Assessment and Management of Patients at Risk for Suicide

Publication Date: July 1, 2024
Last Updated: July 9, 2024

Recommendations

Screening and Evaluation

Screening

There is insufficient evidence to recommend for or against suicide risk screening programs to reduce the risk of suicide or suicide attempts.

(Neither for or against)
315659
When selecting a screening tool, we suggest the use of a validated measure to identify patients at risk for suiciderelated behavior. Tools with evidence and support of use, by population, include the following.
  • General population
    • Columbia Suicide Severity Rating Scale Screener
    • Suicide Cognition Scale – Revised
    • Patient Health Questionnaire-9
  • Populations at increased risk
    • Beck Suicide Intent Scale/Beck Scale for Suicidal Ideation
    • Columbia Suicide Severity Rating Scale Screener
(Weak for)
315659

Assessment

When performing a suicide risk assessment, we suggest including, but not limited to, factors (see Table 6) within the following domains.
  • Self-directed violence, thoughts, and behaviors
  • Current psychiatric conditions and current or past mental/behavioral health treatment
  • Psychiatric symptoms
  • Social determinants of health and adverse life events
  • Availability of lethal means
  • Physical health conditions
  • Demographic characteristics
(Weak for)
315659
While risk stratification is an expected component of routine care, there is insufficient evidence to recommend for or against the use of a specific tool or method to determine the level of suicide risk. (Neither for or against)
315659

Risk Management and Treatment

Non-pharmacologic Interventions

We suggest cognitive behavioral therapy–based psychotherapy focused on suicide prevention to reduce the risk of suicide attempts in patients with a history of suicidal behavior within the past six months. (Weak for)
315659

We suggest offering cognitive behavioral therapy (including problem solving–based psychotherapies) focused on suicide prevention to reduce suicidal ideation for patients with a history of self-directed violence.

(Weak for)
315659
There is insufficient evidence to recommend for or against completing a crisis response plan or safety planning intervention to reduce the risk of suicide attempts in patients with recent suicidal ideation, a lifetime history of suicide attempts, or both. (Neither for or against)
315659
There is insufficient evidence to recommend for or against Collaborative Assessment and Management of Suicidality to reduce suicidal ideation. (Neither for or against)
315659
There is insufficient evidence to recommend for or against offering dialectical behavior therapy to reduce suicidal ideation and the risk of suicide attempts or suicide. (Neither for or against)
315659
There is insufficient evidence to recommend for or against peer-to-peer programs to reduce suicidal ideation. (Neither for or against)
315659

Pharmacologic and Other Somatic Treatments

We suggest clozapine to reduce the risk of suicide attempts for patients with schizophrenia or schizoaffective disorder and either suicidal ideation or a history of suicide attempt(s).

(Weak for)
315659
We suggest offering ketamine infusion as an adjunctive treatment for short-term reduction in suicidal ideation in patients with the presence of suicidal ideation and major depressive disorder. (Weak for)
315659
There is insufficient evidence to recommend for or against ketamine infusions or esketamine to reduce the risk of suicide or suicide attempts. (Neither for or against)
315659
There is insufficient evidence to recommend for or against lithium to reduce the risk of suicide or suicide attempts for patients with mood disorders. (Neither for or against)
315659
There is insufficient evidence to recommend for or against repetitive transcranial magnetic stimulation to reduce the risk of suicide or suicide attempts. (Neither for or against)
315659

Post-acute Care

We suggest sending patients periodic caring communications (e.g., postal mail, text messages), in addition to usual care, for 12 months following hospitalization related to suicide risk to reduce the risk of suicide attempts. (Weak for)
315659
There is insufficient evidence to recommend for or against offering brief contact interventions (e.g., telephonic interventions, crisis cards, World Health Organization Brief Intervention and Contact treatment modality) in addition to usual care following discharge from the emergency department to reduce the risk of suicide attempts. (Neither for or against)
315659

Technology-based Modalities

We suggest the use of self-guided digital interventions (app or web) that include, but are not limited to, cognitive behavioral–based therapeutic content for short-term reduction in suicidal ideation.

(Weak for)
315659
There is insufficient evidence to recommend for or against the use of standalone or adjunctive technology-based tools (e.g., mobile and web apps, automated telephonebased) to reduce the risk of suicide attempts or suicide. (Neither for or against)
315659

Other Management Modalities

We suggest multi-component community interventions to reduce the risk of suicide. Common components include but are not limited to: training on mental/behavioral health topics and/or suicide risk factors; local networking and/or community facilitation; and providing mental/behavioral health and/or suicide prevention materials.

(Weak for)
315659
We suggest reducing access to lethal means to reduce the risk of suicide by firearms, jumping, or medication overdose. (Weak for)
315659
There is insufficient evidence to recommend for or against the use of targeted messaging to at-risk populations to reduce suicidal ideation and improve help-seeking behavior. (Neither for or against)
315659
There is insufficient evidence to recommend for or against standalone gatekeeper training to reduce the risk of suicide. (Neither for or against)
315659
There is insufficient evidence to recommend for or against crisis lines to reduce suicidal ideation or the risk of suicide attempts or suicide. (Neither for or against)
315659

Recommendation Grading

Overview

Title

Assessment and Management of Patients at Risk for Suicide

Authoring Organization

Veterans Health Administration / Department of Defense

Publication Month/Year

July 1, 2024

Last Updated Month/Year

July 15, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Target Patient Population

Adult patients at risk for suicide who may receive care in the VA or DoD health care delivery systems, or VA and DoD adult beneficiaries who receive care from community-based providers

Target Provider Population

VA, DoD, and community providers and others involved in the health care team assessing and managing adult patients at risk for suicide

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

Methodology

Number of Source Documents
213
Literature Search Start Date
April 1, 2018
Literature Search End Date
April 1, 2024