Regarding suicidal ideation, a question that is usually asked is: “Have you thought seriously about taking your own life?” When we present these kinds of numbers, that's a question that's asked in a mental health survey. But when you're sitting with individuals clinically, it's really important to get into the details of trying to understand. When did they last have those kinds of thoughts? Is it something they've been thinking about for a number of months? What triggers them, what brings up those thoughts? And then getting into even more detail, it's to try to really understand if the person has actually come close to attempting. Have they actually made preparations, or figured out whether they would use a gun or pills?
When we think about suicidal ideation, that's one level. Concerning whether someone has made an attempt, there has been controversy in the field about whether it was a serious suicide attempt or a self-harm where there was not an intent to die. What we know at this time is that people who self-harm, whether they say they're intending to die or not, are at risk for later attempts. That's another level, to say how lethal the attempt was. That's a gradation of going from thinking about suicide, planning it, to attempting. A number of scales actually measure the depth and severity of suicidal behaviour.