Suicide risk assessment: clinical implications of the unpredictability of suicidal behavior

Risk assessment in the context of suicidal ideation and behavior cannot be conducted with certainty. Recent meta-analyses demonstrate that neither individual risk factors, composite risk scores, clinical judgment, nor adherence to theoretical models or artificial intelligence enables sufficiently accurate prediction of suicidal behavior. This raises the question of how clinicians should respond to the well-documented limitations in the precision of risk assessment. This article first reviews the current state of empirical evidence and subsequently reflects on the implications of these findings for clinical practice. Three alternative approaches to risk assessment are presented. Building on these, an integrated model for risk assessment is introduced in a practice-oriented manner.