involves two types of loss, friendship and self-esteem.
Assessment
Adolescents need to have a thorough physical examination to assure they are in good physical condition. Assess for signs of depression such as anorexia, insomnia, excessive, fatigue or weight loss.
In younger adolescents, depression may be manifested by behavioral problems such as disobedience, temper tantrums, absence and running away from home. Self destruction and accident proneness may be noted.
Difficulties in school, acting out with chemicals, alcohol, sexually active or trouble with legal authorities may be further clues.
Depressed adolescents find it so hard to be alone, they seek constant activity as a means of escape. In contrast, others may withdraw from contact with other people and become completely isolated.
Either behavior can be detected through assessment of activity and interaction levels.
Adolescents who attempt suicide tend to be loners or have difficulty expressing their feelings to others and therefore, do not receive emotional support from friends.
Others are perfect students. The stress of trying to achieve continually at this level may provoke suicide.
If another family member or a close friend committed suicide, the chance an adolescent will do so is greater than usual. Adolescents who have Internet contacts may arrange a group suicide.
Because suicide reflects a problem in family interaction, family assessment is helpful.
Caution parents not to discount reports from their childs friends who tell them they are concerned about their child.
Close to their chosen time, some adolescents may demonstrate characteristics behaviors that show they are making preparations to end their life.
Suicide Warning Signs
Giving away prized possessions Organ donation questions Sudden, unexplained elevation of mood, which may indicate the individual has reached a decision about the suicide and feels relief Accident proneness, carelessness and death wishes Statements such as this is the last time youll see me.
Decrease in verbal communication Withdrawal from peer activities or previously enjoyed events Previous attempts (80% of all completed suicides have been preceded by a failed attempt) Preference for art, music, and literature with themes of death
Recent increase in interpersonal conflict with significant others Running away from home Recent experience of a friend or famous person committing suicide Asking information about suicide prevention and intervention
Nursing Diagnosis
Risk for violence, self directed, related to symptoms of depression or expressed desire to hurt oneself
Nursing Interventions
Includes trying alleviate their pain and depression and counseling them in an effort to help them change their perspective on the value of life. Establishing expected outcomes will be difficult because they are often too depressed to come up with an alternative solution to their problems. (Their goal is to kill themselves, not solve problems)
Try to find out the things in the childs life that are still important.
Build a plan that will help view life as worth living enough to work through problems.
Show them no one can change everything, but anyone can make one or two changes than can make a difference. After these small changes are made, a domino effect can be created to change more and more of ones circumstance.
A general measure is to help adolescents speak honestly about thoughts of suicide and the problems that have led them to think that death is a solution. An adolescent at this point needs referral to a consultant well versed in suicide prevention to improve self-image and offer alternative solutions to problems.
For an adolescents safety, a period of observation in a hospital setting is desirable after a suicide attempt to prevent them from inflicting personal injury again and to allow assessment in a neutral setting, away from the stress that precipitated the attempt.
All antidepressant medicines have a black box warning because some have been associated with elevating the mood of depressed adolescents enough to allow them to formulate a plan and commit suicide after taking them.
Continuing evaluation by both history taking and physical examination is necessary, because the young person may attempt suicide again if support people and better problem-solving ability are not available at another time.
