How to Assess Suicide Method Risk in Hospitalized Mood Disorders
How should clinicians assess likely self-harm methods in hospitalized adults with major depressive disorder or bipolar disorder?
Hospitalized adults with major depressive disorder and bipolar disorder have very high suicide risk, but the methods used for self-harm are not identical across diagnoses. This guide applies when clinicians are evaluating suicidal risk or planning means-safety counseling and need to focus questioning on the methods most commonly seen in each mood disorder group.
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Identify whether the patient has MDD or BD
Begin by determining whether the hospitalized adult is being treated for major depressive disorder or bipolar disorder. In this study, method patterns differed by diagnosis, so the rest of the assessment should be organized around that distinction rather than assuming a single mood-disorder profile.
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Ask about cutting and piercing access in both diagnoses
Assess directly for self-inflicted injury by cutting and piercing instruments in all patients with either diagnosis. This was the most common method in both groups, occurring in 30.8% of MDD admissions and 35.5% of BD admissions, with higher prevalence in BD.
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Prioritize medication and ligature method review in MDD
If the patient has MDD, specifically review access to analgesics, other sedatives and hypnotics, other and unspecified solid and liquid substances, and hanging-related means. These methods were more common in MDD than BD: analgesics 16.7% versus 11%, other sedatives and hypnotics 4.9% versus 3.7%, other and unspecified solid and liquid substances 3.9% versus 3.3%, and hanging by strangulation and suffocation 3.7% versus 2.5%.
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Do not overinterpret medication-category differences that were absent
Ask about tranquilizers and other psychotropic agents and other specified drugs and medicinal substances in both diagnoses, but do not use these categories to distinguish MDD from BD. They were common in both groups and did not differ significantly: tranquilizers and other psychotropic agents 29.4% in MDD versus 29.2% in BD, and other specified drugs and medicinal substances 14.0% versus 14.3%.
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Use the identified method pattern to guide means restriction planning
When a patient reports a current or prior attempt method in one of the common categories identified in this study, incorporate that method into immediate prevention planning. The authors conclude that restricting access to the most prevalent forms of self-injury could be a practical suicide-prevention approach and note that highly lethal techniques may carry short- and long-term suicide risk.
Clinical Considerations
- The findings come from a retrospective inpatient administrative database and describe prevalence patterns rather than a validated bedside prediction algorithm.
- The dataset is based on discharge records rather than unique patients, so some individuals may have been counted more than once.
- Administrative coding is subject to detection, reporting, and coding bias, and coded events could not be individually confirmed.
- The study included hospitalized adults aged 18 years or older and may not generalize to outpatient or pediatric populations.
Bottom Line
In hospitalized adults with mood disorders, always assess access to cutting instruments, and in MDD add specific review of analgesics, sedatives-hypnotics, unspecified substances, and hanging-related means because these methods were relatively more common than in BD.
