Suicide Risk Screen
RISK FACTOR
LOWER RISK
Intent/Ambience
Lethality of attempt
(or Plan)
No intent to die
None/Ideation
only


Minimal intent
Gesture


Moderate* intent
Non-lethal*
Prior attempts
2–10 years ago

1–2 years ago

6–12 months ago*
Hopelessness
Substance abuse
Support system
Current stressor
severity
Loss & trauma
(past 6 mos)
Gender
Age
Marital status
Sexual orientation
Hopeful
None
Good support
None
 Some hope
 Recreational
 Some support
Mild
 Ambivalent*
 Abuse*
 Conflicted*
Moderate*
Clear intent**
Potentially lethal
(esp., firearm,
hanging, OD)**
 1 week – 6 months
ago**
 Hopeless**
 Dependence*
 None*
Severe*
None

Moderate


Multiple*
15–24
Single






70+
Widowed
Ethnicity
Non-white/
black
None
Chronic/severe
illness and/or
functional
impairment
Female
1–15
Married/Partner
Heterosexual
Mitigating Factors
Nurturing care taking role
Religious Faith
Social Role
Has a purpose and meaning in life
Resilient
Good Problem Solving Ability
MILD RISK


Serious*
Male
24–69
Divorced
Gay/Lesbian or
Bisexual
White


MODERATE RISK
Acute illness
and/or mild
functional
impairment

Chronic illness
and/or mild
functional
impairment
HIGH RISK




Chronic illness
and/or moderateto-severe
functional
impairment
Support System
None
Active Support System of family
Support of friends
Can you identify reasons for living?
What types of things do you anticipate your might change in your future?
Patients with multiple risk factors, especially when presenting with psychiatric illness, substance abuse and comorbid conditions, should be assessed further for suicide risk and necessary precautions. Consider the total
number and severity of all risk factors.
* Risk Factors in
**
striped bordered area may indicate need for further assessment.
Risk Factors in solid bordered area indicate cause for immediate assessment of risk and intervention.
NOTE: This tool is designed to screen for demographic factors that may help identify patients who fall into a
statistically higher risk group for self-harm. This tool is not intended to be a definitive or comprehensive
assessment. Patients with higher scores should be assessed further for necessary level of care to minimize the
risk of self-harm.
Staff member signature:
Date/Time:
Source: Loma Linda University Behavioral Medicine Center.
Suicide Risk Assessment: Practical Strategies and Tools for Joint Commission Compliance