Depression & Suicide Risk Assessment

Major depressive disorder presents with persistent low mood, anhedonia (loss of interest or pleasure), changes in sleep and appetite, fatigue, poor concentration, feelings of worthlessness or guilt, and, in more severe cases, thoughts of death or suicide — symptoms must persist most of the day, nearly every day, for at least two weeks to meet diagnostic criteria. Any direct or indirect statement suggesting suicidal ideation must be assessed directly and specifically — asking a patient plainly whether they are thinking of harming themselves does not "put the idea in their head" and is a core, evidence-based safety practice, not something to avoid out of discomfort. A thorough risk assessment goes beyond yes/no and asks about a specific plan, access to lethal means (particularly firearms and stockpiled medication), intent, and both risk factors (prior attempts, substance use, hopelessness, social isolation, a recent significant loss) and protective factors (reasons for living, social support, engagement in treatment).