Assessment of suicide risk

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The routine assessment of suicide risk is an important clinical skill.

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

Factors associated with risk:

• Having a clear plan
• Having the means to carry out the plan
• Age(45 an older)
• Alcohol dependence
• Irritation, rage, violence
• Prior suicidal behaviour
• Male
• Medication usage
• Unwilling to accept help
• Longer than usual duration of current depression
• Prior inpatient psychiatric treatment
• Recent loss or seperation
• Loss of physical health
• Unemployed or retired
• Single, widowed or divorced.

Assessment instruments

Main article: Suicide risk assessment tools

• Adult Suicidal Ideation Questionnaire (ASIQ)
• Beck Hopelessness Scale (BHS)
• Coping Inventory for Stressful Situations (CISS)
• Firestone Assessment of Self-Destructive Thoughts (FAST)
• Lifetime Parasuicide Count (LPC)
• Inventory of Suicide Orientation-30 (ISO-30), for adolescents
• Parasuicide History Interview (PHI)
• Positive and Negative Suicide Ideation Inventory (PANSI)
• Reasons for Living Scale (Long Form - 72 Items)
• Reasons for Living Inventory for Adolescents (RFL-A)
• Reasons for Living Inventory for Young Adults (RFL-YA)
• Scale for Suicidal Ideation
• Suicidal Behavior History Form (SBHF)
• Suicide Behaviors Questionnaire-Revised (SBQ-R)
• Suicidal Ideation Questionnaire (SIQ)
• Suicide Probability Scale (SPS)
• Suicide Resilience Inventory - 25 (SRI-25)

Clinical guidelines

Recently a number of clinical guidelines have been published:

• [http://www.cks.nhs.uk/schizophrenia CSK guidelines

What to do if you think suicide is likely

Arrange for a psychiatric assessment with a view to a protective hospital admission.

See also

• List of prescription drugs associated with increased risk of suicide
• Parasuicide
• Suicide amongst discharged psychiatric patients

Key texts

Books

• Beck A T, H. Resnik and J. Lettier (1974)The Prediction of Suicide.Charles Press :

• Maris, R. W., Berman, A. L. & Silverman, M. M. (2000). Comprehensive Textbook of Suicidology. Guilford Press: New York.

Papers

• Beck, A. T., Schuyler, D. & Herman, I. (1974). Development of suicidal intent scales. In: The Prediction of Suicide (ed. A. T. Beck, H. Resnik and J. Lettier), pp. 45–56. Charles Press.
• Beck, A. T., Kovacs, M., and Weissman, A. Assessment of suicidal intention: The Scale for Suicidal Ideation. Journal of Consulting and Clinical Psychology.
• Beck, A. T. & Steer, R. A. (1989). Clinical predictors of eventual suicide : a five to ten year prospective study of suicide attempters. Journal of Affective Disorders 17, 203–209.

Additional material

Papers

• + assessment Google Scholar

External links

• Evaluation and Treatment of Patients with Suicidal Ideation