Suicidality – epidemiology, risk factors, and diagnosis in various clinical settings (part 1)
Authors:
Andrea Rashovska; Veronika Ročinová; Martina Sebalo Vňuková; Martin Anders; Eva Kitzlerová
Authors‘ workplace:
Psychiatrická klinika 1. LF UK a VFN v Praze
Published in:
Čes. a slov. Psychiat., 122, 2026, No. 3, pp. 86-94.
Category:
Review
doi:
https://doi.org/10.48095/cccsp202607
Overview
Suicidality represents a major public health concern, accounting for more than 700,000 deaths annually worldwide. This review article summarizes current evidence on the epidemiology, risk factors, and diagnostic approaches to suicidality, with an emphasis on practical application across diverse clinical settings. The strongest predictor of suicide remains a prior suicide attempt (OR ≈ 16.33), while the presence of any psychiatric diagnosis is associated with an OR of approximately 11.68. The predictive accuracy of both clinical judgment and psychometric instruments remains statistically limited and has not improved over the past 50 years of research, underscoring the need for repeated risk assessment over time. Biological factors include a genetic component (heritability 17–55%), dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, alterations in the serotonergic system, and neuroimmune dysregulation with elevated pro-inflammatory cytokines (IL-6, TNF-a, CRP). The choice of screening tool varies by clinical setting: in primary care, the Patient Health Questionnaire-9 (PHQ-9), the Ask Suicide-Screening questions (ASQ), or the two-item screening questions recommended by the National Institute for Health and Care Excellence (NICE) are advised; in psychiatric settings, the Columbia Suicide Severity Rating Scale (C-SSRS) is considered the standard; and in somatic (non-psychiatric) settings, the ASQ validated for use by non-psychiatric staff is recommended. Systematic psychiatric evaluation prior to discharge for every patient following a suicide attempt remains insufficiently implemented in clinical practice.
Keywords:
screening – risk factors – suicidality – C-SSRS – ASQ – PHQ-9 – suicide prevention – clinical assessment
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Addictology Paediatric psychiatry PsychiatryArticle was published in
Czech and Slovak Psychiatry
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