Risk Factors and Warning Signs for Suicide

History of suicidality

Previous suicide attempt

Making detailed suicide plans, taking steps to implement the plan (obtaining a gun or pills), and taking precautions against being discovered

Other history or exposure

Family history of suicide or a psychiatric disorder

Traumatic childhood experiences, including physical or sexual abuse

Exposure to another person's suicide

Experience of discrimination based on race or sexual orientation or gender identity

Bullying or other humiliating experiences (eg, cyberbullying, social rejection, discrimination, occupational or legal problems)

Social situation and history

Unemployment or financial difficulties, particularly if they caused a drastic fall in economic status

Recent widowhood or other death of family or friends

Recent separation or divorce

Recent arrest or involvement with the legal or justice system

Social isolation

Career transition

Comorbid disorders

Depressive illness, especially at onset and with recent initiation of antidepressants; see Antidepressant Medication and Suicide Risk

Borderline personality disorder and other personality disorders

Bipolar disorder

Anorexia and bulimia nervosa in women

Schizophrenia

Anxiety disorders and posttraumatic stress disorder

Chronic pain

Chronic physical health conditions

A chronic, painful, or disabling physical disorder, especially in formerly healthy patients

Clinical features

Marked motor agitation, restlessness, and anxiety with severe insomnia

Marked feelings of guilt, inadequacy, and hopelessness; perception of being a burden to others (burdensomeness); self-denigration; nihilistic delusion

Delusion or near-delusional conviction of a physical disorder (eg, cancer, a heart disorder, sexually transmitted infection) or other delusions (eg, delusions of poverty)

Command hallucinations

Impulsive, hostile personality

Impulsivity and aggression

Medication and substance use

Alcohol use disorder, opioid use, or other substance use disorder (including misuse of prescription medications), especially if recent use has increased

Use of medications that may contribute to suicidal behavior (eg, abruptly stopping paroxetine and certain other antidepressants can result in increased depression and anxiety, which in turn increases risk of suicidal behavior)Use of medications that may contribute to suicidal behavior (eg, abruptly stopping paroxetine and certain other antidepressants can result in increased depression and anxiety, which in turn increases risk of suicidal behavior)