Research Article| Volume 34, ISSUE 2, P21-28, April 2020

Clinical validation of the nursing diagnosis risk for suicide in the older adults

Published:January 22, 2020DOI:


      • The nursing diagnosis “risk for suicide” should be understood as a meaningful behaviour rather than a symptom of an illness.
      • Validation of risk factors for nursing diagnosis “risk suicide” can help nurses clinical judgment more precise manner in older adults.



      To clinically validate risk factors for the nursing diagnosis risk for suicide in older adults.


      Case-control study (105 older adults). The strength of the association between variables was assessed using odds ratio (OR). Risk factors were grouped into hierarchical blocks according to the Integrated Motivational–Volitional Model of Suicidal Behaviour.


      Anxiety; guilt; divorce; hostility; inability to express feelings; loss of important relationship; financial problems; apathy; low self-esteem; hopelessness; dependence and functional incapacity; unhappiness; failure; frustration; marked change in attitude and behavior; sadness; self-neglect; stockpiling medication; depression; ideation and suicidal plans; and mental disorders were associated with risk for suicide.


      It is expected that this study will contribute to clinical nursing practice by the identification of this diagnosis in a safer and more precise manner.
      Descriptors: clinical judgment, nursing diagnosis, psychiatric nursing, suicide, older adult.
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        • Almeida O.P.
        • Almeida S.A.
        Short versions of the Geriatric Depression Scale: A study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV.
        International Journal of Geriatric Psychiatry. 1999; 14: 858-865
      1. Borim, F. S. A., Barros, M. B. A., Botega, N. J. Transtorno mental comum na população idosa: pesquisa de base populacional no Município de Campinas, São Paulo, Brasil. Cad. Saúde Pública, Rio de Janeiro, v.29, n.7, p.1415-1426, 2013.

      2. Britton P.C., Duberstein P.R., Conner K.R., Heisel M.J., Hirsch J.K, Conwell Y. (2008) Reasons for living, hopelessness, and suicide ideation among depressed adults 50 years or older. The American Journal of Geriatric Psychiatry 16(9), 736-41. doi:

        • Cha K.S.
        • Lee H.S.
        The effects of ego-resilience, social support, and depression on suicidal ideation among the older adult in South Korea.
        Journal of Women & Aging. 2017; 28: 1-16
        • Conwell Y.
        • Van Orden K.
        • Caine E.D.
        Suicide in older adult.
        The Psychiatric Clinics of North America. 2011; 34: 451-468
        • Conwell Y.
        Challenges to preventing suicide in later life.
        Ciência & saúde coletiva. 2015; 20: 1652-1653
        • Cunha J.A.
        Manual da versão em português das escalas de Beck.
        Casa do Psicólogo, São Paulo2001
        • De Leo D.
        • Draper B.M.
        • Snowdon J.
        • Kolves K.
        Suicides in older adult: a case-control psychological autopsy study in Australia.
        Journal of Psychiatric Research. 2013; 47: 980-988
        • Eades A.
        • Segal D.L.
        • Coolidge F.L.
        Suicide risk factors among older adult: exploring thwarted belongingness and perceived burdensomeness in relation to personality and self-esteem.
        The International Journal of Aging and Human Development. 2019; 88: 150-167
        • Erlangsen A.
        • Stenager E.
        • Conwell Y.
        Physical diseases as predictors of suicide in older adult: a nationwide, register-based cohort study.
        Social Psychiatry and Psychiatric Epidemiology. 2015; 50: 1427-1439
        • Fassberg M.M.
        • Cheung G.
        • Canetto S.S.
        • Erlangsen A.
        • Lapierre S.
        • Lindner R.
        • Waern M.
        A systematic review of physical illness, functional disability, and suicidal behaviour among older adult.
        Aging & Mental Health. 2016; 20: 166-194
        • Fung Y.L
        • Chan Z.C
        A systematic review of suicidal behaviour in old age: a gender perspective.
        J Clin Nurs. 2011; 20: 2109-2124
      3. Goncalves, D.M., Stein, A. T., Kapczinski, F. Avaliação de desempenho do Self-Reporting Questionnaire como instrumento de rastreamento psiquiátrico: um estudo comparativo com o Structured Clinical Interview for DSM-IV-TR. Cad. Saúde Pública, Rio de Janeiro, v.24, n.2, p.380-390, 2008.

      4. Herdman T.H. & Kamitsuru S., eds (2018) NANDA International Nursing Diagnoses: definitions & classification 2018–2020.

