Friday, November 22, 2013

Rising Suicide Rates: A Call for Action

        Suicide is a major public health concern resulting in heavy emotional consequences for survivors and their loved ones. According to an article from Fox News, recent data has forced the “silent crisis” into the public attention (Dhar,2013). While suicide rates among children and elderly have leveled off in recent years, over the past decade suicide trends have risen nearly thirty percent for middle-aged adults. It is thought the ongoing economic downturn and access to medications among other factors have contributed to the rising rates among the baby boomer population. In addition, for all age groups, there are often underlying psychological conditions including depression, and anxiety, which lead to suicidal behavior.
    
http://www.helpguide.org/mental/suicide_prevention.htm
   Despite recent efforts to target suicide prevention, the social stigmas associated with mental illness have been a barrier for progress. There are damaging misconceptions that those suffering from severe depression want to be left alone, while evidence supports the contrary. It is commonly assumed that individuals experiencing depressive thoughts can pull themselves through out of willpower, when in reality, they are in need of social and professional support (Dhar,2013).The article emphasizes that communication is crucial to identify common behaviors associated with suicide and to intervene before it is too late.

While there have been recent school-based interventions for suicide directed at young adults and teens, it is evident the adult population is also in need of attention (Dhar,2013). The World Health Organization(WHO) validates that suicide has not been properly addressed in today's society because of the lack of awareness and social stigmas (WHO, 2013). The current data regarding the problem is skewed because incidences of suicide are often under reported and under prioritized in most countries. Even still, within the Unites States, suicide is reported to be among the top 20 leading causes of death for individuals ten and older (WHO,2013). To target prevention at the individual, family, community, and global level, the Center for Disease Control and Prevention (CDC) suggests a public health approach to combat suicide. Government programs are shown to be effective in promoting awareness, providing evidence-based prevention strategies, and advocating for social change (CDC, 2013). The National Strategy for Suicide Prevention is one organization that provides guidance for schools, health care systems, workplaces, clinicians, and other sectors in society. The public health mission for this program is to cultivate a positive dialogue for discussing mental health, enhance surveillance data to increase awareness, and to better integrate suicide prevention in the health care system(CDC, 2013).

   Nurses and other health care providers  play a key role in identifying the warning signs and establishing interventions for suicidal behavior.  Through a health history and assessment, one can determine if the individual has a history of suicidal attempts, psychological disorders, agitation, hopelessness, chronic pain, substance abuse, or other determinants of suicidal behavior. In addition, as a nurse, it is important to recognize the protective factors for suicide by educating the client on problem-solving behaviors, providing clinical support for underlying mental health concerns, and increasing the client's awareness of community resources( "Suicide Prevention",2012). 

7 comments:

  1. Great post, Sara! It is definitely true that stigma related to mental illness is a very real barrier to seeking help. For my population health clinical, I have been addressing mental health with a community of elderly Chinese immigrant. According to a number of studies I have looked at during this past semester, depression disproportionately affects elderly Chinese immigrants. This is thought to be related to the stresses of immigration and acculturation as well as weakened family support systems. Unfortunately, this population is also less likely to seek help for mental illness. Depression is highly stigmatized in Chinese culture and many people do not seek help because of their fear of being perceived as 'weak' or of bringing shame to their family. As nurses, it is important to keep stigmas related to mental illnesses in mind when working with patients from diverse cultural backgrounds--many of these patients may not as easily 'admit' to having mental illnesses or they will describe 'physical' rather than 'emotional' symptoms because they may perceive that it is more acceptable for them to do so.

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    1. Just wanted to add some additional thoughts to Jennifer's post as we were in the same population health clinical. One very useful tool that we were able to share with this population with regards to depression was a simple brochure targeted towards the general public. It was simple and people friendly in that it used basic terms to help any individual identify whether or not he/she is experiencing any depressive symptoms. In this one brochure, it provided symptoms checklist, conversation starters and also encouragements that depression should be talked about and not simply stigmatized. I wonder what impact it would have if more brochure, handouts or checklist like these would be produced. It would perhaps help screen for depression and other contributing factors prior to an individual committing suicide. (http://www.depressioncenter.org/news-and-publications/beyond-sadness/)

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  3. This is a such a great topic in mental health, Sarah. Thanks for discussing it at greater length. I'm really interested in finding out more about the suicide prevention interventions in school systems. Its much easier to access this population and feel confident that everyone targeted is getting the information. However, I'm even more curious as to how the adults who are affected by greater and greater loss and hardships in today's society will be effectively educated on the risks and resources available. Although we could arguably work hard to integrate specific questions into our care with patients in an effort to assess their risks, there are still so many other individuals who never or rarely step foot in a hospital or doctors office. Even those who do interact with health professionals, with the unfortunate stigma that still surrounds mental health issues, I imagine it would imagine many individuals would be reluctant to open up about feelings of depression or hopelessness. This would be a great topic to explore further!

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  4. Hi Sarah. Thank you for this post. It plays very heavily into my post about psychologists in the primary care setting. It would be impressive how many people we could help if we had easier access trained mental health professionals. While doctors and nurses may see something in their assessment, often people are referred to outside sources for mental health and follow-up is very rarely completed. In fact, I read (not sure in which post) that a large majority of people that attempt or complete suicide did visit their pirmary care physician within 30 days prior. Having a psychologist in the primary care setting could help address the emotional needs that the primary physician may not feel qualified to address.
    Thank you again, it will be very interesting to see how the Oregon State model plays out and if it will be adapted by other facilities.

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  5. Sarah, thank you for your post. The more we talk about mental health and make it a part of every day conversation, the stigma attached becomes less powerful. I am glad that you addressed the nurses's role in depression screening and suicide prevention. I had an experience early this year where I was called to help a friend's friend who was having suicidal ideations and making threats. As soon as I arrived on scene, I realized that I was not well prepared to handle the situation and felt helpless. Fortunately, we were able to get the patient to agree to go to the ED, but it could have played out a different way. In our psych nursing class, I feel I did gain skills that would have bettered this encounter, but I wish we would have addressed mental health more frequently throughout the last 16 months. As you pointed out, there is a growing number of suicides occurring in the baby boomer population, the same population which a lot of us will be working with as we start our nursing careers,and I wish we were better prepared. The American Foundation for Suicide Prevention has some great resources available for anyone interested....http://www.afsp.org

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  6. Thank you Sara for bringing up an uncomfortable, but essential subject to public health. I liked that you brought up communication as a serious barrier to effective prevention strategies. I remember the first few times I completed the mental health section of my clinical institution's admission assessment for incoming patients. I was then that I realized how difficult and awkward it can feel to ask questions related to suicide and other mental health topics even when it is clear to the patient that they are just being read off of a form. I imagine the feelings associated with discussing these issues outside of a standardized framework must amplify those feelings greatly. Comfort with such discussions, however, is likely going to be an essential component of any plans for prevention.

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