Digitalized suicide risk assessment in emergency psychiatry services

Emergency psychiatry services represent the primary point of contact for patients with acute suicidal risk; however, traditional risk assessment remains inconsistent and vulnerable to error.

This study aims to develop a comprehensive model for the digitalized assessment of suicide risk in emergency psychiatry services by integrating validated risk factors from the specialist literature into a clinical stratification algorithm. The study seeks to create a practical instrument that enables the rapid and standardized classification of patients into risk categories - low, moderate, high, and imminent - thereby supporting clinical decisions regarding the need for hospitalization and the intensity of therapeutic intervention.

We developed a 30-factor stratification algorithm that integrates the following categories of factors: psychiatric disorders, weighted at 30%; psychological factors, weighted at 20%; personal history factors, weighted at 25%; socio-demographic factors, weighted at 10%; and acute contextual factors, weighted at 15%. The algorithm was developed on the basis of a synthesis of meta-analyses published between 2017 and 2025.

The conceptual scoring system ranges the level of risk factors (RF) from 0 to 100 points and uses provisional operational intervals for stratification: low risk, 0 ≤ RF ≤ 25; moderate risk, 25< RF ≤ 75; high risk, 75< RF ≤ 100; and imminent risk, defined by composite alarm conditions that override the numerical score. These intervals have not yet been clinically calibrated. The digitalized system also includes protective factors, which are considered separately in the recommendations section to assess the feasibility of the safety plan and continuity of care. This study reports the original development and formal specification of a conceptual, mathematical, and algorithmic model; it does not report clinical validation or patient-level predictive performance.

The implementation of a digitalized system for suicide risk assessment in emergency psychiatry services may support clinicians in making clinical decisions regarding the psychiatric care of patients with acute suicidal risk in the short and medium term.