Suicide is a global public health concern that claims over 700,000 lives annually, according to the World Health Organization (WHO). It is now recognized as one of the leading causes of death worldwide, especially among adolescents and young adults. Because suicide is often preventable, nurses play a fundamental role in identifying at-risk individuals, implementing prevention strategies, and ensuring patient safety. The nursing diagnosis Risk for Suicide identifies individuals who may be vulnerable to self-inflicted harm with the intent of ending one's life. Early recognition, timely intervention, and multidisciplinary care are essential for reducing morbidity and mortality associated with suicidal behaviors.
This guide provides an in-depth overview of the nursing diagnosis, including definitions, related factors, outcomes, interventions, assessment, and real-life examples relevant to modern clinical practice.
NANDA Definition
Risk for Suicide: At risk for self-inflicted, life-threatening injury.
This diagnosis applies when a patient exhibits behaviors, thoughts, or circumstances that increase the likelihood of suicidal ideation or attempts. Unlike an active suicide intent diagnosis, this identifies the potential risk before a harmful act occurs, allowing nurses and healthcare professionals to intervene proactively.
Understanding the Significance of Suicide Risk
Suicide affects people of all ages, socioeconomic groups, and cultures. However, certain populations demonstrate disproportionately higher risks. Studies reveal that individuals with mental health disorders, chronic illnesses, trauma histories, and limited social support are significantly more likely to contemplate or attempt suicide.
According to the Centers for Disease Control and Prevention (CDC):
- Suicide is the 10th leading cause of death overall
- Among adolescents (15–19 years), suicide is the second leading cause of death
- Men die by suicide at four times the rate of women
- 90% of suicides are associated with underlying psychiatric disorders
These statistics highlight the critical need for vigilant nursing assessment and intervention.
Related Factors
The following contributory elements increase an individual's vulnerability to suicide. Nurses must assess these factors to identify risk levels accurately.
1. Behavioral Indicators
- History of previous suicide attempts
- Impulsive actions or reckless behavior
- Purchasing weapons or stockpiling medication
- Sudden giving away of valuable possessions
- Writing a will unexpectedly
- Unexplained improvement or sudden euphoria after major depression
- Marked deterioration in school or job performance
2. Verbal Cues
- Statements such as “I wish I were dead,” “My family would be better off without me,” or “I can’t go on”
- Direct threats of self-harm or suicide plans
- Expressions of hopelessness or purposelessness
Verbal cues are often ignored or minimized, yet they are among the strongest predictors of suicidal intent.
3. Situational Factors
- Living alone or isolated environments
- Retirement with loss of daily roles
- Recent relocation or institutionalization
- Economic loss or unemployment
- Loss of autonomy due to disability or illness
- Firearms accessible at home
- Youth living in confinement (group homes, detention centers)
4. Psychological Factors
- Family history of suicide
- Depression, bipolar disorder, PTSD, schizophrenia
- Alcohol or drug abuse
- Childhood abuse or trauma
- Feelings of guilt, shame, worthlessness
- Sexual minority stress affecting LGBTQ+ youth
5. Demographic Indicators
- High-risk groups include adolescents, elderly adults, Native Americans, males, widowed or divorced individuals
6. Physical Factors
- Chronic or terminal illness (e.g., cancer, neuropathic pain)
- Neurological impairment
- Disfigurement
7. Social Indicators
- Loss of significant relationships
- Family conflict or estrangement
- BEREAVEMENT, grief, and loneliness
- Legal issues or disciplinary actions
- Social isolation
- Cluster suicides within communities
Assessment: Key Signs Nurses Must Recognize
Nurses should use validated screening tools such as the Columbia-Suicide Severity Rating Scale (C-SSRS), PHQ-9, or SAFE-T to identify risk levels.
Critical warning signs include:
- Expressed desire to die or harm oneself
- Sudden behavioral calmness after agitation
- Interest in suicide methods
- Lack of purpose or withdrawal from activities
- Increased use of alcohol or drugs
- Statements such as “I won't be a burden anymore”
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels:
- Cognitive Ability
- Depression Control
- Distorted Thought Self-Control
- Impulse Control
- Self-Mutilation Restraint
- Suicide Self-Restraint
- Will to Live
Client Outcomes
- Does not engage in self-harm behaviors
- Expresses reduced suicidal thoughts or hallucinations
- Verbalizes emotions and anger safely
- Relinquishes access to harmful objects
- Participates in safety planning
NIC Interventions (Nursing Interventions Classification)
Suggested NIC Interventions:
- Anxiety Reduction
- Coping Enhancement
- Crisis Intervention
- Suicide Prevention
- Surveillance
Specific Nursing Actions
- Remain with the patient during periods of high stress or agitation
- Conduct suicide risk screening upon admission and as needed
- Assess for access to firearms, medications, or sharp objects
- Implement 1:1 observation when necessary
- Develop a personalized safety plan documenting triggers and coping strategies
- Encourage cognitive-behavioral therapy (CBT) and peer support groups
- Educate family members about warning signs
- Ensure a nonjudgmental, empathetic therapeutic environment
Real-Life Clinical Examples
Example 1: Adolescent With Depression
A 17-year-old reports bullying and begins giving away possessions. Nursing care includes suicide risk screening, safety planning, family counseling, and referral to a psychiatrist.
Example 2: Elderly Patient With Chronic Pain
An older adult expresses being “tired of living” and has access to medications. Interventions include medication review, pain management consultation, family involvement, and environmental safety modifications.
Example 3: Post-Traumatic Veteran
A military veteran diagnosed with PTSD isolates himself and abuses alcohol. Nursing care focuses on trauma-informed communication, substance-use rehabilitation, therapy referrals, and close monitoring.
Consequences of Unaddressed Suicide Risk
Failure to intervene can result in self-harm, completed suicide, accidental fatal behaviors, worsening depression, and emotional trauma for families and healthcare providers.
Conclusion
Suicide risk assessment is a critical nursing responsibility. Identifying warning signs early and applying evidence-based interventions can save lives. Nurses must act as advocates, educators, and vigilant observers to ensure patients receive compassionate and competent care. By understanding behavioral, psychological, demographic, and social risk factors, nurses can reduce suicide rates and promote mental well-being across diverse populations.
Sources
- World Health Organization (WHO). Suicide statistics and prevention strategies.
- Centers for Disease Control and Prevention (CDC). Suicide data and reports.
- NANDA International Nursing Diagnoses.
- American Psychiatric Association. Mental Health Disorder Guidelines.
- Columbia University. Columbia-Suicide Severity Rating Scale.
