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Keith Olson in his excellent book Counseling Teenagers used an adaptation of a questionnaire originally designed by A.G. DeVries in order to make a quick evaluation of a potential suicide from the person’s self rating.

This questionnaire can be a tool to establish a need and then refer the person to a professional who is comfortable in dealing with potential suicidal tendencies.

                                                                                                          YES            NO

1. My future happiness looks promising.
2. I have recently had difficulty sleeping.
3. I think I am to blame for almost all my troubles.
4. When I’m sick, the doctor often prescribes sedatives for me.
5. My future looks secure.
6. Sometimes I really feel afraid.
7. Sometimes I fear I will lose control over myself.
8. Lately I haven’t felt like participating in my usual activities.
9. I go on occasional drinking sprees.
10. Within the last few years I have moved at least twice.
11. I have someone whose well being I care about very much.
12. I generally feel that I am completely worthless.
13. I frequently have a drink in the morning.

Suicidal adolescents will tend to produce the following pattern of responses:

1. No
2. Yes
3. Yes
4. Yes
5. No
6. Yes
7. Yes
8. Yes
9. Yes
10. Yes
11. No
12. Yes
13. Yes

G. Keith Olson, Counseling Teenagers (Loveland, COL Group Books, 1984), p. 376.