Desire for death and risk of suicide: Covarying wish to die out of suicidal ideation

Quantitative assessment of a patient's perceived risk for suicidal behavior is commonly included in suicide risk screening and treatment monitoring. Although conceptually similar, no work has examined how one's wish to die (WTD) relates to their perceived risk for suicide, or what constitutes one's belief that suicide is possible beyond their WTD. In the current study, 1168 patients presenting across a hospital system with non-zero risk for suicide completed the Collaborative Assessment and Management of Suicidality-Brief Intervention (CAMS-BI). WTD was covaried out of the overall risk rating, and nonparametric correlations between the remaining residuals and theoretical and clinical risk factors were conducted. The residuals were significantly correlated with wish to live, constructs in theoretical models of suicide (e.g., psychological pain, self-hate), and multiple risk factors and warning signs such as past suicidal behavior, recent suicide planning, and impulsivity. This work highlights the distinct difference between one's self-rated overall risk of suicide and their desire for death. Thus, clinical efforts must work beyond one's desire to die to reduce a patient's belief that suicide is possible in the future. Targeting factors correlated to perceived risk residuals once WTD was covaried such as self-hate, hopelessness, and wish to live may be fruitful.