NUR 3450 Module 1 Suicide Risk Paper: The PHQ-9, the Columbia Scale and a Safety Plan Example

A Score of 19 and a Yes on Item 9: Screening, Asking Directly and Planning for Safety

Student Name

B.S.N., Accelerated Second Degree, Thomas Edison State University

NUR-3450: Nursing Care of Clients with Alterations in Behavioral Health

Mentor Name

Month Day, Year

A Score of 19 and a Yes on Item 9: Screening, Asking Directly and Planning for Safety

The Patient

Mr. Daniels is invented for this paper. He is 34, works nights at a distribution center and separated from his wife four months ago. He sees his young son on weekends. For two months he has slept poorly, stopped eating regular meals, quit his softball league and called in sick more often. At a primary care visit for back pain, he told his physician that sometimes he wished he would not wake up. The physician arranged a same-day evaluation, and he agreed to a voluntary stay on the crisis unit. He was quiet and polite on arrival and avoided eye contact.

Measuring Depression

Kroenke et al. (2001) validated the PHQ-9, a nine-item questionnaire in which patients say how often each of the nine diagnostic symptoms of major depression bothered them over the previous two weeks, on a four-point scale. The total runs to 27; five-point steps from 5 to 20 separate levels of severity, and in primary care and obstetric clinics a total of at least 10 picked out major depression accurately. Item 9, which asks whether death or self-injury has been on the patient's mind, stands apart: any answer other than never calls for a closer look, whatever the total.

Mr. Daniels totaled 19, in the moderately severe band, and marked item 9 as present on more than half of recent days.

Measuring Suicide Risk

Posner et al. (2011) evaluated the Columbia scale across three studies at several sites, covering both teenagers and adults. The scale asks directly about a series of increasingly serious experiences: wishing to be dead, nonspecific thoughts of suicide, thoughts with a method, thoughts with some intent to act and thoughts with a specific plan and intent. A second section covers behavior: attempts, attempts stopped by others or by the person and acts of preparation. Its scores held together well and agreed with other measures, and higher scores foretold later attempts.

The student, with the staff nurse present, asked the screening questions. Mr. Daniels described wishing to be dead and thinking of killing himself, and said he had thought about taking all of his back pain pills. He denied intent and a specific plan and said his son was the reason he would not. He had no past attempts, but two weeks earlier he had counted the pills in the bottle.

What Prevents Suicide

Mann et al. (2005) systematically reviewed suicide prevention strategies. The strongest evidence supported training physicians to recognize and treat depression and restricting access to lethal means. Many people who are prevented from using one method do not substitute another, because suicidal crises are often brief. Other strategies, such as screening alone and public awareness campaigns, had less evidence.

Nursing Diagnoses

Three nursing diagnoses guided care: risk for suicide, given his depression, his separation and the pills at home; hopelessness; and disturbed sleep.

Nursing Care

Safety came first. The unit placed Mr. Daniels on observation according to its policy for moderate risk, removed belts and cords from his room and checked his belongings. The student learned to ask directly and calmly about suicidal thoughts at each contact, since asking does not plant the idea and many patients feel relieved to be asked.

Therapeutic communication followed. The student sat with him, used open questions and reflected his feelings, such as the shame he described about his separation. When he said he felt like a failure as a father, the student did not argue but asked what kind of father he wanted to be. He talked for the first time about his son's birthday.

A written safety plan was developed with the staff nurse and the social worker before discharge. It listed his warning signs, such as lying awake after a night shift replaying the separation, coping steps he could take alone, people and places that could distract him, family and friends he could call, the 988 line and the clinic's number and what he would do to make his apartment safer.

Talking With Family

With his permission, the student and nurse called his brother, who had not known how bad things were. They explained the warning signs on the safety plan and how he could help, including checking in after night shifts. Family who know the plan can act on it. His brother also agreed to drive him to his first outpatient appointment.

Means Counseling

Following Mann and colleagues' evidence on lethal means, the team asked whether there were firearms in his home; there were none. His brother agreed to keep the remaining pain medication and dispense a week at a time. The student explained to Mr. Daniels that this was a temporary safety step, not a judgment.

Medication and Follow-Up

His psychiatrist started an antidepressant. The student taught him that improvement often takes several weeks and that some people feel more energy before their mood lifts, a time when close follow-up matters. An outpatient appointment was scheduled within seven days of discharge, and the clinic arranged a phone check two days after he left.

Evaluation

Over five days, his PHQ-9 fell to 14, he slept better, and on repeat questioning he denied current suicidal thoughts. He completed his safety plan and could name three people he would call.

Limits

Screening tools support but do not replace clinical judgment. Risk can change quickly. A student assists with assessment but does not determine observation levels. Mr. Daniels is invented.

Conclusion

The PHQ-9 measured the depth of Mr. Daniels's depression and flagged item 9, the Columbia scale clarified the seriousness of his thoughts and behavior and Mann and colleagues' review pointed to treatment and limiting access to means as the strongest protections. Asking directly, writing a personal safety plan with him, securing his medications and arranging close follow-up turned screening into care.

References

Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

Mann, J. J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., Hegerl, U., Lonnqvist, J., Malone, K., Marusic, A., Mehlum, L., Patton, G., Phillips, M., Rutz, W., Rihmer, Z., Schmidtke, A., Shaffer, D., Silverman, M., Takahashi, Y., . . . Hendin, H. (2005). Suicide prevention strategies: A systematic review. JAMA, 294(16), 2064-2074. https://doi.org/10.1001/jama.294.16.2064

Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., Currier, G. W., Melvin, G. A., Greenhill, L., Shen, S., & Mann, J. J. (2011). The Columbia-Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266-1277. https://doi.org/10.1176/appi.ajp.2011.10111704