4- Suicide Risk Assessment

Source: https://app.lecturio.com/#/lecture/c/7526/9026/32962

Correct Answer: C. A wish to die without an active plan or intent

Explanation:
Passive suicidal ideation refers to thoughts such as wishing not to wake up or wishing to be dead without intent or a concrete plan. This differs from active suicidal ideation, which involves intent and planning.

Which of the following best defines passive suicidal ideation?

A. Thoughts of self-harm with a specific plan and intent
B. Engagement in self-injurious behavior without intent to die
C. A wish to die without an active plan or intent
D. Recurrent intrusive thoughts of death unrelated to mood

Correct Answer: C. Active suicidal ideation with a plan but no intent

Explanation:
This patient has a specific plan but explicitly denies intent and expresses a desire for help. Suicide risk assessment must evaluate thoughts, intent, and plan separately, as they do not always co-occur.

A patient states: “I have thought about shooting myself, but I don’t want to die and I’m here because I want help.”
How should this presentation be classified?

A. Passive suicidal ideation
B. Active suicidal ideation with intent
C. Active suicidal ideation with a plan but no intent
D. Non-suicidal self-injury

Correct Answer: C. Non-suicidal self-injury (NSSI)

Explanation:
While parasuicidal behavior is still used, Non-Suicidal Self-Injury (NSSI) is the preferred term in current literature. It refers to deliberate self-harm without intent to die, though accidental death remains a risk.

Which term is increasingly preferred in modern psychiatric literature over parasuicidal behavior?

A. Passive suicidal ideation
B. Active suicidal ideation
C. Non-suicidal self-injury (NSSI)
D. Suicidal gesture

Correct Answer: C. Family history of suicide

Explanation:
Static risk factors are unchangeable, such as age, sex, race, and family history of suicide. Substance use, firearm access, and depression are modifiable through intervention.

Which of the following is considered a static (non-modifiable) suicide risk factor?

A. Substance use disorder
B. Access to firearms
C. Family history of suicide
D. Untreated depression

Correct Answer: C. There is a bimodal distribution with peaks in youth and older adults

Explanation:
Suicide risk demonstrates a bimodal distribution, with higher risk among adolescents/young adults (15–24) and older adults (≥65 years). This pattern is consistently supported by epidemiological data.

Regarding age-related suicide risk, which statement is most accurate?

A. Suicide risk increases steadily with age
B. Only adolescents are at high risk
C. There is a bimodal distribution with peaks in youth and older adults
D. Suicide risk is lowest in older adults

Correct Answer: C. Women attempt suicide more often, but men complete suicide more frequently

Explanation:
Women attempt suicide more frequently, whereas men have higher completion rates, largely due to use of more lethal methods (e.g., firearms). Sex is a static risk factor.

Which statement about sex differences in suicide is correct?

A. Women are more likely to complete suicide than men
B. Men and women attempt suicide at equal rates
C. Women attempt suicide more often, but men complete suicide more frequently
D. Sex is a modifiable suicide risk factor

Correct Answer: C. Symptoms and severity can be reduced with treatment

Explanation:
While the presence of a mental disorder may not always be modifiable, symptom severity, distress, and functional impairment can often be reduced through treatment, lowering suicide risk.

Which of the following best explains why mental illness is considered a modifiable suicide risk factor?

A. Mental illnesses are always fully curable
B. The presence of mental illness can be eliminated
C. Symptoms and severity can be reduced with treatment
D. Mental illness is temporary by definition

Correct Answer: B. Substance use

Explanation:
Substance use significantly increases suicide risk by causing disinhibition, impaired judgment, and impulsivity, making it more likely for individuals to act on suicidal ideation.

Which factor is most directly associated with disinhibition and increased likelihood of acting on suicidal thoughts?

A. Religious involvement
B. Substance use
C. Family history of suicide
D. Age

Correct Answer: C. Access can be reduced through education and safety planning

Explanation:
While ownership itself may not be eliminated, lethal means counseling, safe storage, and temporary removal can significantly reduce suicide risk, making firearm access a modifiable factor.

Why is access to firearms considered a modifiable suicide risk factor?

