Suicide Risk Assessment and Care Planning — Definition of Types of Suicidal Ideation and Behavior — Clinical Pathway: Outpatient Specialty

Suicide Risk Assessment and Care Planning Clinical Pathway — Outpatient Specialty Care

Definition of Types of Suicidal Ideation and Behavior

From Columbia Suicide Severity Rating Scale;
Posner, Brent, Lucas, Gould, Stanley, Brown, Fisher, Zelazny, Burke, Oquendo, & Mann, 2009

Suicidal Ideation

Most severe
Least severe
Active Suicidal Ideation with Specific Plan and Intent
  • Patient endorses thoughts of killing oneself with details of plan fully or partially worked out and has some intent to carry it out
Active Suicidal Ideation with Some Intent to Act, without Specific Plan
  • Patient endorses active suicidal thoughts of killing oneself and reports having some intent to act on such thoughts, as opposed to “I have the thoughts but I definitely will not do anything about them.”
Active Suicidal Ideation with Any Methods (Not Plan) without Intent to Act
  • Patient endorses thoughts of suicide and has thought of at least one method to harm self; (how) during the assessment period.
    • e.g., thought of method to kill oneself but not a specific plan
Non-specific Active Suicidal Thoughts
  • Patient endorses general, non-specific thoughts of wanting to end one’s life/die by suicide (e.g., “I’ve thought about killing myself”) without thoughts of ways to kill oneself/associated methods, intent, or plan
Wish to Be Dead
  • The wish to be dead, to not be alive anymore, or to fall asleep and not wake up.

Suicidal Behavior

Most severe
Least severe
Actual Attempt
  • A potentially self-injurious act committed with at least some wish to die as a result of act. Behavior was in part thought of as method to kill oneself. Intent does not have to be 100%. If there is any intent/desire to die associated with the act, then it can be considered an actual suicide attempt. There does not have to be any injury or harm, just the potential for injury or harm. If person pulls trigger while a gun is in mouth but gun is broken so no injury results, this is considered an attempt.
Interrupted Attempt
  • When person is interrupted (by an outside circumstance) from making a suicide attempt (if not for that, actual attempt would have occurred).
Aborted Attempt or Self-interrupted Attempt
  • When person begins to take steps toward making a suicide attempt, but stops themselves before they actually have engaged in any self-destructive behavior. Examples are similar to interrupted attempts, except that the individual stops him/herself, instead of being stopped by something else.
Preparatory Acts or Behavior
  • Acts or preparation toward imminently making a suicide attempt. This can include anything beyond a verbalization or thought, such as assembling a specific method (e.g., buying pills, purchasing a gun) or preparing for one’s death by suicide (e.g., giving things away, writing a suicide note).

Non-suicidal Self-injury

The deliberate, direct destruction or alteration of body tissue, without conscious suicidal intent, but resulting in injury severe enough for tissue damage to occur