Impaired Reality Testing
- Psychosis
- Intoxication with alcohol or other drugs (Do not allow an intoxicated suicidal patient to go home. Transfer the patient to an emergency room [see page 308]).
Hopelessness
Ask the patient:
- “Are you feeling hopeless?” or “Can you see things getting better for you?”
Previous Suicide Attempts
- The more lethal the method used, the higher the risk.
- Suicide risk increases with each attempt.
- People who have had multiple suicide attempts should be considered chronically at risk.
- People who were recently discharged from an inpatient psychiatric ward, particularly those who attempted suicide, are at higher risk.
Current Severe Psychiatric Disorder
- Major depression
- Schizophrenia
- Alcohol use problems
- Borderline and antisocial personality disorders, especially in combination with major depression
Other Factors that Increase Risk
- Family history of suicide or suicide attempts (there is likely a genetic as well as a family environment contribution)
- Alcohol and other substance use problems
- Debilitating medical illness
- Recent loss (divorce, unemployment, death of someone close)
Assess reasons for living and protective factors
Ask the patient:
- “Things have been pretty rough. What keeps you going?”
- “You’ve been thinking about suicide, but you say you wouldn’t follow through. What keeps you from harming yourself?”
Factors associated with lower suicide risk include:
- religious or moral beliefs that suicide is wrong
- being married
- children under age 18 living at home
- employment
- good social supports
- strong therapeutic relationship
- good problem-solving skills
- higher level of self-esteem.