Note: This content is derived from the 2019 VA/DOD Clinical Practice Guideline for the Assessment and Management of Patients at Risk for Suicide. For the latest clinical practice guideline for this condition, visit https://www.healthquality.va.gov/guidelines/MH/. 

Common Warning Signs

Common warning signs of suicidal behavior (i.e., signals of intention to engage in suicidal behaviors) include:

• Communicating about one’s suicidal thoughts or behaviors
• Seeking access to lethal means (e.g., buying a gun, stockpiling harmful medications)
• Engaging in preparatory behaviors (e.g., saying goodbyes, putting affairs in order)

Screening for and Assessing Suicide-related Thoughts and Behaviors

The 2019 VA/DOD Clinical Practice Guideline (CPG) for the Assessment and Management of Patients at Risk for Suicide outlines a few important procedures for clinicians engaged in screening for and assessing suicide risk.

1. Use a validated screening tool. The most widely-used example is the Columbia-Suicide Severity Risk Scale (C-SSRS).
2. Conduct a comprehensive assessment of each patient’s risk and protective factors. Examples of risk factors for suicide include, but are not limited to, any prior suicide attempt, current suicidal ideation, recent psychosocial stressors, availability of firearms, prior psychiatric hospitalization, and psychiatric conditions or symptoms such as mood or substance use disorders, hopelessness, insomnia, and agitation. Protective factors may include a strong social support network, meaningful employment, and healthy coping skills.
3. Do not use a single instrument or method when evaluating suicide risk. At a minimum, use a validated assessment tool (e.g., C-SSRS) and conduct a clinical interview of the patient. Using multiple methods enables clinicians to develop more nuanced understandings of their patients’ risk levels, which feeds into more individualized treatment and management plans.