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3: Assessment of Risk Factors

Screening and Evaluation » Evaluation
3: Assessment of Risk Factors

We recommend an assessment of risk factors as part of a comprehensive evaluation of suicide risk, including but not limited to: current suicidal ideation, prior suicide attempt(s), current psychiatric conditions (e.g., mood disorders, substance use disorders) or symptoms (e.g., hopelessness, insomnia, and agitation), prior psychiatric hospitalization, recent bio-psychosocial stressors, and the availability of firearms.

Strength:

Strong for

Category:

ReviewedNew-replaced

Grades and Definitions

Strong for
or "We recommend offering this option …"
Weak for
or "We suggest offering this option …"
No recommendation
or "There is insufficient evidence …"
Weak against
or "We suggest not offering this option …"
Strong against
or "We recommend against offering this option …"

Categories and Definitions

Evidence Reviewed* Recommendation Category* Definition*
Reviewed New-added New recommendation following review of the evidence
New-replaced Recommendation from previous CPG that has been carried over to the updated CPG that has been changed following review of the evidence
Not changed Recommendation from previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed but the recommendation is not changed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed based on review of the evidence
Not reviewed Not changed Recommendation from previous CPG that has been carried forward to the updated CPG, but for which the evidence has not been reviewed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has not been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed because it was deemed out of scope for the updated CPG
*Adapted from the NICE guideline manual (2012): The guidelines manual. London: National Institute for Health and Care Excellence;2012. and Martinez Garcia L, McFarlane E, Barnes S, Sanabria AJ, Alonso-Coello P, Alderson P. Updated recommendations: An assessment of NICE clinical guidelines. Implement Sci. 2014;9:72.

Recommendation Resources

Findings suggest that a comprehensive suicide risk evaluation should include a clinical assessment of risk factors. Factors that increase risk for suicidal thoughts and/or behaviors with the most evidence were organized into categories including: current suicidal ideation, prior suicide attempt(s), current psychiatric conditions (e.g., mood disorders) or symptoms (e.g., hopelessness), prior psychiatric hospitalization, recent bio-psychosocial stressors, and the availability of firearms.

Training Resources

This section includes links to recommended trainings about the assessment of risk factors.

VA Comprehensive Suicide Risk Assessment (CSRE) printable worksheet
The Suicide Prevention Resource Center
Thumbnail image of The Columbia Risk and Protective Factors Page The Columbia Risk and Protective Factors Page provides a checklist of risk and protective factors for suicide that can be used with any version of the Columbia Suicide Severity Rating Scale (C-SSRS)
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Webinars

This section includes links to recommended webinars about the assessment of risk factors.

CPG Webinar Evidence-Based Practice in Suicide Risk Screening and Evaluation: Why, What, How and When? Presented by Dr. Nazanin Bahraini
CPG Webinar Suicide Risk Factors Research & Clinical Implications Presented by Dr. Megan Harvey and Christie Machan, LCSW
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Articles

This section includes links to recommended articles about the assessment of risk factors.

Anglemyer, A., Horvath, T., & Rutherford, G. (2014). The accessibility of firearms and risk for suicide and homicide victimization among household members: a systematic review and meta-analysis. Annals of internal medicine, 160(2). 101-110. https://doi.org/10.7326/M13-1301
Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., Musacchio, K. M., Jaroszewski, A. C., Chang, B. P., & Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological bulletin, 143(2). 187-232. https://doi.org/10.1037/bul0000084
Glenn, C. R., Kleiman, E. M., Cha, C. B., Deming, C. A., Franklin, J. C., & Nock, M. K. (2018). Understanding suicide risk within the Research Domain Criteria (RDoC) framework: A meta-analytic review. Depression and anxiety, 35(1). 65-88. https://doi.org/10.1002/da.22686
Zalsman, G., Hawton, K., Wasserman, D., van Heeringen, K., Arensman, E., Sarchiapone, M., Carli, V., Höschl, C., Barzilay, R., Balazs, J., Purebl, G., Kahn, J. P., Sáiz, P. A., Lipsicas, C. B., Bobes, J., Cozman, D., Hegerl, U., & Zohar, J. (2016). Suicide prevention strategies revisited: 10-year systematic review. The lancet. Psychiatry, 3(7). 646-659. https://doi.org/10.1016/S2215-0366(16)30030-X
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Podcasts

This section includes links to recommended podcasts about the assessment of risk factors.

Rocky Mountain MIRECC Short Takes on Suicide Prevention
Short Takes podcast icon Risk Factors, Warning Signs, and Drivers of Suicide with Dr. Peter Gutierrez
Short Takes podcast icon Suicide Risk Assessment: A new look at an old tool and why it remains essential with Dr. Peter Gutierrez
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