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Prevention Tips for Clinicians

Medscape: Assessing Suicide Risk - 12 things that should alert a clinician to a real suicide potential:

 1. Patients with definite plans to kill themselves – People who think or talk about suicide are at risk; however, a patient who has a plan(e.g., to get a gun and buy bullet) has made a clear statement regarding risk of suicide.

 2. Patients who have pursued a systematic pattern of behavior in which they engage in activities that indicate they are leaving life – This includes saying goodbye to friends, making a will, writing a suicide note, and developing a funeral plan.

 3. Patients with a strong family history of suicide – Family history of suicide especially indicative of suicide risk if the patient is approaching the anniversary of such a death or the age at which a relative committed suicide.

 4. The presence of a gun, especially a handgun.

 5. Being under the influence of alcohol or other mind-altering drugs – Drug abuse is especially significant if the drugs are depressants.

 6. If the patient encounters a severe, immediate, unexpected loss – E.g., when a person is fired suddenly or left by a spouse.

 7. If the patient is isolated and alone.

 8. If the person has a depression of any type.

 9. If the patient experiences command hallucination – A command hallucination ordering suicide can be a powerful message of action leading to death.

 10. Discharge from a psychiatric hospital – Patients are at suicide risk upon discharge from a psychiatric hospital, which is a very difficult time of transition and stress; the structure, support, and safety of the institution are no longer available to the patient; the patient feels apprehension and is confronted with the reality of change, which translates into fright and vulnerability.

 11. Anxiety – Anxiety in all of its forms leads to a risk for suicide; the constant sense of dread and tension proves unbearable for some.

 12. Clinician’s feelings- Regardless of what the patient says or does, it matters if the clinician has a feeling that the patient is going to commit suicide; such perceptions are part of the clinical judgment and are an important part of the suicide assessment and intervention.

Author: Stephen Soreff, MD, President of Education Initiative, Nottingham, NH; Faculty, Boston University, Boston , MA and Daniel Webster College, Nashua, NH


Chief Editor: Eduardo Dunayevich, MD, Adjunct Assistant Professor, Department of Psychiatry, University of Cincinnati College of Medicine; Clinical Research Physician, Neuroscience, Lilly Research Laboratories


Retrieved from Medscape Mobile App: Suicide


There are a variety of suicide risk assessment tools that practitioners can use.  The following is one to assess suicide risk.  The practitioner should obtain information from the patient self-report and clinical interview as well as additional collaborative sources. 


Dr. Rudd calls this: THE SUICIDAL MODE - risk factors contributing  to SUICIDALITY  (PTPTBE) : Predispositions. Triggers. Physiology. Thoughts. Behaviors. Emotions:



  1. Genetic factors.

  2. Medical illness.

  3. Family Suicide history.

  4. Trauma history.

  5. Impulsivity.

  6. Aggression.

  7. Previous Suicidal behaviors.

  8. Psychiatric history.


TRIGGERS: (Perceived loss):

  1. Job.

  2. Relationship.

  3. Financial.

  4. Illness.

  5. Legal.

  6. Traumatic events.

  7. Significant other.

  8. Major life changes.



  1. Agitation.

  2. Sleep disturbance.

  3. Concentration problems.

  4. Physical pain.



  1. Substance abuse.

  2. Self-harm.

  3. Preparing for death.

  4. Practicing and Rehearsing Suicide.

  5. Suicide threats.

  6. Poor expression of emotion.

  7. Social withdrawal.



  1. Shame.

  2. Guilt.

  3. Anger.

  4. Anxiety.

  5. Panic.

  6. Depression.

Brief Cognitive Behavioral Therapy (B-CBT) For Suicidal Soldiers, Treatment Manual

M. David Rudd, Ph.D., ABPP,  University of Utah

Craig J. Bryan, PsyD, ABPP, University of Texan Health Science Center at San Antonio

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