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Depression and Suicide: Signs and Symptoms

Discuss about the Depression and Suicide for Role of Nurses.

Depression is a mental illness with the mental or behavioral disorder. It is more common in women than men. Signs and symptoms of depression can be feeling of anxiety continuously, feeling of helplessness and guilt, feeling fatigue, weight or appetite changes, suicidal behavior, loss of pleasure and interest in day to day activities, difficulty in making decisions and concentration.

Suicide is defined as a mental illness in which a person intentionally takes their own life. Sign and symptoms of suicide can be excessive moodiness and sadness, feeling helplessness, feeling of isolation, changes in personality or appearance and self or dangerous –harmful behavior (Albert, 2015).

According to Australian bureau of statistics, nearly 4.0 million Australian (17.5%) were affected by the behavioral or mental condition. About 2.1 million (9.3%) people were suffered from mood or behavioral disorder. Approximately one in twenty Australian were affected by depression. ("4364.0.55.001 - National Health Survey: First Results, 2014-15", 2017). People of age group between 15-64 years old with behavioral or mood disorder were more likely to be unemployed than people without behavioral and mood disorder. Based on gender, approximately 10.4 % of females are suffered from depression as compared to men which are 7.4%. The rate of depression is increased in an age group of 55-64 years old.

Approximately 3,000 people died by committing suicide in Australia. It is the 13th leading cause of death in Australia. Death from suicide in males occurs 3 times greater than females. The death rate for males is 19.3% per 100,000 people whereas in case of females it is 6.3% per 100.000 people. The highest proportion of death occurs in males at the age group of 40-44 years old while in the female age group is 45-49 years old.

According to WHO report 2016, more women are affected by depression than men. Various factors responsible for this- women may have a stronger genetic predisposition to depression as compared to men, women are more sensitive to hormone change as compare to men especially after menopause and childbirth ("Depression", 2017). Women tend to think more as compare to men that may expose them to develop depression, relationship problems which make them more sensitive to develop depression. Women who are working tend to have more depression as they have to look for children, maintain home and take care of older people.

Prevalence of Depression and Suicide in Australia


Age group between 15-45 years old suffered more from suicidal behavior ("3303.0 - Causes of Death, Australia, 2015", 2017). The various factors responsible for higher suicidal behavior or thoughts are lower income level, lower education, unemployment, and relationship status. The number of suicidal attempts increases gradually with a decrease in socioeconomic status, increased globalization exposes individuals at higher risk of feeling insecurity economically and suicidal behavior. As most of the people live in nuclear families the demanding nature of nuclear families causes more stress and burden which leads to a suicide attempt. Unemployment among adults leads to more stressful conditions, loss of confidence, and isolation from friends or families which contribute to suicidal behavior (McCann, 2010)

In Jonathan’s case study there are many factors that may lead to the development of mental illness. The various factors can be, Bereavement which is defined as loss of loved ones due to death. Death of Jonathan’s mother caused depression and suicidal behavior in him. Bereavement results in the development of negative feelings which makes him more depressed and developed low self –esteem. Loss of Jonathan’s mother causes prolonged depression which may lead to suicidal behavior. Loss of a parent during adult hood result in higher chances of depression as they are more emotionally attached. Long term depression results in low self-esteem, loss of interest and prominent suicidal thoughts (Zisook & Kendler, 2007)

After the death of Jonathan’s mother, Jonathan is unable to concentrate at the workplace which makes him feel more distressed and caused severe depression. Symptoms of major depression are feeling fatigue and worthlessness, concentration is impaired, diminished pleasure or loss of interest in day to day activities, recurring death or suicidal thoughts, alcohol abuse and feeling being deprived. These were the symptoms which were experienced by him. Jonathan Low performance at the workplace and not submitting assessments at TAFE on time caused more distressful conditions which severe depression and lead to suicidal thoughts.

Jonathan’s father was not able to give time to him after the loss of his mother.  Jonathan’s father is working on weekends in order to pay family funds bill which makes him feel more isolated and distressed. The feeling of isolation worsens the depression (Parkes, 1982). The relationship between Jonathan and Leah becomes very weak after the loss of his mother. Jonathan started to feel distressed which affected his bonding with Leah. These conditions severely affected their relationship status and make him feel more depressed. These are the various factors which contribute to depression and recurrent thoughts of suicide.

Factors Contributing to Depression and Suicidal Thoughts


The principle of nonmaleficence involves legal and ethical duty to prevent harm to others. It is considered before the start of new treatment. Nurses must maintain certain standards of ethical conduct. The code of conduct for nurses is based on nature of clients, society, and health, Nurses must promote and restore client’s health, prevent alleviation of illness and sufferings. The nonmaleficence involves the right of patient and healthcare practice (Casey, 2015). It is a duty of health care provider or nurse to provide most appropriate treatment for that condition with minimum amount of pain and possible suffering. Various policies must be followed which should include protection and safety of patient health and dignity to avoid harm. The purpose is to provide care to a patient with trust that it will not cause harm even if some pain or suffering is involved.