        • Harding T.W
        • De Arango M.V
        • Baltazar J.
        • Climent C.E
        • Ibrahim H.H.A
        • Ladrido-Ignacio L.
        • et al.
        Mental disorders in primary health care: a study of their frequency and diagnosis in four developing countries.
        Psychol Med. 1980; 10: 231-241
        • Holm A.L.
        • Severinsson E.
        The emotional pain and distress of borderline personality disorder: A review of the literature.
        International Journal of Mental Health Nursing. 2008; 17: 27-35
        • Jahn D.R.
        • Poindexter E.K.
        • Cukrowicz K.C.
        Personality disorder traits, risk factors, and suicide ideation among older adult.
        International Psychogeriatrics. 2015; 27 (1785–94.10.1017/S1041610215000174)
        • Joiner T.E.
        Why people die by suicide.
        Harvard University Press, Cambridge, MA2005
        • Kim S.H.
        Suicidal ideation and suicide attempts in older adult: Influences of chronic illness, functional limitations, and pain.
        Geriatric Nursing. 2016; 37: 9-12
        • Kjolseth I.
        • Ekeberg O.
        • Steihaug S.
        Older adult people who committed suicide: their contact with the health service. What did they expect, and what did they get?.
        Aging & Mental Health. 2010; 14: 938-946
        • Koo Y.W.
        • Kolves K.
        • De Leo D.
        Suicide in older adult: differences between the young-old, middle-old and oldest old.
        International Psychogeriatrics. 2017; 29: 1297-1306
        • Lopes M.V.O.
        • Silva V.M.
        • Araujo T.L.
        Methods for establishing the accuracy of clinical indicators in predicting nursing diagnoses.
        International Journal of Nursing Knowledge. 2012; 23: 134-139
        • Meneghel S.N.
        • Moura R.
        • Hesler L.Z.
        • Gutierrez D.M.D.
        Suicide attempts by older adult women – From a gender perspective.
        Ciência & Saúde Coletiva. 2015; 20: 1721-1730
        • Minayo M.C.S.
        • Cavalcante F.G.
        Suicide attempts among the older adult: A review of the literature (2002/2013).
        Ciência & Saúde Coletiva. 2015; 20: 1751-1762
        • Nicholson Jr., N.R.
        Social isolation in older adult: An evolutionary concept analysis.
        Journal of Advanced Nursing. 2009; 65: 1342-1352
        • O’Riley A.A.
        • Van Orden K.A.
        • He H.
        • Richardson T.M.
        • Podgorski C.
        • Conwell Y.
        Suicide and death ideation in older adult obtaining aging services.
        The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2014; 22: 614-622
        • O’Connor R.C.
        • Kirtley O.J.
        The integrated motivational–volitional model of suicidal behaviour.
        Phil. Trans. R. Soc. B. 2018; 373 ((s/n), 20170268)
        • Purcell B.
        • Heisel M.J.
        • Speice J.
        • Franus N.
        • Conwell Y.
        • Duberstein P.R.
        Family connectedness moderates the association between living alone and suicide ideation in a clinical sample of adults 50 years and older.
        The American Journal of Geriatric Psychiatry. 2012; 20: 717-723
        • Rosellini A.J.
        • Bagge C.L.
        Temperament, hopelessness, and attempted suicide: Direct and indirect effects.
        Suicide & Life-Threatening Behavior. 2014; 44: 353-361
        • Santos K.O.B.
        • Araujo T.M.
        • Oliveira N.F.
        Estrutura fatorial e consistência interna do Self-Reporting Questionnaire (SRQ-20) em população urbana.
        Cad. Saúde Pública. 2009; 25: 214-222
        • Santos R.L.
        • Virtuoso Júnior J.S.
        Confiabilidade da versão brasileira da escala de atividades instrumentais da vida diária. Rev Bras Promoção Saúde. 21(4), 290-6. Disponível em.
        • Shah A.
        • Bhat R.
        • Zarate-Escudero S.
        • De Leo D.
        • Erlangsen A.
        Suicide rates in five-year age-bands after the age of 60 years: the international landscape.
        Aging & Mental Health. 2016; 20: 131-138
        • Shin K.M.
        • Cho S.M.
        • Hong C.H.
        • et al.
        Suicide among the older adult and associated factors in South Korea.
        Aging & Mental Health. 2013; 17: 109-114
      5. Sousa G.S., Perrelli J.G.A., Botelho E.S. (2018) Nursing diagnosis for Risk of Suicide in older adult: integrative review. Rev. Gaúcha Enferm. [online]. 2018, vol.39, e2017-0120. Epub Aug 02, 2018. ISSN 1983-1447. 10.1590/1983-1447.2018.2017-0120.

        • Szücs A.
        • Szanto K.
        • Aubry J.-M.
        • Dombrovski A.Y.
        Personality and suicidal behavior in old age: A systematic literature review.
        Frontiers in Psychiatry. 2018; 9: 128
        • Turvey C.L
        • Conwell Y.
        • Jones M.P
        • Phillips C.
        • Simonsick E.
        • Pearson J.L
        • Wallace R.
        Risk factors for late-life suicide: a prospective, community-based study.
        Am J Geriatr Psychiatry. 2002; 10 (12095899): 398-406
        • Van Orden K.A.
        • Wiktorsson S.
        • Duberstein P.
        • Berg A.I.
        • Fässberg M.M.
        • Waern M.
        Reasons for attempted suicide in later life.
        The American Journal of Geriatric Psychiatry. 2015; 23: 536-544
        • Vanderhorst R.K.
        • Mclaren S.
        Social relationships as predictors of depression and suicidal ideation in older adult.
        Aging & Mental Health. 2005; 9: 517-525
        • Waern M.
        • Runeson B.
        • Allebeck P.
        • Beskow J.
        • Rubenowitz E.
        • Skoog I.
        • Wilhelmsson K.
        Mental disorder in older adult suicides: a case-control study.
        The American Journal of Psychiatry. 2002; 159: 450-455
        • Wetherall K.
        • Robb K.A
        • O’Connor R.C.
        An Examination of Social Comparison and Suicide Ideation Through the Lens of the Integrated Motivational-Volitional Model of Suicidal Behavior.
        Suicide Life Threat Behav. 2019; 49: 167-182
        • World Health Organization
        Preventing suicide: a global imperative.
        WHO. Disponível em, Geneva2014