Suicide Risk Assessment (Suicide Prevention) Suicidal Risk Management

Suicide Risk Assessment (Suicide Prevention) Suicidal Risk Management

Suicide can be described as a fatal act of self-harm initiated with the intention of ending one's own life. Although often seen as impulsive, it may be associated with years of suicidal behavior including suicidal ideation or acts of deliberate self-harm.

Self-harm is defined as any act of self poisoning or self injury irrespective of motivation, and is associated with an increased risk of suicide.
Timely identification of persons at risk of suicide is critical to ensure adequate provision of care. Family physicians play an important role as most individuals who died by suicide visited their physicians in the month preceding death, and about 90% consulted their FP several times the prior year. This is a golden opportunity to train the primary care doctors and nurses in suicide screening and referral to higher centre.

Assessing the risk of suicide in a person expressing suicidal thoughts, or presenting with self-harm or a suicide attempt, is crucial in attempting to prevent deaths. Asking questions about suicidal thoughts does not increase the risk of suicide. There are a number of risk-predicting score systems for determining suicidal intent. However, none has good predictive ability, and various psychiatric guidelines advise these should NOT be used alone. Instead a comprehensive clinical interview should be used along with the structured instruments

Systematic suicide risk assessment should identify acute and chronic, modifiable, and treatable risk factors and weigh them against protective factors in determining management. Risk factors also have limitations. For example, a history of a prior suicide attempt is a clear risk factor for death by suicide but it is not modifiable risk factor but it dictates the management.

Warning Signs of Suicide

Wanting to die
Great guilt or shame
Being a burden to others
Empty, hopeless, trapped, or having no reason to live
Extremely sad, more anxious, agitated, or full of rage
Unbearable emotional or physical pain
Making a plan or researching ways to die
Withdrawing from friends, saying good bye, giving away important items, or making a will
Taking dangerous risks such as driving extremely fast
Displaying extreme mood swings
Eating or sleeping more or less
Using drugs or alcohol more often


Risk Factors

Previous suicide attempt
Mental illness, such as depression
Social isolation
Criminal problems
Financial problems
Impulsive or aggressive tendencies
Job problems or loss
Legal problems
Serious illness
Substance use disorder
Relationship:
Adverse childhood experiences
Family history of suicide
Relationship problems
Sexual violence
Barriers to health care
Cultural and religious beliefs such as a belief that suicide is noble resolution of a personal problem
Suicide cluster in the community


Protective Factors:

Coping and problem-solving skills
Cultural and religious beliefs that discourage suicide
Connections to friends, family, and community support
Supportive relationships with care providers
Availability of physical and mental health care
Limited access to lethal means among people at risk

Warning signs (sometimes called risk predictors) may be discovered by the clinician in the context of a psychiatric evaluation and often overlap with risk factors (e.g., in the case of a psychotic and intoxicated individual). The combination of both triggers suicide related behaviour