In assessing acute suicide risk in the emergency department, which feature MOST strongly predicts imminent risk and should prompt inpatient admission?
- A Passive ideation ('I wish I were dead') without a plan
- B History of a serious previous attempt using a highly lethal method ✓
- C Recent break-up with mild hopelessness
- D Family history of suicide with no current ideation
Correct answer: B. History of a serious previous attempt using a highly lethal method
Explanation
The single strongest predictor of future suicide is a previous serious attempt, especially one using a highly lethal method (e.g., gunshot, hanging, self-immolation). This reflects intent, planning, and low rescue expectation. The Columbia Suicide Severity Rating Scale (C-SSRS) and clinical judgment both weight past attempt lethality heavily. Passive ideation without a plan carries much lower imminent risk; family history without current ideation, while a risk factor, is not a sufficient trigger for immediate inpatient admission.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.