Attitude Toward Suicide Suicide is a deeply complex and emotionally charged topic that affects healthcare providers and the patients they care for. As defined, suicide is a death that results from an intentional self-destructive act. Healthcare providers, particularly nurses, often encounter patients at risk for suicide or who have attempted suicide. Their attitudes toward suicide, how they handle these situations, and the ethical dilemmas they face are critical components in the care they provide. This article explores the definition of suicide, its impact in healthcare, the connection between addiction and suicidal thoughts, nurses’ attitudes toward suicide in diverse patient groups, the economic implications, causes of suicide, populations at risk, and the role of euthanasia.
What is Suicide?
Suicide is defined as a death that is the result of an intentional self-destructive act. Despite the significant clinical and theoretical interest in suicide, suicide attempts, attitudes toward suicide, and assisted suicide, there is relatively little research conducted by nurses on these topics. However, a related area of research that has been studied extensively by nurses is the impact of suicide on survivors—those family members and significant others bereaved by a suicide.
Suicide in Health Care
Few nursing studies have addressed suicide specifically. Valente (1994) utilized a qualitative methodology to compare the messages of psychiatric patients who attempted or committed suicide. The study found that most of these patients sent clear suicidal messages, and the messages from those who completed suicide could be differentiated from those who attempted it.
Demi, Bakeman, Sowell, Moneyham, and Seals (1996) studied suicidality in HIV-infected women and discovered that suicidal thoughts were common among these women. Family cohesion was found to moderate the effect of HIV-related symptoms on emotional distress. The researchers also found differences between women who neither thought about nor attempted suicide and those who did, although there were no significant differences between those who only thought about suicide and those who attempted it.
In another study, Grabbe, Demi, Camann, and Potter (1997) used a national database to assess suicidal risk factors among the elderly during their last year of life. Using logistic regression, they confirmed traditional risk factors such as age, race, gender, alcohol use, and mental illness and provided preliminary evidence that cancer is also a risk factor among the elderly.
Addiction and Suicidal Thoughts
Several studies have addressed the link between addiction and suicidal thoughts, particularly in adolescents. Burge, Felts, Chenier, and Parrillo (1995), using a national database, studied suicidal behaviors among U.S. high school students and found a significant positive relationship between cocaine use and the severity of outcomes of suicide attempts. They also identified a less strong relationship between marijuana use, alcohol use, sexual activity, and suicide attempts.
Rew, Taylor-Sechafer, and Fitzgerald (2001) found that among homeless youths, 35.1% had seriously considered suicide in the past 12 months, and 12.3% had actually attempted suicide. The study also found that participants with a history of sexual abuse were more likely to have considered suicide in the past year. Another study by Rew, Thomas, Horner, Resnick, and Beuhring (2001) discovered that among a group of tri-ethnic adolescents, Hispanic Latina girls had significantly higher rates of suicide attempts than any other ethnic gender group.
Nurses’ Attitudes Toward Suicide in Diverse Patient Groups
Several studies by nurses have investigated their attitudes toward suicide in diverse patient groups. For example, oncology nurses’ knowledge and misconceptions about suicide were explored using a vignette depicting a suicidal cancer patient. The study found that although nurses correctly identified several risk factors, few knew that race, age, and gender were also risk factors. Moreover, few nurses assessed whether patients had a specific suicide plan, and less than one-third identified appropriate interventions to prevent suicide in an at-risk patient.
Another study compared nurses’ attitudes toward suicide based on their clinical specialty, age, and highest degrees and found no significant differences in any of the subscales based on clinical specialty. However, age and degree levels were significant on only the right-to-die subscale. A comparison of doctors’ and nurses’ attitudes toward the suicide of young people revealed few differences (Anderson, M., Standen, Nazir, & Noon, 2000). Another study explored patients’ and psychiatric nurses’ opinions regarding care for inpatients; both groups believed that communication with patients is the most important skill in psychiatric nursing (McLaughlin, 1999).
Suicidal Attempts in Economically Distressed Situations
There is limited research on non-nurses’ attitudes toward suicide, especially among economically distressed populations. One study explored attitudes toward suicide among low-income, elderly, inner-city residents, comparing men and women, African Americans, and Whites. The study found no significant differences in attitudes based on race or gender. The researchers suggested that social class and place of residence might be better predictors of attitudes toward suicide in the elderly than race and gender (Parker, Cantrell, & Demi, 1997).
Several studies have explored the effectiveness of “no-suicide contracts” with conflicting findings. Some studies have found no support for the effectiveness of these contracts, while others note that no-suicide contracts are often negotiated when there is a high risk of suicide. There is a general consensus that national standards should be established for observing patients identified as at risk for suicide.
Causes of Suicide
Many studies have been conducted on suicide survivors, including parents, spouses, children, siblings, and therapists. Most of these studies have been descriptive and found that death by suicide produces extreme distress in survivors, with increased guilt, stigma, resentment, and continuous questioning of why the suicide occurred. Several studies have compared those bereaved by suicide with those bereaved by other modes of death, but these studies have reported conflicting findings.
Suicidal Risk Populations and Euthanasia
Suicide rates among the elderly are rising, coinciding with increased interest in euthanasia and assisted suicide. Nurses are closely involved with elderly and terminally ill patients who are contemplating suicide and assisted suicide. Matzo and Emanuel (1997) found that nurses were more likely to have performed patient-assisted euthanasia than physicians; however, the number who admitted to hastening a patient’s death was very small. There is a need for more research on this topic to understand better the ethical, clinical, and emotional challenges that healthcare providers face.
Researchers should move beyond simply describing attitudes toward suicide and the effects on survivors. There is a need for studies focused on developing interventions to prevent suicide, helping nurses cope with requests for assisted euthanasia, and supporting those affected by a death by suicide.
Conclusion
Suicide presents a significant challenge in healthcare, affecting both patients and the professionals who care for them. Understanding the causes of suicide, the populations at risk, and the factors contributing to suicidal thoughts and behaviors are crucial for developing effective prevention and intervention strategies. As healthcare providers, particularly nurses, play a critical role in identifying and supporting at-risk individuals, it is vital to understand their attitudes toward suicide and the factors influencing these attitudes. Additionally, the ethical dilemmas surrounding assisted suicide and euthanasia highlight the need for further research and discussion to support healthcare providers in making informed and compassionate decisions in these challenging situations.