Suicide Risk Assessment and Self-harm Practice Questions

25 multiple-choice questions on Suicide risk assessment and self-harm for paramedic and EMT students, from Chapter 29 (Psychiatric Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. The strongest single risk factor for death by suicide is:

   1. A. Female sex at birth
   2. B. Being in adolescence
   3. C. A previous suicide attempt
   4. D. A past diagnosis of anxiety
   Show answer

   Answer: C. A previous suicide attempt

   A prior attempt greatly increases the risk of a future death by suicide. Women attempt suicide more often, but men die by suicide more often, so female sex is not the strongest factor. Adolescence and anxiety disorders add risk, but much less than a past attempt does.

2. Asking a patient directly whether he is thinking about suicide:

   1. A. Plants the idea in the patient's mind
   2. B. Should be left to psychiatrists only
   3. C. Violates the patient's right to privacy
   4. D. Does not increase his risk of suicide
   Show answer

   Answer: D. Does not increase his risk of suicide

   Research shows direct questions do not increase suicidal thinking and often bring relief. The belief that asking plants the idea is a common, harmful myth.

3. Which is the best way to ask about suicide?

   1. A. 'Are you thinking about killing yourself?'
   2. B. 'You're not thinking of doing anything stupid?'
   3. C. 'You wouldn't ever hurt yourself, would you?'
   4. D. 'Is everything basically okay at home for you?'
   Show answer

   Answer: A. 'Are you thinking about killing yourself?'

   A direct, nonjudgmental question gets an honest answer. Leading questions that expect 'no' discourage disclosure.

4. In the United States, the most common method in deaths by suicide is:

   1. A. Drug overdose
   2. B. Firearms
   3. C. Hanging
   4. D. Jumping
   Show answer

   Answer: B. Firearms

   Firearms account for more than half of suicide deaths. Overdose is the most common method of attempts, but it is less often fatal.

5. Compared with women, men are more likely to:

   1. A. Attempt suicide
   2. B. Die by suicide
   3. C. Use less lethal methods
   4. D. Seek mental health care
   Show answer

   Answer: B. Die by suicide

   Men die by suicide about four times as often, largely because they use more lethal means. Women make more attempts.

6. A 50-year-old man says he plans to shoot himself tonight and has a handgun at home. His risk is best described as:

   1. A. Low, because people who talk about it rarely act
   2. B. Moderate, because he has never attempted before
   3. C. Low, because he is the one who called for help
   4. D. High, because he has a specific, lethal plan
   Show answer

   Answer: D. High, because he has a specific, lethal plan

   A specific plan, a timeline, and access to lethal means indicate high risk. The idea that people who talk about suicide will not act is a myth; most give some warning.

7. At the home of a patient with suicidal thoughts, you see a handgun on the kitchen table. You should:

   1. A. Withdraw and have police secure the weapon
   2. B. Unload it and hand it to the patient's spouse
   3. C. Ignore it as long as the patient remains calm
   4. D. Ask the patient to put it away in a drawer
   Show answer

   Answer: A. Withdraw and have police secure the weapon

   Weapons on scene are a law enforcement matter, and means restriction protects both the patient and crew. Handling an unfamiliar firearm yourself is unsafe.

8. You are transporting a patient who expressed suicidal intent. Inside the ambulance, you should:

   1. A. Seat the patient near the side door
   2. B. Let the patient hold your shears
   3. C. Keep sharps and drugs out of reach
   4. D. Store her belongings beside her
   Show answer

   Answer: C. Keep sharps and drugs out of reach

   The ambulance holds many means of self-harm: needles, scalpels, shears, and medications. Secure them and keep her belongings, which may contain pills or blades, away from her. Seating a suicidal patient by an exit invites an attempt to jump out. Handing her any sharp object is unsafe.

9. A severely depressed patient suddenly seems calm and at peace after weeks of agitation. This may mean:

   1. A. He has recovered from depression
   2. B. He has decided to die by suicide
   3. C. His medicine is causing sedation
   4. D. He is entering a manic episode
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   Answer: B. He has decided to die by suicide

   A sudden calm can follow a decision to end one's life. Recovery from depression is usually gradual, not abrupt.

