Suicidal ideation involves the mental preoccupation of a person about suicide. The individual may regularly think that he/she would commit suicide, or he/she may think about what life would be if he/she is not around. A person may also replay the suicidal act out in his or her mind.
It is important to be knowledgeable about the warning signs that can be seen in patients with suicidal ideation. When signs of suicidal ideation are recognized sooner, the sooner the nurse can find and give the help the patient needs.
Signs and Symptoms of Suicidal Ideation
A person with suicidal ideation may show the following signs and symptoms:
- appearing to feel hopeless
- feeling unbearable emotional pain
- being pre-occupied with violence and dying
- mood swings
- talking about doing revenge and guilt
- showing a heightened state of anxiety
- showing changes in personality and daily routine
- experiencing changes in his or her sleeping patterns
- increased use of drugs and alcohol
- showing risky behaviors
- holding a gun or any objects that could end life
- experiencing depression, panic attacks, and concentration impairment
- self-isolation
- saying goodbye to others and saying it was the last time
- verbalizing severe remorse and criticizing oneself
Causes of Suicidal Ideation
Suicide ideation occurs when a person thinks and feels that they are no longer able to manage an overwhelming situation. Financial problems, death of a loved one, end of a relationship, severe illness, or health conditions may cause suicidal ideation.
Other situations that may cause suicidal ideation include grief, sexual abuse, financial problems, remorse, rejection, and unemployment. Some of them believe that committing suicide is the only way out.
The common causes of suicidal ideation include:
- Genetic. People who are born into families that have a history of mental illness or suicidal thoughts and behaviors are at risk of developing suicidal thoughts and behaviors themselves. However, even if the person has a family history of suicide, not everyone who has a family history will develop suicidal ideations.
- Physical. According to some research low levels of neurotransmitters and the changes to the structure and function of the brain may increase the risk of having a mental illness which includes suicidal ideation.
- Environmental. People with repeated negative life events and experiences will affect a constant level of stress of a person. This event has overwhelmed the person which will affect a person’s ability to cope with problems and is at higher risk of suicidal ideation.
- Mental health problems. Mental health problems such as depression, anxiety, schizophrenia, and bipolar disorder may increase the risk of suicidal ideation.
Risk Factors to Suicidal Ideation
The patient may be at risk for suicide if the patient has the following:
- attempted suicide before
- feeling hopeless, worthless and agitated
- feeling of loneliness
- stressful life event experience such as loss of a loved one, breakup, financial or legal problems
- diagnosed with a psychiatric disorder, such as major depression, post-traumatic stress disorder, or bipolar disorder
- family history of mental disorders, substance abuse, suicide, and violence, including physical and sexual abuse
- present medical conditions that can be linked to depression and suicidal thinking, such as chronic illness, chronic pain, and terminal illness
- lesbian, gay, bisexual, or transgender with an unsupportive family in a hostile environment
Teenagers may experience suicidal ideation followed by stressful life events. A young person sees stressful life events as serious and insurmountable. CA common cause that increases the risk of teenager and children for suicidal ideation include:
- psychiatric disorders that include depression
- conflict with close friends, significant others, family members
- physical and sexual abuse history
- physical or medical issues
- being a victim of bullying
- uncertainty of sexual orientation
- hearing an account of suicide or knowing a peer that committed suicide
To help reduce the risk of suicidal ideation, supporting and listening to the patient can make a difference.
Complications of Suicidal Ideation
Suicidal ideation and attempt to do suicide will affect the person’s functioning, especially in their daily lives. Suicide is an impulsive act during a person’s moment of crisis that may leave the patient with severe injuries such as organ and brain damage.
People who are left behind after doing suicide, are more likely to experience grief, depression, and guilt.
