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Nursing Guide to Depression and Suicide: Nursing Diagnosis, Interventions, & Care Plans

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Etiology and Epidemiology 

Depression Definition

Depression is a multifaceted mood disorder involving the limbic system and affecting dopamine, serotonin, and norepinephrine. It causes an imbalance in neurotransmitter and receptor function. The condition is also known as depressive illness, seasonal affective disorder, and suicidal ideation. 

Depression ICD-10 Code: F32.9

  • Major depressive disorder, single episode, unspecified. 

Types of depression include: 

  • Atypical depression 
  • Bipolar disorder (formerly called manic depression) 
  • Chronic depression (dysthymia) 
  • Major depression 
  • Postpartum depression 
  • Psychotic depression 
  • Seasonal affective disorder (SAD) 
  • Treatment-resistant depression 

Approximately 10% to 20% of people experience periods of depression (Silverstone et al., 2017). Most people do not seek treatment, as they believe their symptoms may go away on their own, so it is difficult to determine an exact incidence of the condition. Diagnosis is more common in females as they seek treatment more often than males. 

Causes of depression include: 

  • Alcohol or drugs 
  • Bipolar disorders 
  • Familial in nature 
  • Having a family member with depressive disorders is a risk factor 
  • Postpartum 

Depression can lead to alcohol and/or drug use, a failure to improve the depressive state, and even death. Up to 90% of those who die by suicide have a mental disorder but may have gone untreated (Gianatsi et al., 2020). Suicide is the 10th leading cause of death in the U.S., with the highest incidence among middle aged white men (ASFP, 2021). 

Depression Diagnosis 

To diagnose clinical depression, at least two of these three signs must be present: 

  • Anxiousness 
  • Constant sadness 
  • Loss of pleasure in life 

Managing Depression

The goals of managing depressing include: 

  • Keeping the individual from harm, potentially with inpatient monitoring 
  • Administering prescribed medications 
  • Assisting the individual and family to set realistic goals and outcomes 
  • Instituting safety precautions 
  • Referring for counseling and follow-up psychiatric care 

Depression Nursing Care Plan

Nursing Considerations 

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnosis, interventions, expected outcomes, and education for individuals with depression and suicide are listed below. 

Assessment 

  • History 
    • Individual has the following feelings/thoughts: 
      • Constant sadness 
      • Helplessness or worthlessness 
      • Hopelessness 
      • Loss of pleasure in life 
      • Poor self-esteem 
      • Restlessness or irritability 
      • Suicidal thoughts 
    • Change in appetite 
    • Crying 
    • Inability to concentrate 
    • Recent injury or diagnosis of chronic or terminal illness 
    • Weight loss 
  • Typically, there are no unusual physical findings other than the following observed signs: 
    • Lack of concentration and memory 
    • Poor eye contact 
    • Self-hatred 
    • Slow body movements (catatonia) 
    • Tearfulness 
  • Laboratory tests may be performed to rule out medical causes of depression. 
  • A computed tomography (CT) or magnetic resonance imaging (MRI) of the brain may also be performed. 
  • The provider may use the following instruments in reaching a diagnosis: 
    • Beck Depression Inventory 
    • Children’s Depression Inventory 
    • Geriatric Depression Scale 

Nursing Diagnosis/Risk For 

  • Alteration in mood 
  • Anxiety 
  • Fear 
  • Ineffective family coping 
  • Self-care deficit 

Interventions 

  • Administer proper care to keep individual from harm. 
  • Administer prescribed medications, such as antidepressants. 
  • Assist individual and family to set realistic goals and outcomes. 
  • Encourage the following: 
    • Activity, as capable and within the limits of supervision 
    • Proper intake of fluids and a well-balanced diet 
    • Self-care, as tolerated, with some restrictions based on individual safety (e.g., no razors or sharp utensils) 
  • Keep individual in open room, monitored or close to nursing station. 
  • Institute safety precautions. 
  • Monitor the following: 
    • Individual safety 
    • Side effects from medications 
    • Suicide attempts 
      • Immediate care should be administered with a suspected suicide attempt (overdose, self-inflicted trauma) 
  • Refer for counseling and follow-up psychiatric care. Treatments may include: 
    • Cognitive behavioral therapy 
    • Psychotherapy 
    • Psychodynamic therapy 
    • Brain stimulation therapies 
      • Electroconvulsive therapy may be utilized in some cases 
      • Repetitive transcranial magnetic stimulation (rTMS) 
    • Interpersonal therapy 

Expected Outcomes 

  • Responsive to medical treatment for depression 
  • No suicidal ideation 

Patient/Caregiver Education 

  • General Education 
    • Individual should receive immediate follow-up with psychiatrist and mental health counselor. 
    • Follow-up care may be as often as weekly. 
    • Stress importance of long-term follow-up and medication compliance. 
    • Discuss diagnosis and treatment plans with individual and family. 
    • Provide information about counseling/support groups. 
  • Discharge Planning/Instructions 
    • Arrange for follow-up counseling with mental health professional. 
    • Determine suicide risk to enable discharge to home or to other facility. 
  • Prevention 
    • Healthcare providers should evaluate those who are seen regularly and may be at risk. 
    • Early intervention should be done in those with depressive thoughts and behaviors. 
    • Screen individuals with family history of depression or mental illness. 
    • Monitor prescribed drugs for efficacy and side effects worsening symptoms. 

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Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2026

Course Contributor 

The content for this course was revised by Sean Kennard, BSN, RN. 

Sean Kennard is an Air Force veteran with 10 years of active-duty service plus clinical experience in various mental health settings. Sean was educated and trained In Virginia as a Registered Nurse, where he practiced pediatric behavioral health nursing at Cumberland Hospital for Children and Adolescents in New Kent. He earned his Associate’s Degree in Nursing from ECPI University and Bachelor of Science in Nursing from Western Governors University. Sean is a former Program Director of a Senior Behavioral Health Unit and currently coaches licensure exam strategies to nursing graduates. His clinical skillset is in behavioral health across the lifespan, including behavioral case management and geropsychiatric nursing. He most recently worked as a Forensic Psych Nurse at Central State Hospital in Georgia during the onset of the pandemic before contracting with Relias as a Behavioral Health Subject Matter Expert Technical Writer. 

References 

FAQs

Sean Kennard, BSN, RN

Sean Kennard is an Air Force veteran with 10 years of active-duty service plus clinical experience in various mental health settings. Sean was educated and trained In Virginia as a Registered Nurse, where he practiced pediatric behavioral health nursing at Cumberland Hospital for Children and Adolescents in New Kent. He earned his Associate’s Degree in Nursing from ECPI University and Bachelor of Science in Nursing from Western Governors University. Sean is a former Program Director of a Senior Behavioral Health Unit and currently coaches licensure exam strategies to nursing graduates. His clinical skillset is in behavioral health across the lifespan, including behavioral case management and geropsychiatric nursing. He most recently worked as a Forensic Psych Nurse at Central State Hospital in Georgia during the onset of the pandemic before contracting with Relias as a Behavioral Health Subject Matter Expert Technical Writer.