Demographic: age and sex; marital status; employment status; certain professions (farmers, vets, doctors, and dentists); economic class (high and low); minority groups. | Family history: suicide and mental illness, particularly alcoholism and bipolar affective disorder. | Mental illness: repeated relapses; recent admission/discharge from psychiatric unit; recent relapse in mental illness; self neglect; agitation; depressive symptoms, especially anhedonia and insomnia; severe anxiety and panic; psychotic symptoms; chronic schizophrenia, recurrent depression. | Hopelessness: difficulty seeing any future; particularly worrying if only able to see 1–2 hours future; ‘nothing to live for’; negative thoughts, helplessness, guilt, ‘I'm a burden’. |
Life events: especially if involving loss and repeated or chronic; childhood adversity, especially abuse; recent bereavement; relationship instability; redundancy; loss of privilege. | Personality disorder: personality traits:
impulsivity aggression lability of mood.
| Previous self harm: especially if previous high suicide intent attempt, superficial cutting, recent increasing intent if repeated self harm. | Suicidal ideas and plans: especially if recent worsening and associated with distress; suicide plans/preparations, e.g. will, note, internet, lethality of chosen method, and possible rescue/treatment. Beware, as proposed method can easily change from a low-lethality method to a high-lethality method. |
Lack of social capital: social isolation and living alone; lack social support; institutionalisation, for example, prison. | Substance misuse: precipitated by loss of interpersonal relationships. Especially if:
| Chronic medical illness: beware if the medical condition is accompanied by pain and functional disability; chronic pain, cancer; cardiovascular disease; dialysis; GI disease; male patients with GU disease; neurological illness: epilepsy (especially early onset), MS, dementia, post-cerebral trauma. | Psychotic symptoms: distressing psychotic phenomena, persecutory delusions, nihilistic delusions; command hallucinations perceived as omnipotent. |
Access to lethal means: firearms; suicide ‘hot spots’. | Poor problem solving skills: low IQ; poor coping skills. | Medication: both prescribed and over the counter; (consider weekly scripts). | Cognitive functioning: delirium, low IQ. |
| | | Insight: previous high pre-morbid functioning and fear of deterioration; early stage of illness. |