Nursing Care for a Patient with a Risk of Suicide Due to Depression Using the Solution-Focused Brief Therapy Approach: Case Study

Icih Susanti ^1,†, Noki Irawan Saputra ^1,†, Lina Budiyanti ^1,†, Aam Amalia ^1,†, Rohman Hikmat ^2,†, Iyus Yosep ^3,†,*

1. Rumah Sakit Jiwa Cisarua, West Java Province, Bandung Barat, Jawa Barat, Indonesia

2. Doctoral Students of Nursing, Faculty of Nursing, Prince of Songkla University, Hat Yai District, Songkhla 90110, Thailand

3. Department of Mental Health, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Jawa Barat, Indonesia

† These authors contributed equally to this work.

* Correspondence: Iyus Yosep

Academic Editor: Roghieh Nooripour

Special Issue: Mental Health and Well-Being in Adolescents: Current Evidence and Future Directions

Received: September 11, 2025 | Accepted: November 12, 2025 | Published: November 17, 2025

OBM Neurobiology 2025, Volume 9, Issue 4, doi:10.21926/obm.neurobiol.2504309

Recommended citation: Susanti I, Saputra NI, Budiyanti L, Amalia A, Hikmat R, Yosep I. Nursing Care for a Patient with a Risk of Suicide Due to Depression Using the Solution-Focused Brief Therapy Approach: Case Study. OBM Neurobiology 2025; 9(4): 309; doi:10.21926/obm.neurobiol.2504309.

© 2025 by the authors. This is an open access article distributed under the conditions of the Creative Commons by Attribution License, which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is correctly cited.

1. Introduction

Depression is a mental health problem for which no solution has yet been found, and its prevalence is increasing every year. According to the World Health Organization (WHO), depression is the leading cause of inability to function normally in adolescents aged 10 to 19 [1]. The WHO also states that 3.8% of the world's population experiences depression, of which 5% occurs in adulthood and 5.7% in old age. In the adolescent group, the WHO noted that 1.1% of adolescents aged 10–14 years experience depression, while around 2.8% of adolescents aged 15–19 years experience it. Not only globally, but in Indonesia, there is also an increase in cases of depression. Based on basic health research, around 6.2% of people aged 15–24 years experience depression. This is supported by data from the Indonesian Pediatrician Association (IDAI) Yogyakarta, which shows that 3% of school children and 6% of adolescents experience major depression. This disease is also more common in productive age groups than in children or the elderly [2].

Adolescence is a transitional period between childhood and adulthood, during which they face developmental tasks such as adapting to their surroundings, discovering their identity, developing serious relationships with the opposite sex, and freeing themselves from the environmental and cultural influences of adulthood, while also fulfilling their responsibilities. This condition makes adolescents more susceptible to depression [3]. The age groups most vulnerable to depression are adolescents and the elderly. This occurs because both tend to pay more attention to changes in their bodies (body image) [4]. In addition, adolescents are susceptible to pressure and stress, as well as to difficulty adjusting to their surroundings. Adolescents who experience depression will usually show symptoms such as feelings of sadness, hopelessness, loss of enthusiasm, guilt, slow thinking, and decreased enthusiasm for daily activities, with several underlying causes [5].

Several factors, such as genetics, can cause depression, changes in neurotransmitters in the brain, environmental stress, or previous traumatic experiences, can cause depression. Adolescents' inability to adapt to their environment could be one of the causes of depression. Academic pressure and social issues, especially the impact of the COVID-19 pandemic, can trigger stress and anxiety in adolescents [6]. Teenagers experiencing depression typically exhibit symptoms such as decreased interest in previously enjoyed activities and isolation from others. Depression can also lead adolescents to engage in aggressive behavior, such as drug abuse or antisocial behavior. In more severe cases, they may even experience thoughts of suicide, and depression can increase the risk of suicide [7]. Therefore, the role of nurses as professional caregivers is crucial in providing prompt and appropriate action to prevent more serious consequences in adolescents experiencing depression.

Management of adolescents at risk of suicide generally uses two approaches: medication and nursing intervention. In the treatment guidelines for depressive disorders, psychotherapy can be chosen as a form of treatment, either alone or in combination with antidepressant medication [8]. As part of the nursing intervention, this process begins with assessment and evaluation, complemented by a supportive intervention, namely Solution-Focused Brief Therapy (SFBT). SFBT is a powerful model for crisis care across settings and populations and offers a solution to address current concerns about existing suicide interventions [9]. In addition, according to him, SFBT prioritizes collaboration that considers patients as experts in their lives, thus providing a sense of ownership and increasing the client's motivation during counseling. SFBT is a counseling technique that seeks more effective ways to reduce the number of sessions towards solutions, such as discussions through in-situ therapy [10].

