Chapter 25: Suicide & Nonsuicidal Self-Injury

Chapter 25 delves into the critical topics of suicide and nonsuicidal self-injury (NSSI), establishing them as urgent public health priorities in psychiatric mental health nursing. Essential terminology is defined, differentiating suicidal ideation from actual attempts and discouraging the use of stigmatizing language like "commit suicide". The chapter details the complex epidemiology of suicide, noting its status as a leading cause of death across several age demographics (including 10-to-34-year-olds) and highlights demographic disparities and rising rates. A thorough examination of risk factors covers biological predispositions (such as low serotonin levels and genetic links), cognitive traits (like profound hopelessness and rigid thinking), and environmental influences (including adverse childhood experiences, social isolation, and easy access to lethal methods). Significant attention is given to the nursing process, emphasizing rigorous risk assessment using standardized tools like the SAFE-T and C-SSRS, recognition of both overt and covert warning signs, and evaluation of plan lethality, differentiating between hard (higher-risk) and soft (lower-risk) methods. Key interventions involve developing a strong therapeutic alliance, implementing rigorous environmental safety precautions in the inpatient milieu, and facilitating comprehensive primary prevention (e.g., QPR model) and postvention strategies for survivors and staff. Treatment modalities reviewed include careful use of psychopharmacology—specifically antidepressants, antipsychotics, and lithium, which is noted for its ability to reduce long-term risk—along with somatic therapies like ECT for acute risk reduction. Finally, the chapter discusses NSSI as a condition distinct from suicide intent, exploring its function in providing relief from negative emotions (pain offset relief), and outlining nursing care focused on wound management, establishing therapeutic boundaries, and teaching alternative coping mechanisms to replace self-injurious behaviors.