A nurse is assessing a client. Which assessment finding would be most concerning and require immediate intervention?

Prolonged Grief Disorder (PGD), as defined in the ICD-11 and DSM-5-TR, is characterized by persistent and functionally impairing grief lasting beyond 6-12 months ^[3]. However, the immediate safety risk in this scenario is not contingent on the timeline of grief but on the acute presentation of suicidal intent. The statement "I should have died instead of my spouse" reveals intense survivor guilt and a sense of worthlessness, which are cognitive distortions that elevate suicide risk. When this is paired with the act of giving away personal belongings—a recognized behavioral red flag indicating a plan and preparatory actions—the lethality risk escalates sharply. This aligns with the core principles of Psychological First Aid (PFA), which prioritize ensuring safety and stabilizing individuals in crisis ^[1].

The other options describe manifestations that are common in the acute phase of bereavement and do not signal an immediate threat to life. Difficulty sleeping, decreased appetite, anger toward the perpetrator of the loss, and a transient sense of the deceased's presence are all normative grief reactions. Research on maladaptive grief symptoms (MGS) and posttraumatic stress symptoms (PTSS) indicates that while these reactions can be distressing, they do not inherently carry the same imminent risk as active suicidal planning ^[2]. The neurobiological model of grief suggests that most individuals transition from acute grief (AG) to integrated (adaptive) grief through functional emotion regulation processes ^[4]. The presence of preparatory behaviors for death, however, indicates a failure of these adaptive mechanisms and a progression toward a life-threatening crisis that overrides the need for further longitudinal observation at that moment.

• Suicidal Ideation with Plan — Thoughts of ending one's life accompanied by a specific method or preparatory actions, indicating high lethality risk.
• Survivor Guilt — Intense remorse or self-blame for surviving a traumatic event when others did not, often a cognitive distortion in grief.
• Behavioral Red Flags — Observable actions like giving away possessions that suggest a person is preparing for death by suicide.
• Psychological First Aid (PFA) — An evidence-informed modular approach to assist individuals in the immediate aftermath of crisis, prioritizing safety and stabilization.