Suicide Risk Assessment (incl. Youth Suicide)

Suicide risk assessment should happen early in the assessment of any depressed patient.

Epidemiology

1 in 7 people with recurrent depression dies by suicide; 70% of suicides occur in people with depression. Suicide is the 7th leading cause of death overall. Men are about 3× more likely to die by suicide than women, though attempts are around 30× more common than completed deaths. Highest-risk age groups: men >85 and 30–34; women 50–54. Most common methods: hanging (~55%), poisoning (~20%), firearms (~6%).

Risk factors

Male sex; Aboriginal or Torres Strait Islander background; psychiatric illness (especially with melancholic or psychotic features); a previous attempt; family history of suicide; exposure to others’ suicidal behaviour; chronic illness; social isolation; severe hopelessness; access to means; alcohol/drug use; impulsivity; a history of aggression/violence; unemployment; recent losses.

Protective factors

Access to good-quality mental health care; regular engagement with health services; restricted access to lethal means; strong family/community connection; good coping skills (problem-solving, assertiveness); religious beliefs discouraging suicide.

Patients experiencing suicidal thoughts may fear they’re “going crazy,” that they’re a danger to others, or feel ashamed — normalise the conversation to reduce this barrier.

Assessment

Ask directly about: suicidal thoughts/ideation; intent; planning (including acquiring means); access to means; previous attempts; protective factors; and the lethality of any planned method or past attempt.

Management

• Involve family and friends where appropriate.
• There’s no evidence that suicide “contracts” are effective on their own.
• Arrange frequent, assertive review — tell the patient explicitly when you’ll see them next.
• Facilitate contact with mental health services.
• Provide a crisis card with contact numbers — friends/family, Lifeline, the Suicide Call Back Service.