The first step involves conducting the suicide risk assessment. Joiner and colleagues provide a template for a semi-structured interview to use (see the article by Chu and colleagues (2015) in the Resources section of this course). Box 1 is a sample semi- structured interview for clinicians to conduct when assessing suicide risk. The Joiner system requires the assignment of a risk category that then guides the clinician’s intervention. After risk is assessed, clinicians can use the suicide decision-tree to
determine risk level (see Figure 1 and Table 4). For example, a person who has not attempted suicide multiple times experiencing suicidal ideation with limited intensity and duration, with no intent, would be assigned a low-risk category; a person who has attempted death by suicide multiple times with strong intent and who has made preparations for suicidal behavior would be assigned to the extreme-risk category.
BOX 1: SUICIDE RISK ASSESSMENT INTERVIEW This is a sample risk assessment interview that asks questions relevant to using the decision tree (see Figure 1) and determining an individual’s risk. Suicide Risk Assessment Interview Assess ideation and desire: 1. Have you been having thoughts of suicide or killing yourself? Have you been having thoughts of wanting to be dead? Please tell me about them. a. How often are you having these thoughts? b. How long do they last? If the patient answers “no” to question 1, ask : Have you ever had thoughts about suicide or wanting to be dead? 2. Tell me about previous suicide attempts. How many times have you hurt yourself with some desire to die? How did you do it (by what means)? What were the results? Now assess resolved plans and preparation: 3. On a scale of 0 to 10, rate the strength of your intention to kill yourself right now (or tomorrow, or next week), with 0 being no intention at all and 10 being definite intention. What was the strength of your intention last week? What do you imagine your intention will be in the near future? 4. Do you have any plan(s) for how you would kill yourself? What are they? If patient answers no to question 4, ask : Have you ever made a plan to kill yourself? What was it? Have you researched methods of killing yourself? If there is no current or past planning, proceed to question 9: 5. Have you made preparations for a suicide attempt (e.g., buying pills, rope, gun)? Have you written a suicide note? 6. Do you have the pills, rope, gun? 7. When and where do you think you will implement your plan? Will there be an opportunity to implement your plan? When? 8. Are you afraid to die? (Scale of 0 to 10, with 0 = not at all afraid; 10 = very afraid) Are you confident that you could attempt suicide? Now assess perceived burdensomeness and belongingness: 9. People sometimes think things like: My friends or family would be better off without me. Do you ever have thoughts like that? 10.Are you connected to others? Does anyone live with you? 11.When you feel badly, is there someone you can call? Who are they? Is there anyone you feel close to? 12.How hopeless do you feel? Is there more you can say about it? Now assess important factors (other significant findings): 13.Have you ever harmed yourself by cutting, burning, or causing other injury without the intention of dying (NSSI)? 14.Is there something stressful happening or currently going on? Has there been something stressful recently? 15.What do you do when you feel bad? People sometimes do impulsive things to help themselves feel better like self- harming, drinking alcohol, binge eating, having sex, or destroying things. What do you do to try to feel better? 16.Interviewer should assess for the presence of psychopathology. 17.Interviewer should assess for agitation, social withdrawal, rage, insomnia, guilt, nightmares, impulsivity, and marked irritability. Note . Adapted from “Routinized Assessment of Suicide Risk in Clinical Practice: An Empirically Informed Update,” by C. Chu, K. M. Klein, J. M. Buchman-Schmitt, M. A. Hom, C. R. Hagan, & T. E. Joiner, 2015. Journal of Clinical Psychology , 71(12), pp. 1186-1200.
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