Suicide risk and self-harm refer to thoughts, intentions, behaviors, and psychological states associated with the possibility of self-injury or suicide. This domain includes suicidal ideation, suicide attempts, non-suicidal self-injury, psychological pain, hopelessness, perceived burdensomeness, and protective factors such as reasons for living.
Assessment in this area is especially sensitive. Suicide-related instruments are not prediction tools in a simple sense and should not be interpreted as determining whether a person will or will not attempt suicide. Instead, they support structured assessment of risk-related processes, symptom severity, recent change, and clinical context.
Core assessment focuses on suicidal thoughts, planning, intent, behavior history, and recent changes in risk.
The Columbia-Suicide Severity Rating Scale (C-SSRS) assesses suicidal ideation and suicidal behavior, including severity, intensity, behavior history, and recent risk indicators. It is widely used in clinical and research settings and requires appropriate interpretation.
The Suicide Behaviors Questionnaire-Revised (SBQ-R) is a brief measure assessing lifetime suicidal thoughts or attempts, recent ideation, communication of suicidal intent, and perceived likelihood of future suicidal behavior.
The Suicidal Ideation Attributes Scale (SIDAS) assesses frequency, controllability, closeness to attempt, distress, and functional impact of suicidal thoughts.
The Scale for Suicide Ideation (SSI; Beck) assesses the presence and intensity of suicidal thoughts, including desire, planning, deterrents, and subjective control over suicidal impulses. It is a professional clinical measure rather than a simple online screening tool.
The Suicide Probability Scale (SPS) assesses broader suicide-related risk indicators, including hopelessness, suicidal ideation, negative self-evaluation, and hostility.
Some instruments provide brief structured screening for suicide risk, especially in clinical, primary-care, or emergency contexts.
The Risk Assessment Suicidality Scale (RASS) is a brief instrument developed to assess suicide risk indicators in both general and clinical populations. It has also been adapted into online calculator formats, although such tools should be interpreted cautiously and not used as stand-alone risk determinations.
The SAD PERSONS Scale is a historical suicide-risk checklist based on demographic and clinical risk factors. Although widely known, later research has raised serious concerns about its predictive accuracy, especially because it relies heavily on static risk factors and may miss clinically important dynamic risk states.
Brief screeners may be useful for triage or documentation, but they should always be embedded in broader clinical assessment.
Some instruments focus on acute suicidal crisis states rather than only lifetime ideation or behavior history.
The Suicide Crisis Inventory (SCI-2) assesses the Suicide Crisis Syndrome, including recent crisis-related symptoms such as entrapment, affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal.
This approach is useful because suicide risk can change rapidly, and recent crisis states may not be fully captured by lifetime history measures.
When a suicide attempt has occurred, assessment often focuses on intent, context, and motivations.
The Suicide Intent Scale (SIS; Beck) assesses the circumstances and subjective intent associated with a suicide attempt. It is designed for use after an attempt and requires careful clinical interpretation.
The Inventory of Motivations for Suicide Attempts (IMSA) assesses motivations for suicide attempts, including internal motivations such as escape from unbearable thoughts or emotions and interpersonal motivations such as communication, help-seeking, or influence.
The Self-Injurious Thoughts and Behaviors Interview (SITBI) assesses suicidal ideation, suicide plans, suicide attempts, gestures, and non-suicidal self-injury. It is a structured interview rather than a simple self-report questionnaire.
Several instruments assess subjective states that may contribute to suicidal desire.
The Psychache Scale (PAS-13) assesses psychological pain, including the presence, frequency, and tolerability of intense emotional suffering. It is especially relevant in suicide-risk research, where psychache is understood as a central subjective component of suicidal distress.
The Unbearable Psychache Scale focuses more specifically on psychological pain experienced as intolerable or unbearable.
The Suicide Cognitions Scale (SCS), and its brief versions, assess suicide-related beliefs such as being unlovable, perceiving problems as unsolvable, and experiencing emotional pain as unbearable.
The Psychological Strain Scales (PSS; Zhang) assess psychological strain within the strain theory of suicide, including value strain, aspiration strain, deprivation strain, and coping strain. This approach conceptualizes suicide risk partly in terms of unresolved psychological conflicts and blocked coping resources.
