Pamela E. Marcus, RN APRN/PMH-BC marcusrn@verizon.net 301.952.9286 Ms. Marcus has no conflicts of interest. There are no discussions of off-label medications in this presentation At the end of this presentation, the participants will: Identify individuals who would be at risk for suicidal thoughts and behavior after sustaining Intimate Partner Violence (IPV) List four assessment questions to assess the level of risk of suicide in these individuals Identify three interventions to prevent suicidal gestures Marcus 1
50,000 individuals die due to violence 15,007 fatalities occurred in 16 states of a CDC study in 2006 National Violent Death Reporting System Of these deaths 55.9 % were individuals who completed suicide In several research studies, a significant risk for suicidal ideation and completion was physical abuse occurring in adulthood Both men and women African American women who have experienced IPV have a higher risk of suicidal ideation and suicidal attempts Depression and IPV increases the rate of suicidal ideation PTSD and IPV increases the rate of suicidal drive Crosses multiple cultures Consider that the individual may be embarrassed by the IPV and may be reluctant to disclose their feelings of hopelessness and possible suicidal thoughts or behaviors Using Shea s equation for suicidal intent: Real Suicidal Intent = Stated Intent +Reflected Intent + Withheld Intent Marcus 2
Chronological Assessment of Suicide Events: CASE Approach Behavioral Incident: Ask a series of questions to encourage expressing the suicidal ideation in depth Gentle Assumption: Ask a series of questions as though the suicidal behavior was occurring. Symptom Amplification: Ask questions about the symptoms and the link to suicidal thoughts Denial of the Specific: An attempt to gather information that the individual may be withholding by asking specific thoughts about suicide: Have you ever thought about using your medications in an overdose attempt? Determine the risk factors Identify protective factors, both internal and external factors Suicide inquiry use the CASE approach Determine the risk level and intervention Document action and evaluate effectiveness of the intervention Marcus 3
High risk: admit to the hospital either voluntary or involuntary Prevent eminent suicidal behavior Moderate risk: Partial Hospitalization if the individual is safe staying at home in the evening and night Low risk: Out patient psychotherapy and aware of the emergency numbers if symptoms increase Internal factors Ability to problem solve Spiritual beliefs External factors Relationships Support systems Valued relationships with people and animals that include responsibility for meeting their basic needs Culturally congruent intervention for African American women Intervention has been tested in research Has ten ninety minute group meetings that are evidenced based interventions Groups emphasize protective factors; such as coping strategies, problem solving tools and positive identification with African American women who have overcome adversity Marcus 4
Meeting 1: Introduction and commitment to safety Meeting 2: Education about IPV and suicide Meeting 3: Safety planning for IPV and suicide behavior Meeting 4 and 5 Reduce intrapersonal risk factors and enhance intrapersonal protective factors Meetings 6 and 7: Reduce social and situational risk factors, such as relationship problems and interpersonal problem areas Meetings 8 and 9: Reduce cultural and environmental risk factors and enhance associated protective factors Meeting 10: Review and develop aftercare plans, graduation and feedback http://www.cdc.gov/violenceprovention/intimate partnerviolence/consequences.html. Retrieved May 10, 2011. Davis, RL. (2011) Domestic violence-related deaths. Journal of Aggression, Conflict and Peace Research. 2(2):44. Davis, SP; Arnette, NC; Bethea, KS, Graves, KN, et al (2009) The Grady Nia Project: A culturally competent intervention for low-income, abused, and suicidal African American women. Professional Psychology: Research and Practice (40): 141-150 Marcus 5
Shea, SC (2009) Suicide Assessment Part 1: Uncovering suicidal intent a sophisticated art. Psychiatric Times (26): 1-6. Shea, SD (2009) Suicide Assessment Part 2: Uncovering suicidal intent using the Chronological Assessment of Suicide Events (CASE Approach).Psychiatric Times (26): 1-26. Suicide Prevention Resource Center: Suicide Assessment Five-Step Evaluation and Triage for Mental Health Professionals SAFE-T www.sprc.org/library/safe_t_pcktcrd_edc.pdf Marcus 6