Clinician's Corner: A Brief Guide to Suicide Risk Assessment
Research identifies keys to suicide risk assessment.
Posted Mar 27, 2019
Suicide can be a taboo subject. For some people, it is an uncomfortable discussion and many parents are reluctant to discuss suicidal thoughts with their children. Often there is a myth that talking about suicide will increase risk. According to data from the National Institute of Mental Health, suicide is the 10th-leading cause of death in the United States. More concerning is the fact that suicide is the second-leading cause of death in individuals ages 10-14 and the third-leading cause of death in individuals ages 15-34. In light of the recent deaths by suicide discussed in the media, from celebrities to survivors of mass shootings, suicide appears to be a public health issue.
Research on Suicide Risk
Decades of research provide evidence that numerous factors are associated with the risk of death by suicide. Studies on suicide among adolescents have consistently reported that the strongest correlates of suicide attempts include suicidal thoughts or ideation, engaging in self-harm, and hopelessness (Mars et al., 2019). Furthermore, a recent study conducted by researchers in the United Kingdom reported that about one-third of adolescents that exhibit suicidal thoughts later make a suicide attempt (Mars et al., 2019).
New research has also sought to identify predictors of suicide among adolescents. Using a representative sample, Mars and colleagues (2019) found that for adolescents with a history of suicidal ideation, cannabis use, other illicit drug use, non-suicidal self-harm, and higher levels of the personality type intellect/openness were strongly associated with engaging in attempted suicide. The authors also found that among adolescents with a history of self-harm, the strongest evidence predicting suicide attempts were cannabis use, other illicit drug use, and sleep difficulties (sleeping too little or waking up during the night).
Components of a Risk Assessment
As a clinician, there is a high probability that you have or will encounter a patient that expresses suicidal thoughts or behaviors. The following section is not intended to be exhaustive and offers some primary areas of consideration when evaluating suicide risk. Please refer to your professional guidelines for assistance and regulations. (Also refer to Bryan and Rudd, 2006 for a more detailed discussion.) When evaluating suicide risk, it is important to recognize that risk varies by several demographic variables such as age, gender, sexual orientation, and ethnicity.
Predisposition to Suicide: One of the frequent contributors to suicide risk is having a mental health diagnosis such as depression. Bryan and Rudd (2006) state that risks are elevated following discharge from inpatient treatment, being a married man or unmarried woman, and identifying as gay, lesbian, bisexual, or transgender.
Precipitants or Stressors: Life events are another important factor to examine. During your risk assessment, it is critical to ask questions about any significant losses such as employment, relationships, chronic health issues, and family conflict. Some research reports that medical diagnoses can increase risk of suicide by as a result of having psychiatric symptoms such as mood disturbance or anxiety (Bryan & Rudd, 2006).
Presence of Hopelessness: Research consistently discusses the need to assess hopelessness. Bryan and Rudd (2006) recommend that clinicians inquire about the severity and duration of hopelessness. Furthermore, it is important to recognize that hopelessness may not be as associated with suicide among some cultural groups due to moral experiences and beliefs that may act as a buffer against hopelessness.
Dimensions of Suicidal Thinking: When assessing suicidal ideation, it is important to examine multiple areas outside of whether the person reports thinking about suicide or dying. According to Bryan and Rudd (2006), clinicians should assess frequency, intensity, and duration of suicidal thoughts. Within this process, clinicians should also evaluate the individuals’ intent and access to means of harming themselves.
Protective Factors: Clinicians should also explore and strengthen protective factors. Bryan and Rudd (2006) suggest that clinicians ask questions such as: “Do you have access to family or friends whom you can talk to and depend on? What reasons do you currently have for living?” This type of information is useful to help identify ways to reduce risk and identify people that could serve as social support with implementing a safety plan.
Resources on Suicide Prevention
Copyright 2019 Erlanger A. Turner, Ph.D.
Bryan, C. J., & Rudd, M. D. (2006). Advances in the assessment of suicide risk. Journal of Clinical Psychology, 62(2), 185-200.
Mars, B., Heron, J., Klonsky, E. D., Moran, P., O'Connor, R. C., Tilling, K., ... & Gunnell, D. (2019). Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: a population-based birth cohort study. The Lancet Psychiatry, 6, 321-337.