---
title: "Suicide"
url: https://mghmclean.org/residents/handbk/part2a/suic.htm
description: "· There is no evidence that “contracts for safety” are effective in reducing suicide attempts!"
published: 2026-08-10
updated: 2026-08-10
---

# Suicide

Published 2026-08-10

PART 3 / CH 19

Roy Perlis

A. Risk assessment

· take a detailed history

· gather information from collateral sources (family, e.g.)

Key elements of suicide evaluation

| in | look for |
|---|---|
| HPI | precipitantsdegree, persistence of SIdetails of plan (means, chance of rescue) |
| ROS | comorbid psychiatric illness, substance abuse |
| Psych | lethality of past attempts |
| FH | psychiatric illness, suicides |
| SH | extent of supports (lives alone? connections?) |
| MSE | delirium or intoxication; restlessness/akathisia; mood/anxiety; psychosis; impulsivity; poor judgement |

B. Psychiatric illness is the major risk factor for suicide

| Diagnosis | Prevalence in suicide |
|---|---|
| Major Depression | 50% |
| Bipolar, manic | rare |
| Substance abuse | 25% |
| Anxiety Disorders | 10-15% |
| Psychosis | 10% |
| Personality Disorders | 5-10% |

C. Risk factors in selected populations

1. Major depression (short term risks)

· Severe anhedonia

· Panic attacks/ psychic anxiety

· Global insomnia

· Impaired concentration

· Alcohol abuse

2. Alcohol abuse

· Loss of relationship within 6 weeks

· Other concurrent drug use

· Late in disease course

D. Interventions should be carefully documented

Discharge checklist

1. Access to means of suicide removed

2. Precipitants addressed

3. Underlying psychiatric illness treated,

including substance abuse

4. Increased outpatient supports (ie, not alone)

5. Close follow-up arranged

6. Decision-making and safety documented

· *There is no evidence that “contracts for safety” are effective in reducing suicide attempts!*

*source*: Fawcett J, Clark DC, Scheftner WA (1991) Psychiatr Med 9: 299-311.