Suicide Risk Assessment Guide

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SUICIDE RISK ASSESSMENT GUIDE

REFERENCE MANUAL

INTRODUCTION

The Suicide Risk Assessment Pocket Card was developed to assist clinicians in all areas but especially in primary care and the emergency room/triage area to make an assessment and care decisions regarding patients who present with suicidal ideation or provide reason to believe that there is cause for concern. This reference guide provides more specific information and the rationale for the sections on the pocket card. The sections of the guide correspond with the sections of the card. The Reference Guide may also be used as a teaching aid for new providers, residents and students at all levels and disciplines as well as other caregivers. This introduction provides general information regarding the nature and prevalence of suicidal behaviors and factors associated with increased risk for suicide and suicide attempts. Suicidal thoughts and behaviors (including suicide attempts and death by suicide) are commonly found at increased rates among individuals with psychiatric disorders, especially major depressive disorder, bipolar disorders, schizophrenia, PTSD, anxiety, chemical dependency, and personality disorders (e.g., antisocial and borderline). A history of a suicide attempt is the strongest predictor of future suicide attempts, as well as death by suicide. Intentional self-harm (i.e., intentional self-injury without the expressed intent to die) is also associated with long-term risk for repeated attempts as well as death by suicide.

Psychiatric co-morbidity (greater than one psychiatric disorder present at the same time) increases risk for suicide, especially when substance abuse or depressive symptoms coexist with another psychiatric disorder or condition..

A number of psychosocial factors are also associated with risk for suicide and suicide attempts. These include recent life events such as losses (esp. employment, careers, finances, housing, marital relationships, physical health, and a sense of a future), and chronic or long-term problems such as relationship difficulties, unemployment, and problems with the legal authorities (legal charges). Psychological states of acute or extreme distress (especially humiliation, despair, guilt and shame) are often present in association with suicidal ideation, planning and attempts. While not uniformly predictive of suicidal ideation and behavior, they are warning signs of psychological vulnerability and indicate a need for mental health evaluation to minimize immediate discomfort and to evaluate suicide risk.

Certain physical disorders are associated with an increased risk for suicide including diseases of the central nervous system (epilepsy, tumors, Huntington’s Chorea, Alzheimer’s Disease, Multiple Sclerosis, spinal cord injuries, and traumatic brain injury), cancers (esp. head and neck), autoimmune diseases, renal disease, and HIV/AIDS. Chronic pain syndromes can contribute substantially to increased suicide risk in affected individuals.

Patients with traumatic brain injuries may be at increased risk for suicide. In comparison to the general population TBI survivors are at increased risk for suicide ideation (Simpson and Tate, 2002), suicide attempts (Silver et al. 2001) and suicide completions (Teasdale and Engberg, 2001). TBI-related sequelae can be enduring and may include motor disturbances, sensory deficits, and psychiatric symptoms (such as depression, anxiety, psychosis, and personality changes) as well as cognitive dysfunction. These cognitive impairments include impaired attention, concentration, processing speed, memory, language and communication, problem solving, concept formation, judgment, and initiation. Another important TBI sequelae that contributes to suicidal risk is the frequent increase in impulsivity. These impairments may lead to a life-long increased suicide risk which requires constant attention.

Although relatively rare, suicidal thoughts and...
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