Acute Suicide

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)
• 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…)