hopelessness, the provider should conduct a more detailed suicide assessment. Keep in mind, though, that using a tool is only half the assessment process. The evaluator must use the information from the screening and assessment tools, as well as the
words, gestures, and nonverbal behavioral information from the individual, to evaluate the information and determine the individual’s level of risk for carrying out the suicide action.
SUICIDE ASSESSMENT
A suicide assessment is a more comprehensive evaluation than screening and is performed by a clinician to confirm suspected suicide risk, estimate the imminent danger to the patient, and decide on a course of treatment. Although assessments can involve structured questionnaires, they also Structuring the assessment interview If significant risk factors are present or any suicide warning signs are evident, a suicide assessment must be conducted. It is important to ask patients directly about suicide and obtain additional information from family members, friends, other clinicians, and appropriate others. When conducting a suicidal inquiry, health care professionals must use a nonjudgmental, noncondescending, matter-of-fact approach. Individuals at elevated risk for suicide may be guarded during an interview or may respond with vague language,
can include a more open-ended conversation with a patient and/or friends and family to gain insight into the patient’s thoughts and behaviors, risk factors, protective factors, and medical and mental health history.
which should prompt the interviewer to probe and inquire further. See Table 2 for examples of these statements as well as possible responses. Healthcare Consideration: When assessing a patient for suicide, health care professionals need to demonstrate self-awareness of their emotional reactions, attitudes, and beliefs related to suicide.
Table 2. Common Individual Statements and Appropriate Responses The Individual’s Statement Possible Responses Everyone will be better off without me. • Who would be better off? • What would be better for those people? • Where are you planning to go? I just can’t bear it anymore. • What is so hard to bear?
• What would make your life better? • When did you begin to feel this way?
I just want to go to sleep and not deal with anything again.
• What do you mean by “sleep”? • What is it that you don’t want to deal with anymore?
I want it to be over.
• What is it that you want to be over? • How can you make it be over?
I won’t be a problem much longer.
• How are you a problem? • What is going to change in your life so that you won’t be a problem any longer? • When will you no longer be a problem?
Things will never work out.
• What can you do to change that? • What, then, do you propose to do?
It is all so meaningless. • What would make life more meaningful? • What are some aspects of your life that make it worth living? • What is happening in your life that makes it so meaningless? Note : Adapted from Videbeck, S. L. (2017). Psychiatric-mental health nursing (7th ed.). Wolters Kluwer. UNDERSTANDING LEVELS OF SUICIDE RISK
Suicidal thoughts and behaviors are linked to many different circumstances, including illness and life stressors—notably periods of crises such as illness, chronic pain, financial stress, and relationship break-ups (APA, 2017).
Evidence-based practice! A history of a previous suicide attempt is the strongest predictor of suicide and places an individual at high risk (Schreiber & Culpepper, 2021). A study examining medical records from 1987 to 2007 identified 1,490 individuals with a first suicide attempt requiring medical attention (Schreiber & Culpepper, 2021). More than 59% died from that first suicide attempt, and among those who survived their first suicide attempt, 85% died by suicide from a subsequent attempt within one year (Schreiber & Culpepper, 2021).
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