DEPRESSION AND SUICIDE PREVENTION. Michelle Giddings, DNP, APRN, FNP-BC, PMHNP-BC

Transcription

1 DEPRESSION AND SUICIDE PREVENTION Michelle Giddings, DNP, APRN, FNP-BC, PMHNP-BC

2 Learning Objectives Increase awareness about depression and suicide prevention. Identify risk factors of depression and suicide.. Evaluate for symptoms of depression. Increase understanding of depression treatments. Identify 3 methods of screening for depression/suicide risk

3 DEPRESSION Prevalent in Primary care settings. Often occurs with other illnesses. 20,000,000 in the US Varies in the severity. If untreated, most episodes of major depression last 6-24 months.

4 DEPRESSION - RISK FACTORS Prior episodes of depression or suicide attempts Family history of depression Postpartum period Medical co-morbidity Lack of social support Stressful life events Personal history of sexual abuse Current substance abuse

5 DIAGNOSIS OF DEPRESSION Major depressive disorder may be preceded by at least five symptoms present during 2-week period, with one being either depressed mood or loss of interest/pleasure. Other possible symptoms: Disruption in sleep, appetite (or weight) Insomnia (initial, middle, & terminal) psychomotor agitation or retardation Fatigue Feelings of worthlessness Diminished ability to think/concentrate Recurrent thoughts of death

6 Diagnostic reasoning

7 TREATMENT OF MAJOR DEPRESSION Medications: SSRIs, SNRIs, NDRIs, MAOIs, Tricyclics, Atypical antidepressants. Prescribing principles (Discussion) Referral.

8 Most suicidal people are Depressed. Many suicides are preventable. Prevention is often a matter of a caring person with the right knowledge being available in the right place at the right time.

9 Highest suicide rate in US; Over 65 year olds, especially white males >85years. Women attempt twice as often as men, but use less lethal means Majority of completed suicides committed by males Guns account for half of all completed suicides Worldwide. Suicide tenth leading cause of death in US

10 Suicide ideation: thought of self-inflicted death self-reported or reported to others Passive: only thoughts of suicide Active: plans of causing one s own death Suicide threat: verbal or nonverbal warning (direct or indirect) that person planning to take one s own life Suicide attempt: any self-directed action that will lead to death if not stopped All suicide behavior is serious, whatever the intent, and deserves nurse s highest priority care

11 Does person have plan, means to carry out plan? Most suicidal person is one who has: Highly lethal method (e.g., gunshot to head) Specific plan (as soon as wife goes shopping) Means available (loaded gun in desk drawer) Person exhibits little ambivalence, as compared with someone asking for help When assessing suicidal behavior, place emphasis on lethality of method threatened or used

12 Risk factors increase the likelihood for suicide: Mental health problems, such as depression Substance abuse or increased alcohol use Feeling Hopeless, Worthless, Despair Previous suicide attempts or suicide gestures Hints or talk about suicide

13 PROTECTIVE FACTORS AGAINST SUICIDE Effective clinical care for mental, physical, substance abuse disorders Easy access to clinical interventions Restricted access to lethal methods Family and community support and supportive relationships in ongoing medical/mental health care Learned skills in problem solving, conflict resolution, nonviolent handling of disputes Cultural and religious beliefs give sense of hope that discourages suicide

14 Patient Education Assessing Suicide Risk Mobilizing Social Support Family Education Community resources National Suicide Prevention Lifeline ( )

15 SCREENING FOR DEPRESSION AND SUICIDE RISK Most widely use in primary care seang PHQ 2 PHQ 9 Suicide Assessment for primary care seang Ask Do you have thoughts of killing yourself?

16 REFERENCES FACTS ABOUT ADULT SUICIDE: Office of Suicide Prevention Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry 10th Edition; by Benjamin J. Sadock & Virginia A. Sadock. Psychiatric Nursing: Contemporary PracticeMary Ann Boyd. Lippincott Williams & Wilkins, 2008 Screening Instruments for Depression Mark H. Ebell, MD, MS, Athens, Georgia Am Fam Physician Jul 15;78(2):