一位診斷為重度憂鬱症的病人說：「什麼都不重要了，如果我不在這裡，大家會過得更好。」下列哪些危險因子與該病人的自殺風險增加最密切相關？（選所有適合的）
A client diagnosed with major depressive disorder states, 'Nothing matters anymore. Everyone would be better off if I weren't here.' Which of the following risk factors are most strongly associated with increased suicide risk in this client? (Select all that apply.)
- APresence of a detailed plan✓ 正解有詳細的自殺計畫
- BRecent loss of a significant relationship✓ 正解近期失去重要關係
- CGiving away personal belongings✓ 正解贈送個人財物
- DImproved mood after a deep depressive episode✓ 正解深度憂鬱發作後情緒改善
- EFrequent attendance at religious services頻繁參加宗教活動
自殺風險評估是心理社會完整性領域的重中之重。核心概念是識別致死性與行為警訊。正確答案 A 是因為具體的計畫（工具、時間、地點）顯示執行機率極高。B 選項的失落是強大的壓力源，易引發無望感。C 選項是「交代後事」的行為表現。最容易被忽略的是 D：當重度憂鬱者情緒突然變好時，往往是因為他們終於下定決心要實行自殺計畫，且體力有所恢復能付諸行動，這在臨床上是高度危險信號。E 選項通常是保護因子而非危險因子，因為宗教信仰往往能提供社會支持與對生命的敬畏。護理師應直接詢問自殺意念，並在發現危險因子時立即啟動一對一監控，確保環境安全。
High suicide risk is indicated by the presence of a specific plan, recent significant losses, giving away possessions, and a sudden improvement in mood after a severe depressive episode, which may signal renewed energy to act on suicidal thoughts. These factors require immediate safety interventions and close monitoring.
美國護理實務中對於「自殺合約」已不再推薦，改強調「安全計畫（Safety Planning）」，著重於應對技能；台灣目前在精神科病房仍普遍使用自殺防範切結書，且家屬陪伴的角色在預防中佔比極高。