Management of the Suicidal Patient

Suicidal thoughts and behaviors emerge from interacting psychiatric, psychological, social, medical, existential, and other influences. The factors associated with developing suicidal ideation overlap incompletely with those that facilitate progression from thoughts of suicide to suicidal behavior. Therefore, suicide assessments require attention to the origins of suicidal thinking and the features that may signal movement toward action, including changes from a patient's chronic baseline, intent, planning, preparatory behavior, and access to lethal means. This task is difficult because suicidal states fluctuate, patients often minimize or conceal their intentions, and available instruments do not reliably predict individual attempts. Consequently, clinical management depends on a longitudinal risk formulation paired with interventions that reduce the immediate opportunity for self-harm, address modifiable drivers of suicidality, strengthen the patient's ability to navigate future crises, and match the intensity of care to acute risk. When a patient dies by suicide despite these efforts, thoughtful management extends care to families, treatment teams, and clinicians who are affected by the loss.