The long-term effect of suicidal ideation and behavior are devastating for the person, this will also increase the risk for complications such as:
- Severe injury
- Damage to all organ system
- Brain death
- Brain damage
- Seizures
- Coma
- Death
Suicide ideation can affect suicide survivors and must face grief because of the complicated stigma of dying by suicide. Suicide survivors can show attitudes such as:
- Extreme guilt
- Complicated grieving
- Shame
- Anger
- Feeling unable to properly grieve in a public way due to the stigma of suicide
- Deep depression
Diagnosis of Suicidal Ideation            Â
If a person has depression and has thought of committing suicide, the patient should be advised to see for immediate medical help.
The physician may ask the following question to diagnose the patient:
- How long are you experiencing thoughts of doing suicide?
- Do you have any history of depression?
- How far have your views on doing suicide gone? Have you come up with a plan?
- Are you taking any medications? If yes, what are they?
- Are you taking drugs and alcohol? If so, how often?
Treatment for Suicidal Ideation
If the patient has a suicidal ideation but has no crisis, the doctor and the therapist may recommend psychotherapy, medications, and lifestyle changes that can decrease the risk of suicide.
- Psychotherapy. Psychotherapy is a kind of therapy that is also known as talk therapy. During psychotherapy, the patient will learn about how to cope with suicidal ideation, moods, feelings, thoughts, and behaviors.           Â
- Family therapy and education. The patient’s loved ones should be involved in the patient’s treatment. Family involvement can help the patient to better understand what he or she is going through. Family therapy will help for the improvement of family dynamics. Staying connected with the family is important.
- Substance use disorder treatment. This treatment will help the patient with an increase in alcohol and drug use. Early prevention and treatment of substance abuse are important to prevent further complications. Substance use disorder treatment includes avoiding or limiting the use of alcohol and other forms of drugs.
- Lifestyle changes. Lifestyle changes include stress management, sleep improvement, eating, and exercise habits, building a solid support network, and giving time for hobbies and interests. Lifestyle changes include sleeping at least 7 to 8 hours a day, eating a balanced diet, getting regular exercise, and spending time outdoors with friends.
- Medications. Medications may be given to treat underlying depression that causes suicidal ideation. Medications include antidepressants, antipsychotic medications, and anti-anxiety medications. The patient should be instructed to follow the doctor’s recommendations about the proper use of the medication.
Prevention of Suicidal Ideation
The nurse should know what triggers depression and suicidal ideation in a person. To prevent suicidal ideation, the nurse can help the patient by:
- Asking the patient if he or she is thinking about suicide.
- Keep the patient safe by staying with the patient and removing any means of committing suicide, such as knives and other sharp objects.
- Encourage the patient to vent out his feeling and listen and be there for him or her.
- Instruct the patient to call a helpline or call someone that the patient trust, such as a friend, family member, or a spiritual mentor.
- After the crisis has passed, take time to follow up with the patient.
- The nurse should tell the patient that he or she should always remember that the patient is not alone. The nurse should inform the patient that he or she can call a crisis line or prevention hotline that can help in the support that the patient needs.
Nursing Diagnosis for Suicidal Ideation
Nursing Care Plan for Suicidal Ideation 1
Risk for Suicide                                             Â
Nursing Diagnosis: Risk for Suicide related to grief, physical illnesses, and hopelessness secondary to suicidal ideation.
Desired Outcomes:
- The patient will stop attempting to hurt himself or herself.
- The patient will verbalize and show eagerness to live.
- The patient will demonstrate acceptable alternative methods to cope with his or her condition and situation.
