Comparison of suicide attempters and completers.

Nurses are challenged to estimate risk for suicide and to manage and prevent suicide. Evaluating and differentiating suicide attempters from completers is a serious clinical responsibility; miscalculation of risk and inadequate vigilance can have lethal consequences. In this retrospective study, suicide messages, risk, and symptom distress were examined among a matched cohort of suicide completers (SC) (n=25) and suicide attempters (SA) (n=25) at a Veterans Administration Medical Center. Staff members documented and reported patients' clear, and frequent messages about suicide. Themes within psychiatric patients' suicide messages and the number of documented suicide messages helped differentiate SA s from SCs. SCs were more likely to have a fear of being killed, hopelessness, and perceived symptom distress. SAs (28.6%) typically made a contract with staff not to commit suicide in the hospital while no SCs did so. Over 50% of the suicide messages were clear and directly referred to suicide. Indirect or unclear messages about suicide are more likely to be overlooked or discounted by staffmembers. All of the patients who completed suicide after hospital discharge, did so in the first 6 weeks after discharge. The paper includes a review of the relevant literature.