Revisiting Ambivalence: Integrating Reasons for Living and Dying into Suicide Risk Assessment

Assessing and treating an individual’s suicide risk involves understanding both their reasons for dying and their reasons for living. While there is much research identifying various reasons for living and dying associated with suicidality, there is a lack of guidance on how clinicians can incorporate such evidence into clinical practice. One challenging factor, for example, is that a specific reason for living may be protective for one person, but not protective—or even a risk factor—for another. In this article, we synthesize the literature to date and offer specific, evidence-based guidance on how we can integrate reasons for living and dying into suicide assessment protocols and utilize them for treatment planning. We highlight how reasons for living can vary by gender and at different points across the lifespan. Additionally, we look at specific populations at heightened risk for suicide death, such as military veterans and individuals with a history of psychiatric hospitalization.