10. A man was discharged from a psychiatric unit 1 week ago after a suicide attempt. Regarding his current risk, you should know that:

    1. A. Discharge means that the risk has ended
    2. B. Risk is lowest right after a stay
    3. C. Only a new plan would raise his risk
    4. D. The weeks after discharge are high risk
    Show answer

    Answer: D. The weeks after discharge are high risk

    Suicide risk is especially high in the days and weeks after psychiatric hospital discharge, so a recently discharged patient with suicidal thoughts needs careful assessment and transport. Discharge reflects improvement, not elimination of risk. A prior attempt is the strongest risk factor even before a new plan is stated.

11. Nonsuicidal self-injury such as cutting is:

    1. A. A sign the patient has no suicide risk at all
    2. B. Seen only in borderline personality disorder
    3. C. Often a way of coping with emotional distress
    4. D. Usually an attempt to manipulate other people
    Show answer

    Answer: C. Often a way of coping with emotional distress

    Self-injury typically relieves intense emotions. It is linked to a higher future suicide risk, so it never means the patient is safe.

12. A 16-year-old girl has superficial cuts on her forearm and is calm. You should:

    1. A. Treat the wounds; ask about suicidal thoughts
    2. B. Bandage the wounds and leave her with a parent
    3. C. Explain to her the dangers of cutting herself
    4. D. Assume she wants attention and keep it brief
    Show answer

    Answer: A. Treat the wounds; ask about suicidal thoughts

    Every self-injury warrants a suicide risk screen. Dismissing it as attention-seeking is stigmatizing and misses those at risk.

13. A high school student died by suicide last week. Regarding his classmates, you should know that:

    1. A. They are protected by seeing the loss
    2. B. Only their closest friends are ever affected
    3. C. Talking about it will plant the idea
    4. D. Their own suicide risk rises for a time
    Show answer

    Answer: D. Their own suicide risk rises for a time

    Exposure to a peer's suicide raises suicide risk among other young people for a period (suicide contagion), which is why schools and agencies use postvention and safe messaging. Seeing the loss does not protect them. Risk extends beyond close friends. Asking directly about suicidal thoughts does not plant the idea.

14. The Columbia Suicide Severity Rating Scale screening questions focus on:

    1. A. Ideation, intent, plan, past behavior
    2. B. Orientation, memory, and attention span
    3. C. Mood, sleep, appetite, and energy level
    4. D. Alcohol, drug, and tobacco use history
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    Answer: A. Ideation, intent, plan, past behavior

    The C-SSRS screens for suicidal thoughts, their intensity, preparation, and prior behavior. Mood and sleep questions screen for depression, not suicide risk itself.

15. The national suicide and crisis lifeline number in the United States is:

    1. A. 311
    2. B. 988
    3. C. 211
    4. D. 811
    Show answer

    Answer: B. 988

    988 connects callers to trained crisis counselors by call or text. 211 connects to community social services and is not a crisis line.

16. Which group has the highest suicide rate in the United States?

    1. A. Women aged 45 to 64
    2. B. Children aged 10 to 14
    3. C. Men over age 75
    4. D. Married men aged 30 to 40
    Show answer

    Answer: C. Men over age 75

    Older men, especially those living alone with illness, have the highest rate. Middle-aged women have the highest rate among women but still well below older men.

17. You find a person unresponsive in a closed car. A sign taped to the window warns of toxic gas, and buckets of chemicals are inside. You should:

    1. A. Open the doors to reach the patient
    2. B. Break a window to let the gas escape
    3. C. Enter quickly while holding your breath
    4. D. Stay back and call for hazmat help
    Show answer

    Answer: D. Stay back and call for hazmat help

    'Detergent' or chemical suicides mix household chemicals to make hydrogen sulfide or another toxic gas, and the warning sign is meant for rescuers. Opening doors or breaking windows releases the gas onto you, and holding your breath does not protect you. Isolate the area, stay upwind, and wait for responders with proper protective equipment.