Hopelessness is a major cognitive risk factor for suicidal ideation and behavior, especially when combined with depression, perceived entrapment, or lack of future orientation.
The Beck Hopelessness Scale (BHS) is usually covered in the depression domain, but it is also relevant to suicide-risk assessment because it captures negative expectations about the future. ©
The Hopelessness Scale for Children (HSC) adapts hopelessness assessment for younger populations. It is modeled on the Beck Hopelessness Scale and assesses future expectations, loss of motivation, and negative views of the future.
Some approaches assess mechanisms proposed by contemporary theories of suicide.
The Interpersonal Needs Questionnaire (INQ) assesses perceived burdensomeness and thwarted belongingness, two constructs from the interpersonal theory of suicide. These constructs are associated with suicidal desire, especially when individuals feel disconnected from others and believe they are a burden.
The Acquired Capability for Suicide Scale (ACSS), including versions focused on fearlessness about death, assesses reduced fear of death and related capability constructs. It is used in research on why some individuals may be more able to act on suicidal thoughts.
These instruments assess theoretical risk mechanisms rather than direct prediction of suicidal behavior.
Assessment of suicide risk should include protective factors, not only risk indicators. These measures examine beliefs, commitments, relationships, and sources of meaning that may reduce the likelihood of suicidal behavior or support ambivalence toward suicide.
The Reasons for Living Inventory (RFL, BRFL) assesses beliefs and commitments that may protect against suicidal behavior, including survival and coping beliefs, responsibility to family, child-related concerns, fear of suicide, fear of social disapproval, and moral objections.
The Reasons for Living Inventory for Adolescents (RFL-A) is a developmentally adapted version of the RFL that assesses protective beliefs, family and peer-related concerns, future orientation, and reasons for staying alive in adolescents.
Protective factors do not eliminate risk, but they are important for understanding resilience, ambivalence, and potential sources of support.
Self-harm and non-suicidal self-injury (NSSI) should be assessed separately from suicidal behavior, even though they may co-occur and share some risk factors.
The Inventory of Statements About Self-Injury (ISAS) assesses the frequency of different self-injury behaviors and the functions of non-suicidal self-injury. It includes functions such as affect regulation, self-punishment, anti-dissociation, interpersonal influence, and peer bonding.
The Deliberate Self-Harm Inventory (DSHI) assesses the presence, frequency, severity, duration, and type of deliberate self-harm behaviors without conscious suicidal intent.
The Functional Assessment of Self-Mutilation (FASM) assesses methods, frequency, and functions of self-injurious behavior. It is especially relevant when the goal is to understand why self-injury occurs, such as emotion regulation, attention-seeking, or social avoidance.
The Self-Harm Inventory (SHI) assesses a broader history of self-harm and self-destructive behaviors. It has been used in relation to borderline personality features and broader self-injurious behavior patterns.
The Self-Injurious Thoughts and Behaviors Interview (SITBI) can also be used here because it assesses both suicidal and non-suicidal self-injurious thoughts and behaviors in a structured format.
The Adolescent Non-suicidal Self-Injury Assessment Questionnaire assesses the frequency, methods, motivations, and contextual factors of non-suicidal self-injury in adolescents.
Suicide risk and self-harm overlap with several neighboring domains but should not be reduced to any one of them.
Depression, bipolar disorder, trauma, psychosis, substance use, chronic pain, borderline personality features, and eating disorders may all involve elevated suicide risk. However, suicide-related assessment focuses on specific processes such as ideation, intent, planning, attempt history, psychological pain, capability, interpersonal disconnection, and protective factors.
Self-harm may function as emotion regulation, self-punishment, dissociation management, interpersonal communication, or habit-like behavior. Its function must be assessed directly rather than inferred from diagnosis alone.
Suicide-risk instruments are not stand-alone predictors. A low score does not guarantee safety, and a high score does not determine that suicidal behavior will occur.
Interpretation requires attention to recent change, access to means, intent, planning, past attempts, substance use, agitation, sleep disruption, psychosis, trauma, interpersonal crisis, protective factors, and available support.
Online or self-report assessment in this domain should be framed as screening, self-reflection, or structured symptom description, not as emergency triage or diagnosis.