Clinical evaluation of suicide risk

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Abstract
Suicide risk assessment may well be the most complex clinical task that mental health professionals face. Tests have shown to be of little use. To confront this complexity, assessment and prediction are best seen as interwoven with understanding suicide, a multi-dimensional malaise. With the essential concepts of lethality and perturbation, a clinical theory of suicide is presented. Intrapsychic aspects (i.e., unbearable psychological pain, cognitive constriction, indirect expressions, inability to adjust, and ego) as well as interpersonal aspects (i.e., interpersonal relations, rejection-aggression, identification-egression), are outlined to aid in assessment. Transference and countertransference issues in assessment are noted. A case illustration to aid in clinical insight is provided. It is concluded that all assessment and prediction of suicide risk ultimately depends on the skill of the clinician.

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