Question
When to screen for suicide risk in clinical settings?
Answer
Suicide risk screening is most effective when it is integrated into clinical workflows at critical points rather than being treated as a one-time event. The initial intake or assessment is a foundational moment for screening, regardless of whether the patient is new or returning. Using standardized tools such as the PHQ-9 in conjunction with suicide-specific screeners like the BSS ensures consistency and provides a data-informed basis for ongoing care. These tools help establish baseline mental health information, which can be shared across providers within an integrated care model.
Screening should also be triggered by significant life stressors or transitions, including job loss, divorce, trauma, or major changes in physical functioning. Mental health symptoms such as depression, anxiety, or increased substance use—especially when paired with impulsivity—warrant immediate attention due to their strong correlation with suicidal behavior. Specific populations at higher risk should be monitored closely, including individuals with psychiatric diagnoses like bipolar disorder or PTSD, veterans (particularly those with combat exposure), adolescents, and those facing chronic illness or major life changes.
Ongoing screening is essential in dynamic and high-risk populations. Tools like the Columbia-Suicide Severity Rating Scale (C-SSRS), the Beck Scale for Suicide Ideation (BSS), and the SAFE-T framework provide structured approaches for identifying risk levels and planning appropriate interventions. These tools not only support clinical decision-making but can also serve therapeutic functions by helping patients articulate their distress and engage more meaningfully in treatment planning.
This Ask the Expert is an edited excerpt from the course, ‘Suicide Prevention for Health Professionals: Screening, Referrals, and Veterans Issues,’ presented by Ryan Kirk, PsyD, MSW, HSPP
