Risk assessment - summary of key points

This page is also available as a pdf: riskAssessment.pdf

All patients with depression should be assessed for possible risk of self-harm or suicide.

Risk factors for suicide identified through research studies are:

Risk factors specific to depression

  • Family history of mental disorder.
  • History of previous suicide attempts (this includes self-harm).
  • Severe depression.
  • Anxiety.
  • Feelings of hopelessness.
  • Personality disorder.
  • Alcohol abuse and/or drug abuse.
  • Male gender.

Other risk factors for consideration

  • Family history of suicide or self-harm.
  • Physical illness (especially when this is recently diagnosed, chronic and/or painful).
  • Exposure to suicidal behaviour of others, either directly or via the media.
  • Recent discharge from psychiatric inpatient care.
  • Access to potentially lethal means of self- harm/suicide.

Possible protective factors

  • Social support.
  • Religious belief.
  • Being responsible for children (especially young children).

In assessing patients’ current suicide potential, the following questions can be explored:

  • Are they feeling hopeless, or that life is not worth living?
  • Have they made plans to end their life?
  • Have they told anyone about it?
  • Have they carried out any acts in anticipation of death (e.g. putting their affairs in order)?
  • Do they have the means for a suicidal act (do they have access to pills, insecticide, firearms...)?
  • Is there any available support (family, friends, carers...)?
  • Where practical, and with consent, it is generally a good idea to inform and involve family members and close friends or carers. This is particularly important where risk is thought to be high.
  • When a patient is at risk of suicide this information should be recorded in the patient’s notes. Where the clinician is working as part of a team it is important to share awareness of risk with other team members.
  • Regular and pro-active follow-up is highly recommended.