1. Marital Status

Persons married with children are at lowest risk, persons never married are highest, and intermediate are persons widowed, separated or divorced. Risk is high during first 6-12 months of marital loss.

2. Age

Risk for completed suicide rises steadily with age to 55-65 for women and 75-85 for men. Early peak during adolescences, ages 15-19 years. Predominant age group for attempts is 20-35. Fifty percent of attempters are under age 30.

3. Sex

Completed suicides 3 times more common among men. Attempted unsuccessful suicides 3 times more common among women.

4. Religion

Higher rates among Protestants than Catholic and Jews.

5. Ethnic Background

Higher among immigrants, especially from countries with high suicide rates. Japan, Hungary and Sweden.

6. Isolation

Higher among persons living alone without social or familial ties.

7. Insomnia

Severe insomnia, even without depression, if unrelieved may lead to suicidal action.

8. Drugs & Alcohol

Have an effect that may 'release' latent depression and suicidal urges that are otherwise self- controlled.

9. Family History

Especially if parent of same sex died by suicide.

10. Previous attempts

10% unsuccessful attempters eventually succeed. Higher risk if earlier tries were dangerous acts.

11. Recent loss

Loss of loved person, prestige or position, self-esteem

12. Recent Childbirth

Post-partum depression may not be evident.

13. Mental status

Presence of depression, intent to die, formulated suicidal plan, statement that personal affair have been arranged, personal belongings given away or sold, by end of interview patient looks tense and is unable to plan any alternative immediate course of action (e.g., cannot commit to return to discuss his/her problem further).

Approximately 15% of depressive patients ultimately commit suicide. But 80% of persons who commit suicide give definite warning signs about their intent. An examination of the literature reveals a number of pre-suicidal indicators:

   1. expression of suicidal thoughts

   2. prior suicidal attempts

   3. giving away prized possessions

   4. depression over broken relationships

   5. despair over a chronic illness or personal problems

   6. change in eating or sleeping habits

   7. marked personality change

   8. abuse of alcohol or drugs

   9. a sense of hopelessness

  10. being anxiety prone

  11. experiencing of social exclusion (e.g., romantic breakups, loss of employment)

  12. feelings of guilt or self-shame

  13. shame over personal failure

  14. insecurity about one's capabilities

  15. feelings of worthlessness

  16. depressed mood

  17. preoccupation with self

  18. sense of time drastically limited to the present

  19. thinking becomes extremely concrete and rigid

  20. thought processes become inflexible

  21. creative problem-solving capabilities curtailed

  22. goals become extremely short-term

  23. behavior impulsive, lack of anticipated consequences

  24. passivity, tendency to deny responsibility for one's action

  25. identify with the role of victim

  26. suicidal history in family members

  27. suicidal plan

  28. availability of weapons

  29. high frequency of recent stressful events

  30. high expectations followed by a failure to live up to those expectations

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