The nurse is assessing a patient with chronic depression who admits to having grown increasingly despondent for the past 2 weeks; he attributes this to the likelihood of his business going bankrupt and his wife's recent filing for divorce

Question

Which statements merit further evaluation as possible covert expressions of suicide ideation? Select all that apply. a. "I'm not sure what to do; I'm lost.".
b. "I only see one way out of this.".
c. "It will be better after tomorrow.".
d. "I've never felt this bad before.".
e. "I couldn't live without my kids.".
f. "Thank you for all you've done.".

Answer 1

B, C, E, F
Covert clues to suicide risk are often statements that focus on an impending end or resolution, suggest that the problem will no longer exist or matter, or represent terminating with (or saying goodbye to) others. "Seeing only one way out" suggests he is hopeless and feels forced to take a drastic or unfortunate action (suicide). "It will be better after tomorrow" implies that he is going to act to end the problems before then, possibly by suicide. "I couldn't live without my kids" suggests he feels he must die. Thanking staff can be a way of saying goodbye, a termination action that suggests he is leaving. However, being uncertain of what to do, feeling lost, and feeling "worse than ever" are ways of expressing his current status (despair) and not necessarily hints that he is planning suicide.