Risk and Protective Factors
What raises risk and what buffers it
Two sides of one ledger
Risk assessment is not just a hunt for danger. Every person carries both risk factors, which raise the statistical likelihood of suicidal behavior over time, and protective factors, which buffer against it. A useful formulation weighs both, because protective factors are often where intervention gains the most traction.
Major risk factors
The strongest single predictor of future suicidal behavior is a prior suicide attempt. Other significant risk factors include mental health conditions such as depression, bipolar disorder, psychosis, and posttraumatic stress disorder (PTSD), substance use problems, chronic pain or serious illness, a family history of suicide, exposure to trauma or abuse, and recent significant losses such as a relationship ending, a job loss, or legal trouble.
Access and transition risks
Ready access to lethal means, especially firearms in the home, substantially raises the risk that a suicidal crisis becomes fatal. Transitions are also dangerous windows: the weeks after discharge from psychiatric hospitalization or an emergency department visit carry sharply elevated risk, which is why follow-up during that period is a core prevention strategy.
Populations with elevated risk
Some groups carry heavier statistical burdens, including middle-aged and older men, veterans, lesbian, gay, bisexual, transgender, and queer (LGBTQ)+ youth facing rejection, American Indian and Alaska Native communities, and people recently released from incarceration. Elevated group risk never predicts an individual, but it should lower the threshold for asking.
Protective factors
Connectedness is the headline protector: strong relationships with family, friends, community, and a therapist. Other protective factors include reasons for living such as children, pets, or faith, cultural or religious beliefs that discourage suicide, effective coping and problem-solving skills, engagement in treatment, and restricted access to lethal means. Protective factors do not cancel risk, but they are levers a counselor can actively strengthen.
Using the ledger clinically
Risk factors describe populations and long time horizons. They tell you who deserves screening and how much cushion a person has, but they do not tell you what is happening this week. That is the job of warning signs, covered in the next lesson.