GPAtlas🧭 When to suspect
Suicidal thinking sits on a spectrum – from passive thoughts that life is not worth living, through active ideation, to ideation with a plan and intent. It is common, often concealed, and rarely volunteered without being asked. The central skill in primary care is to ask directly and well, then respond to the person's needs and immediate safety – not to assign a risk score.
Actively enquire about suicidal thoughts in anyone presenting with low mood, depression, hopelessness or anxiety, after an adverse life event (relationship breakdown, job loss, financial crisis, legal problems, bereavement), and in those with chronic pain or physical illness, substance misuse, or in the perinatal period. Primary care is the service most people contact before suicide: the majority consult their GP in the year beforehand and roughly four in ten within the final three months. Escalating or frequent attendance (more than once a month), for any reason, is itself associated with raised risk – treat a rising consultation rate as a soft warning sign.
| Who is at higher risk | Triggers & warning signs |
|---|---|
|
• Previous self-harm or suicide attempt – the single strongest risk factor |
• A recent adverse life event – loss, separation, debt, shame, legal trouble |
|
• Men in midlife – the highest age-specific rates are in men around 50–54, and men die by suicide roughly three times as often as women |
• Expressing hopelessness, feeling trapped or a burden, or saying goodbye |
|
• Mental illness (depression, bipolar disorder, psychosis, personality disorder) and alcohol or drug misuse |
• Escalating or frequent consultations, or a striking, unexplained calm after severe distress |
|
• Social isolation, living alone, recent bereavement, and certain occupations |
• Withdrawing from work, family or usual activities; giving away possessions |
|
• Autistic people and neurodivergence, and those in contact with the criminal justice system |
• New or worsening access to a means of harm |
|
⚠️ Common pitfall Treating a “low risk” label as reassurance. NICE is explicit that risk-assessment tools, scales and low/medium/high stratification must not be used to predict suicide or to decide who gets care – the low-risk paradox is that most people in contact with services who die by suicide were rated low risk at their last contact. Suicidal states fluctuate fast. Assess the person's needs and immediate safety and build a collaborative formulation, rather than scoring them. |
Source: NICE NG225 · ONS · NCISH
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