| Nursing Interventions for Suicidal Ideation | Rationale  |
| 1. Assess the patient’s risk for self-injury and suicide by talking to the patient and asking the patient the following questions: Have you ever thought of hurting and harming yourself?Have you ever tried suicide?Do you previously consider killing yourself?  | Verbal and behavioral cues about the intent to end his or her life may be present in patients considering suicide. The nurse should assess the patient’s suicide ideation or the attempt of killing himself or herself. The status of the patient’s suicide risk can be increased if the patient has a history of suicide attempts. |
| 2. Ask the patient about his or her history of suicide and ask for the history of suicide within his or her family. | Patients with a history of suicide with themselves and a history of suicide within the family have an increased risk of suicide. |
| 3.. Ask the patient about his or her suicidal thoughts and statements. | Verbal cues of the patient with a suicidal plan may be present and the patient may talk about his or her life and life problems that may lead to suicide. |
| 4. Assess for the presence of sleep habit problems and assess for substance use. | Substance abuse happens when a person uses alcohol or another substance that leads to health issues and disability. The nurse should also ask for any changes in the patient’s sleeping patterns because severe insomnia and lack of rest and sleep may increase the risk for suicide. |
| 5. Assess for the presence of mood disorders and the presence of unexplained happiness or desire. | Changes in the patient’s behavior and mood may affect the patient’s decision-making that may carry out suicide plans. Mood disorders such as depression and bipolar depression are commonly linked to suicide. |
| 6. Identify the available support for the patient especially the patient’s family and significant other’s support. | The patient may isolate himself or herself and may not have available support which will lead to depression. Support resources are important to decrease the risk of suicide. |
Nursing Care Plan for Suicidal Ideation 2
Nursing Diagnosis: Ineffective Coping related to inadequate coping skills, inadequate social support, poorly developed social skills, and situational crises secondary to suicidal ideation as evidenced by, changes in usual communication patterns, decreased use of social support, presence of destructive behaviors, and poor problem-solving.
Desired Outcomes:
- The patient will avoid using chemical agents.
- The patient will identify ways that will help him or her to feel comfortable with the new coping techniques.
- The patient will verbalize willingness to acquire new coping strategies through group, individual, therapy, coping, and cognitive-behavior skills.
| Nursing Interventions for Suicidal Ideation | Rationale |
| 1. Identify the patient’s strengths and coping skills such as talking to others, creative outlets, social activities, and problem-solving abilities. | Assessing the patient’s strength and coping skills will help in planning alternatives to self-defeating behaviors.  |
| 2. Identify the patient’s coping behaviors that will not help the patient and will result in negative sequelae.   | Identifying the areas that need to be prioritized is important for the nurse. Doing target teaching and planning strategies will be more effective and will enhance the patient’s behavior. |
| 3. Identify the support system and the available resources for support that will be able to help the patient to cope with the situation. | The nurse should assess the patient’s living situation with his or her family members, caregivers, and the community. An adequate support system will help the patient to cope with the stressors and will help in the overall mental health of a person. |
| 4. Use therapeutic communication when talking with the patient such as active listening, and giving open-ended questions. | Therapeutic communication can help the nurse to foster a trusting relationship with the patient that will further explore barriers to the patient’s ability to cope. |
| 5. Advise the patient to practice the use of stress-relieving and relaxation techniques. | The nurse may encourage the patient to practice stress-relieving and relaxation techniques such as reading books, listening to music, avoiding distractions, and guided imagery. |
Nursing Care Plan for Suicidal Ideation 3
Nursing Diagnosis: Hopelessness related to long-term stress, helplessness, perceiving the future as wasted, and severe stressful events secondary to hopelessness as evidenced by, decreased affect, judgment and problem-solving, and lack of motivation and interest in life.
Desired Outcomes:
- The patient will express the determination to live and will verbalize positive future orientation.
- The patient will express the meaning of life and will be optimistic about the expectations for the future.
| Nursing Interventions for Suicidal Ideation | Rationale |
| 1. Identify the physical and psychological changes that affect the patient. | Determine the changes that make the patient feel hopeless such as illnesses, recent job loss, inadequate family support abandonment, and trauma. |
| 2. Assess for the patient suicidal ideation or thoughts of harming himself or herself. | The main concern of the nurse is to prioritize the patient’s safety. To provide safety, evaluate the patient’s thoughts such as harming himself or herself, and ask if there are previous suicide attempts. |
| 3. Establish short-term goals and take time to listen. Â Â Â | The patient may assume that no one cares for him or her which will lead to hopelessness. The nurse should create rapport with the patient and encourage the patient to express the cause of his or her hopelessness. |
| 4. Encourage the patient to be involved in the decision-making and encourage the patient to participate in the activities and interventions. | A patient who is feeling hopeless may not participate in decision-making and may let others take control of his or her decision. The nurse should encourage the patient to take initiative in choosing what he or she wants and encourage the patient to participate in the activities of daily living. |
| 5. Encourage the patient to join and participate in group activities. | Encouraging the patient to interact with others may help the patient connect with others which can bring a sense of hope and will help ease loneliness. |
| 6. Help the patient to identify his or her strengths. | When a person is feeling overwhelmed, the person will no longer view their lives objectively. Identifying own strengths helps in self-awareness and self-reflection. |
Nursing Care Plan for Suicidal Ideation 4
Risk for Self-directed Violence
Nursing Diagnosis: Risk for Self-Directed Violence related to hopelessness, loneliness, social isolation, and severe depression secondary to suicidal ideation.
