Assessing risk of suicide in clinical practice: A framework for conceptualizing risk. AmreshShrivastava MBBS, MD, DPM, MRC Psych 1 ψ Charles Nelson Ph.D., C. Psych.2 1. Assistant professor of psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, Regional Mental Health Care - St. Thomas, Associate scientist, Lawson health research Institute, London, Ontario, Canada, 2.Psychologist, Regional Mental Health Care - St. Thomas, Ontario, Adjunct Professor, Clinical Psychology, University of Western Ontario – London, Ontario Associate scientist, Lawson health research Institute, London, Ontario, Canada ψ. Corresponding author AmreshShrivastava MD, DPM, MRCPsych Regional mental health care, 467, Sunset Drive, N5P 3V9, St.Thomas, Ontario, Canada Phone 1-519-631-8510, Fax: 1-519-631-2512 E Mail: amresh.edu@gmail.com Website: www.amreshshrivastava.com Word count: Abstract: 122, Text: 2322, References: 18

Abstract Background: . Suicide is the prime cause in most of the lawsuits and litigations in clinical practice. Accurate assessment of suicide depends upon the information of risk factors. Concept of risk is continuously evolving. objective of the present paper is to reconceptualize ‘risk’ based upon contemporary thought and biopsychosocial understanding of psychopathology. Method: we reviewed all the risk factors in electronic search and compiled list of 76 published risk factors. These factors were re-categorized by prioritizing according to the multidimensional nature of risk. Result: we attempted to re-group risk factors into constituent domains e.g. biological; environmental; spiritual; social & psychological domains. We propose a different evaluation of risk factors which has following characteristics. 1. A net sum of ‘risk’ shall be the quantum of risk factors in relation to protective factors in a given individual, at a given time. Risk consists of a ‘set’ of vulnerability & resilience, operating as mutually dependent factors. 2. Absolute risk in an individual is ratio of risk factors & protective factors. 3. There are two types of risk factors, trait risk and state risk. In trait risk an individual develops limitations in coping mechanism. Trait factors determine lifetime risk arising from genetics-familial, presence of mental illness, adverse childhood experience & learned coping mechanism. State risk determines current or situational response in presence of recent life events, lack of support system, current mental state & personal belief system. Conclusions: A new scale based upon these concepts can be constructed and its utility can be tested. The re-organization of risk factors in risk-vulnerability & state-trait dimensions appears to be feasible and clinically useful.