Suicide is a leading cause of death in the United States. According to the Centers for Disease Control and Prevention (CDC, 2023), it is the second leading cause of death in adolescents.
Suicide is a preventable public health problem; therefore, healthcare providers must be educated in suicide prevention. Further research is necessary to prevent the deaths from suicide of many Americans each year.
Risk Factors
Individuals with chronic mental disorders such as depression, schizophrenia, and substance abuse are more closely associated with risk for suicide (Bachmann, 2018). According to the CDC (2023) there are a combination of factors that contribute to the risk of suicide. These factors may stem from individual, relationships, and societal issues. Below are risk factors associated with suicide:
Hopelessness
Previous attempt
Family history of suicide
Loss (relational, financial, work, social)
Family history of child maltreatment
History of mental disorders, in particular depression
Impulsive or aggressive tendencies
Cultural and religious beliefs
Physical illness
Easy access to lethal methods
Unwillingness to obtain help because of stigma attached to mental health
Local epidemic of suicide
History of alcohol and substance abuse
Isolation (feeling cut off from other, socially isolated)
Protective Factors
Protective factors are strengths, skills, or resources that help individuals deal more effectively with stressful situations. Protective factors often increase resilience and allow the individual to handle negative life events in a more healthy and appropriate manner. Examples of stressful and traumatic life events may include dealing with a loss of a loved one, academic failure, loss of employment, divorce, physical and/or mental illness, etc.
Examples of protective factors (CDC, 2022) may include:
Family and community support
Access to care for clinical interventions and support
Support from medical and mental healthcare professionals
Effective care for mental, physical, and substance abuse disorders
Ability to problem solve, conflict resolution skills, and appropriate anger management skills
Religious and cultural beliefs that discourage suicide
Assessment
As nurses, we are often the first healthcare provider the individual comes into contact within the healthcare system. As such, nurses must perform a suicide assessment on admission, during any changes with the individual's medication or treatment plan, changes made for precautions, and before hospital discharge (Wärdig, et al., 2022). Additionally, there are various screening tools to assess for depression and suicide available to healthcare providers, for example the 21-item Beck Depressive Inventory (Beck et al., 1961) or the 10-item Geriatric Depression Scale (Yesavage et al., 1983). Additional screening instruments are available to detect suicide risk such as the Beck Hopelessness Scale (Beck et al., 1974), which differentiates those individuals who threaten suicide and those who may attempt suicide.
Healthcare Providers Role in Suicide Prevention
All healthcare providers must be able to recognize the risk factors and warning signs of suicide. When these signs are present, the healthcare provider must follow through with the individual. Think of suicide assessment, management, and prevention as similar to a person who is choking or having a cardiac arrest.
Healthcare providers would not walk away from someone who just experienced a choking episode or cardiac arrest, nor should we walk away from someone who is expressing suicidal thoughts. It is imperative that we are knowledgeable about the suicidal risks factors and what to do when an individual shares suicidal thoughts and intent with us. Healthcare providers must know the resources that are available to assist in these cases to prevent an unnecessary death.
Suicidal Interventions
Developing a trusting and therapeutic relationship with the individual is imperative. When trust is established, individuals often share more personal information. Initially, the healthcare provider must assess the individual's potential for suicide by asking the person about their thoughts. Screening for suicidal ideation is essential to ascertain the individual's level of suicidality. Individuals may have fleeting thoughts of suicide from time to time; however, it is necessary to determine if they have established a plan, i.e., how they intend to take their life. Individuals with a well thought out plan are considered to be at a higher risk for suicide. Often, healthcare providers are uncomfortable with talking to someone about suicide because they are fearful that this will motivate them to do so which is not the case (Wärdig et al., 2022). If you are concerned about someone who expressed a well-defined plan with strong lethality such as the use of a gun, it is imperative that this person is admitted to a psychiatric facility for an evaluation. In the state of Florida, the Baker Act Law allows individuals to be involuntary committed to a mental health facility for 72 hours for a professional evaluation by mental health provider if they are harmful to themselves or others.
The National Action Alliance for Suicide Prevention and the 988 Suicide & Crisis Lifeline suggest 5 steps to help safeguard people from the risk of suicide and support them when in crisis:
Ask: Asking and talking about suicide may in fact reduce rather than increase suicidal ideation.
Help keep them safe: Reducing a suicidal person's access to lethal means is an important part of suicide prevention.
Be there: Increasing someone's connectedness to others and limiting their isolation has shown to be a protective factor against suicide.
Help them connect: Individuals that called the 988 Lifeline were significantly more likely to feel less depressed, less suicidal, less overwhelmed, and more hopeful by the end of call.