18. A patient who just took an intentional overdose is alert and wants to refuse transport. The best approach is to:

    1. A. Accept the refusal because she is alert and oriented
    2. B. Have her sign a refusal form and leave instructions
    3. C. Treat her as unable to refuse; follow local hold rules
    4. D. Leave a family member to watch her for symptoms
    Show answer

    Answer: C. Treat her as unable to refuse; follow local hold rules

    A recent suicide attempt calls her capacity into question and makes her a danger to herself. Being alert and oriented does not equal decision-making capacity.

19. Which is a protective factor against suicide?

    1. A. Strong family and community ties
    2. B. A recent divorce or breakup
    3. C. Chronic pain and disability
    4. D. Easy access to a firearm at home
    Show answer

    Answer: A. Strong family and community ties

    Connectedness, purpose, and access to care reduce risk. Recent loss, chronic pain, and lethal means all increase it.

20. An intoxicated man says he plans to kill himself, then laughs it off as a joke. You should:

    1. A. Ignore it because he is clearly intoxicated
    2. B. Take it seriously and assess further
    3. C. Wait until he is sober before asking again
    4. D. Tell him that it isn't funny and move on
    Show answer

    Answer: B. Take it seriously and assess further

    Alcohol lowers inhibitions and raises the risk of acting on suicidal thoughts. Waiting until he is sober leaves a high-risk period unassessed.

21. No-suicide contracts, in which a patient promises not to harm himself:

    1. A. Make it safe to leave the patient home
    2. B. Are legally binding on the patient
    3. C. Do not reliably prevent suicide
    4. D. Are the standard of care in EMS
    Show answer

    Answer: C. Do not reliably prevent suicide

    There is no evidence that these contracts prevent suicide, and they may give false reassurance. Safety planning and continued evaluation are preferred.

22. A man's wife died by suicide and he says it is his fault. The most appropriate response is:

    1. A. 'Did you notice any warning signs beforehand?'
    2. B. 'She made a selfish choice, and that's on her.'
    3. C. 'You will get over this in time, I promise.'
    4. D. 'This is not your fault. Can I call someone?'
    Show answer

    Answer: D. 'This is not your fault. Can I call someone?'

    Survivors of suicide loss are themselves at higher risk, so support and connection matter. Asking about warning signs implies he should have prevented it.

23. Which phrase reflects current, non-stigmatizing terminology?

    1. A. 'Died by suicide'
    2. B. 'Committed suicide'
    3. C. 'Successful suicide'
    4. D. 'Failed attempt'
    Show answer

    Answer: A. 'Died by suicide'

    'Committed' implies a crime, and 'successful' or 'failed' frames death as a goal. 'Died by suicide' is neutral and accurate.

24. A 15-year-old girl posted a goodbye message online after being bullied, and her parents called 911. She now denies any intent. You should:

    1. A. Accept her denial because she is calm now
    2. B. Transport her for evaluation despite denial
    3. C. Have her parents take away her phone tonight
    4. D. Advise a visit to her school counselor
    Show answer

    Answer: B. Transport her for evaluation despite denial

    Her message is objective evidence of suicidal intent, which outweighs a later denial. Removing the phone does nothing to assess or reduce her risk.

25. A man with depression has been drinking heavily tonight and says he is thinking of ending his life. Alcohol raises his suicide risk mainly because it:

    1. A. Slows his breathing
    2. B. Deepens sleep and rest
    3. C. Lowers his blood sugar
    4. D. Increases impulsivity
    Show answer

    Answer: D. Increases impulsivity

    Alcohol lowers inhibition and increases impulsivity, so an intoxicated person may act on suicidal thoughts he would otherwise resist; intoxication is present in many suicide deaths. Its sedating and metabolic effects, such as slower breathing, deeper sleep, or low blood sugar, are not why it raises suicide risk. Take his statements seriously and assess fully.