The Principle of Beneficence states that nurses must act with kindness and work for client’s benefit. This principle help to build trust with the patient. Without this principle, it would be very difficult to treat client’s mental health especially in case of depression (Nabokov & Nabokov, 1995). Nurses should act with kindness and build client’s trust. Nurses must communicate with compassion to tell what their problem is and why treatment is necessary. Nurses must create a safe and supportive environment so that client’s feel less distressful.  Nurses must encourage them and make them feel more positive.

Mental health act 2007 (NSW) objective is to ensure the care and treatment of mentally disordered or ill patient.  The objective of this act is to provide treatment with care for mentally ill or disordered client’s (Basak & Chatterjee, 2016). The objective of nurses is to facilitate the treatment and cares through facilities of community care, to provide hospital care on a voluntary basis where appropriate, to facilitate the involvement of that person who cares for them in decision-making treatment. Various aspects of this act are to ensure that client should receive best possible treatment and care for the least restrictive environment. The patient suffering from depression having suicidal thoughts must receive timely high-quality treatment and care , the care and treatment must assist client’s  to work, live and participate especially in case of depression and suicidal behavior, the right of  dignity, and self-respect for clients  suffering from depression and suicidal thoughts must be kept at higher priority, encouragement of client to participate in the recovery and development plan, their wishes and expressed view must be considered in that development, the information given to clients must be understandable. (Daw, 2014)

Jonathan's Case Study: Factors that Led to Depression and Suicidal Thoughts

The urgent mental risk from Jonathan’s case study is his suicidal behavior. There are various nursing care plans and interventions that can be used to improve Jonathan mental illness. Risk factors that can cause suicidal thoughts are bereavement, grief /loss of a parent, psychiatric illness, and helplessness. It is possibly evidenced by a statement of helplessness, hopelessness, and nothing to live for and suicidal behavior. The nursing interventions for suicidal thoughts or behavior is to make arrangements for the client’s with family or friends, a hospitalization must be considered if the client is having highly suicidal behavior. Nurses must encourage them to avoid decision making during mental illness. Nurses must encourage them to talk freely about their feelings and must be provided with alternative ways of handling anger, frustration, and disappointment. The nurse must remove pills if present to prevent self-harm. Nurses must contact client’s family members and arrange family for individual counseling (Frauenfelder, Müller-Staub, Needham & van Achterberg, 2013). The impact of these interventions is that client will stop or refrain from attempting suicide, the client will remain safe in the hospital, the client will join the family in counseling family crisis. The rationale behind these interventions is to provide safety, comfort and relieve them from isolation, they must be provided with another way of dealing with strong emotions and sense of control over their options, to ensure that environment provided to the patient must be safe, to reestablish social ties and diminish the feeling of isolation.


Hopelessness in individual sees limited or no personal and alternative choices. It is related to support chronic pain, stress which is long term, significant in terms of chronic pain, long-term stress, a significant loss in support system, received helplessness. It is possibly evidenced by decreased judgment, decreased motivation, lack of care, loss of interest in life (Hooks, 2016). Nurses must encourage client to look into their negative thinking and reframe it into neutral thinking, nurses must help patient to identify areas of strength nurses must identify certain things in client past that given them joy and meaning in life, nurses must discuss this to encourage into their lives, nurses must encourage them to make contact with people or their loved ones that provided them support and comfort in the past . The impact of these interventions is clients must express their will to live, the client will understand the meaning of life,  the client will identify the things if that thing is wrong or right, and the client will have an optimistic approach for the decisions made (Karaca, 2017).  The rationale behind this is refraining people to look into their situation that allows them for an alternative approach which allows the client to find their strength and look towards their life more positively, creative activity gives client joy and intrinsic pleasure and satisfaction, hopelessness makes them feel more isolated and abandoned.

Nurses' Role in the Treatment and Care of Patients with Depression and Suicidal Thoughts

The mental condition from Jonathan’s case study is depression. There are various nursing interventions for depressed patients which promotes a feeling of wellness and health, meeting client’s psychological needs and coping abilities assessment. The less social interaction of the client with other people is related to fear of rejection, lacking a support system, disturbed self-concept and lack of motivation and energy. Nurses must ensure that activities must be provided that requires less concentration. Nurses must encourage clients for motor activities which required less concentration such as walking. When clients feel more depressed nurses must provide them one to one activity. Nurses must involve clients in group activities. Nurses must maximize their interactions with others (P Mendez, 2017). The possible impact of these interventions is to help the client to identify feelings that lead to poor interaction, the client will participate in social activities, the client will do one- on- one interaction, and the client will attend therapeutic / group meetings. The rationale behind this is to help clients who suffers from depression, lack of memory and concentration, activities which boost up their morale must be played, these activities will help them feel relax and might help them to elevate mood. These interventions maximize client’s interaction potential and minimize anxiety feeling, socialization help them to feel less isolated and more positive, communication with others help them to get distressed from self-preoccupation.

