B. A young, single white male who is alcohol dependent, hopeless, impulsive, has just been rejected by his girlfriend, and has ready access to a gun he has hidden.
All of the persons described are potentially at risk for suicide. However, the person most likely to be at highest risk is the person who has the greatest number of risk factors, the fewest mitigating factors (factors which counter the tendency towards suicide, such as strong religious beliefs which hold suicide to be a sin), the most imminent intent, the most specific and lethal plan, and access to lethal means (especially if those means cannot be controlled in such a way that the patient’s access to them can be prevented). The young, single man who suffers from alcoholism is impulsive, feels hopeless, and has a lethal plan that he has partially enacted (by hiding the gun to prevent others from taking it from him). His isolation, alcoholism, recent loss, impulsiveness, specific plan, and ready access to a highly lethal means suggest a high degree of risk. The 50-year-old married male has a somewhat vague plan with intent that is dependent on how events at work play out. He is married as opposed to isolated, and his plan involves a relatively low-lethality means; relatively speaking, he is at lower risk. The woman with bipolar disorder who lost her parents and has a history of a suicide attempt as a teenager might seem to be at higher risk because of her significant loss, mood disorder, and history of a previous attempt, but her risk is somewhat mitigated by her ability to cope effectively for many years since that attempt. The older Hispanic man has experienced a very significant loss and does not have ready access to family support at a difficult time in his life, and his chronic illness is a risk factor as well. However, both his culture and his religion are mitigating factors in that Catholics typically hold suicide to be a mortal sin, and Hispanic persons tend to hold to a belief that one is fated to deal with certain burdens in life.
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