A nurse is assessing a patient recently diagnosed with major depressive disorder. Which findings should the nurse recognize as warning signs of suicide? (Select all that apply)

Choice A reason: Increased social engagement reflects enhanced dopamine and serotonin activity in the nucleus accumbens and prefrontal cortex, signaling improved mood in depression. This contrasts with suicide risk, which involves reduced amygdala reactivity and hippocampal monoamine deficits. Such behavior indicates recovery, not suicidal ideation, making it an incorrect warning sign. Choice B reason: Depression, or hopelessness, is a core suicide risk factor, driven by serotonin depletion in the prefrontal cortex and hippocampus, impairing emotional regulation. Amygdala hyperactivity amplifies negative affect, while low dopamine reduces reward-seeking, fostering despair. This neurobiological state strongly predicts suicidal ideation, making it a critical warning sign. Choice C reason: Withdrawing from social connections withdrawal reflects reduced oxytocin and dopamine signaling in the ventral striatum, common in depression. This isolation exacerbates amygdala-driven fear and prefrontal cortex dysfunction, increasing suicide risk by diminishing social support’s protective effects on the hypothalamic-pituitary-adrenal axis, making it a significant neurobiological indicator of suicidal behavior. Choice D reason: Giving away personal belongings signals suicidal intent, linked to prefrontal cortex planning despite serotonin deficits in depression. This behavior reflects hopelessness, with reduced amygdala reward processing and hippocampal dysfunction, preparing for death. It’s a strong neurobiological marker of imminent risk, as it indicates active decision-making toward suicide. Choice E reason: Sudden mood improvement after depression may indicate suicide risk, as resolved prefrontal cortex planning reduces anxiety, increasing dopamine transiently. This masks serotonin deficits and hippocampal despair, enabling action on suicidal plans. The amygdala’s deceptive calm, despite ongoing monoamine imbalances, makes this a critical warning sign.