Suicide Risk Assessment (SRA)

The Suicide Risk Assessment is an important part of the psychiatric interview. A suicide risk assessment is a comprehensive assessment that determines what an individual's risk is for suicide at a given point in time – a suicide risk assessment cannot predict the future.

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
  • 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.
  • Always ask about access to guns and firearms if there is serious suicidal intention. Death by suicide from a firearm is a major cause of death by suicide in many countries, including both Canada and the United States.[4] Males are at a significantly higher risk of death by firearms than females.

The mnemonic SAD PERSONS can be used to evaluate risk factors:[5]

  • S - Sex (male > female)
  • A - Age (risk increases with age)
  • D - Depression
  • P - Previous attempt (this is the best indicator of suicide risk)
  • A - Alcohol abuse
  • R - Rational thinking loss (impulsive)
  • S - Social supports lacking
  • O - Organized plan
  • N - No spouse
  • S - Sickness
  • Children
  • Social supports
  • Religious
  • Good health
  • Pregnant
  • Sense of responsibility

Suicide Assessment Scales

Name Rater Description Download
Columbia-Suicide Severity Rating Scale (C-SSRS)[6] 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)

Consider the other following factors in your decision to discharge/admit:

  1. Diagnosis
  2. Severity of suicidal ideation
  3. Coping skills
  4. Living situation
  5. Social supports
  6. Risk factors
  7. Access to follow-up
  8. What is the intent, lethality, and access to means?