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SUICIDE RISK ASSESSMENT COMPLETED [date name="date1" default="07/29/2020"]

Patient factors associated with an increased risk for suicide include:

Current presentation positive for:[checkbox name="variable_15" value=" Hopelessness| Psychic pain| Severe or unremitting anxiety| Panic attacks| Shame or humiliation| Psychological turmoil| Decreased self-esteem| Extreme narcissistic vulnerability| Impulsiveness| Aggression| Violence against others| Agitation| Loss of executive function| Thought constriction (tunnel vision)| Polarized thinking| Closed-mindedness| Current depressive or mixed episode| Current suicidal ideation| Current plan for suicide| Current suicidal plan with high lethality| Current suicidal intent| Access to firearms or other lethal means| Substance intoxication (in the absence of a formal substance use disorder diagnosis)| Recent discharge from inpatient psychiatric setting| Recent suicide attempt| Recent serious suicide attempt| Recent suicide attempt that was violent, near lethal or premeditated| Poor judgement"].

Psychiatric history positive for: [checkbox name="variable_10" value=" Past psychiatric hospitalizations| Past suicidal ideation| Past suicidal plan| Past suicide attempt (including aborted or interrupted attempts)| history of suicidal plan or attempt with high lethality or high suicidal intent| Diagnosis of Major depressive disorder |Diagnosis of Bipolar disorder, (greater risk with depressive or mixed episodes)| Diagnosis of Schizophrenia| Diagnosis of Anorexia nervosa| Alcohol use disorder| Other substance use disorders| Cluster B personality disorders (particularly borderline personality disorder)| Comorbid psychiatric and/or personality disorders|"].

Medical history positive for: [checkbox name="variable_11" value=" Neurological disease| Multiple sclerosis| Huntington’s disease| Brain injury| Spinal cord injury| Seizure disorder| Malignant neoplasms| HIV/AIDS| Peptic ulcer disease| Chronic obstructive pulmonary disease, especially in men| Chronic hemodialysis-treated renal failure| Systemic lupus erythematosus| Pain syndrome|"].

Family history positive for: [checkbox name="variable_12" value="history of suicide (particularly in first-degree relatives)|history of mental illness| history of substance use disorders|"].

Demographic risk factors positive for:[checkbox name="variable_13" value=" Male gender| Widowed/divorced/single marital status (particularly for men)| Elderly age group (age group with greatest proportionate risk for suicide)| Adolescent and young adult age groups (age groups with highest numbers of suicides)| White race| Gay, lesbian, or bisexual orientation|"].

Psychosocial risk factors positive for:[checkbox name="variable_14" value=" Functional impairment| Recent lack of social support (including living alone)| Unemployment| Drop in socioeconomic status| Poor relationship with family| Domestic partner violence| Recent stressful life event| Childhood traumas (sexual/physical abuse)| Unstable or poor therapeutic relationship"].

Patient factors associated with an increased risk for suicide include:

Current presentation positive for: .

Psychiatric history positive for: .

Medical history positive for: .

Family history positive for: .

Demographic risk factors positive for: .

Psychosocial risk factors positive for: .

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