Table 1.

Definitions and suicide risk formulation

Suicidal ideation (SI)	Thoughts, fantasies and wishes about ending one’s own life	If a patient states that SI is present, the clinician is obligated to explore SI furtherly by posing the following questions:
			• Content (active thoughts of suicide vs. passive wishes for death)
			• Content (planning or not?)
			• Duration of SI
			• Frequency of SI
			• Intensity of SI
			• Controllability or not?
			• Expectations about death (i.e., thoughts of reuniting with lost significant others; thoughts of evoking punishment of others; the need to escape a painful physical or psychological situation; thoughts of harming others first before harming him or herself)
Suicide threat (ST)	Thoughts of engaging in self-injurious behavior that are verbalized and intended to lead others to think that one wants to die, despite no intention of dying (e.g., ‘if you leave me, I will kill myself ’)	If patient manifests a ST, clinicians should furtherly investigate the followings:
			• Are there non-suicidal self-injurious thoughts? e.g., are there any thoughts of engaging in self-injurious behavior characterized by the deliberate destruction of body tissue in the absence of any intent to die or not?
Suicide plan (SP)	Having plans on how to end one’s own life	If a patient has a SI, clinicians should carefully investigate the presence and characteristics of SP as following:
			• Has a specific plan been formulated or implemented, including a specific method, place and time?
			• What is the anticipated outcome of the plan?
			• Are the means of committing suicide available or readily accessible?
			• Does the patient know how to use these means?
			• What is the lethality of the plan? (patient’s conception of lethality vs objective lethality?)
			• What is the likehood of rescue?
			• Have any preparations been performed (e.g., changing wills, suicide notes, etc.) or how close has the patient come to completing the plan?
			• Has the patient practiced the suicidal act or has an actual attempt already been made?
			• Is there a history of impulsive behaviours or SUD that might increase impulsivity?
			• What is the patient’s ability to control impulsivity?
Suicide attempt (SA)	Self-destructive act with intent to end one’s own life, even though is not fatal	If patient did a SA, clinicians should furtherly investigate the followings:
			• Is a self-injurious behaviour accompanied by any intent to die or not? If yes, it is a real SA
			• Is a non-suicidal self-injurious behaviour? i.e., a deliberate destruction of body tissue in the absence of any intent to die?
			• Investigate if patient had a previous SA and/or a family history of a SA or CS
			• Managing patient as follows:
			Medical stabilization
			Inpatient hospitalization
Completed suicide (CS)	Self-injurious behaviour with intent to end one’s own life and is fatal	Clinicians should apply post-suicide interventions, i.e., helping family, friends and coworkers understand why suicide victims killed themselves and decreasing the assumption of inappropriate guilt for the death
			• Identify ‘survivors’ at risk of suicide
			• Prevent PTSD, complicated grief, depressive symptoms

SUD: substance use disorder, PTSD: posttraumatic stress disorder