Suicide and suicidal behaviour
Definitions
- Suicide – the intentional act of ending one's own life.
- Suicide attempt – a non-fatal self-directed act with intent to die.
- Suicidal ideation – thoughts of ending one's life.
- Deliberate self-harm – self-injury with or without suicidal intent.
Risk factors
- Previous suicide attempt – the strongest predictor.
- Mental illness: depression, bipolar disorder, schizophrenia, alcohol and substance abuse.
- Hopelessness, chronic painful illness (HIV, cancer), recent loss, unemployment, debt, domestic violence, social isolation.
- Male sex (completed suicide), family history, access to means.
Warning signs
Talking about death or being a burden, hopelessness, saying goodbye, giving away possessions, withdrawal, writing a note, and a sudden calmness in a previously depressed patient – may mean a decision has been made.
Assessment
Ask directly about suicidal thoughts – asking does not put the idea into the person's mind. Assess plan, means, intent, timing and protective factors. A patient with a plan, access to means and intent is at high risk. Tools such as the SAD PERSONS scale help but do not replace clinical judgement.
Management
- After an attempt: medical stabilisation first (treat injury/poisoning), then psychiatric assessment. Tricyclic overdose is dangerous because of cardiotoxicity (arrhythmias).
- Treat the underlying disorder (antidepressants, lithium, psychotherapy).
- A suicide attempt is a cry for help needing care, not punishment.
Nursing process
Assessment
Ideation, plan, means, intent, mood, hopelessness, substance use, supports, environment.
Nursing care plan
Nursing diagnosis | Goal | Interventions | Rationale |
|---|---|---|---|
Risk for suicide | Patient remains safe | Constant one-to-one observation for high risk; remove harmful objects (belts, sharps, cords, medicines); check visitors' items | Prevents self-harm |
Hopelessness | Expresses hope | Listen non-judgementally, show empathy, build trust, identify strengths | Therapeutic relationship reduces risk |
Ineffective coping | Uses healthy coping | Problem-solving, counselling, involve family | Alternatives to self-harm |
Deficient knowledge (family) | Family supports safety | Teach warning signs, restrict access to means, follow-up and crisis contacts | Safety after discharge |
A "no-suicide contract" must never replace observation and risk assessment.
Evaluation
No self-harm, denies suicidal ideation, engages in treatment, safety plan in place.