suicidologyAmerican Association of Suicidology. Suicide Prevention, Intervention, Research, Education, Training.

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 ), 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)

Risk Factors for Suicide and Suicidal Behaviors I.
Risk Factors for Suicide and Suicidal Behaviors II.
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…)

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