SUICIDE ETIOLOGY AND RISK AND PROTECTIVE FACTORS

Suicide etiology and risk are complex and include family history, genetics, epigenetics, neurobiology, medication use, gender, mental health disorders, psycho-sociocultural factors, age, life experiences, and other considerations.

Nurses face the same risk factors for suicide as any other member of the population. These risk factors may include:

  • Family history of suicide or neuropsychiatric conditions
  • Previous suicide attempt(s)
  • Having a mental health disorder (e.g., depression, substance use disorder, posttraumatic stress disorder, traumatic brain injury)
  • Being a divorced or widowed female
  • Socioeconomic factors (especially for men), including occupation, education, and income
  • Personality factors (e.g., paranoid personality features, obsessive-compulsive features)
  • Developmental factors (e.g., behavioral disinhibition, negative emotional states)
  • Life experiences, including history of trauma or abuse
  • Impulsive/aggressive tendencies
  • Cultural and religious factors
  • Barriers to accessing mental health care
  • Lack of or poor supportive social networks
    (NV DPBH, 2021)

Suicide Risk Factors for Nurses

In addition to the risks noted above, the profession of nursing presents many factors that can result in physical, mental, and emotional fatigue, referred to as nurse burnout. The majority of nursing professionals experience burnout at some point in their careers, and burnout affects approximately 38% of nurses each year (Clark, 2022).

Burnout can affect job performance, change how nurses perceive their role, and place patients in danger. Burnout increases the risk of suicide among nurses and results from:

  • Exposure to repeated trauma (secondary trauma)
  • Working long, consecutive shifts
  • Repeated requests to work overtime
  • Workplace incivility, violence, and bullying
  • Inadequate self-care
  • Isolation from family and friends
  • Fearing for one’s safety or the safety of loved ones
  • Financial stressors
  • Access to and knowledge of lethal substances
  • Chronic, high workplace stress
  • Issues with management
  • Work/life role conflict
  • Feeling unsupported in the role
  • Lack of feeling of belonging
  • Feeling unprepared for the role
  • Fear of harming a patient
  • Being evaluated for substance use disorder
  • Depression
    (ANA, 2023)

Suicide Protective Factors

Although there are many risk factors for suicide, there are also factors that protect people from making an attempt or dying by suicide. These protective factors are both personal and environmental.

Personal protective factors include:

  • Values, attitudes, and norms that prohibit suicide, such as strong beliefs about the meaning and value of life
  • Strong problem-solving skills
  • Social skills, including conflict resolution and nonviolent ways of handling disputes
  • Good health and access to mental and physical healthcare
  • Strong connections to friends and family as well as supportive significant others
  • Strong sense of cultural identity
  • A healthy fear of risky behaviors and pain
  • Optimism about the future and reasons for living
  • Sobriety
  • Medical compliance and a sense of the importance of health and wellness
  • Good impulse control
  • A strong sense of self-esteem or self-worth
  • A sense of personal control or determination
  • Strong coping skills and resiliency
  • Being married or a parent

External/environmental protective factors include:

  • Opportunities to participate in and contribute to school or community projects and activities
  • Strong relationships, particularly with family members
  • A reasonably safe and stable environment
  • Availability of consistent and high-quality physical and behavioral healthcare
  • Financial security
  • Responsibilities and duties to others
  • Cultural, religious, or moral objections to suicide
  • Owning a pet
  • Restricted access to lethal means
    (WMU, 2023; CDC, 2022b)
BARRIERS TO SEEKING HELP AMONG NURSES

Mental health stigma is the primary reason that 80% of people with mental health issues do not speak up and do not seek help (Project Helping, 2023). Nurses struggling with substance use, mental health issues, and job problems face mental health stigma, limited access to treatment, and licensure issues. A recent study found that nurses were much more likely to have positive blood toxicology results for nearly all substances compared to the general population. However, these nurses were also less likely to have a documented diagnosis of substance use disorder or treatment before suicide (Handzel, 2022).

Nurses with suicidal ideation are less likely to seek out professional help. Barriers to accessing mental health services include:

  • Concerns about potential negative impact on one’s career
  • Feelings of being judged or unsupported by peers, managers, and/or senior leadership for seeking behavioral healthcare
  • Concerns about confidentiality, especially when care is accessed at or provided by clinicians at the same hospital or health system
  • Difficulties in getting time off work for treatment
  • Challenges with scheduling appointments with providers

Additionally, many states inquire about mental health history on applications for nursing licensure, which may impact nurses’ attitudes about seeking help. Although it is not legal under the Americans with Disabilities Act, many state boards ask non-ADA-compliant questions about mental health, targeting specific diagnoses, focusing on historical data in the absence of current impairments, and/or requiring a prediction of future impairment. Consequently, applicants and nurses may hide mental health issues, resulting in the underuse of mental health resources by those in need (Handzel, 2021).