SFBT has unique characteristics that distinguish it from traditional counseling approaches. SFBT is particularly relevant for adolescents, who seek a quick way to address their problems. The use of SFBT in adult depressed patients is as good as other psychotherapies, such as Cognitive Behavior Therapy (CBT) and emotional, behavioral, and academic therapy for adolescents in schools and services [11]. SFBT can help adolescents identify their strengths and resources and design concrete steps to achieve their goals [12]. SFBT therapists can help adolescents divert attention from the problems they face and focus more on solutions. SFBT helps adolescents find solutions to their difficult situations, which can increase their self-confidence and ability to overcome difficulties. Cases of suicide risk in adolescents in May 2025, in the recovery room of a mental hospital in West Java, amounted to 19 cases, one of which had attempted suicide. Therefore, researchers are interested in analyzing cases of adolescents at risk of suicide under nursing care and equipped with SFBT supportive therapy.

2. Methods

This writing method uses a descriptive case study, with a nursing process strategy on 1 patient that focuses on one of the critical problems in nursing care at risk of suicide. In this case study, the initial stage is to conduct an assessment, analyze and formulate the problem, develop a plan, implement, and provide supportive interventions, including Solution-Focused Brief Therapy (SFBT). After that, the results of the evaluation of subjective and objective data and the Mini Plus 5.0.0 score are seen. This case study was conducted in May 2025 in the recovery room X of the Mental Hospital (RSJ) in West Java. Data collection techniques include interviews, observations, and documentation. Data presentation techniques with tables and narratives. The assessment instrument used is Mini Plus 5.0.0, a suicide risk assessment tool used by RSJ. All potentially identifying information was anonymized.

2.1 Scaling Question

We used a 0 to 10 scale to assess the patient’s perceived ability to stay safe and to cope with depressive symptoms and suicidal thoughts. Anchors were 0 (no ability to keep safe) and 10 (complete confidence in sustained safety and coping). After the initial rating, the therapist elicited reasons for the current score and identified the smallest next step. Example prompts were as follows. On a scale from 0 to 10, where are you right now in your ability to keep yourself safe? What makes it that high and not lower? What would a one-point improvement look like the next day? Who or what could help you reach that next point? Scores were recorded each session and used to guide goal setting and safety planning. Scores range from 1 to 33: 1–5 = low, 6–9 = moderate, and ≥10 = high suicide risk.

2.2 Exception Questions

The therapist invited descriptions of times when suicidal ideation was absent or less intense and explored differences that made those times possible. Example prompts were as follows. When recently did the thoughts bother you less? What was different about that situation? What did you or others do that helped? How likely is it that you can reproduce a similar situation, rated on a 0 to 10 scale?

2.3 Miracle Question

The therapist invited a detailed picture of preferred future functioning. Example prompts were as follows. Suppose tonight a miracle happens and the current problems are resolved. Tomorrow, what would be the first minor signs at home or at school that tell you things are better? Who would notice and what would they see you doing? These descriptions were translated into specific, observable next steps.

2.4 Safety Linkage

“Scaling ratings informed a brief safety plan that included warning signs, coping steps, people to contact, and access to professional help. A rating below 5 triggered additional check-ins by nursing staff and notification of the attending physician.”

Therapists/Clinicians. Two psychiatric nurses (ages 30 and 38, both female) delivered all sessions. Both held RN mental health credentials, completed 24-hour SFBT training, had ≥X years of experience, and received weekly SFBT supervision.

2.5 Ethics Statement

This case study received ethical approval from the Health Research Ethics Committee of the West Java Provincial Mental Hospital with letter number KEP/46/KEPK-RSJPROVJABAR.

3. Case Description

3.1 Patient Characteristics

The patient is a 17-year-old Javanese Muslim female enrolled in the 11th grade of a vocational high school. At intake on May 20, 2025, she reported a prior suicide attempt by jumping from a tall building and described recurrent suicidal thoughts, particularly when seeing tall buildings.

3.2 Mental Status Examination

Appearance: untidy, oily hair consistent with infrequent shampooing, lethargic.

Behavior and psychomotor: cooperative, reduced initiative.

Speech: spontaneous, low volume, coherent.

Mood and affect: sad mood with a constricted and gloomy affect.

Thought: suicidal ideation with a prior plan to jump from a height, feelings of despair, and a wish to meet her mother.

Perception: no suspiciousness reported.

