Suicide Risk Assessment

• Over their lifetime, the vast majority (80%) of psychiatric patients with bipolar disorder have suicidal ideation or ideation plus suicide attempt. (1)
• Suicide completion rates in patients with bipolar I disorder may be as high as 10%-15%, thus, a careful assessment of the patients risk for suicide is critical. (2)
• All patients should be asked about suicidal ideation, intention to act on these ideas, and extent of plans or preparation for suicide. (2)
• The instruments below may be useful in assessing suicidality but none have established predictive validity

Suicide Behaviors Questionnaire-Revised (SBQ-R):

• The SBQ-R is designed to assess suicide-related thoughts and behaviors. This instrument is made up of 4 items each assessing a different dimension of suicidality (or risk of suicide).

Suicidal Ideation and Risk Level Assessment:

• The clinician asks suicide screening questions, determines risk factors for suicide and then assesses suicide risk and action plan.
• The clinician asks questions that may elicit specific information relating to suicidal thoughts, plans and behaviors.

Considerations When Interviewing Potentially Suicidal Patients:

• The American Psychiatric Association  (APA) publishes a practice guideline and quick reference guide for assessing and treating suicidal patients. Considerations to inform a psychiatric interview are attached along with links to the APA materials. 

References:

1. Valtonen H, Suominen K, Mantere O, et al., Suicidal ideation and attempts in bipolar I and bipolar II disorders, J Clin Psych, 2005 Nov; 66 (11): 1456-62
2. American Psychiatric Association, Practice Guidelines for the Treatment of Patients with Bipolar Disorder, AM J Psychiatry 159: 4, April 2002 Supplement.