Assessment of acute suicide risk Opportunities for comprehensive risk evaluation in clinical practice

Introduction: The identification of acute suicide risk is of paramount importance for the prevention of suicidal behavior. However, we currently lack sufficient data to reliably detect pre-suicidal mental states. Objective: Hungarian adaptation of the screening test and questionnaire developed by Galynker and colleagues based on the concept of the suicide crisis syndrome. Method: Acute Suicidal Risk Test, based on the suicide crisis syndrome, and Rihmer's Short Suicide Scale were administered consecutively to all patients treated at our outpatient and inpatient clinic during the study period. In cases where the screening tests were positive, a more detailed questionnaire assessing the symptoms of suicide crisis syndrome was completed. Results: 99 patients completed a total of 150 questionnaires, with one-third (n = 35) being outpatients and two-thirds (n = 64) inpatients. The most frequent clinical diagnoses were depressive (44.7%), adjustment (34%), psychotic (33.3%), and substance use disorders (33.3%), with a high rate of comorbidities. The screening tests indicated suicide risk in 54.3% (n = 19) of outpatients and in 76.6% (n = 49) of inpatients. After inpatient treatment, this proportion significantly decreased (n = 17, 33.3%). The full diagnostic criteria for suicide crisis syndrome were the most frequently met in patients with a positive Acute Suicidal Risk Test, either alone (74.2%) or in combination with the Short Suicide Scale (87.1%). The presence of both positive Acute Suicidal Risk Test and Short Suicide Scale was associated with severe Suicide Crisis Syndrome symptoms (29%). Discussion: The short screening test, based on the suicide crisis syndrome, identified acute suicidal risk in a significant proportion of patients. One of the key advantages of the suicide crisis syndrome concept and method is its ability to detect suicide risk even in the absence of overt suicidal intents. The value of the acute screening test is further enhanced by Rihmer's Short Suicide Scale, which primarily assesses lifetime suicidal risk. Conclusion: The combined use of these tests supports clinical decision-making for acute psychiatric admissions and helps prevent the premature discharge of patients, underscoring the relevance of this screening method in suicide prevention. Orv Hetil. 2025; 166(4): 146-153.