Signs and Risk Factors.

Here is a list of 13 things that should alert a doctor or a family member about a potentially suicidal patient:

• Patients with definite plans to commit suicide: Individuals who think or talk about suicide are at risk; however, a patient with a plan (e.g., obtaining a weapon and buying ammunition) has made a clear statement about the risk of suicide. 
• Patients who have followed a systematic pattern of behavior indicate that they are ending their lives: this includes saying goodbye to friends, making a will, writing a suicide note, and developing a funeral plan. 
• Patients with a strong family history of suicide: A family history of suicide indicates suicide risk if the patient approaches the anniversary of a family member’s suicide or the age at which a relative committed suicide. 
• The presence of a firearm, especially a handgun. 
• Psychotic symptoms, especially in adolescents: Kelleher et al. reported in a study of 1112 school adolescents (aged 13 to 16) that 7% of the total sample said psychotic symptoms at the study’s outset. Of that subsample, 7% reported a suicide attempt at the 3-month follow-up, compared to 1% of the sample. The authors concluded that adolescents with psychopathology reporting psychotic symptoms have a high clinical risk of suicide attempts. 
• Being under the influence of alcohol or other mind-altering drugs: drug abuse is especially significant if the drugs are depressants.
•  If the patient experiences a severe, immediate, and unexpected loss, such as being suddenly fired or left by their spouse. 
• If the patient is isolated and alone. 
• If the person has depression of any kind. 
• If the patient experiences a command hallucination, a command hallucination ordering suicide can be a powerful action-inducing message that leads to death. 
• Discharge from psychiatric hospitals: Patients are at risk of suicide when discharged from a psychiatric hospital, which is a tough transition and stressful moment; the structure, support, and safety of the institution are no longer available to the patient. 
• Anxiety: Anxiety in all its forms leads to suicide risk; the constant feeling of fear and tension becomes unbearable for some. 
• Doctor’s feelings: Regardless of what the patient says or does, the doctor needs to have a sense that the patient is contemplating suicide.