Screening for Suicide-related Thoughts and Behaviors
DoD has not recommended any suicide-related screening tools for use across the department. In general, the type of screening tool selected for use will depend on the qualifications of the individual administering the tool (e.g., licensed versus unlicensed provider, education and/or training level of provider), the care setting (e.g., inpatient versus outpatient), and the purpose of the screening (e.g., research, intake evaluation, routine check, imminent risk determination).
Please see Module A: Assessment and Determination of the Risk for Suicide in the 2013 VA/DoD Clinical Practice Guideline for the Assessment and Management of Patients at Risk for Suicide (VA/DoD Suicide CPG) for more information on screening methods.
When talking with patients about suicide-related topics, it is important to understand and use universal suicide-related terms.
“The terms “suicidality” and “risk for suicide” are sometimes used interchangeably. The use of the term “risk for suicide” is preferred when communicating with the patient and documenting clinical care.” (VA/DoD Suicide CPG, p. 13)
Definitions of Suicide-related Terms (from the VA/DoD Suicide CPG)
Suicidal self-directed violence: Behavior that is self-directed and deliberately results in injury or the potential for injury to oneself with evidence, whether implicit or explicit, of suicidal intent.
Suicide: Death caused by self-inflicted injurious behavior with any intent to die as a result of the behavior.
Suicide attempt: A non-fatal self-inflicted potentially injurious behavior with any intent to die as a result of the behavior.
Preparatory behavior: Acts or preparation towards engaging in self-directed violence, but before potential for injury has begun. This can include anything beyond a verbalization or thought, such as assembling a method (e.g., buying a gun, collecting pills) or preparing for one’s death by suicide (e.g., writing a suicide note, giving things away).
Suicidal intent: Past or present evidence (implicit or explicit) that an individual wishes to die, means to kill him/herself, and understands the probable consequences of his/her actions or potential actions. Suicidal intent can be determined retrospectively and inferred in the absence of suicidal behavior.
Suicidal ideation: Thoughts of engaging in suicide-related behavior (various degrees of frequency, intensity, and duration).
Interrupted by self or other: A person takes steps to injure self but is stopped by self or another person prior to fatal injury. The interruption may occur at any point.
Physical injury: A bodily injury resulting from the physical or toxic effects of a self-directed violent act interacting with the body.
(Developed in collaboration with the Centers for Disease Control and Prevention).
Definitions of Factors Contributing to Risk for Suicide (from the VA/DoD Suicide CPG)
Warning signs for suicide: Warning signs are those observations that signal an increase in the probability that a person intends to engage in suicidal behavior in the immediate future (i.e., minutes and days). Warning signs present tangible evidence to the clinician that a person is at heightened risk for suicide in the short term; and may be experienced in the absence of risk factors.
Acute risk factors: Acute (of brief duration) and stressful episodes, illnesses, or life events. While not usually internally derived, these events can build upon and challenge a person’s coping skills.
Chronic risk factors (pre-existing): Relatively enduring or stable factors that may increase a person’s susceptibility to suicidal behaviors, such as genetic and neurobiological factors, gender, personality, culture, socio-economic background and level of isolation.
Protective factors: Capacities, qualities, environmental and personal resources that increase resilience; drive an individual toward growth, stability, and/or health and/or increase coping with different life events.