Clinical Psychological Assessment: From Diagnostic Interviews to Suicide Risk Evaluation

By: Saida Eazizayene

Clinical assessment is a structured, systematic process for gathering information about a client’s psychological, emotional, behavioral, and social functioning. It serves as the foundation for accurate diagnosis, effective treatment planning, and ethical clinical decision-making. Through assessment, clinicians gain a comprehensive understanding of a client’s concerns, strengths, and needs, enabling them to provide appropriate, evidence-based care.

Despite its importance, clinicians often face challenges integrating formal suicide risk assessment tools into routine practice (Rudd & Bryan, 2022). The primary goals of clinical assessment include determining the nature and severity of presenting concerns, establishing an accurate diagnosis when appropriate, guiding treatment and intervention planning, monitoring progress, evaluating outcomes, and facilitating communication among professionals. When guided by evidence-based practices, clinical psychological assessments can enhance therapeutic outcomes and reduce treatment duration by preventing the use of mismatched or ineffective interventions (Wright et al., 2022).

Types of Clinical Interviews

Clinical interviews are a core component of assessment and generally fall into three categories: structured, semi-structured, and unstructured interviews.

Structured interviews follow a standardized format in which the same questions are asked in the same order for every client. An example is the Structured Clinical Interview for DSM-5 (SCID-5). These interviews offer high reliability, strong diagnostic accuracy, and reduced interviewer bias. However, they may feel impersonal and limit the ability to explore unique client experiences.

Semi-structured interviews include a core set of standardized questions while allowing clinicians to ask follow-up questions as needed. This approach balances consistency with flexibility and is widely used in mental health settings to support both diagnosis and rapport-building.

Unstructured interviews resemble open conversations guided by the clinician’s judgment and clinical expertise. While they allow for deeper exploration of individual experiences and can strengthen rapport, they are less reliable and may risk overlooking key diagnostic areas.

The Mental Status Examination (MSE)

The Mental Status Examination (MSE) is a structured method for observing and documenting a client’s current mental functioning. It provides a snapshot of cognitive, emotional, and behavioral states at the time of assessment and is a critical component of comprehensive clinical evaluation.

A holistic approach to suicide risk assessment is essential and should incorporate individual-specific factors that may influence risk, such as homelessness, bullying, or experiences of rejection (Rudd & Bryan, 2022).

A complete MSE typically includes the following components:

• Appearance and behavior: physical appearance, grooming, posture, and psychomotor activity

• Attitude: level of cooperation, defensiveness, or hostility

• Mood and affect: mood as the sustained emotional state, and affect as observable emotional expression

• Speech and language: rate, volume, coherence, and tone

• Thought process: logic, organization, and flow of ideas

• Thought content: presence of delusions, obsessions, or suicidal or homicidal ideation

• Perception: hallucinations or perceptual disturbances

• Cognition: orientation, attention, memory, and abstract thinking

• Insight and judgment: awareness of one’s condition and ability to make sound decisions

The MSE helps clinicians identify signs of mental illness, cognitive impairment, or acute psychological distress.

Suicide Risk Screening and Assessment

Screening for suicide risk is inherently complex. Many individuals at risk are not reluctant to discuss suicidal thoughts; rather, the challenge lies in the rapid and unpredictable fluctuations in suicidal ideation and desire to die. These thoughts can change from moment to moment or across days and weeks, making it difficult for existing assessment tools to accurately capture risk within clinically relevant timeframes (Rudd, 2023).

Numerous risk factors and warning signs are associated with suicide, including a history of previous attempts, mental health disorders (such as depression, bipolar disorder, or substance use disorders), family history of suicide, social isolation, and significant life stressors such as loss, trauma, or legal and financial difficulties. Warning signs may include talking or writing about death or suicide, expressing hopelessness or feeling trapped, withdrawing from social relationships, and sudden changes in mood or behavior.

When these signs are present, clinicians should conduct an immediate suicide risk assessment. This includes direct questioning about suicidal thoughts, intent, and plans, as well as evaluating access to lethal means, perceived lethality, and protective factors such as social support and coping skills. Structured tools, such as the Columbia-Suicide Severity Rating Scale (C-SSRS) or the Beck Scale for Suicide Ideation, are often used to support clinical judgment and enhance assessment accuracy.

References

Rudd, M. D., & Bryan, C. J. (2022). Finding Effective and Efficient Ways to Integrate Research Advances Into the Clinical Suicide Risk Assessment Interview. Frontiers in Psychiatry, 13, Article 846244. https://doi.org/10.3389/fpsyt.2022.846244 

Rudd, M. D. (2023). Recognizing flawed assumptions in suicide risk assessment research and clinical practice. Psychological Medicine, 53(5), Article 0033291721002750. https://doi.org/10.1017/S0033291721002750 

Wright, A. J., Pade, H., Gottfried, E. D., Arbisi, P. A., McCord, D. M., & Wygant, D. B. (2022). Evidence-Based Clinical Psychological Assessment (EBCPA): Review of Current State of the Literature and Best Practices. Professional Psychology, Research and Practice, 53(4), 372–386. https://doi.org/10.1037/pro0000447