Chronic Low self-esteem is a feeling of negative self – evaluation or feeling about self or self-capabilities. It may be related to psychological/biochemical changes, feeling of guilt and shame, repeated failure and many expectations of self (Almasalha et al., 2012).  It is possibly evidenced by evaluating self as unable to deal with situations, unable to assess their own achievements, negative feelings of self, frequently feeling worthlessness, positive feedback rejections, and self-negative verbalization. Nurses must teach them with visualization techniques which help them to replace negative thoughts with a positive one. Nurses must encourage them to participate in a group discussion where other client’s share the same feeling (Zauszniewski, J.2012).  Nurses must arrange training, counseling for clients.  Nurses must involve the client in those activities where they can improve by using their own problem-solving skills. The desired outcomes are client’s  will maintain self-esteem, the client’s  will start believing in self, the client’s  will identify unreal self-expectations. The rationale behind these interventions is to promote more realistic and healthier self – image which makes them feel more positive, to make them feel less isolated and provide them an environment where they get positive feedback of self.  Low self-esteem clients have difficulty in determining their wants and needs and feeling of low self-esteem usually interfere with low problem-solving skills (Roecklein, 2012).

References

3303.0 - Causes of Death, Australia, 2015. (2017). Abs.gov.au. Retrieved 21 August 2017, from https://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/3303.0~2015~Main%20Features~Intentional%20self-harm:%20key%20characteristics~8

4364.0.55.001 - National Health Survey: First Results, 2014-15. (2017). Abs.gov.au. Retrieved 21August2017,fromhttps://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/4364.0.55.001~2014-15~Main%20Features~Mental%20and%20behavioural%20conditions~32

Albert, P. (2015). Why is depression more prevalent in women?. Journal Of Psychiatry & Neuroscience, 40(4), 219-221.

Almasalha, F., Xu, D., Keenan, G., Khokhar, A., Yao, Y., & Chen, Y. et al. (2012). Data Mining Nursing Care Plans of End-of-Life Patients: A Study to Improve Healthcare Decision Making. International Journal Of Nursing Knowledge, 24(1), 15-24.

Basak, A., & Chatterjee, T. (2016). Structural and Neurochemical Alterations in Brain Regions of Depression and Suicide Patients. Clinical Depression, 02(03).

Casey, P. (2015). Beneficence and non-maleficence: confidentiality and carers in psychiatry. Irish Journal Of Psychological Medicine, 33(04), 203-206.

Daw, R. (2014). The Mental Health Act 2007 – The Defeat of an Ideal. International Journal Of Mental Health And Capacity Law, 1(16), 1310.

Depression. (2017). World Health Organization. Retrieved 21 August 2017, from https://www.who.int/mediacentre/factsheets/fs369/en/.

Frauenfelder, F., Müller-Staub, M., Needham, I., & van Achterberg, T. (2013). Nursing interventions in inpatient psychiatry. Journal Of Psychiatric And Mental Health Nursing, 20(10), 921-931.

Haddad, A. (1987). Using principles of beneficence, autonomy to resolve ethical dilemmas in perioperative nursing. AORN Journal, 46(1), 120-125.

Hooks, R. (2016). Developing nursing care plans. Nursing Standard, 30(45), 64-65.

Karaca, T. (2017). Evaluation of First Year Nursing Students’ Care Plans-Nursing Diagnosis and Nursing Intervations. International Journal Of Nursing Care, 5(1), 40.

McCann, S. (2010). Suicide, Big Five Personality Factors, and Depression at the American State Level. Archives Of Suicide Research, 14(4), 368-374.

P Mendez, A. (2017). Transition Course in Psychiatric Nursing as an Intervention in Facilitating Students’ Perceived Preparedness In Handling Patients with Mental Illness. Nursing & Care Open Access Journal, 2(1).

PARKES, C. (1982). the risk of suicide after bereavement. Bereavement Care, 1(1), 4-5.

Roecklein, N. (2012). Using Standardized Nursing Languages in End-of-Life Care Plans. International Journal Of Nursing Knowledge, 23(3), 183-185.

Zauszniewski, J. (2012). Intervention development: assessing critical parameters from the intervention recipient's perspective. Applied Nursing Research, 25(1), 31-39.

ZISOOK, S., & KENDLER, K. (2007). Is bereavement-related depression different than non-bereavement-related depression?. Psychological Medicine, 37(06), 779.

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