Tuesday, July 3, 2007

Suicide Assessment

Suicide Assessment

The National Institute for Mental Health (NIMH) (2006) reports that suicide is the eleventh leading reason for death (eighth for males and sixteenth for females) in the United States. Four times as many males complete suicide as females and for every completed suicide there are eight to twenty five uncompleted attempts, (NIMH, 2006). White males, especially over the age of eighty-five, have one of the highest completion rates of suicide, (Captain, 2006). As one can see, suicide is a growing problem in the United States. It is important that healthcare professionals, including nurses, be able to adequately assess patients for the potential of suicide.

According to Mitchell, Garand, Dean, Panzak, and Taylor (2005), suicide involves people of all ages and ethnic backgrounds so it is imperative that the nurse be skilled in suicide assessment. Being skilled in assessment can help decrease the suicide rate. It is up to the healthcare professional to question the patient regarding suicide since most patients will not willingly volunteer such information, (Captain, 2006). Cutliffe and Barker (2004) state that the basis for any assessment should examine the individual, interpersonal, and social circumstances of each patient. Risk factors for suicide that should be assessed include history of mental illness, death of a loved one, poor health, social isolation, depression, relationship breakdown, alcohol and drug abuse, and previous suicide attempts, (Mitchell et al., 2005).

Assessment is important in detecting and preventing suicide, (Mitchell et al., 2005). Captain (2006) suggests asking questions such as “Do you feel your life is no longer worth living?” or “Are you thinking about taking your life?” If the answer to these questions is yes, questioning of a suicide plan is in order. Determine if the patient had a plan and the means to complete the suicide plan, (Captain, 2006). A plan is apt to be fatal if a patient can discuss method and place, if the patient believes the plan can succeed, and if the patient has instituted measures to evade discovery, (Captain, 2006). Assessment of alcohol and drug use is important at this time, as well as questioning ht patient about any prior suicide ideations and attempts, (Mitchell et al., 2005). If the patient is determined to be a suicide risk, the healthcare professional should institute organizational policy in treating this patient, (Captain, 2006). Measures typically include putting the patient on one to one observation, signing of no harm contracts by the patient, removing any potentially harmful objects from the patient’s room, and comprehensive documentation of the measures taken to avoid the potential for suicide, (Captain, 2006).

Assessment Tools
Evaluation of a suicidal patient requires clinical judgment from the healthcare professionals and inexperienced personnel are liable to lack confidence in making judgments regarding a suicidal patient, (Cutliffe & Barker, 2004). The mental health community realized there was a need for a tool that would help nurses assess patients for suicide risk. This led to the development of the Nurses Global Assessment of Suicide Risk (NGASR). The NGSAR helps to develop judgment in less knowledgeable staff and enhance the experienced nurses’ judgment, (Cutliffe & Barker, 2004). Fifteen variables such as hopelessness, recent stressors, and interpersonal interactions are measured by the NGASR to determine suicide risk, (Cutliffe & Barker, 2004). Other tests like the Mini-Mental Status Exam can be used to supplement clinical judgment, (Mitchell et al., 2005). Using these tools for assessment, nurses can help reduce the risk of suicide. (Cutliffe & Barker, 2004).


Captain, C. (2006). Is your patient a suicide risk? Nursing, 36(8) p. 43-47 Retrieved July 2, 2007 from Nursing & Allied Health Comprehensive database.

Cutliffe, J. & Barker, P. (2004). The nurses’ global assessment of suicide risk (NGASR):developing a tool for clinical practice. Journal of Psychiatric and Mental Health Nursing, 11, p.393-400. Retrieved July 2, 2007 from CINAHL database.

Mitchell, A., Garand, L., Dean, D., Panzak, G. & Taylor, M. (2005). Suicide assessment in hospital emergency departments: implications for patient satisfaction and compliance. Topics in Emergency Nursing, 27(4), p. 302-312. Retrieved July 2, 2007 from CINAHL database.

National Institute of Mental Health. (2006). Suicide in the Unites States: statistics and prevention. Retrieved July 2, 2007 from http:www.nimh.nih.gov/publicat/harmsway.cfm