Suicide Risk Screening

What is a suicide risk screening?

Suicide is death that happens when someone harms themselves because they want to end their life. It is a major public health concern and is a leading cause of death in the United States and in the world.

Suicide and suicide attempts can have lasting harmful effects:

• People who survive a suicide attempt may have serious injuries that can affect their long-term health. They may also have depression or other mental health concerns.
• When people die by suicide, it affects their family, friends, and community. They may feel grief, shock, anger, and guilt. Some may develop post-traumatic stress disorder (PTSD), depression, or anxiety. They may also be at risk for suicidal thoughts.

Suicide is often preventable. A suicide risk screening can help determine how likely it is that someone will attempt suicide. During most screenings, a health care provider will ask some questions about behavior and feelings. There are specific questions and guidelines that providers can use. These are known as suicide risk assessment tools. If you or a loved one is found to be at risk for suicide, medical, psychological, and emotional support are available and can help avoid a tragic outcome.

Other names: suicide risk assessment

What is it used for?

A suicide risk screening is used to find out if someone is at risk for attempting suicide.

Why do I need a suicide risk screening?

You or a loved one may need a suicide risk screening if you notice any of the following warning signs:

• Feeling hopeless and/or trapped
• Talking about being a burden to others
• Increased use of alcohol or drugs
• Having extreme mood swings
• Having increased anxiety
• Withdrawing from social situations or wanting to be alone
• A change in eating and/or sleeping habits

A suicide risk screening can be very helpful for people with these warning signs and risk factors. Other warning signs may indicate that someone is at immediate risk for suicide. They include:

• Talking about suicide or wanting to die
• Searching online for ways to end your life, getting a gun, or stockpiling medicines such as sleeping pills or pain medicines
• Talking about having no reason to live

If you or a loved one have any of these warning signs, seek help right away. If there is an immediate life-threatening situation, call 911. Otherwise contact a mental health provider or the National Suicide Prevention Lifeline at 988.

You may also need a screening if you have certain risk factors. You may be more likely to try to harm yourself if you:

• Have attempted suicide before
• Have a mental health disorder such as depression, another mood disorder, or post-traumatic stress disorder (PTSD)
• Have a chronic illness and/or chronic pain
• Have legal problems
• Have lost your job
• Have financial problems
• Have trouble in or recently lost a relationship
• Are being bullied
• Have a history of suicide in your family
• Have a history of trauma or abuse
• Have a history of substance or alcohol use disorder

What happens during a suicide risk screening?

A suicide risk screening may be done by your health care provider or a mental health provider. A mental health provider is a health care professional who specializes in diagnosing and treating mental health problems.

Your health care provider may give you a physical exam and ask you about your use of drugs and alcohol, changes in eating and sleeping habits, and mood swings. These could have many different causes. He or she may ask you about any prescription medicines you are taking. This is important because in some cases, antidepressants can increase suicidal thoughts, especially in children, teenagers, and young adults (under the age of 25). You may also get blood, other lab, or imaging tests) to see if a physical disorder could be causing your suicidal symptoms.

Your provider may also use one or more suicide risk assessment tools. A suicide risk assessment tool is a type of questionnaire or guideline for providers. These tools help providers evaluate your behavior, feelings, and suicidal thoughts. The most commonly used assessment tools include:

• Patient Health Questionnaire-9 (PHQ9). This tool is made up of nine questions to screen for, diagnose, monitor, and measure the severity of depression.
• Ask Suicide-Screening Questions (ASQ). This tool includes four questions and is geared toward youth and adults.
  • If the results of the ASQ show that someone is at risk for suicide, then a brief suicide safety assessment (BSSA) should be done. The BSSA is done by a trained provider (such as a social worker, nurse practitioner, physician assistant, physician, or other mental health provider). It is done to determine if a more comprehensive mental health evaluation is needed.
• Suicide Assessment Five-Step Evaluation and Triage (SAFE-T). This assessment uses a five-step evaluation and triage plan. It is used to determine a person's level of suicide risk. It also includes making a treatment plan that lists what kind of interventions are needed, based on the person's suicide risk level. Examples of possible interventions could include transferring the person to a local psychiatric hospital or referring the person for further evaluation
• The Columbia-Suicide Severity Rating Scale (C-SSRS). This is a suicide risk assessment scale based on a series of simple, easy-to-understand questions that measure suicide risk.

Will I need to do anything to prepare for a suicide risk screening?

You don't need any special preparations for this screening.

Are there any risks to screening?

There is no risk to having a physical exam or a questionnaire.

What do the results mean?

If the results of your physical exam or blood, lab, or imaging test show a physical disorder or a problem with a medicine, your provider may provide treatment and change or adjust your medicines as needed.

The results of a suicide risk assessment tool or suicide risk assessment scale can show how likely it is you will attempt suicide. Your treatment will depend on your risk level. If you are at very high risk, you may be admitted to a hospital. If your risk is more moderate, your provider may recommend one or more of the following:

• Brief interventions such as safety planning and follow-up phone calls. A safety plan includes lists of coping skills and people you can call when you need help, as well as a plan on how to keep you away from objects you could use to harm yourself.
• Psychological counseling (talk therapy) from a mental health professional. There are different types of talk therapy which may be used, including family therapy.
• Medicines, such as antidepressants. However, younger people on antidepressants should be closely monitored. These medicines sometimes increase suicide risk in children and young adults.
• Treatment for substance use disorder (if needed).

Is there anything else I need to know about a suicide risk screening?

If you feel you are at risk for attempting suicide, get help right away. There are many ways to get help. You can:

• Call 911 or go to your local emergency room.
• Call or text 988 to reach the Suicide & Crisis Hotline. Veterans can call and then press 1 to reach the Veterans Crisis Line.
• Text the Veterans Crisis Line at 838255 or chat with them online
• Chat with someone online at 988lifeline.org.
• Call your health care or mental health provider.
• Reach out to a loved one or close friend.

If you are worried that a loved one is at risk for suicide, don't leave them alone. You should also:

• Encourage them to seek help. Assist them in finding help if needed.
• Let them know you care. Listen without judgement and provide encouragement and support.
• Keep them away from weapons, pills, and other items that could cause harm.

You may also want to call the Suicide & Crisis Lifeline at 988 for advice and support.

Learn more about laboratory tests, reference ranges, and understanding results.