You are seeing a patient whom you suspect may be suicidal. Which of the following factors most suggests that the risk of suicide is high?

The patient’s depressive symptoms having recently improved is often associated with an increased risk of suicide, particularly if that improvement is sudden or marked. This phenomenon can be linked to the concept of “lethargy lifting,” where individuals who have been severely depressed may gain enough energy to act on suicidal thoughts they previously lacked the motivation to pursue.

In cases where a patient starts to feel better emotionally but still harbors suicidal ideation, the potential for completing suicide can unfortunately rise, as they may have the drive to act upon their thoughts. It can often signal a critical time when the patient may feel relieved from the weight of their depression yet remains in a vulnerable mental state, creating a paradoxical increase in the risk of self-harm.

This context highlights the importance of closely monitoring patients who show signs of improvement in their depressive symptoms. While engaging in therapy, having a stable support system, or overcoming substance abuse are all positive factors that generally correlate with lower suicide risk, it is the improvement in depressive symptoms that may be misleading and indicates a higher risk in certain circumstances.