Suicidal Ideation

• Self imposed death stemming from depression.

Risk Factors

1. Theories of Suicide
   • Anger turned inward: anger that was previously directed at someone else is turned inward.
   • Hopelessness, depression, and guilt: desperate feelings of the client.
   • A history of aggression and violence: rage and violent behavior is correlated with suicides.
   • Shame and humiliation: suicide viewed as a “saying face” or saving the family name following a suicidal defeat.
   • Developmental stressors: certain stressors at developmental stages have been identified as precipitating factors to suicide.
2. Biological theories
   • Generic tendency: Twin studies have indicated a predisposition toward suicidal behavior.
   • Neurochemical factors: Postmortem studies have revealed a decreased serotonin level in the brainstem and spinal fluid.

Signs and Symptoms

1. Self mutilation
2. Unexplained decrease in daily functioning
3. Isolation and withdrawal, decreased social interaction
4. Channeling of anger and hostility towards self
5. Inability to discuss the future
6. Destructive coping mechanisms
7. Express anger toward self
8. Previous suicide attempts
9. Low self-esteem
10. Anxious and apprehensive
11. Non-verbal cues such as giving away possessions

Assessment

1. Suicidal Assessment: Question to ask the client to assess how realistic the client’s plan is.
   • Do you have thoughts of harming or killing yourself?
   • Do you have a plan to harm or kill yourself?
   • What is the plan?
   • Is it possible to implement the plan?
   • When do you plan to do it?
2. A person is considered at a high-risk for suicide if the plan could be carried out within 24-48 hours. Other issues in determining risk include the lethality of the method and the plan of discovery after death.

Nursing Diagnoses

• High risk for violence, self-directed or directed at others
• Risk for self mutilation
• Ineffective individual coping
• Ineffective family coping
• Spiritual distress

Therapeutic Nursing Management

1. Establish a therapeutic relationship
2. Talk directly with the client about suicide and plans
3. Communicate the potential for suicide to team members and family
4. Stay with the client
5. Accept the person. Listen to the person.
6. Secure a “no suicide/harm” contract
7. Give the person a message of hope based on reality
8. When client is able, encourage gradual increase in activities
9. Maintain suicide precautions, be particularly concerned with personal items the client may used to harm self, remove all dangerous and potentially dangerous items (belts, glass, sharps).