Indicators of Risk for Suicide

By Randy J. Simmonds, Ph.D., L.P.C.

One of the questions that I am asked regarding suicide is, How do I know whether my friend or family member is suicidal. There are no answers that are 100% certain to this concern, but there are some very clear indicators that suggest intervention is needed. Two areas of exploration are useful to answer the question about a friend or loved one: historical context and clinical indicators.

Historical context

Daily functioning.Is the person functioning at fairly good levels in most daily tasks, or are they impaired in their normal life tasks?
Life-style. Is the persons life style stable or somewhat unstable?
Coping style and resources. Does the person have adequate resources and constructive coping styles, or does there seem to be inadequate resources and destructive coping styles?
Significant others.Does the person have multiple relationships of significance or is the persons social network constricted or isolating?
Psychiatric history. Does the person have no prior psychiatric history or experience that indicates good outcomes, or has the person been uncooperative in prior treatment or had negative outcomes?
Medical history.Is the person relatively healthy or does the person have a chronic illness history?
Family history of suicide. Is there a history of suicide in the persons family or is there no prior history of a family member committing suicide?
Previous suicidal acts. Has the person every made attempts at suicide in the past, or has no history of suicidal attempts?

Taking all these factors together can offer some insight and perspective on the risk that may be present. A person who is functioning at fairly good levels in their daily life tasks, has a fairly stable life style, has adequate resources and good coping skills, has multiple significant relationships, has no prior psychiatric history, is in relatively good physical health, has no family history of suicide, and has made no previous attempts at suicide is at a much lower risk for suicide than someone exhibited the opposites.

There is another category of factors that add insight to our concerns about a persons suicidal risk:

Clinical context

Recent losses Has the person suffered no significant losses or has there been a significant loss recently?
Depression and anxiety Is there no or only mild depression and anxiety present or does the person seem severely depressed or anxious?
Isolation and withdrawal. Does the person have regular social contacts or is he or she isolated and withdrawn from social contacts?
Hostility.Does the person express no or mild hostility or severe hostility and anger?
Hopelessness. Is there a strong sense of hope in the person, or does the person express significant hopelessness?
Disorientation and disorganization. Is the person fairly well oriented and organized in their daily life, or do they seen disoriented and disorganized in their life?
Alcohol and drug use.Does the person use alcohol/drugs at a low level, or are there high levels and frequent use?
Change in clinical features. Are there no significant changes in the persons mood or characteristics, or is there a significant and unexplained improvement in their mood?
Suicidal plan - Does the person voice express that he or she has no specific plans regarding suicide, or does the person have a more specific plan with thoughts about a way of committing suicide, and has thought about a time, place and method?
Final arrangements. Has the person made any final arrangements such as giving important things away or updating a will?

Taken together, these 2 areas of exploration, historical issues and clinical issues, can help in considering the risk and deciding if action is needed to keep the person safe.

Randy J. Simmonds, Ph.D. is the Clinical Director of the Samaritan Center of the Rockies, a community based counseling center in Edwards, CO. For more information or questions please call 970-927-8558.