In my last post, I described general features regarding suicide assessment. In this post, I will discuss specific risk factors.
Knowing the various risk factors can be useful in evaluating your client’s situation. There are permanent factors, which don’t really change over time; predisposing factors, which are potentially modifiable; contributing factors, and acute factors, which are important in determining current risk. But first let me start by talking about depression. Out of all of the risk factors, depression is probably the most important one.
Depression
There is a very strong link between clinical depression and suicide. Therefore, evaluating your client for depression is very important. Be sure to use open-ended questions such as “How would you evaluate your mood?” You’ll also want to compare current and previous moods by using a rating scale, to get a better idea relatively where this client is with regard to depressive symptoms. For example, if you had two clients with a similar level of depression, one who has always been this depressed and the other never has been, the risk is probably higher for the latter. It is also advisable to directly observe any depressive behavior(s) such as psychomotor retardation, changes in appearance, poor hygiene, agitation, or changes in sleeping or eating. Lastly, you can use a standardized instrument like the Beck Depression Inventory.
Now that we’ve discussed depression, let me list for you some of the general risk factors mentioned earlier:
Acute factors:
Demographics: recently divorced or separated with feelings of victimization or rage
Suicidal ideation
Recent suicide attempt or hospitalization
Excessive or increased substance use
Withdrawal symptoms
Aggression, violence, risk-taking behavior
Anxiety, panic, paranoia, agitation, ahnedonia
Recent losses or other psychological pain
Hopelessness, guilt, helplessness, feeling trapped, shame, worthlessness, despair
Recent terminal diagnosis, hallucinations, dramatic mood changes
Contributing factors:
Access to weapons
Acute chronic unemployment or economic hardship
Life stress
Permanent Factors:
Demographics (White, American Indian, male, older, separated or divorced)
Previous ideation and/or attempts, as well as familial history
History of self-harm behavior, trauma or abuse
History of violence, impulsivity, parental history of drug use
Divorce, mental illness, violence
Predisposing:
Axis I or II diagnosis
Chronic physical illness
Traumatic brain injury
Low self-esteem
Accepting of suicide, or know someone who has completed suicide
Smoking, perfectionism, family issues around sexual orientation
In my next post, I will cover how to evaluate risk.
Yours in the Joy of Knowledge,
Dr. Barbara LoFrisco
Source: American Association of Suicidology and personal communication with Dr. Caroline Wilde, November 13, 2013
