A psychiatric registrar is stratifying suicide risk in three outpatients with major depression. Patient 1 has passive death wishes, patient 2 has a specific plan involving stockpiled medication but no prior attempts, and patient 3 made a serious suicide attempt requiring ICU admission two years ago and now has mild hopelessness. Which factor carries the strongest predictive weight for eventual completed suicide?
- A Passive death wishes
- B Possession of a specific plan
- C History of a previous medically serious suicide attempt ✓
- D Current mild hopelessness
Correct answer: C. History of a previous medically serious suicide attempt
Explanation
A previous suicide attempt, particularly one with high medical lethality or intent, is the single strongest predictor of eventual completed suicide across diagnoses; a substantial proportion of people who die by suicide have made at least one earlier attempt. Passive death wishes fluctuate and often reflect demoralisation, a specific plan raises acute risk but is less predictive longitudinally than prior behaviour, and mild hopelessness alone adds little discriminatory power compared with documented past behaviour.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.