Suicide Risk Assessment in Patients Denying Suicidal Intent

CONFERENCE REPORTER

In April 2026, 160 out of 100,000 emergency department visits were related to suspected suicide attempts.¹ Suicide risk is always essential for clinicians to watch out for, but how can we assess suicide risk in patients who explicitly deny suicidal ideation and intent? Igor Galynker, MD, and his research group have developed a protocol for a more objective suicide assessment risk which does not rely solely on patient self-reporting or history.² At this year’s American Psychiatric Association meeting, we sat down with Galynker to learn more.

Psychiatric Times: Could you share an overview and clinical highlights from your presentation on suicide risk assessment at APA?

Igor Galynker, MD: My presentation is on suicide risk assessment in those who deny suicidal ideation and intent. I was very excited to see over 100 participants in our learning lab, and it was very lively. The presentation is about the work that we've been doing in the lab for a very long time, close to 15 years right now. And it's based on what is really a paradox in psychiatry, is that most people who die by suicide deny that they are suicidal in their last communication with doctors, significant others, etc; yet our risk assessment in all our suicide prevention is based on self-reported suicide ideation and intent.

So our method, which is the Narrative Crisis Model of Suicide and Suicide Crisis Syndrome, is based, not on the risk and not on suicidal intent that is self-reported, but on objective criteria for suicidal mental process. There are 2 components to this: the suicide crisis syndrome is the acute state, which is short-lived—it lasts about a week at most, and it's a medical condition that needs to be in DSM and is treated medically—and then there is a suicidal mental process that has 4 stages, and it is gradual, with suicidality increasing. For instance, the 3rd stage, which precedes the 4th stage, suicide crisis syndrome, lasts about 3 months. Then, there are plenty of opportunities to intervene whether the patient tells you that they are suicidal or not, and prevent the suicidal crisis.

PT: When clinicians are working with their patients, is there something critical that you think often gets missed with suicide risk assessment?

Galynker: The most critical piece is a person who is going to be sometimes within hours of suicide, and they are going to look you in the eye in the office and tell you, "I'm not suicidal." And you are going to let them go, but they may actually commit suicide.

That is really a critical piece which is still the issue. Whether it’s at the VA, whether it’s the hospital, whether it's an office, it is still the issue because people rely on somebody who is at the worst moment of their life to tell truthfully what they're going to do and be accurate and be honest in that. And that just does not work because their brain is not working the same at that moment.

PT:You mentioned that these other risk assessment methods rely on history and patient self-reporting, why do you think those have not been as effective as your method?

Galynker: A number of reasons. In the last, let's say year, a quarter of American young people said that they seriously considered suicide—that's 10 million people. Not all of those individuals are going to commit suicide because for some, thinking about suicide is an obsession. For others, it's a serious physical issue. And real suicidal danger comes and goes like a wave, where some patients may not even feel it when they talk to you, but there are so many reasons why you cannot base your assessment on that.

PT: Since you have this framework, how would you say that it is fulfilling unmet needs in this area of suicide risk?

Galynker: I would say beautifully, and as it often happens people wanted training. They wanted more training than I was able to give them in one presentation. And at Mount Sinai, we are creating an education center, an international center for suicide prevention program, that will be available online, and it will be modular so people will listen and download the training modules

PT: Is there anything else that you are excited about that you are working on or anything interesting in the field that you have seen recently?

Galynker: Well, the world is changing so rapidly, that a lot of things that we're thinking about as innovative no longer are. For instance, we've been working with machine learning and predicting suicidal behavior using medical records. This is so last decade because nowpeople are online, revealing to the whole world they are suicidal on a subreddit and on Instagram.

Even that is now not last decade, but last year or 2 years ago, because now patients talking to chatbot therapists, and they are telling chatbot therapists that they are suicidal, and chatbot therapist are telling them to kill themselves. Nobody's monitoring or controlling this, and it is affecting hundreds of millions of people.

Dr Galynker is a professor of psychiatry at Mount Sinai Health System in New York, and runs the Suicide Prevention Research Lab along with 2 clinical centers in Manhattan.

References

1. Suicidal thoughts and behavior. Centers for Disease Control and Prevention. May 27, 2026. Accessed June 3, 2026. https://www.cdc.gov/mental-health/about-data/suicidal-thoughts-and-behavior.html

2. Galynker I. Imminent Suicide Risk Assessment in High-Risk Individuals Denying Suicidal Ideation or Intent: Introduction and Training. Conference Proceedings of the American Psychiatric Association. May 2026;16-20. San Francisco, CA.