Assessment and Management of Patients at Risk for Suicide

Publication Date: May 1, 2019
Last Updated: March 14, 2022

Recommendations

Screening and Evaluation

Screening

With regard to universal screening, we suggest the use of a validated screening tool to identify individuals at risk for suiciderelated behavior. (Weak for)
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With regard to selecting a universal screening tool, we suggest the use of the Patient Health Questionnaire-9 item 9, to identify suicide risk. (Weak for)
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Evaluation

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 biopsychosocial stressors, and the availability of firearms. (Strong for)
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When evaluating suicide risk, we suggest against the use of a single instrument or method (e.g., structured clinical interview, self-report measures, or predictive analytic models). (Weak against)
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While it is an expected standard of care, there is insufficient evidence to recommend for or against the use of risk stratification to determine the level of suicide risk. ()
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Risk Management and Treatment

Non-pharmacologic Treatments

We recommend using cognitive behavioral therapy-based interventions focused on suicide prevention for patients with a recent history of self-directed violence to reduce incidents of future self-directed violence. (Strong for)
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We suggest offering Dialectical Behavioral Therapy to individuals with borderline personality disorder and recent self-directed violence. (Weak for)
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We suggest completing a crisis response plan for individuals with suicidal ideation and/or a lifetime history of suicide attempts. (Weak for)
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We suggest offering problem-solving based psychotherapies to:
a. Patients with a history of more than one incident of selfdirected violence to reduce repeat incidents of such behaviors
b. Patients with a history of recent self-directed violence to reduce suicidal ideation
​​​​​​​c. Patients with hopelessness and a history of moderate to severe traumatic brain injury
(Weak for)
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Pharmacologic Treatments

In patients with the presence of suicidal ideation and major depressive disorder, we suggest offering ketamine infusion as an adjunctive treatment for short-term reduction in suicidal ideation. (Weak for)
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We suggest offering lithium alone (among patients with bipolar disorder) or in combination with another psychotropic agent (among patients with unipolar depression or bipolar disorder) to decrease the risk of death by suicide in patients with mood disorders. (Weak for)
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We suggest offering clozapine to decrease the risk of death by suicide in patients with schizophrenia or schizoaffective disorder and either suicidal ideation or a history of suicide attempt(s). (Weak for)
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Post-acute Care

We suggest sending periodic caring communications (e.g., postcards) for 12-24 months in addition to usual care after psychiatric hospitalization for suicidal ideation or a suicide attempt. (Weak for)
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We suggest offering a home visit to support reengagement in outpatient care among patients not presenting for outpatient care following hospitalization for a suicide attempt. (Weak for)
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We suggest offering the World Health Organization Brief Intervention and Contact treatment modality following presentation to the emergency department for suicide attempt, in addition to standard care. (Weak for)
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Technology-based Modalities

There is insufficient evidence to recommend for or against technology-based behavioral health treatment modalities for individuals with suicidal ideation. These include self-directed digital delivery of treatment protocols with minimal or no provider interaction (e.g., compact disc, web-based), and provider-delivered virtual treatment. ()
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There is insufficient evidence to recommend for or against the use of technology-based adjuncts (e.g., web or telephone applications) to routine suicide prevention treatment for individuals with suicidal ideation. ()
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Other Management Modalities

We suggest reducing access to lethal means to decrease suicide rates at the population level. (Weak for)
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There is insufficient evidence to recommend for or against community-based interventions targeting patients at risk for suicide. ()
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There is insufficient evidence to recommend for or against community-based interventions to reduce population-level suicide rates. ()
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There is insufficient evidence to recommend for or against gatekeeper training alone to reduce population-level suicide rates. ()
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There is insufficient evidence to recommend for or against buddy support programs to prevent suicide, suicide attempts, or suicidal ideation. ()
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Recommendation Grading

Overview

Title

Assessment and Management of Patients at Risk for Suicide

Authoring Organization

Publication Month/Year

May 1, 2019

Last Updated Month/Year

January 30, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Male, Female, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory

Intended Users

Counselor, nurse, nurse practitioner, physician, physician assistant, psychologist, social worker

Scope

Assessment and screening, Management, Prevention, Rehabilitation

Diseases/Conditions (MeSH)

D017236 - Suicide, Assisted

Keywords

behavioral health, traumatic brain injury, major depressive disorder, Posttraumatic Stress Disorder, Suicide