A. Firearms are illegal in all regions
B. Firearm ownership predicts mental illness
C. Access can be reduced through education and safety planning
D. Firearms only affect homicide risk

Correct Answer: C. Strong social and religious community ties

Explanation:
Protective factors reduce suicide risk and include social support, stable housing, employment, relationships, religious or spiritual community, and demonstrated resilience.

Which of the following is a protective factor against suicide?

A. Hopelessness
B. Chronic pain
C. Strong social and religious community ties
D. Prior suicide attempt

Correct Answer: C. It should be conducted at every patient encounter

Explanation:
Suicide risk assessment is a dynamic, ongoing process and should be performed at every clinical encounter, just as the mental status exam is a core component of psychiatric evaluation.

Which statement best reflects best clinical practice regarding suicide risk assessment?

A. It should only be performed during initial intake
B. It is only necessary for patients with depression
C. It should be conducted at every patient encounter
D. It replaces the mental status examination

Correct Answer: B. Whether the attempt involved a violent method

Explanation:
Prior suicide attempts significantly increase future risk. Violent methods, lack of help-seeking, hospitalization, and suicide notes are particularly associated with higher lethality and recurrence.

When assessing a patient with a history of suicide attempts, which additional detail is MOST clinically important for estimating future risk?

A. The patient’s current employment status
B. Whether the attempt involved a violent method
C. The patient’s intelligence level
D. The patient’s religious affiliation

Correct Answer: C. Symptom burden and distress can be reduced through medical care

Explanation:
While the illness itself may not be reversible, pain control, medical education, coordinated care, and family support can significantly reduce hopelessness and suicide risk.

Why are chronic pain and end-stage medical illnesses considered modifiable suicide risk factors?

A. The illnesses can always be cured
B. The diseases are psychological in origin
C. Symptom burden and distress can be reduced through medical care
D. Medical illness is unrelated to suicide risk

Correct Answer: C. Increased distress around the anniversary of a loved one’s death

Explanation:
Anniversaries of losses (e.g., deaths, separations) can reactivate grief and suicidal thoughts, particularly in vulnerable individuals. Risk can be mitigated by anticipatory support and grief processing.

Which situation represents an anniversary reaction increasing suicide risk?

A. A patient starting a new medication
B. A patient remembering childhood trauma during therapy
C. Increased distress around the anniversary of a loved one’s death
D. A patient changing jobs

Correct Answer: B. Referring to vocational rehabilitation programs

Explanation:
Employment and structured daily activity foster purpose, community connection, and hope, all of which are protective against suicide. Vocational and disability services are key interventions.

Which intervention best targets employment-related protective factors in suicide prevention?

A. Prescribing antidepressants
B. Referring to vocational rehabilitation programs
C. Limiting access to firearms
D. Hospitalizing the patient

Correct Answer: C. Race reflects population-level statistical risk influenced by systemic factors

Explanation:
Race-related suicide risk reflects population-level trends, shaped by access to care, socioeconomic factors, and historical trauma—not deterministic individual outcomes.

Which statement best reflects the role of race in suicide risk assessment?

A. Race determines individual suicide risk
B. Race has no association with suicide rates
C. Race reflects population-level statistical risk influenced by systemic factors
D. Race should not be discussed in clinical assessment

Correct Answer: C. The physical examination

Explanation:
The MSE is considered the psychiatric equivalent of the physical exam, providing essential information about cognition, mood, thought processes, and safety.

The mental status examination (MSE) in psychiatry is best compared to which component of internal medicine?

A. Laboratory investigations
B. Imaging studies
C. The physical examination
D. Medical history

Correct Answer: C. Accidental death can occur despite lack of intent

Explanation:
Non-suicidal self-injury (NSSI) is not intended to cause death, but accidental fatal outcomes are possible, and NSSI is associated with elevated future suicide risk.

Why should clinicians always screen for self-injurious behavior, even when a patient denies suicidal intent?

A. Self-injury is always a suicide attempt
B. Self-injury guarantees future suicide
C. Accidental death can occur despite lack of intent
D. Self-injury is not clinically significant