What is a major risk factor for youth suicide that clinicians must assess?

• A. Past suicidal ideation is never a concern
• B. Access to means is unrelated
• C. Past suicidal ideation or behavior; access to means; planning; hopelessness
• D. Only family history of mood problems

Answer: (C)

Assessing youth suicide risk relies on looking for several interrelated warning signs, not just one factor. The strongest indicators are a history of suicidal thoughts or prior attempts, the presence of a clear plan or intent to act, access to the means to carry out that plan, and persistent hopelessness about the future. Each element adds important information: past ideation or behavior shows vulnerability and a pattern that can re-emerge; having access to means makes it feasible to act; a concrete plan or specific intent signals that action could be imminent; and hopelessness reflects a mindset where relief or help seems unlikely, increasing the likelihood of acting on the thoughts.

Because risk often comes from a combination of these factors, the best assessment is to look at all of them together rather than focusing on any single one. For example, past ideation alone is concerning, but it becomes much more alarming when accompanied by planning and access to means, especially in the context of hopelessness. Conversely, focusing only on family mood history misses current, actionable risk signals. If these indicators are present, it’s essential to escalate to safety planning and crisis resources to ensure the youth’s immediate safety.