1. The treatment of a suicidal patient in the intensive care unit (ICU) includes evaluation, management, and safeguarding the patient.

2. Evaluation and management of the suicidal patient require an understanding of risk factors, protective factors, the interplay among these elements, and the relationship between the staff and the patient.

3. Psychiatric care is essential during and after the stabilization of medical problems. It is helpful to initiate psychiatric involvement from the beginning of the admission, even if the patient is intubated and heavily sedated. In these circumstances, the consulting psychiatrist can obtain collateral information, assess the severity and lethality of the attempt, establish the chronology of symptoms leading to the presentation, and conduct serial safety assessments.

1. Suicide is the 10th leading cause of death in the United States (as of 2009, 7th in men, 14th in women).

2. It is not possible to make absolute predictions of suicidal behavior.

3. Risk factors for suicide include sociodemographic factors, past and current psychiatric and medical illnesses, family history, and psychosocial stressors (Table 143-1).

4. Protective factors include the absence of these risk factors and the presence of support from medical treaters, family, and community.

5. Assessment of risk and protective factors must be conducted on a case-by-case basis.

1. Suicidal thinking can be expressed in various ways, including explicit declaration or implicit action (e.g., refusal to eat or to cooperate with care). All forms of suicidal thinking require immediate attention.

2. Monitoring is essential and can be accomplished through 1:1 observation or frequent checking on the patient. In some situations, physical restraints may be necessary.

3. The ICU staff should be aware of potential means by which the patient may harm himself or herself, including personal belongings and items brought in by visitors.