Suicide Risk Assessment
A 38-year-old woman with 2 years of major depressive disorder attends with her husband, who reports she has withdrawn from all friends and relatives over the past month, stopped answering calls, and now speaks of being a burden. She uses no alcohol or substances and has no chronic medical illness. She makes no eye contact. Which factor carries the highest suicide risk?
- A.Her age of 38 years
- B.Progressive social isolationCorrect
- C.Her female sex
- D.Absence of chronic medical illness
Explanation
Social isolation and a sense of thwarted belonging are among the strongest and most consistently replicated risk factors for suicide, and they are the ones present and actively worsening in this patient. Interpersonal theories of suicide emphasize that perceived burdensomeness combined with thwarted belonging generates the desire for death, and this woman voices both. Isolation also removes the protective effect of people who might notice deterioration, interrupt an attempt, or bring her to care. Other high-weight factors that must be screened for include a previous attempt, which is the single strongest historical predictor, active suicidal ideation with a plan and available means, hopelessness, recent discharge from psychiatric care, comorbid substance use, and access to lethal means such as firearms. Age is relevant but risk is highest in older men rather than at 38 years. Female sex is associated with more attempts, whereas male sex carries higher completion rates, so being female is not the highest-risk feature here. The absence of serious medical illness is protective rather than a risk factor, since chronic pain, cancer, and neurological disease all increase suicide risk. Management involves direct assessment of ideation, intent, and plan, restricting access to lethal means, mobilizing family support, optimizing antidepressant treatment, and arranging close follow-up or admission if risk is imminent.
Why each option
- A.
- Age influences risk, with the highest rates in older men, but 38 years is not the dominant factor in this presentation.
- B.
- Correct. Progressive social withdrawal with expressed burdensomeness is among the strongest and most modifiable suicide risk factors.
- C.
- Women attempt suicide more often while men complete it more often, so female sex is not the highest-risk feature here.
- D.
- Serious medical illness increases suicide risk; its absence is protective and is not a risk factor at all.
Reference: UpToDate 2025, Suicidal ideation and behavior in adults: Risk assessment and management
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