A Clinical Model for Suicide risk Assessment
Of the common categories of suicidal behaviors, completed suicide is the most difficult to predict; it is the least common. Whereas the lifetime prevalence of attempted suicide in the general population in North America is estimated at 3% (Moscicki et al., 1989; Sakinofsky & Webster, 1994), the lifetime prevalence of completed suicide, at a conservative annual mean rate of 10 per 100,000, is 0.5%. A related and classic problem is the extrapolation of characteristics that denote suicidality in high-risk populations to specific individuals in those populations. Maris, Berman, and Maltsberger (1992) have identified several other salient issues in suicide risk assessment, including membership in a high-risk group, the acuteness of risk/probability of action, the need for risk indicators to be clinically relevant, and the fact that “wha t is being predicted or assessed is not one thing, but actually many multidimensional, intersecting, and interacting parameters” (pp. 642-643). In searching for relevant risk factors, the clinician should be cautious about combining clinical features found among suicide idea¬ tors, attempters, and completers, because they appear to be overlapping but
different populations. The question of suicide risk is thus becoming more refined: Risk for which suicidal behavior, exactly?