Scientizing and routinizing the assessment of suicidality in outpatient practice.

Suicidal patients are difficult and challenging clinical problems. Conceptual tools aid the clinician in organizing and evaluating the clinical situation. The authors provide a framework for suicide risk assessment that emphasizes 2 domains—histor y of past attempt and the nature of current suicidal symptoms—that have emerged in suicide research as crucial variables. These domains, when combined with other categories of risk factors, produce a categorization of risk for the individual patient, leading, in turn, to relatively routinized clinical decision making and activity. Increasing numbers of patients manifesting acute or chronic suicidal behavior present for outpatient care, as managed care limits access to inpatient care and shortens the length of hospitalizations. For the general outpatient practitioner, then, the need for a consistent and empirically grounded assessment framework for suicidality has become crucial. In this article we summarize a general assessment framework, and supplement and elaborate it with reference to recent empirical work on the nature and assessment of suicidal symptoms. It is not our purpose to thoroughly restate the details of assessment frame