Understand Suicide:
Risk Factors

• Demographics: White, American Indian, Male, Older Age (review current rates ), 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

• 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)

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

• 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

-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…)