Reply to classmate week 7 NURS 781

INCLUDE CITATIONS, AND REFERENCES AND A NEW IDEA

Sara

The PHQ-9 is a validated and widely used screening tool that assesses both the presence and severity of depressive symptoms. Item #9 evaluates passive or active thoughts of death or self-harm, making it a critical safety question rather than simply another symptom indicator (Zakhari, 2021). A positive response to item #9 warrants immediate and focused follow-up because endorsement of suicidal ideation, whether passive or active, requires further risk evaluation. In the context of this patient with a spinal cord injury, following up with the Columbia-Suicide Severity Rating Scale (C-SSRS) would be clinically appropriate due to his answer of several days in the last two weeks when asked about the 9th question. The C-SSRS provides a more detailed and structured assessment of suicidal ideation severity, intent, plan, and past behaviors, allowing the clinician to determine the level of risk and necessary interventions (Neal, 2024). While the PHQ-9 functions well as a screening instrument, it is not sufficient alone to determine suicide risk level or disposition. Using the C-SSRS after a positive #9 response enhances patient safety and aligns with best practices in psychiatric assessment (2024).

In the video, I thought the clinician did a nice job administering the PHQ-9 in a calm and structured manner, maintaining a neutral tone and appropriate pacing. When the patient endorsed question #9, the clinician avoided minimizing his response or reacting with alarm. Instead, she followed up to clarify the nature and extent of the patients thoughts. This response reflects therapeutic communication principles. She remained composed, direct, and nonjudgmental, which helps reduce shame and encourages honest disclosure (Zakhari, 2021). I appreciated how she explained why this question is asked in this assessment, stating, “these feelings are not unusual to go through people’s minds”. She also tells the patient not hesitate to reach out to his support team should the feelings he is describing intensify, which is reassuring to the patient. As Neal (2024) explains, sest practice includes explicitly assessing for intent, plan, means, and prior attempts using a structured framework such as the C-SSRS to ensure comprehensive risk assessment.

Protective factors are essential to assess alongside risk factors because they buffer against suicidal behavior and inform clinical decision-making (CDC, 2024). Protective factors include strong social support, family connectedness, religious or spiritual beliefs that discourage suicide, a sense of responsibility to dependents, engagement in treatment, effective coping skills, problem-solving ability, and future orientation (Neal, 2024). Additional protective elements include cultural beliefs that value resilience, positive therapeutic alliance, and restricted access to lethal means (Zakhari, 2021). The CDC notes that availability to consistent and high quality community physical and behvioral healthcare is also an important community protective factor (2024). Identifying protective factors guides safety planning, strengthens resilience-focused interventions, and supports collaborative treatment planning.

References:

Centers for Disease Control and Prevention. (2024, April 25). Risk and protective factors for suicide. Centers for Disease Control and Prevention.

Neal, A. M. (2024). Psychiatric-mental health nurse practitioner review and resource manual (5th ed.).

YouTube. (2021, June 17). Patient Health Questionnaire-9 (PHQ-9)

[Video]. YouTube.

Zakhari, R. (2021). Psychiatric-mental health nurse practitioner certification review. Springer Publishing.