Cognition: not formally tested, no gross disorientation observed during interview.

Insight and judgment: partial to fair.

Motor activity: slowed, low motivation.

3.3 Predisposing and Precipitating Factors

3.3.1 Predisposing

The grandmother who had cared for her since infancy, following her parents’ divorce, died four years earlier, resulting in significant bereavement.

3.3.2 Precipitating

Approximately six months before admission, she was diagnosed with colitis, toxoplasmosis, and hearing loss with limited improvement despite repeated hospital care. The long travel distance required intermittent stays at a halfway house to access treatment. School attendance decreased, she felt embarrassed to meet friends, reported reduced self-confidence and weight loss, and was diagnosed with depression. She attempted suicide twice, by ingesting shampoo and by jumping from a second-floor window two weeks before admission.

3.4 Vital Signs, Pharmacotherapy, and Baseline Risk

Vital signs: blood pressure 100 over 60 millimeters of mercury, pulse 70 per minute.

Pharmacotherapy: Seroquel XR, quetiapine, 400 milligrams, and maprotiline, 50 milligrams.

Admission suicide risk: MINI Plus 5.0.0 score of 31 at triage.

Note on assessments: daily study assessments recorded scores of 21 on May 20, 15 on May 21, 5 on May 22, and 4 on May 23. The triage score differs due to timing and early clinical change after admission.

Diagnosis: severe depressive episode.

Ethics: Written informed consent was obtained before the procedure.

3.5 Implementation and Evaluation of Nursing Care

3.5.1 Primary Outcome and Timeline

Suicide risk decreased across four consecutive assessments. MINI-Plus 5.0.0 scores are summarized in Table 1 and visualized in Figure 1. At triage on admission, a separate screening recorded 31, whereas the daily study assessments began later the same day.

Table 1 MINI Plus 5.0.0 suicide risk scores across sessions.

Figure 1 Trend in MINI-Plus 5.0.0 suicide risk scores across sessions (May 20–23, 2025).

Session 1 Findings, May 21. The pre-session MINI Plus score was 21, indicating high risk. The therapist built rapport and clarified goals and the onset of suicidal thoughts. Scaling Questions, zero to ten, assessed perceived ability to stay safe and cope, with zero indicating no ability and ten indicating complete confidence and sustained safety.

Subjective: She reported persistent sadness related to physical illness and described a suicide plan involving jumping. She confirmed previous attempts by ingesting shampoo and by jumping from a second-floor window two weeks before admission. She rated her ability to stay safe and cope as six out of ten and wished to reach ten. Illustrative quotes include, “I still think about jumping when I see tall buildings,” and “I am tired of going back and forth to the hospital.”

Objective: occasional smiling, maintained eye contact, cooperative.

Post-session risk: MINI Plus was 15, which remains high.

Session 2 Findings, May 22. The PE session MINI Plus was 15 score, which indicates high risk. She remained sad about her illness and feared not seeing her mother because of limited visiting opportunities and transportation constraints. Exceptional work identified times when suicidal ideation was absent or less intense and what made those times possible. A brief Scaling Question and a between session task were used to document triggers, exceptions, helpful actions, and the likelihood of reproducing exceptions on a zero to ten scale.

Subjective: She reported residual passive suicidal ideation without current active intent or plan. She noted that writing and seeking support from a nurse or roommate helped reduce distress. Illustrative quotes include, “Writing and talking to the nurse helps the thoughts pass,” and “I do not feel broken like before.” She rated the improvement as 8 out of 10.

Objective: more frequent smiling, sustained eye contact, cooperative, brighter affect.

Post-session risk: MINI Plus was 5, which indicates low risk.

Session 3 Findings, May 23. Pre-session MINI Plus was 5, which indicates low risk. The physician granted discharge permission, and she planned to go home directly to see her mother. The therapist reviewed the homework and used the Miracle Question to elicit a detailed preferred future.

Subjective: She reported that writing helps when longing for her mother or when intrusive thoughts arise. In response to the Miracle Question, she stated, “I imagine living peacefully with my mother and returning to school to complete my assignments; I feel calmer and can plan for college,” and added, “I do not wish to die now. I want to go back to school.”

Objective: calm, frequent smiling, cheerful facial expression, good eye contact, and engaged with peers.

Post-session risk: MINI Plus was 4, which indicates low risk with a history of prior attempts. The team conducted a follow-up, and her mother planned to pick her up for discharge.

Qualitative Summaries. Short verbatim statements are presented to contextualize the quantitative trend in Figure 1. These excerpts are collated in Table 2, which is cited in the session narratives above.

