Suicide Risk Assessment (SRA)

Last edited on March 7, 2024

Suicide risk assessments setting have poor predictive value in identifying those at risk actually of completing suicide.^[1] However, a structured suicide risk assessment remains a core skill in order to appropriately plan disposition for patients with suicidal ideation and also for medicolegal record keeping.

95% of “high risk” patients will not die by suicide^[2]
- There is no validated method to identify patients at high risk who would improve with treatment/hospitalization.
50% of suicides are from “low risk” patients.^[3]
50% of individuals who complete suicide have no prior history of suicide attempts.
Not all people who die by suicide have a psychiatric disorder.
- In Western high-income countries, the percentage of those who die by suicide with no psychiatric disorder is estimated to be between 5% and 40%. More robust studies estimate this to be at 20%.^[4]
There has been no improvement of accuracy of predicting suicides in the past 40 years, despite other advances in medicine, which speaks to the complexity of suicide as an outcome.

Suicide Assessment Scales

Name	Rater	Description	Download
Columbia-Suicide Severity Rating Scale (C-SSRS)^[7]	Clinician	The Columbia-Suicide Severity Rating Scale (C-SSRS) is a tool that uses a series of questions to assess suicide risk.	Link

The mnemonic CAIPS can be a good way to structure your suicide risk assessment documentation on the medical record:

C - Chronic Factors
- (e.g. - Past history of suicide attempts, history of self-harm)
A - Acute Factors
- (e.g. - Recent break up, job loss, or acute crisis)
I - Imminent Warning Signs
- (e.g. - Means of death has been prepared, such as buying a gun, or having imminent access to the means of death)
P - Protective Factors
- (e.g. - “Supportive family, help-seeking, willing to safety plan, future-oriented, willing to attend follow up)
S - Summary Statement
- (e.g. - “Based on the factors above, patient is at [low/medium/high] risk for suicide)