What are the key behaviors or symptoms that indicate a low, moderate, or high risk of suicide according to Table 31-1?
According to Table 31-1, low suicide risk involves mild anxiety and depression, some feelings of isolation without withdrawal, fairly good daily functioning, several available resources and significant others, constructive coping, and only vague or fleeting suicidal thoughts with no plan. Moderate risk includes moderate anxiety and depression, some helplessness, hopelessness, and withdrawal, moderately good functioning in only some areas, few resources or significant others, some destructive coping, and frequent suicidal thoughts with occasional ideas about a plan. High risk is marked by high or panicked anxiety, severe depression, complete hopelessness, helplessness, withdrawal, and self-deprecation, poor functioning in any activities, few or no resources or significant others, predominantly destructive coping, unstable lifestyle, continual substance abuse, multiple high-lethality previous attempts, marked disorganization and hostility, and frequent or constant thoughts with a specific plan.
Table 31-1 measures suicide risk along several behavioral dimensions and assigns low, moderate, or high intensity to each. For anxiety, low is mild, moderate is moderate, and high is high or a panic state. For depression, low is mild, moderate is moderate, and high is severe. Isolation and withdrawal range from some feelings of isolation with no withdrawal at low risk, to some helplessness, hopelessness, and withdrawal at moderate risk, to a wholly hopeless, helpless, withdrawn, and self-deprecating state at high risk. Daily functioning is fairly good in most activities at low risk, only moderately good in some activities at moderate risk, and not good in any activities at high risk. Resources and support also grade from several available, to a few or only one, to few or none for high risk. Coping strategies shift from generally constructive, to some constructive, to predominantly destructive. Significant others range from several available, to few or only one available, to only one or none. The person's view of past psychiatric help moves from none or a positive attitude to a negative view. Lifestyle changes from stable to moderately stable to unstable. Alcohol or drug use goes from infrequent excess to frequent excess to continual abuse. Previous suicide attempts progress from none or low lethality, to one or more of moderate lethality, to multiple attempts of high lethality. Disorientation and disorganization, and hostility, each move from little or none to some to marked. Finally, suicide planning ranges from vague or fleeting thoughts without a plan, to frequent thoughts with occasional ideas about a plan, to frequent or constant thoughts accompanied by a specific plan.
Key points
- Low-risk signs: mild anxiety and depression; no withdrawal; fairly good daily functioning; several resources and supports; constructive coping; no plan for suicide.
- Moderate-risk signs: moderate anxiety and depression; some helplessness, hopelessness, and withdrawal; functioning good only in some activities; few supports; occasional suicidal plans.
- High-risk signs: panic-level anxiety; severe depression; hopeless, helpless, withdrawn, self-deprecating; poor functioning in all areas; few or no supports; destructive coping.
- Substance use and previous attempts are graded: continual abuse and multiple high-lethality attempts indicate high risk.
- Psychiatric help history also matters: a negative view of help received indicates high risk; positive or moderately satisfied views indicate lower risk.
- Suicide plan intensity is a key indicator, ranging from vague fleeting thoughts (low) to a specific, concrete plan (high).
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