Suicide Risk Questionnaire ©
Screening for Mental Health, Inc.
Are you worried about a friend or loved one?
Did you know that…
70% of people who commit suicide tell someone about it in advance. Sometimes those contemplating suicide talk as if they are saying goodbye or
going away forever. ■ One study observed that nearly 50% of suicide victims had a positive blood alcohol level. ■ Between 20 and 40 percent of
people who kill themselves have previously attempted suicide. Those who have made serious suicide attempts are at much higher risk for actually
taking their lives. ■ Although most depressed people are not suicidal, most suicidal people are depressed. Serious depression can be manifested in
obvious sadness, but often is expressed instead as a loss of pleasure or withdrawal from activities that were once enjoyable.
Answer the following questions for the person you are concerned about:
Part I Suicide Risk Questionnaire
Have you heard:
Life isn’t worth living There’s nothing I can do to make it better
My family would be better off without me I’d be better off dead
Next time I’ll take enough pills to do the job right I feel there is no way out
Take my (prized collection, valuables) – I don’t need
Have you observed:
this stuff anymore
I won’t be around to deal with that Getting affairs in order (paying off debts, changing a will)
You’ll be sorry when I’m gone Giving away articles of either personal or monetary value
I won’t be in your way much longer Signs of planning a suicide such as obtaining a weapon
I just can’t deal with everything – life’s too hard or writing a suicide note
Nobody understands me – nobody feels the way I do
Part II Depression Risk Questionnaire
Have you noticed the following signs of depression:
Depressed mood Feeling of worthlessness, self-reproach, or guilt
Change in sleeping patterns (too much/little, disturbances) Thoughts of death, suicide, or wishes to be dead
Change in weight or appetite
If depression seems possible, have you also noticed:
Speaking and/or moving with unusual speed or slowness
Loss of interest or pleasure in usual activities Extreme anxiety, agitation, irritability or risky behavior
Withdrawal from family and friends Racing thoughts, excessive energy, reduced need for sleep
Fatigue or loss of energy Excessive drug and/or alcohol use or abuse
Diminished ability to think or concentrate, slowed Neglect of physical health
thinking or indecisiveness
Feelings of hopelessness
Turn this page over to learn what your answers may mean for your friend or loved one and what to do
if you believe that you or someone you care about needs help.
Questionnaire Interpretation
IF YOU CHECKED CIRCLES UNDER
Part I only, your friend or loved one may be at risk for suicide and should seek professional help immediately.
Part II only, your friend or loved one may be suffering from depression or bipolar disorder and should seek further evaluation with a mental
health professional or his or her primary care physician.
Parts I and II, the suicide risk is even higher. Strongly encourage your friend or loved one to seek professional help immediately.
What to do if you suspect a friend or loved one is suicidal
Do take it seriously. 70% of all people who commit suicide give some warning of their intentions to a friend or
member of their family.
Do be willing to listen. Even if professional help is needed, your friend or loved one will be more willing to seek help if
you have listened to him or her.
Do voice your concern. Take the initiative to ask what is troubling your friend or loved one, and attempt to overcome
any reluctance on their part to talk about it.
Do let the person know you care and understand. Reassure your friend or loved one that he or she is not alone.
Explain that, although powerful, suicidal feelings are temporary, depression can be treated, and problems can be
solved.
Do ask if the person has a specific plan for committing suicide, and how far he or she has gone in carrying it out.
(Note: asking about suicide does not cause a person to think about – or commit – suicide. This is a myth.)
Do get professional help immediately. Bring your friend or loved one to the nearest emergency room or crisis center.
(If the person is already in treatment, contact his or her clinician.) Your friend or loved one will be more likely to seek
help if you accompany him or her.
Do follow up on treatment. Take an active role in following up with the treatment process and medications.
Be sure to notify the physician about any unexpected side effects or changes in behavior.
If for any reason you are unsure, uncomfortable, or unable to take action, find a healthcare professional with whom
to share your concerns or contact Military OneSource: Stateside 1-800-342-9647 or Overseas 1-800-3429-6477.
Whatever you choose to do, the important thing is to make the effort.
Don’t assume the situation will take care of itself. Don’t act shocked or surprised at what the person says.
Don’t leave the person alone. Don’t challenge or dare.
Don’t be sworn to secrecy. Don’t argue or debate moral issues.
Take an Anonymous Self-Assessment. Available 24/7.
www.MilitaryMentalHealth.org
Provided by Screening for Mental Health, Inc. (SMH)
With funding from the Department of Defense Office of Health Affairs
Contact SMH: One Washington Street, Suite 304, Wellesley Hills MA 02481
Phone: 781-239-0071 Fax: 781-431-7447
Military@MentalHealthScreening.org
Consultants: Ross J. Baldessarini, MD, Kay R. Jamison, PhD. and the American Foundation for Suicide Prevention
Copyright 2006-Screening for Mental Health, Inc. All rights reserved.
