Risk Factors and Protective Factors

A sense of a patient's overall risk is formulated by integrating the results of the clinical interview with patient and caregiver(s), suicide risk assessment, and weighing the balance of the patient's unique risk and protective factors. Patients who have multiple risk factors, particularly in the absence of protective factors, may benefit from enhancing the intervention plan to include a greater level of support and responsiveness.

Risk factors represent aspects of the patient’s clinical presentation, history, environment, family and social context, and demographics that precede suicidal behavior, and may increase risk for suicidal behavior or suicide. Risk factors are important to assess and integrate into a risk formulation as they may increase a patient’s risk for suicidal behavior, beyond the presence of past and/or current suicidal ideation and behavior.

Protective factors are important to assess and understand, as they may decrease the risk of suicidal behavior or suicide. Protective factors can also help with treatment planning, as patients with more protective factors may need less intense treatment approaches compared with patients who do not have as many protective factors.

Patients and families who are able to: a) maintain safety in their current environment, b) engage in using coping strategies, c) willing and able to follow treatment plan recommendations, and d) apply the steps of a safety plan in a crisis situation are at reduced risk compared with patients and families who are not able to demonstrate these factors.

Risk Factors and Protective Factors

	Risk Factors	Protective Factors
Clinical	History of multiple suicide attempts History of chronic, intense suicidal ideation Non-suicidal self-injury Psychiatric disorders Patient with new onset or worsening: Impulsivity Substance use Aggression Poor sleep Poor distress tolerance	No history of self-injury or suicidal behavior Engaged in and responsive to mental health treatment Absence of psychosis Good impulse control
Psychological	Hopelessness Poor emotional regulation and/or mood swings Limited problem solving and coping skills Lack of experience of enjoyment/pleasure	Fear of death or dying due to pain, suffering Religious or spiritual beliefs Belief that suicide is wrong or immoral Healthy problem solving Ability to cope with stress Good frustration tolerance Identifies reasons for living
Demographic	Age > 15 yrs have higher rate of suicide death Attempts are more likely during middle teen years Sex Males more likely to die by suicide Females more likely to attempt suicide	Children < 10 yrs
Family & Social	Exposure to violence, trauma History/current presence of abuse, neglect Family history of suicidal behavior and/or psychiatric illness requiring inpatient treatment Grief, loss Social isolation, disrupted social relationships Victim of bullying or engaged in bullying LGBTQ youth who have experienced any of the above stressors are at higher risk	Engaging in work or school Social support Responsibility to family or pets Engaged and supportive family members
Environmental	Access to lethal means Firearms, unsecured medications	No access to firearms Restricted access to other lethal means