Table 2 Illustrative patient quotes across sessions.

3.5.2 Secondary Outcome: Scaling Question

Perceived ability to stay safe and cope increased during therapy. The rating improved from 6/10 in Session 1 to 8/10 in Session 2; the Session 3 rating was not recorded (see Table 3).

Table 3 Scaling Question ratings by session.

4. Discussion

Our findings align with recent syntheses indicating broad, positive outcomes of SFBT across settings and supportive effectiveness evidence in diverse populations [13]. The rapid decline in MINI-Plus scores (Figure 1) is consistent with proposed mechanisms—enhanced future orientation and perceived agency. SFBT produces significant and broadly generalizable benefits for mental health outcomes across clinical and community settings [14]. Research has shown that SFBT reduces depressive symptoms and enhances well-being and functioning through mechanisms that emphasize agency, goal clarification, and activation of personal resources [15]. This finding aligns with the present case, in which the MINI-Plus 5.0.0 suicide-risk score decreased rapidly within three SFBT sessions [16]. Such results suggest that a concise, strengths-oriented intervention can produce clinically meaningful change when integrated into nursing care for adolescents experiencing depression [17,18].

Furthermore, recent reviews underscore SFBT’s flexibility and its potential synergy with other treatment modalities. SFBT enhances engagement, hope, and future orientation, and it can complement pharmacological or cognitive-behavioral approaches by strengthening motivation and self-efficacy [19]. In this case, improvement occurred during the patient's receipt of both medication and SFBT, illustrating the collaborative impact of multimodal therapy rather than the effect of a single technique [12]. In adolescent mental-health services, brief, solution-focused interventions have also been associated with improved adherence and lower dropout rates [20], supporting their inclusion as supportive strategies within comprehensive nursing practice.

The patient in this case study exhibited symptoms of severe depression with a high risk of suicide. Subjectively, the patient expressed a desire to end his life by jumping from a height, had attempted suicide by drinking shampoo two weeks before hospitalization, and expressed sadness due to a persistent physical illness. Objectively, the patient appeared gloomy, lethargic, made little eye contact, withdrew from social interactions, and cried while sharing stories, with a Mini Plus score of 15 (high risk) of 5.0.0. Predisposing factors that exacerbated the patient's condition included feelings of inferiority due to prolonged illness, feelings of shame among peers, and the loss of a very close grandmother. Depression can lead to feelings of hopelessness, low self-esteem, and urges to self-harm, leading to suicide attempts, particularly in cases of severe depression [18].

The mounting problems faced by patients make them unable to think and bear the burden they are experiencing. The complex issues faced by depressed patients persist, and they don't get answers to all their problems until they finally can't bear it anymore. However, in this thinking process, patients are unable to see the issue from various dimensions; in this case, patients only see the problem from their own perspective [21]. They are unable to think broadly, unable to see the external circumstances that are clearly more miserable than their own lives. Patients think about how to end their suffering immediately, and suicide becomes their decision, without thinking about their future [13]. There is a correlation between depression and suicidal ideation in adolescents at Senior High School X, Jakarta. Therefore, pharmacological and non-pharmacological interventions, including general therapy and supportive interventions such as Solution-Focused Brief Therapy (SFBT), are necessary.

The application of Solution-Focused Brief Therapy (SFBT) to adolescent patients with depression has been shown to help shift attention from problems to solutions and encourage patients to recognize their strengths and resources. Through scaling questions, exception questions, and miracle questions, patients are able to build hope, increase self-confidence, and develop adaptive strategies for coping with crises. This aligns with previous research confirming the effectiveness of SFBT as a supportive intervention in reducing suicidal ideation and behavior [9,12].

In the nursing action stage, in addition to being given nursing actions according to nursing care for patients at risk of suicide, patients were also given SFBT supportive therapy 3 times for 3 days, with a duration of 45-60 minutes per meeting. Researchers used three different techniques in each meeting, namely the first meeting with the scaling question technique, the second with the exception question technique, and the last with the miracle question. The methods in SFBT include scaling questions, exception questions, miracle questions, first-session task formulas, feedback, and presession change questions [22]. At the first meeting, researchers used the Scaling question technique for the problems currently faced by the patient. Researchers asked the patient to rate the problem on a scale of 1 to 10 to indicate the changes the patient wanted to achieve in overcoming the problem. The patient reported the issue was 6 and wanted it to be 10 after the therapy session. One specific SFBT technique frequently used by therapists is the Scaling Question [23]. This technique helps identify the steps taken to achieve goals and the small changes that make a big difference. Scaling techniques can help patients set change targets, allowing them to take full responsibility for the desired change [17].

