Mental health professionals, particularly nurse practitioners (NPs), play a pivotal role in identifying and mitigating suicide risks in diverse populations. Suicide remains a leading cause of death in many demographic groups, yet it is often preventable through the use of advanced screening tools, early recognition of warning signs, and the implementation of comprehensive mental health prevention strategies.
For NPs, this responsibility extends beyond traditional roles, as they work across specialties with patients ranging from adolescents to older adults. Whether in primary care or psychiatric settings, NPs are uniquely positioned to implement primary prevention mental health strategies that can ultimately save lives.
This guide will provide a framework for NPs and mental health professionals on recognizing suicidality, understanding key risk factors, and utilizing evidence-based practices to prevent suicide.
What are the top contributors to suicidal ideation?
Several contributing factors can drive individuals toward suicidal ideation or behaviors. Suicidality is a multifaceted issue with overlapping psychological, physiological, social, and environmental influences. Understanding these contributors helps mental health professionals adopt targeted mental health prevention strategies.
- Psychological and psychiatric factors: Mental health diseases and disorders such as depression, bipolar disorder, and schizophrenia are strongly associated with suicidality. Disorders marked by mood instability or psychosis may impair judgment, exacerbate feelings of hopelessness, and heighten risk. Drug or alcohol use, often coupled with psychiatric diagnoses, can further impair coping mechanisms.
- Social isolation and loneliness: The absence of supportive relationships or a strong sense of community can significantly increase suicide risk. Loneliness and perceived social disconnection are well-documented contributors both in adolescents and older adults.
- Chronic stressors: Stressors such as financial instability, relationship difficulties, career pressures, or experiences of discrimination can push individuals to the brink. Stress compounded over time is a common pathway toward suicidal ideation.
- Environmental factors: Life events, including the recent loss of a loved one, job termination, or exposure to traumatic events, are immediate triggers. Other environmental risks include access to lethal means (e.g., firearms) and a lack of accessible mental health services.
Related learning tool: Suicide Prevention: Identification and intervention with the at-risk person
What are the best ways to recognize suicidal tendencies as an NP?
Top warning signs
- Expressing feelings of hopelessness or being a burden to others
- Verbalizing thoughts of death, dying, or suicide
- Sudden withdrawal from friends, family, or community
- A noticeable decline in work, school, or social commitments
- Giving away possessions or organizing personal affairs
Subtle signs
- Increased restlessness, anxiety, or irritability
- Sudden improvements in mood following extended depressive episodes (may indicate decision-making about suicide)
- Uncharacteristic risk-taking behaviors
- Ambiguous statements such as, “Things would be easier if I weren’t here.”
- Changes in appetite, energy levels, or sleep patterns
What are the top ways to prevent suicide as a healthcare professional?
When managing a patient with accute suicidal ideation, swift action is critical. Steps include ensuring the patient’s safety by removing access to lethal means, conducting crisis interventions, and engaging emergency mental health services when required. Familiarize yourself with local psychiatric crisis teams or hotlines and maintain these connections as a resource.
Screening tools
Evidence-based screening tools like the Columbia-Suicide Severity Rating Scale (C-SSRS) or Patient Health Questionnaire-9 (PHQ-9) are invaluable in detecting at-risk individuals. Train yourself and your team on their usage to enable early intervention. These tools serve as cornerstones for comprehensive suicide prevention protocols in clinical settings.
Non-pharmacologic interventions
Non-pharmacologic approaches such as cognitive-behavioral therapy (CBT) for suicide prevention have shown remarkable efficacy. Dialectical behavior therapy (DBT) is particularly effective in managing suicidal behaviors, especially in individuals with borderline personality disorder. Employing community-based mental health relapse prevention plans can provide long-term support.
Pharmacologic interventions
Selective serotonin reuptake inhibitors (SSRIs) remain a mainstay in the management of depression and suicidal ideation. An NP should evaluate the risk-benefit profile of administering antidepressants, mood stabilizers, or antipsychotic medication for their patients. Monitoring these interventions closely is integral to success.
When to refer
NPs are often the front line in mental health care but must recognize when a patient requires specialized psychiatric evaluation. Referrals may be necessary for patients whose conditions exceed the scope of primary care. Collaborative care models that integrate psychiatry, therapy, and primary care improve outcomes significantly.
To enhance your knowledge and skills on suicide risk and prevention, you can view our comprehensive NP Talks: Suicide Prevention webinar. This resource can deepen your understanding of mental health diseases and disorders while equipping you with the techniques needed to implement effective mental health prevention strategies. Together, we as NPs can create safer spaces for all those navigating mental health challenges.
