SUICIDE ASSESSMENT

EPC 695B: Advanced Behavior Disorders

Fall 2009

The following listing of “risk” has been developed to help the therapist determine the severity of the suicide risk:

Extreme Suicide Risk

· Multiple attempts + serious, feasible plan & preparation

Or

· Serious, feasible plan & preparations + 2 or more other major risk indicators. (Major risk indicators are listed on next page.)

Severe Risk

· Multiple attempts + 2 or more other major risk factors

Or

· Moderate to serious plans & preparation + one other major risk factor

Moderate Risk

· Multiple attempts + any other major risk factor

Or

· No previous attempts + moderate to serious, feasible plans and preparations

Or

· No attempts, no plan, but intense, serious ideation & 2 other variables

Mild Risk

· Multiple attempts, no other factors

Or

· No attempts, ideation of limited intensity and duration

Or

· Some resolved plans and preparation, with no other major factors

Highest Risk Suicide Indicators

1. Past history of attempts, and

2. Resolved plans and preparation, including

a. Specificity, feasibility & lethality of plan

b. Intensity of ideation

c. Courage & competence to make attempts

d. Rehearsal or other preparations for attempt

e. Rigid thinking, with suicide seeming the only option

Major Suicide Risk Indicators

Clinically noteworthy, but not as destructive

1. Suicidal desire & ideation:

a. Lack of reasons for living/lack of deterrents; e.g.,

hopeless despair about future.

b. Wish to die/desire for attempt; e.g., passive attempt or

talk of death or suicide.

c. Frequency of ideation

d. Desire for attempt/passive attempt

c. Lack of reasons to stay alive.

2. Impulsivity

3. Stress levels:

a. Recent interpersonal loss or disruption

b. Increases in physical symptoms

c. Recent incident causing shame & humiliation

4. General symptomatic presentation:

a. Major depression with hopelessness and anhedonia

b. Compromised mental status, such as decompensation,

command hallucinations, or agitation with rigidified

thinking.

c. Acute substance abuse

5. Family history

a. Chaotic relationships/problems with distance regulation

b. Suicide by other family members

c. Physical or sexual abuse

6. Availability of lethal means

a. Guns

b. Experience with violence and death

Suicide Contraindications (Barriers)

1. Marriage

2. Dependent children

3. Understanding the pain that suicide would cause to relatives/friends

4. Future target events (e.g., wedding, birthday)

5. Religious convictions

6. Working social support network

7. Self control and problem solving abilities

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