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Acute Risk Factors

If present, these increase risk in the near-term. Acute risk signifies emergent or imminent threat to life. Clinicians must determine if the suicide plan is formed, with specificity of lethal risk, the presence of a timetable, access to lethal means, etc. Vigilance, safety planning, and possible hospitalization may be necessary. Determine if the acute risk is low, moderate or high.

 

  • 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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