Desired Outcomes:
- The patient will seek support when experiencing self-destructive impulses.
- The patient will show an absence of depression and depressive behavior.
- The patient will not harm himself or herself and others and will express his or her desire to live.
| Nursing Interventions for Suicidal Ideation | Rationale |
| 1. Assess the level of suicide that the patient is experiencing and evaluate the suicidal intent by asking the patient directly if he or she is thinking or if he or she has plans of killing himself or herself. | Consistent monitoring and a protective environment are important to a high-risk patient. Guidelines for the necessity and urgency of interventions must be given to the patient. |
| 2. Advise the patient to vent out his or her feelings such as anger, sadness, and guilt. | The patient will be able to achieve self-control by trying out new methods of dealing with overwhelming emotions. |
| 4. Monitor the patient for signs of suicidal ideations, anxious sentiments, mood changes, and history of suicide attempts in the past. | These indicators suggest the need for additional assessment and psychiatric treatment. |
| 5. Offer environmental protection and surveillance by inspection and removal of harmful materials that may cause self-injury. | A safe environment is important to retain control until internal control of oneself is achieved for the patient. |
| 6. Identify the possibility of suicide as an option and discuss the effects of the client’s action if he or she pursues the intention of committing suicide. | The patient may think that suicide is the only option. Explaining and discussing the effect of the client’s action helps the nurse to examine and discuss other alternatives to help the patient cope with the situation. |
Nursing Care Plan for Suicidal Ideation 5
Nursing Diagnosis: Self-care Deficit related to perceptual or cognitive impairment, severe anxiety, and severe preoccupation secondary to suicidal ideation as evidenced by, decreased consumption of food or nutrients to meet daily requirements, decreased ability to function secondary to sleep deprivation, inability to organize simple steps in grooming, and weight loss.
Desired Outcomes:
- The patient will be able to groom and dress appropriately with minimal help from the nurse and the family.
- The patient will be able to have enough sleep with the aid of nursing measures and medications.
| Nursing Interventions for Suicidal Ideation | Rationale |
| 1. Check for the patient’s limitations in doing self-care by asking the patient open questions. | Assessing the patient’s limitations in doing self-care helps the nurse explore the needs of the patient. |
| 2. Instruct the patient about the importance of hygiene, and assist the patient in using toiletries and hygiene aids such as soap, shampoo, washcloth, makeup, toothbrush, and shaver. | The patient should be instructed about the importance of being clean and well-groomed which will help the patient to increase his or her self-esteem. |
| 3. Advise the patient to have appropriate rest periods after the activities. | Suicide ideation and depression may affect the sleeping pattern of the patient. Sleeping is important to maintain the proper functioning of the body and brain. |
| 4. Advise the patient to use relaxation measures, especially in the evening such as drinking warm milk, back rub, and tepid bath. | Relaxation measure is important to induce sleep and this will promote relaxation at night. |
| 5. Check the patient weight weekly and observe the patient’s eating patterns. | The weight of the patient may be affected when the patient is under stress because the patient cannot eat adequately. |
| 6. Instruct the patient to eat food that is high in protein and high in calories. | Eating foods that ate high in protein and high calories is essential for patients experiencing depression, these foods will minimize the risk of weight loss. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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