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
References: American Psychiatric Association. (2004). Practice Guidelines for the Assessment and Treatment of Patients with Suicidal Behaviors. In: Practice Guidelines for the Treatment of Psychiatric Disorders Compendium, 2nd edition. pp. 835-1027. VA: Arlington. Beautrais, A.L. (2003). Subsequent mortality in medically serious suicide attempts: A 5 year follow-up. Australian and New Zealand Journal of Psychiatry; 37: 595-599. Brown, G.K., Henriques, G.R., Sosdjan, D., & Beck, A.T. (2004). Suicide intent and accurate expectations of lethality: Predictors of medical lethality of suicide attempts. Journal of Consulting and Clinical Psychology; 72, 1170-1174. CDC. Youth Risk Behavior Survey, (2005). Morbidity and Mortality Weekly, Surveillance Summaries, Volume 55, No. SS-5 (June 6, 2006), 1-108. Kessler, R.C., Borges, B., & Walters, E.E. (1999). Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry; 56, 617-626. Owens, D., Horrocks, J., & House, A. (2002). Fatal and non-fatal repetition of self-harm. Systematic review. British Journal of Psychiatry; 181, 193-199. Rudd M.D., Berman, A.L., Joiner, T.E., Nock, M.K., Silverman, M.M., Mandrusiak, M., Van Orden, K., & Witte, T. (2006) Warning signs for suicide: Theory, research and clinical applications. Suicide and Life Threatening Behavior; 36, 255-62. Silver, J.M., Kramer, R., Greenwald, S., Weissman, M. (2001). The association between head injuries and psychiatric disorders: findings from the New Haven NIMH Epidemiological Catchment Area Study. Brain Injury, 15, 11, 935-945. Simpson, G. & Tate, R. (2002). Suicidality after traumatic brain injury: demographic, injury and clinical correlates. Psychological Medicine, 32, 687-697. Teasdale, T.W. & Engberg, A.W. (2001). Suicide after traumatic brain injury: A population study. The Journal of Neurology, Neurosurgery, and Psychiatry, 71 (4), 436-440. Berman, A.L., Jobes, D.A. & Silverman, M.M. (2006) Adolescent Suicide: Assessment and Intervention. NY: Guilford Publications. Brown, G., Ten Have, T., Henriques, G., Xie, S., Hollander, J. & Beck, A. (2005). Cognitive Therapy for the Prevention of Suicide Attempts, A Randomized Controlled Trial. JAMA, 294(5). 563-570. Institute of Medicine. (2002) Reducing Suicide: A National Imperative. Washington DC; The National Academies Press. Jacobs, D.G. (Ed.) (1999). The Harvard Medical School Guide to Suicide Assessment and Intervention. San Francisco, CA: Jossey-Bass. Jacobs, D. & Brewer, M (2004). American Psychiatric Association practice guidelines provides recommendations for assessing and treating patient with suicidal behaviors. Psychiatric Annals, 34 (5), 373-380. Jobes, David A., (2006) Managing Suicidal Risk: A Collaborative Approach. New York, NY: The Guilford Press. Joiner, T. (2005). Why People Die By Suicide. Cambridge, MA: Harvard University Press. Maris, R. W., Berman, A.L., & Silverman, M.M. (2000) Comprehensive Textbook of Suicidology Rudd, M.D. (2006) The Assessment and Management of Suicidality. Sarasota, FL: Professional Resource Press. Shea, S. (2002). The Practical Art of Suicide Assessment: A Guide for Mental Health Professional and Substance Abuse Counselors. Hoboken, NJ: John Wiley & Sons. Shea, S. (2004) The Delicate Art of Eliciting Suicidal Ideation. Psychiatric Annals, 34 (5), 374-400. Shneidman, E.S. (2004). Autopsy of a Suicidal Mind. London, Oxford University Press. Shneidman, E.S. (1996). The Suicidal Mind. London, Oxford University Press. Simon, R.I. (2004). Assessing and Managing Suicide Risk: Guidelines for Clinically Based Risk Management. Washington DC: American Psychiatric Publishing, Inc. Simon, R. & Hales, R. (2006). Textbook of Suicide Assessment and Management. Arlington, VA: American Psychiatric Publishing, Inc.