Depression is a mood disorder that causes lasting sadness, loss of interest, and low energy. It can affect sleep, appetite, and the will to live. Your first priority is safety, including direct screening for suicide, followed by restoring hope and daily functioning.
Each care plan below follows the nursing process (ADPIE).
Risk for Suicide
- Depressed mood and hopelessness
- Previous suicide attempt
- Access to lethal means
- Recent loss or major stressor
- Starting antidepressants as energy returns
- Client does not harm self during the hospital stay
- Client agrees to tell staff when having suicidal thoughts
- Client creates and uses a written safety plan after discharge
- Ask directly about suicidal thoughts, plan, means, and intent
- Warning signs such as giving away items or sudden calm
- Room and belongings for dangerous items
- Mood changes after starting antidepressants
| INTERVENTION | RATIONALE |
|---|---|
| Ask directly, "Are you thinking about killing yourself?" | Asking directly does not cause suicide and gives the client permission to talk. |
| Provide close observation per the suicide precaution level ordered | Constant or frequent checks prevent self-harm. |
| Remove dangerous items such as belts, cords, sharps, and plastic bags | A safe environment removes means of self-harm. |
| Work with the client on a safety plan with warning signs, coping steps, and people to call | A plan gives the client clear steps when thoughts return. |
| Teach the client and family about the 988 Suicide and Crisis Lifeline | 988 gives 24/7 access to crisis support by call or text. |
EVALUATION
- Client remains free of self-harm
- Client tells staff about suicidal thoughts
- Client has a written safety plan and knows how to reach 988
Hopelessness
- Long-term stress or loss
- Feeling of no control
- Depressed brain chemistry
- Client says things will never get better
- Poor eye contact and flat affect
- Little interest in activities or self-care
- Client names one positive thing or goal within 72 hours
- Client takes part in one activity daily
- Client expresses hope and makes plans for the future
- Mood and statements about the future
- Sleep, appetite, and self-care
- Response to antidepressants, which may take 2 to 4 weeks to work
| INTERVENTION | RATIONALE |
|---|---|
| Spend time with the client even if they say little | Presence shows the client they matter. |
| Set small, achievable daily goals | Success with small tasks builds a sense of control. |
| Give antidepressants as ordered and teach that full effect takes weeks | Knowing the timeline helps the client keep taking them. |
| Encourage contact with support people and groups | Connection reduces isolation and builds hope. |
EVALUATION
- Client names a goal
- Client joins in daily activities
- Client describes hope for the future
Practice this in Priority Care
Decide which client needs you first, including one at risk for suicide.
Play Priority CareQuick answers
Why is suicide risk higher shortly after starting an antidepressant?
Energy can improve before mood does, giving the client the energy to act on suicidal thoughts.
Does asking about suicide put the idea in a client's head?
No. Asking directly is safe and is the best way to find out who needs protection.
For learning only. Individualize every care plan to your client, and follow your program, current guidelines, provider orders, and facility policy.