Risk Factors and Warning Signs

What is possible, in working to prevent suicide attempts, is to recognize common crises and “warning signs” that may precipitate a suicide attempt. We then can make an effort to reach out to these people at risk.

Being aware of the risk factors and commonly associated variables of suicide is the first step in being able to assess for suicide risk and lethality on which interventions are subsequently based. There are a variety of risk factors associated with suicide, from immediate issues to long-term predictors. Keep in mind that there are also protective factors that also need to be considered in assessment.

Risk and lethality are related to the presence, intensity, and number of factors. While many of these factors may appear to be of a general nature, it is the clustering of these factors that contributes to the person’s mood, belief system, and coping ability that may lead to the risk of suicide. Additional risk factors for children are also presented.

Immediate Suicide Predictors

  • Previous attempt or attempts
    • The method
    • The rescuer
  • Verbal suicide threat
  • Suicide Plan
    • Method
    • Availability of means
    • Decisions of time and place
    • Lethality of plan 

Life Events or Conditions

  • Presence of triggering or precipitating event
    • Client attributes ideation to an event or trigger
    • Timing of event? (During period of emotional distress?)
  • Psychiatric History
    • Depression
    • Bipolar
    • Schizophrenia
    • Anxiety Disorders
    • Personality Disorders (more likely gestures/attempts)
    • Discharged from psychiatric hospital (within 3 months)
    • Adaptation to prior psychological treatment
  • Substance Use
    • Drugs
    • Alcohol
  • Physical Illness: Chronic, incurable, and painful conditions
  • Loss of Relationships
    • Death of relative or close friend
    • Terminal illness of a relative or close friend
    • End of a relationship through divorce, separation, or estrangement
    • Anniversary date of loss
  • Loss of status or security
    • Job
    • Money or savings
    • Status, self-confidence
    • Religious faith
    • A dream
  • Major life changes
    • Developmental
    • Trauma
    • Other environmental stressors
  • Family variables
    • Family history of rejection or instability
    • Family history of suicide 

Emotional or Behavioral Factors

  • Suicide Ideation: Expressing thoughts of death, suicide, or wishes to be dead
  • Fantasies about Suicide: Positive fantasies about death or aftermath
  • Social Isolation
    • Few, if any, close relationships
    • Showing loss of interest in friends or pleasure in usual activities
  • Hopelessness
    • Expressed feelings of hopelessness, despair, guilt, helplessness
    • Inability to articulate reasons for living
  • Sudden mood change
    • Sudden, unanticipated signs of improvement in mood
    • Sudden disappearance of depressed or other symptoms
    • Suddenly becoming calm and resolved
  • Perception of current emotional state and perceived choices
    • Belief that current emotional pain is intolerable and inescapable
    • Unable to think of alternate reasons, viewpoints or choices
    • Belief that suicide is only option to relieve pain
  • “Personality” Variables
    • Hostility
    • Perfectionism or overly responsible behavior (leads to self-blame and guilt)
    • Level of impulsivity
    • Pessimism
    • Dependency
    • Rigidity
  • Change in appetite or weight: Suddenly eating less or losing weight
  • Change in sleeping patterns: Sleeping less than usual, or very little
  • Decrease in activity level and response rate
    • Speaking and/or moving with unusual speed or slowness
    • Decrease in sexual drive
    • Diminished ability to think or focus
    • Complaining of, or displaying reduced energy level
  • “Preparation” actions
    • Giving personal, valued articles away
    • Writing a will
    • Planning for the care of those left behind 

Demographic Variables

  • Gender
    • Male (succeed more)
    • Female (attempt more)
  • Race
    • White
    • Native Americans (Native Alaskans)
    • Other
  • Age
    • Elderly
    • Teens and young adults
  • Marital status: Separated, widowed, divorce
  • Employment
    • Loss of job or change in status
    • Unemployed
    • “High risk” job setting 

Here are some warning signs for children (ages 5-12)

Three or more of these behaviors lasting for an extended period of time (e.g., 1 month) would signal a need for assessment:

  • Sudden and dramatic changes in eating or sleeping patterns lasting for an extended period of time (e.g., over 1 month)
  • Frequent (2-3 per week) night terrors causing child to have extreme anxiety, which persist for an extended period of time
  • Sudden increase in bedwetting or bedsoiling, when this had not been a problem, and when it persists for an extended period of time
  • Child’s sudden change in mood resulting in severe crying spells, extreme sadness, rageful outbursts, or complete withdrawal, that do not seem related to any external event (such as a death of a family member, or a pet), and which last for an extended period of time
  • Artwork, pretend play, or peer play that depict consistent themes of death, violence, loss, and which persist for an extended period of time
Any one of these behaviors on their own would indicate a need for assessment:
  • Child’s displaying extreme sexualized behavior, beyond what a child of that developmental stage would normally display or have knowledge about
  • Child’s obssessional talk about death, mutilation, or violence (several times per day)
  • Child’s acting out mutilating behaviors towards self, others, or animals.