3: Assessment of Risk Factors
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3: Assessment of Risk Factors
When performing a suicide risk assessment, we suggest including, but not limited to, factors (see Table 6 below) within the following domains:
- Self-directed violence, thoughts, and behaviors
- Current psychiatric conditions and current or past mental/behavioral health treatment
- Psychiatric symptoms
- Social determinants of health and adverse life events
- Availability of lethal means
- Physical health conditions
- Demographic characteristics
Strength:
Weak for
Category:
ReviewedAmended
Grades and Definitions
- Strong for
- or "We recommend offering this option …"
- Weak for
- or "We suggest offering this option …"
- No recommendation
- or "There is insufficient evidence …"
- Weak against
- or "We suggest not offering this option …"
- Strong against
- or "We recommend against offering this option …"
Categories and Definitions |
||
---|---|---|
Evidence Reviewed* | Recommendation Category* | Definition* |
Reviewed | New-added | New recommendation following review of the evidence |
New-replaced | Recommendation from previous CPG that has been carried over to the updated CPG that has been changed following review of the evidence | |
Not changed | Recommendation from previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed but the recommendation is not changed | |
Amended | Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed and a minor amendment has been made | |
Deleted | Recommendation from the previous CPG that has been removed based on review of the evidence | |
Not reviewed | Not changed | Recommendation from previous CPG that has been carried forward to the updated CPG, but for which the evidence has not been reviewed |
Amended | Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has not been reviewed and a minor amendment has been made | |
Deleted | Recommendation from the previous CPG that has been removed because it was deemed out of scope for the updated CPG | |
*Adapted from the NICE guideline manual (2012): The guidelines manual. London: National Institute for Health and Care Excellence;2012. and Martinez Garcia L, McFarlane E, Barnes S, Sanabria AJ, Alonso-Coello P, Alderson P. Updated recommendations: An assessment of NICE clinical guidelines. Implement Sci. 2014;9:72. |
Recommendation Resources
The goal of suicide risk assessment is to help providers determine a patient’s risk of suicide at a given point in time. Although suicide risk assessments have poor predictive value in identifying those at risk, they can identify factors that are contributing to a patient’s risk, which can facilitate treatment planning. Evaluation of risk factors is a crucial component of suicide risk assessment. Several factors have been associated with increased risk for suicide.
Factor Category | List of Factors to Consider |
---|---|
Self-directed violence related |
|
Current psychiatric conditions and current or past mental/behavioral health treatment |
|
Psychiatric symptoms |
|
Social determinants of health and adverse life events |
|
Availability of lethal means |
|
Physical health conditions |
|
Demographic Characteristics |
|
Training and Clinical Resources
This section includes recommended trainings and clinical resources about the assessment of risk factors.
- VA Comprehensive Suicide Risk Evaluation (CSRE) printable worksheet
- The Columbia Risk and Protective Factors provides a checklist of risk and protective factors for suicide that can be used with any version of the Columbia Suicide Severity Rating Scale (C-SSRS)
- Healthy People 2030: Social Determinants of Health
Webinars
This section includes recommended webinars about the assessment of risk factors.
