Suicide

Suicide risk is not a diagnosis that can be confirmed by one answer, one score or one laboratory test. The clinical task is to determine whether suicidal thinking is present, how close the patient may be to acting, what is driving the risk, and what can make the environment safer today. Use PHQ-9 item 9 as a universal screening question for adults presenting for care. A positive response is a doorway to assessment, not a risk classification. Ask directly and use plain language: - “Have you wished you were dead or wished you could go to sleep and not wake up?” - “Have you had thoughts of killing yourself?” - “Do you intend to act on those thoughts?” - “Have you decided how you would do it?” - “Do you have access to the method now, and have you taken any steps to prepare?” Direct questions do not create suicidal thoughts. They make concealed risk easier to identify. An experienced clinician listens for movement from desire toward action. Passive thoughts of death are different from active suicidal ideation; active ideation...