When assessing suicide risk, which question most directly determines immediacy of risk?

• A. Do you want to kill yourself?
• B. How long have you been thinking about it?
• C. Do you have a gun loaded?
• D. Why haven't you killed yourself?

Answer: (A)

The key idea is identifying immediate danger by uncovering the person’s current intent to act. Asking about whether they want to kill themselves directly taps into their present motivation to act now. If they express a desire to die, that signals imminent risk and requires urgent safety steps, such as ensuring they aren’t left alone, removing means if possible, and arranging prompt crisis intervention or emergency contact.

Questions about how long they’ve been thinking about suicide show ideation over time but don’t necessarily reveal whether they intend to act soon; someone can have persistent thoughts without immediate plan or intent. Asking about access to a gun addresses capability and lethality, which are important risk factors, but it doesn’t directly determine whether action is imminent. Asking someone why they haven’t killed themselves is not a reliable or therapeutic way to gauge risk and can hinder honest disclosure.

So, the direct query about wanting to kill oneself best identifies immediacy of risk and triggers the appropriate urgent safety response.