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Assessing Suicidal Ideation and Behaviors in Patients

October 02, 2019

SAN DIEGO—Mental health clinicians should assess patients’ past and present suicidal ideation and behaviors, both regularly and during times of stress, an expert said at the Psych Congress 2019 Suicide Prevention 360 Pre-Conference.

“You won’t put suicidal thoughts in a person’s head,” Jill M. Harkavy-Friedman, PhD, vice president of research for the American Foundation for Suicide Prevention (AFSP), told attendees. “You can’t make a person suicidal.”

The daylong preconference, one of two Psych Congress 2019 preconference tracks, was presented in partnership with AFSP as part of the Suicide Prevention 360 Initiative.

In the opening session of the day, Dr. Harkavy-Friedman presented a model that clinicians can use in their offices, patient by patient, to understand and assess suicide risk. She urged attendees to run “toward” patients with suicide, not “away” from them.

Also from Psych Congress: How Safety Planning Can Help Prevent Suicides

In 2017, the last year for which statistics are available, 47,173 people have been identified as dying by suicide, according to the presentation. An estimated 1.4 million adults were estimated to have attempted suicide, and 54% of Americans have experienced loss due to suicide.

Males are 3.5 times more at risk for suicide, middle-aged people have higher risk than other groups, and white and Native American/Alaskan Indian youth are more at risk than other youth groups, Dr. Harkavy-Friedman said.

But she told the audience not to focus too much on such statistics.

“If you hear someone talking about suicide or not wanting to be around or ending their life … take it seriously,” she said. “The risk is there for every age group, for every ethnicity, and we can’t just look at demographics and say this person is at risk or this person isn’t at risk.”

Suicide Prevention: Predictors, Warning Signs, and Interventions

Clinicians may not think their patients are suicidal, but they can develop suicide risk later, possibly in the face of stressful events, Dr. Harkavy-Friedman said. Asking about depression is not enough, as not everyone who dies by suicide has depression, she said.

When discussing suicidal behaviors, she recommended asking about: the type of behavior (ideas vs attempts), the frequency and persistence of behaviors, past and present intend to die, medical damage from previous attempts, and circumstances surrounding suicidal behavior.

Another key tool in reducing suicide is reducing people’s access to lethal means, Dr. Harkavy-Friedman said. She noted that in the United States, rural states with most lenient firearm rates have the highest suicide rates.

If someone attempts suicide with a firearm, the chance they will die from the attempt is 85% to 90%, Dr. Harkavy-Friedman said. In contrast, only 2% of people who attempt suicide by poisoning die.

“You can’t kill yourself if you don’t have access to lethal means. That’s the bottom line,” she said.

—Terri Airov


Understanding and approaching suicide risk.” Presented at the Psych Congress 2019 Suicide Prevention 360 Pre-Conference: San Diego, CA; October 2, 2019.

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