- Financial Well-Being and Suicide Risk in Military Veterans Presented by Dr. Eric Elbogen
- Firearm Acquisition & Ownership — Decision Making Within the Context of Injury Risk Presented by Dr. Joseph Simonetti
- Neurocognitive Disorders and Suicide Presented by Dr. Joleen Sussman and Kelly Soberay, MA
- Preventing Suicide Among Veterans Experiencing Homelessness: Drivers or Risk and Tailoring Evidence-Based Care Presented by Dr. Ryan Holliday, Kenneth Bruemmer, Evan Polzer, MA and Shawn Liu, LCSW
- Suicide Prevention among those with Neurologic Conditions Presented by Dr. Lisa Brenner
- Suicide Prevention in Veterans with Substance Use Disorders Presented by Dr. James Haug and Erin Higgins, LCSW, LAC
- Suicide Risk Factors Research & Clinical Implications Presented by Dr. Megan Harvey and Christie Machan, LCSW
- Suicide Risk and Prevention for Sexual and Gender Minority Populations Presented by Dr. John Blosnich
- TBI, Suicide, and Evidence-Informed Intervention Strategies Presented by Dr. Lisa Brenner
- The Role of Relationships in Risk for Self-Directed Violence Presented by Dr. Danielle Weber
- Treating PTSD in the Context of Suicidality Presented by Dr. Sadie Larsen and Dr. Lisa-Ann Cuccurullo
- Understanding and Addressing Suicide Among Homeless and At-Risk Veterans Presented by Drs. Ryan Holliday and Jillian Weber and Mr. Shawn Liu, LCSW
- Understanding and Navigating Elevated Suicide Risk when Working with Justice-Involved Veterans Presented by Drs. Ryan Holliday, Matthew Stimmel, Alicia Desai and Ms. Katherine Stewart, LCSW
Podcasts
This section includes recommended podcast episodes about the assessment of risk factors.
- Rocky Mountain MIRECC Short Takes on Suicide Prevention
- Risk Factors, Warning Signs, and Drivers of Suicide with Dr. Peter Gutierrez
Articles
This section includes recommended articles about the assessment of risk factors.
- 2019). Association of Firearm Ownership, Use, Accessibility, and Storage Practices With Suicide Risk Among US Army Soldiers. JAMA network open, 2(6). e195383. https://doi.org/10.1001/jamanetworkopen.2019.5383 (
- 2022). Risk factors for suicide in adults: systematic review and meta-analysis of psychological autopsy studies. Evidence-based mental health, 25(4). 148–155. https://doi.org/10.1136/ebmental-2022-300549 (
- 2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological bulletin, 143(2). 187-232. https://doi.org/10.1037/bul0000084 (
- 2018). A longitudinal study of risk factors for suicide attempts among Operation Enduring Freedom and Operation Iraqi Freedom veterans. Depression and anxiety, 35(7). 609–618. https://doi.org/10.1002/da.22736 (
- 2020). Evaluation of Suicide Mortality Among Sexual Minority US Veterans From 2000 to 2017. JAMA network open, 3(12). e2031357. https://doi.org/10.1001/jamanetworkopen.2020.31357 (
- 2023). Associations Between Natural Language Processing-Enriched Social Determinants of Health and Suicide Death Among US Veterans. JAMA network open, 6(3). e233079. https://doi.org/10.1001/jamanetworkopen.2023.3079 (
- 2021). Risk factors for completed suicide in the general population: A prospective cohort study of 242, 952 people. Journal of affective disorders, 282. 707–711. https://doi.org/10.1016/j.jad.2020.12.132 (
- 2018). Risk factors for the transition from suicide ideation to suicide attempt: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Journal of abnormal psychology, 127(2). 139–149. https://doi.org/10.1037/abn0000317 (
- 2022). Midlife suicide: A systematic review and meta-analysis of socioeconomic, psychiatric and physical health risk factors. Journal of psychiatric research, 154. 233–241. https://doi.org/10.1016/j.jpsychires.2022.07.037 (
- 2021). Living alone, loneliness and lack of emotional support as predictors of suicide and self-harm: A nine-year follow up of the UK Biobank cohort. Journal of affective disorders, 279. 316–323. https://doi.org/10.1016/j.jad.2020.10.026\ (
- 2023). Notes from the Field: Recent Changes in Suicide Rates, by Race and Ethnicity and Age Group - United States, 2021. MMWR. Morbidity and mortality weekly report, 72(6). 160–162. https://doi.org/10.15585/mmwr.mm7206a4 (
- 2023). Handgun Divestment and Risk of Suicide. Epidemiology (Cambridge Mass.), 34(1). 99–106. https://doi.org/10.1097/EDE.0000000000001549 (