Assessing Risk for Imminent Suicide

Most suicide victims see a health professional shortly before their death; yet, at present, clinicians have no tools for identifying those at acute risk. Clinical instruments valuable in predicting suicide over a 10-year period were not effective in predicting completed suicides within a period of 6 months. In fact, the difference between chronic and imminent suicide risk has only recently been articulated in the literature. A promising approach is to assess suicide risk along multiple dimensions. In this article, we review an evaluation model that consists of four domains: 1) long-term suicide risk, 2) implicit acceptance of suicide as a solution to problems, 3) acuity of the suicidal state, and 4) clinicians' emotional response (ie, countertransference) to the acutely suicidal patient. The first domain has already been integrated into clinical practice. The review focuses on the next three dimensions and suggests ways to utilize them in clinical practice.