[1] Risk for suicide is re-evaluated throughout the course of care to assess the patient's response to personal situational changes and clinical interventions.
[2]: 230 Accurate and defensible risk assessment requires a clinician to integrate a clinical judgment with the latest evidence-based practice,[3] although accurate prediction of low base rate events, such as suicide, is inherently difficult and prone to false positives.
[4] The assessment process is ethically complex: the concept of "imminent suicide" (implying the foreseeability of an inherently unpredictable act) is a legal construct in a clinical guise, which can be used to justify the rationing of emergency psychiatric resources or intrusion into patients' civil liberties.
Over-sensitivity to risk can have undesirable consequences, including inappropriate deprivation of patients' rights and squandering of scarce clinical resources.
On the other hand, underestimating suicidality as a result of a dismissive attitude or lack of clinical skill jeopardizes patient safety and risks clinician liability.
[10] Risk level can be described semantically (in words) e.g. as Nonexistent, Mild, Moderate, Severe, or Extreme, and the clinical response can be determined accordingly.
Joiner found two factors, Suicidal Desire and Ideation, and Resolved Plans and Preparation.
The MSSI was also shown to have higher discrimination between groups of suicide ideators and attempters than the BDI, BHS, PSI, and SPS.
The SABCS was the first suicide risk measure to be developed through both classical test theory (CTT) and item response theory (IRT) psychometric approaches and to show significant improvements over a highly endorsed comparison measure.
Answers are on a Likert scale that ranges in size for each question, based on data from the original questionnaire.
[19][20] The Nurses Global Assessment of Suicide Risk (NGASR) was developed by Cutcliffe and Barker in 2004 to help novice practitioners with assessment of suicide risk, beyond the option of the current lengthy checklists currently available.
[22] As of 2019, the small countries of Antigua and Barbuda and Grenada are the only in the world where suicide is more common among women than among men.
[22] Gelder, Mayou and Geddes reported that women are more likely to die from suicide by taking overdose of drugs than men.
[10] Prolonged stress lasting 3 to 5 years, such clinical depression co-morbid with other conditions, can be a major factor in these cases.
[25] A similar pattern is seen in Australia, where Aboriginal people, especially young Aboriginal men, have a much higher rate of suicide than white Australians, a difference which is attributed to social marginalization, trans-generational trauma, and high rates of alcoholism.
[28][29] The literature on this subject consistently shows that a family history of suicide in first-degree relatives, adverse childhood experiences (parental loss and emotional, physical and sexual abuse), and adverse life situations (unemployment, isolation and acute psychosocial stressors) are associated with suicide risk.
This is also the case for a range of acute and chronic health problems, such as pain syndromes, or diagnoses of conditions like HIV or cancer.
[10] High risk is also associated with a state of severe anger and hostility, or with agitation, anxiety, fearfulness, or apprehension.
[3] Command hallucinations are often considered indicative of suicide risk, but the empirical evidence for this is equivocal.
[31] Assessment of suicide risk includes an assessment of the degree of planning, the potential or perceived lethality of the suicide method that the person is considering, and whether the person has access to the means to carry out these plans (such as access to a firearm).
The assessment would always include an exploration of the timing and content of any suicide note and a discussion of its meaning with the person who wrote it.
Other motivations for suicide include being motivated to end the suffering psychologically and a person suffering from a terminal illness may intend to die from suicide as a means of managing physical pain and/or their way of dealing with possible future atrophy or death.
[35]: 847 The long-term suicide rate for people with schizophrenia was estimated to be between 10 and 22% based upon longitudinal studies that extrapolated 10 years of illness for lifetime, but a more recent meta-analysis has estimated that 4.9% of people with schizophrenia will die from suicide, usually near the illness onset.
The risk is higher for the paranoid subtype of schizophrenia, and is highest in the time immediately after discharge from hospital.
In this group, elevated suicide risk is associated with younger age, comorbid drug addiction and major mood disorders, a history of childhood sexual abuse, impulsive and antisocial personality traits, and recent reduction of psychiatric care, such as recent discharge from hospital.