How common is suicide?
Suicide is often considered the most preventable form of death. In the United States, it is the second leading cause of death among youth and young adults ages 10-34. According to the CDC, over 48,000 Americans die by suicide every year.
Why should nurse practitioners be aware of suicide prevention?
Over 90% of people who die by suicide have a diagnosable mental health disorder at the time of death. Moreover, they will often come into contact with a health professional during the time of suicide risk. In fact, one study found that 45% of individuals who died by suicide had contact with a health provider within a month of their death.
It is essential that nurse practitioners ask the question, “What keeps you safe?” Engaging with patients and letting them know it is a safe place to talk goes a long way in helping to prevent someone from acting on their thoughts of death by suicide.
Related: Suicide Prevention: Identification and Intervention with the At-risk Person
No matter what a patient may come in for, it is important to have this topic in the back of the mind. One quick question can help identify if a patient has certain risk factors, at which point a nurse practitioner can refer the patient to a mental health specialist. Saving someone’s life can be that simple.
How does suicide affect LGBTQIA+ populations?
Studies have shown that LGBTQIA+ adolescents are more than three times as likely as their peers to attempt suicide. Transgender youth, specifically, were nearly six times as likely to attempt suicide as their cisgender peers. There are many reasons for this. Two important ones are family support and the experiences of LGBTQIA+ students in schools.
These statistics are important for nurse practitioners to keep in mind when treating patients in the LGBTQIA+ community. Asking just a couple of questions about family acceptance and social support networks can help a nurse practitioner quickly gauge an LGBTQIA+ patient’s mental health and suicide risk status
What leads to suicide?
There is no single cause of suicide. Instead, there are many stressors that converge to create a heightened risk period. Depression is the most common condition, and it regularly goes undiagnosed and untreated. It is important for nurse practitioners to screen for depression in all patients, regardless of their presenting complaint.
Other common underlying conditions include anxiety and substance abuse problems. When untreated, these mental health conditions increase a patient’s risk of dying by suicide.
What are the key symptoms of depression?
Two key signs that a patient might struggle with depression are loss of interest in things they typically enjoy and feeling sad or irritable. Depression may feel to some patients like sadness or hopelessness and to others like numbness or emptiness.
It is important to know these different ways a person might experience and express feelings of depression in order to be able to recognize it in a patient.
What other factors contribute to suicide?
There are many changes or stressors in a person’s life that can contribute to suicide risk. The most common are:
- Relationship problems (42%)
- Gender identity (40%)
- Crisis in the past or upcoming two weeks (29%)
- Problematic substance use (28%)
- Physical health problems (22%)
- Job/financial problem (16%)
- Criminal/legal problem (9%)
- Loss of housing (4%)
Many people struggle with one or more of these issues daily. No one will go through their whole life without ever experiencing these hardships. However, it is when these issues compound that they become harder to handle and make the risk of suicide greater.
When should a nurse practitioner be concerned about suicide risk?
One thing for nurse practitioners to note when considering a patient’s suicide risk is any changes in behavior. This can be hard to catch when seeing a new patient. However, there are certain questions to ask patients in order to better gauge their mental health.
Nurse practitioners should ask about a patient’s sleep schedule, appetite, and increased use of alcohol or drugs. Ask if a patient is withdrawing from social engagements, not attending work, or avoiding hobbies they usually find enjoyable.
These questions can help nurse practitioners to understand changes in a patient’s behavior which might signal increased suicide risk. New or changed behaviors are especially relevant if they are related to a painful event or loss in the patient’s life. This can include the death of a loved one or pet, getting fired or expelled from school, or an unwanted move.
What protective factors should nurse practitioners ask about?
In addition to asking patients about their risk factors for suicide, it is helpful to learn about a patient’s protective factors. These are personal or environmental characteristics that help protect people from suicide. Major protective factors include:
- Effective behavior healthcare
- Connectedness to individuals, family, friends, and pets
- A sense of community and engagement in social institutions
- Life skills including problem-solving, coping skills, and the ability to adapt to change
- Self-esteem and a sense of purpose or meaning in life
- Cultural, religious, or personal beliefs that discourage suicide
How can nurse practitioners ask about suicide?
Many people may shy away from asking a patient if they are considering suicide because they are worried about bringing the topic to the patient’s mind. However, asking the question will not increase the patient’s suicide risk. There are more dire consequences to not asking, and many patients may feel relieved to be able to discuss the topic openly.
The questions should be asked at every annual exam and again at any visit that warrants a discussion (i.e., if the patient is coming in with any condition that might put them at higher risk for death by suicide or attempting suicide).
Some tips for asking about suicide are:
- Don’t wait
- Be gentle but persistent
- Talk to the person in private
- Allow the person to talk freely
- Give yourself plenty of time
What interventions should nurse practitioners take in situations of acute suicide risk?
It is important for nurse practitioners to take action when they feel a patient is at acute risk of suicide. These include getting patients help through contact with their mental health clinical, a hospital, or a crisis hotline.
For a less acute risk, nurse practitioners can help patients to develop a safety plan and get connected to mental health specialists. The goal should always be to get the patient to professional help. This can be with a hand-off or referral if the patient does not have a preexisting mental health provider.
