Risk Factors & Warning Signs
Comprehensive reference for suicide risk factors and warning signs based on empirical research and clinical consensus.
IS PATH WARM? Warning Signs
American Association of Suicidology consensus warning signs (Rudd et al., 2006)
IdeationAcute indicator
Talking or writing about death, dying, or suicide
Substance Abuse
Increased or excessive alcohol/drug use
Purposelessness
No reason for living; no sense of purpose in life
AnxietyAcute indicator
Anxiety, agitation, unable to sleep or sleeping all the time
TrappedAcute indicator
Feeling trapped—like there is no way out
HopelessnessAcute indicator
Hopelessness about the future
Withdrawal
Withdrawing from friends, family, and society
AngerAcute indicator
Rage, uncontrolled anger, seeking revenge
Recklessness
Acting recklessly without thinking of consequences
Mood ChangesAcute indicator
Dramatic mood changes
Chronic (Baseline) Risk Factors
Enduring predispositions that elevate baseline suicide risk over time
Historical
- • Previous suicide attempt(s)
- • Previous psychiatric hospitalization
- • History of non-suicidal self-injury
- • Family history of suicide
- • History of childhood abuse/neglect
- • Trauma history / PTSD
Clinical
- • Chronic mental illness
- • Personality disorder (esp. BPD)
- • Substance use disorder
- • Chronic physical illness/pain
- • Traumatic brain injury
- • Sleep disorders
Demographic/Social
- • Male gender
- • Older age (65+)
- • LGBTQ+ identity (due to minority stress)
- • Military/veteran status
- • Social isolation
- • Access to lethal means
Acute Risk Factors
Time-limited factors that acutely elevate risk when interacting with baseline vulnerabilities
Suicidal Symptoms
- • Current suicidal ideation
- • Suicidal plan
- • Suicidal intent
- • Preparatory behavior
- • Recent attempt (<90 days)
- • Rehearsal behavior
Psychiatric State
- • Severe hopelessness
- • Severe agitation
- • Severe anxiety/panic
- • Severe insomnia
- • Severe anhedonia
- • Command hallucinations
- • Acute intoxication
Situational
- • Recent significant loss
- • Acute shame/humiliation
- • Recent discharge from hospital
- • Discontinuation of medication
- • Anniversary of loss
- • Exposure to suicide
Interpersonal Theory Constructs (Joiner, 2005)
Key psychological states that, when co-occurring, indicate elevated risk
Perceived Burdensomeness
Belief that one's existence is a burden to family, friends, or society. “Everyone would be better off without me.”
Thwarted Belongingness
Experience of being alienated, disconnected, not belonging to a valued group. Social isolation and loneliness.
Acquired Capability
Reduced fear of death and elevated physical pain tolerance, often from exposure to painful/provocative events (self-harm, violence, accidents).
Protective Factors
Factors that may reduce suicide risk (but do not “rule out” risk)
Important: Protective factors should contextualize risk but never override the presence of acute risk factors. Do not use protective factors to dismiss or minimize expressed suicidality.
References
Rudd, M. D., et al. (2006). Warning Signs for Suicide: Theory, Research, and Clinical Applications. Suicide and Life-Threatening Behavior, 36(3), 255-262.
Rudd, M. D. (2006). Fluid Vulnerability Theory: A Cognitive Approach to Understanding the Process of Acute and Chronic Suicide Risk. In T. E. Ellis (Ed.), Cognition and Suicide (pp. 355-368). APA.
Joiner, T. E. (2005). Why People Die by Suicide. Harvard University Press.
Van Orden, K. A., et al. (2010). The Interpersonal Theory of Suicide. Psychological Review, 117(2), 575-600.