Suicidal behaviour and suicide risk !
Suicidal behaviour ranges from thoughts of death to attempts. It is preventable: asking directly and connecting people to care saves lives.
Updated 2026-11-01
Structures involved
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What it is
A spectrum that includes suicidal ideation, planning, suicide attempts and death by suicide. Suicide risk assessment is a core clinical skill: it identifies risk and protective factors and guides the level of care and a safety plan.
Who gets it
Worldwide, more than 700,000 people die by suicide each year, most in low- and middle-income countries, and it is a leading cause of death among young people aged 15 to 29. In the Americas, rates have risen in recent decades, men die by suicide more often and there are many more attempts than deaths. In Colombia, suicidal behaviour is a public health priority under the mental health law (Ley 1616 de 2013) and suicide attempts are a notifiable event to the public health surveillance system.
Causes
- Multifactorial: mental disorders, substance use, acute stress and social factors interact
- Most people who die by suicide have a mental disorder, often depression or a substance use disorder, but many crises occur impulsively during acute stress
Risk factors
- A previous suicide attempt, the strongest single predictor
- Depression, bipolar disorder, schizophrenia, personality disorders and substance use
- Hopelessness, impulsivity and recent loss (relationship, job, money)
- Chronic pain or serious medical illness
- Family history of suicide, childhood abuse, violence and discrimination
- Social isolation; male sex and older age for death by suicide
- Easy access to lethal means
- Recent discharge from psychiatric hospitalisation
Pathophysiology
Studies link suicidal behaviour to reduced serotonergic function in the prefrontal cortex, which weakens control over impulsive responses, together with an overactive stress-hormone axis and threat circuits involving the amygdala. These biological factors interact with psychological pain, hopelessness and life events; no single cause explains a suicide.
Classification
- Passive ideation (wish to be dead) and active ideation (thoughts of killing oneself)
- Ideation with a plan or intent
- Suicide attempt (self-injurious behaviour with some intent to die)
- Non-suicidal self-injury (without intent to die), which still raises later suicide risk
Symptoms and signs
- Talking or writing about death, wanting to die or being a burden
- Hopelessness and withdrawal from family and friends
- Giving away belongings or saying goodbye
- Marked mood changes, including sudden calm after a period of depression
- Increased alcohol or drug use
- Reckless behaviour
Diagnosis
- Clinical
- Ask directly and without judgement about suicidal thoughts; asking does not increase risk. Assess ideation, plan, intent, access to means, previous attempts, risk and protective factors, and use structured tools such as the Columbia Suicide Severity Rating Scale (C-SSRS) as aids, not as the only basis for decisions.
- Tests
- No test predicts suicide. After an attempt, toxicology screening, paracetamol and salicylate levels when overdose is possible, and tests guided by the medical injuries.
- Imaging
- Not part of risk assessment; imaging only for injuries after an attempt.
Differential diagnosis
- Non-suicidal self-injury
- Delirium or intoxication with self-harm
- Accidental overdose or injury
- Factitious behaviour
Goal of treatment
Keep the person safe now, treat the underlying disorder, reduce access to lethal means and build a lasting network of care and support.
Treatment
- Acute
- Immediate risk: stabilise medical injuries, never leave the person alone, remove potential means from the environment and arrange psychiatric evaluation; involuntary admission when the law allows and the risk is imminent.
- Conservative
- A written safety plan made with the person: warning signs, coping strategies, people and places for distraction, contacts and professional services, and steps to make the environment safer. Psychotherapies such as cognitive behavioural therapy for suicide prevention and dialectical behaviour therapy reduce repeat attempts.
- Medical
- Treat the underlying disorder: antidepressants, lithium in mood disorders (it reduces suicide), clozapine in schizophrenia with suicidal behaviour, and treatment of substance use.
- Follow-up
- Nursing precautions: level of observation set by risk (including constant one-to-one), room and belongings check for hazardous items, supervised medication, close follow-up after discharge, which is a high-risk period.
Complications
- Death
- Permanent injury or organ damage after an attempt
- Repeat attempts
- Grief and higher risk among family and friends (survivors of suicide loss)
Prognosis
Most people who survive an attempt do not die by suicide later, but the risk stays well above the general population for years, highest in the first months. Treating the underlying disorder and early, active follow-up lower that risk.
Prevention
- Asking directly about suicide in people at risk and referring them to care
- Limiting access to lethal means
- Responsible media reporting about suicide
- Life-skills and mental health programmes for young people
- Follow-up contact after an attempt or a hospital discharge
- Anyone in crisis can seek help through emergency services, the nearest health centre or a mental health crisis line; family and friends can help by listening and staying with the person
Test yourself
Think of the answer, then tap the question to see it.
What is the strongest single predictor of death by suicide?
A previous suicide attempt.
Does asking a patient directly about suicidal thoughts increase their risk?
No. Asking directly is safe and is the basis of risk assessment.
Which drug reduces suicide in mood disorders, and which in schizophrenia?
Lithium in mood disorders; clozapine in schizophrenia.
What are three elements of a safety plan?
Warning signs, coping strategies and contacts (people and professional services), plus making the environment safer by limiting access to means.
Why is the period after psychiatric discharge important?
Suicide risk is especially high in the weeks after discharge, so early follow-up is a priority.
Related conditions
- Major depressive disorder
- Bipolar disorder
- Schizophrenia
- Alcohol use disorder
- Generalized anxiety disorder
Educational information, not medical advice. For any symptom, see a health professional.
Sources: Suicide (World Health Organization, 2025); Prevención del suicidio (Organización Panamericana de la Salud (OPS/OMS), 2025); Suicide Prevention (National Institute of Mental Health (NIMH), 2025).
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