Assessment of suicide risk

The assessment of suicide risk is an important clinical skill for the medical community

People most at risk will have strong suicidal ideation with frequent, intense and prolonged thoughts of suicide, as well as a history of multiple well-planned attempts where rescue was unlikely. They express an unambiguous wish to die, and have a clear plan and the means to carry it out.

It is important to note that the risk of suicide attempts can be higher in groups that are less likely to succeed. For example, in on year the State of New York reported only 70 suicide deaths among teenagers, but more than 150,000 attempts. Because young people still live with their families they are more likely to be discovered in the act. It does not mean, however, that each attempt should not be taken seriously.

Factors associated with risk:


 * Age (45 and older or adolescent)
 * Alcohol dependence or recreational drug use
 * Irritation, rage, violence
 * Prior suicidal behaviour
 * Unwillingness to accept help
 * Longer than usual duration of current depression
 * Prior diagnosis of depression, psychosis, or other mental ilness
 * in-patient psychiatric treatment
 * Recent loss or separation
 * Loss of physical health
 * Unemployment or retirement
 * Being single, recently widowed or divorced, particularly when the person is without a support system

Stages of Planning
There are three levels of suicide contemplation. The basic task is to find which of these stages best describes how close someone is to actually acting on his or her suicidal tendancies. At any of these levels the person is suffering from a thought disorder and needs professional counciling.


 * 1) Suicidal ideation - At this point suicide seems to the person to be the best answer to life's problems. There is no specific plan in place, and the person is toying with various methods of arranging his or her demise.
 * 2) Planning - The person has a preferred method of death and is setting up the situation to implement it. A person in this stage could be acquiring a weapon, making out a will, or writing letters of intent to be found after his or her death.
 * 3) Action - This person is carrying out his or her plan. Disposal of assets, donations or large gifts, unexpected travel plans, or sending children or dependents to visit others without explaination are all signs of this stage.   This person is in immanent danger of taking his or her life.

The suicide method of choice is an important measure of the seriousness of the person's situation. The more lethal the method, the more serious the situation. The presence or lack of a support system, such as family and friends, who can watch the person and see that they receive treatment is also a consideration.

It is important to remember that anyone seriously considering suicde is suffering from mental illness and needs treatment. One who has a set plan and is beginning to carry it out needs immediate attention. If no help is readily available, the person should go to an emergency room without delay. Someone who is idealizing suicide but has not planned to carry it out, or is in the early stages of plannng, should be carefully observed and referred to a doctor, counselor, member of the clergy, or other experienced person as soon as possible.