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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

January 2013

Assessing Suicide Risk in the Primary Care Setting 

As the 10th leading cause of death among people age 10 and older in the United States, suicide is a serious public health problem. A key component in preventing suicides is raising awareness about suicide risk and educating people—including physicians and other health care providers—on suicide prevention strategies and resources.

According to the Centers for Disease Control and Prevention, suicide accounted for 36,891 deaths. Historically, suicide rates have been highest among those 65 and older, but that has changed in recent years, and now suicide rates are highest among 25 to 64 year olds. American Indian, Alaskan Natives, and non-Hispanic whites are at high risk.

Self-destructive or suicidal thoughts often precipitate a mental health emergency. Clinically, assessing the acute risk of harm to self or others is crucial in making immediate treatment decisions. A thorough risk and safety assessment should include questions aimed at eliciting whether the patient has specific thoughts about harming himself or others, has taken any action demonstrating an intent or plan to harm, and has the means by which to carry out such plans.

Also consider risk factors such as a recent onset of chronic major life stressors, a history of relatives or acquaintances that have completed suicide, and poor social connections or supports or living alone.  For cases involving minors, children in the home, co-morbid substance use, past history of violence or self harm, or generally unreliable informants, it may be important to collect additional information from friends or family, with the patient’s consent.

Risk factors for suicide include:

  • One or more previous suicide attempts
  • Depression, especially when accompanied by feelings of hopelessness
  • History or evidence of bipolar disorder
  • A suicide attempt (or the completed suicide) of a friend, peer, or family member
  • Previous suicide attempt using a method other than ingestion
  • Abusing drugs or alcohol more than three times per week
  • Intoxication (patients under the influence of substances including alcohol are more likely to act on suicidal impulses)
  • Multiple negative consequences resulting from substance abuse

The leading cause of suicide is untreated depression. Although most people suffering from depression are not suicidal, most people experiencing suicidal thoughts are depressed. In most cases, it is possible to recognize and treat the crisis or depressive episode that is prompting suicidal thoughts. If you suspect depression or have questions about the safety of the patient, perform an assessment for depression. Symptoms of depression include:

  • Low mood
  • Change in appetite or weight
  • Change in sleeping patterns
  • Loss of interest in once pleasurable activities
  • Loss of energy or fatigue
  • Feelings of worthlessness
  • Thoughts of death, suicide, or wishes to be dead
  • Increased irritability or anger
  • Isolation or avoiding contact with other people

How United Behavioral Health can help your patients—For complex clinical situations, United Behavioral Health (UBH) is available to provide consultative assistance. Practitioners can call the UBH Physicians Consultation Service at (800) 292-2922. To refer a patient for behavioral health services and to facilitate the coordination of care, call UBH at
(888) 777-4742.

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Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
Senior Vice President, Provider Network and Product Development

Joann Peck,
Manager, Network Planning and Administration

Annmarie Dadoly,

Kristin Edmonston,
Production Coordinator