The second session employed exception questions to identify times when suicidal ideation was absent or less intense, and to elicit the differences that made those exceptions possible. The researcher used the exception question technique, asking the patient, "When in your life have you thought less about suicide?" The patient answered, "I don't think about suicide when I'm talking to my mother." SFBT is a short, solution-focused therapy that minimizes the number of therapy sessions [16]. The exception question technique can help patients recognize instances where their problem did not arise, or where they successfully overcame challenges [24]. An exception is an experience that occurred in the patient's past. A problem has occurred, but the exception to that problem did not arise for some reason. This provides the patient with an opportunity to formulate a solution [25]. Patients can learn from positive experiences and apply them to more challenging situations by identifying exceptions [26]. In this case study, the patient found a solution: having a place to talk about any problems.

In the third meeting, the researcher used the miracle questionnaire technique. The researcher asked the patient to imagine positive things if the physical illness and problems he was facing were resolved. The patient said that if he recovered, he would be diligent in going to school, according to his mother's words, would not be disobedient anymore, and wanted to complete the school assignments he had left for a long time [27]. The therapist should throw out magic questions —that is, questions that ask what would happen if the problem magically disappeared or were solved. Magic questions are a collection of questions given to patients to help them imagine a problem situation that could be resolved in the future [28]. Patients are allowed to imagine how they would analyse the changes they desire for their future. The miracle questionnaire is a technique that encourages patients to imagine what their lives would be like if their problems were resolved [16]. This technique is effective in reducing depressive symptoms in adolescents by helping them envision a more positive future.

In the evaluation phase, researchers re-measured the Mini Plus 5.0.0 score after the intervention. The Mini Plus 5.00 is a structured diagnostic tool developed to rapidly screen patients for major psychiatric disorders as outlined in the DSM-IV and ICD-10. This tool is used to assess the presence of various psychiatric, mood, or anxiety disorders, which may impact clinical outcomes [29]. MINI-Plus 5.0.0 scores decreased from 21 (May 20) to 15 (May 21), then to 5 (May 22) and 4 (May 23), after being given SFBT therapy. In addition, subjective patient data was obtained, it was known that after giving SFBT, the patient expressed feelings of calm and comfort, could sleep at night, did not want to think about suicide, wanted to increase faith with more active worship, told stories when suicidal thoughts arose, there was no sense of despair, the patient also said he wanted to get well soon and be reunited with his parents and be able to go back to school, and had been allowed to go home by the doctor in charge [30].

4.1 Limitations and Implications for Practice

This single-case report limits generalizability and precludes causal inference. Improvements occurred alongside pharmacotherapy, introducing potential confounding and therapist-allegiance bias. No long-term follow-up was conducted. In practice, SFBT can be implemented as a brief supportive intervention in recovery wards when staff receive basic training and supervision. Future studies should include multi-case series or pilot randomized designs with follow-up.

5. Conclusions

In an inpatient adolescent with major depression and suicide risk, a brief, solution-focused nursing intervention delivered alongside pharmacotherapy was feasible, well tolerated, and associated with rapid clinical stabilization. The structured use of scaling, exception, and miracle questions supported safety planning, engagement with care, and a shift toward future-oriented coping.

As a single-case report, these observations are not generalizable and do not permit causal attribution to one component of care. Even so, the case illustrates how Solution-Focused Brief Therapy can be integrated into routine psychiatric nursing with minimal session time and clear documentation prompts.

For practice, nurses may consider SFBT techniques as adjunctive, skills-based conversations embedded in daily contacts, provided that staff receive basic training and supervision and that safety procedures remain in place. For research, multi-case series or pragmatic pilot trials with follow-up and fidelity monitoring are needed to evaluate the durability of change, mechanisms of benefit, and optimal integration with pharmacological management and standard ward protocols.

Acknowledgments

All authors would like to thank West Java Provincial Mental Hospital for giving us the opportunity to conduct this research.

Author Contributions

Made substantial contributions to the conception and design, or acquisition of data, or analysis and interpretation of data: IS, NIS, LB, AA, RH, IY; Involved in drafting the manuscript or critically revising it for important intellectual content: IS, NIS, LB, AA, RH, IY; Gave final approval of the version to be published. Each author must have participated sufficiently in the work to take public responsibility for the appropriate portion of the content: IS, NIS, LB, AA, RH, IY; Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: IS, NIS, LB, AA, RH, IY.

Funding

This research did not receive external funding.

Competing Interests

The authors have declared that there is no conflict of interest.

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