Chapter 23: Suicidal Thoughts & Behaviors

Suicidal Thoughts & Behaviors defines core terminology including completed suicide, suicide attempts, and suicidal ideation, while distinguishing these from physician-assisted suicide (PAS), physician aid in dying (PAD), and euthanasia. The text analyzes the epidemiology of suicide, identifying key demographic disparities related to gender, age—particularly the rising rates among adolescents and the unique presentation in older adults—and cultural groups such as Native Americans. Theoretical frameworks are explored, ranging from Freud's concept of internalized aggression and Menninger's triad of revenge, depression, and guilt, to Shneidman's theory of unbearable psychological pain and sub-intentioned suicide. Biologically, the chapter discusses the neurobiology of suicide, highlighting the association between low cerebral spinal fluid levels of 5-hydroxyindoleacetic acid (5-HIAA) and impulsive violence. Central to the clinical application is the mastery of risk assessment using standardized tools like the Modified SAD PERSONS Scale and the Suicide Assessment Five-Step Evaluation and Triage (SAFE-T), which structure the evaluation of risk factors, protective factors, and suicidal intent. The summary details critical nursing interventions during the crisis period, such as establishing safety plans, maintaining continuous observation, and managing environmental safety by removing lethal means. It also emphasizes the importance of communication techniques that convey hope and non-judgmental support. Beyond the immediate crisis, the chapter addresses postvention strategies aimed at mitigating the traumatic aftereffects on family and friends, known as survivors of suicide, who face complicated grief and increased suicide risk themselves. Additional topics include the impact of suicide contagion, the correlation between traumatic brain injury (TBI) and suicidality, and the role of comorbidities like depression and substance use in elevating risk.