Chronic Risk Factors (If present, these increase risk over one’s lifetime.)

A.     Perpetuating Risk Factors – permanent and non-modifiable

• Demographics:  White, American Indian, Male, Older Age (review current rates[1]), Separation or Divorce, Early Widowhood

• History of Suicide Attempts – especially if repeated
• Prior Suicide Ideation

• History of Self-Harm Behavior

• History of Suicide or Suicidal Behavior in Family

• Parental History of:

-           Violence

-           Substance Abuse (Drugs or Alcohol)

-           Hospitalization for Major Psychiatric Disorder

-           Divorce

• History of Trauma or Abuse (Physical or Sexual)

• History of Psychiatric Hospitalization

• History of Frequent Mobility

• History of Violent Behaviors

• History of Impulsive/Reckless Behaviors

Predisposing and Potentially Modifiable Risk Factors

• Major Axis I Psychiatric Disorder, especially:

-           Mood disorder,

-          Anxiety Disorder

-          Schizophrenia

-          Substance Use Disorder (Alcohol Abuse or Drug Abuse/Dependence)

-          Eating Disorders

-           Body Dysmorphic Disorder

-          Conduct Disorder…

• Axis II Personality Disorder, especially Cluster B

• Axis III Medical Disorder, especially if involves functional impairment and/or chronic pain)
• Traumatic Brain Injury

• Co-morbidity of Axis I Disorders (especially depression and alcohol misuse), of Axis I and Axis II (especially if Axis II Disorder is Antisocial PD or Borderline PD), of Axis I and Axis III Disorders

• Low Self-esteem/High Self-hate

• Tolerant/Accepting Attitude Toward Suicide

• Exposure to Another’s Death by Suicide

• Lack of Self or Familial Acceptance of Sexual Orientation

• Smoking

• Perfectionism (especially in context of depression)

Contributory Risk Factors

• Firearm Ownership or Easy Accessibility
• Acute or Enduring Unemployment
• Stress (job, marriage, school, relationship…)

Acute Risk Factors (If present, these increase risk in the near-term)

• Demographics: Recently Divorced or Separated with Feelings of Victimization or Rage

• Suicide Ideation (Threatened, Communicated, planned,  or Prepared for);

• Current Self-Harm Behavior

• Recent Suicide Attempt

• Excessive or Increased Use of Substances (alcohol or drugs)

• Psychological Pain (acute distress in response to loss, defeat, rejection, etc.)

• Recent Discharge from psychiatric hospitalization

• Anger, Rage, Seeking Revenge
• Aggressive Behavior

• Withdrawal from Usual Activities, Supports, Interests, School or Work; Isolation (e.g. lives alone)

• Anhedonia
• Anxiety, Panic
• Agitation
• Insomnia
• Persistent Nightmares
• Suspiciousness, Paranoia (ideas of persecution or reference)
• Severe feelings of confusion or disorganization
• Command Hallucinations Urging Suicide
• Intense affect states (e.g. desperation, intolerable aloneness, self-hate…)
• Dramatic Mood Changes

• Hopelessness, Poor Problem-solving, Cognitive Constriction (thinking in black and white terms, not able to see gray areas, alternatives…), Rumination, Few Reasons for Living, Inability to Imagine Possibly Positive Future Events

• Perceived Burdensomeness
• Recent diagnosis of terminal condition

• Feeling Trapped, Like There is No Way Out (other than death); Poor Problem-Solving

• Sense of Purposelessness or Loss of Meaning; No Reasons for living

• Negative or mixed attitude toward help-receiving
• Negative or mixed attitude by potential caregiver to individual

• Recklessness or Excessive Risk-Taking Behavior, Especially if Out of Character or Seemingly Without Thinking of Consequences, Tendency toward Impulsivity

Precipitating or Triggering Stimuli (Heighten Period of Risk if Vulnerable to Suicide)

• Any Real or Anticipated Event Causing or Threatening:

-          Shame, Guilt, Despair, Humiliation, Unacceptable Loss of Face or Status

-          Legal Problems (loss of freedom), Financial Problems , Feelings of Rejection/Abandonment

• Recent Exposure to Another’s Suicide (of friend or acquaintance, of celebrity through media…)