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(approval number: 31-74).Analysis 2Analysis 2 was conducted by three professionals from the field of psychiatric care (‘professionals’), namely a doctor, a nurse, and a clinical psycholo-gist, each of whom had at least 10 years of experi-ence in clinical psychiatric care, including ward duty. To ensure objectivity, none of the profes-sionals had engaged in any way with the cases in our sample. The three professionals were provided with Resources A and B in advance and were asked to analyse three sets of items using a fish-bone diagram (a diagram for analysing the poten-tial causes of an outcome, which is often used to analyse the causes of accidents). The three sets of items were: factors that led to each person’s suicide (C), imminent suicide signs (D), and preventive strategies or other observations (E). The profes-sionals conducted this analysis separately and then came together to compare and consolidate their findings for C, D, and E. The items they all agreed upon (F) were set aside for further analysis.Analysis 3Analysis 3 focused on F, as derived through anal-ysis 2. The imminent signs and risk factors were labelled/encoded and organised by content using the KJ Method (where data are sorted into groups that present relationships of affinity, opposition, and causality in order to generate a hypothesis). We prioritized reducing omission of behaviours that could be signs, and as such included two behaviours that the three professionals had not agreed upon but had all noted, and one sign that, although not noted by the professionals, was evidently a sign of imminent suicide risk.Analysis 4We considered F in terms of the human factor, such as cases where the staff failed to record important patient information. We labelled/encoded items describing the handling of patient informa-tion by the hospital staff and categorised them using the KJ Method.Ethical ConsiderationsThis study was approved by the psychiatric hospital in question (approval number: 2) and the ethics committee of the Graduate School of Health and Sports Science at Juntendo University Patient CharacteristicsTable 1 shows the patients’ characteristics based on Resource A: sex, age, the diagnosis stated in the medical records, the retrospective diagnosis given by the three professionals in Analysis 2, and the period of hospitalisation.Rates of suicidal ideation, self-injury, and suicide attempt (Analysis 1)Of the 18 cases analysed, 11 (61.1%) had a prob-lem-list entry of attempted suicide or suicidal ideation at the time of admission, and 11 (61.1%) had a past suicide attempt more than two weeks before the suicide attempt that led to death (or before hospitalisation if the hospitalisation period was less than fourteen days). Further, in the two weeks preceding their death (or during the hospi-talisation period if the hospitalisation period was less than fourteen days), 7 (38.9%) had made suicidal utterances, 2 (11.1%) had self-harmed, and 3 (16.7%) had attempted suicide unsuccessfully, while 11 (61.1%) had had no suicidal utterances or suicide-related behavior.Objective Signs of Imminent Suicide Risk (Analysis 3)Table 2 shows the major categories, sub-catego-ries, and sub-sub-categories of the signs indicating imminent suicide risk, along with examples. In the following, the major categories are denoted by ‘ ’, sub-categories by [ ], sub-sub-categories by < >. Our analysis yielded five major categories. The first one, namely ‘signs emanating from the patient’, describes signs that the patient expresses sponta-neously, without any engagement from the hospital staff. The second, namely ‘signs gleaned through engagement’, describes signs that the hospital staff glean through their engagement with the patient. The third, namely ‘signs from response to treat-ment’, describes signs that the patient exhibits in response to medical intervention. The fourth, that is, ‘signs associated with reports from the family’, describes signs reported by the patient’s family. The fifth, namely ‘signs inferred from multiple sources of information’, describes signs that are inferred from an integrated analysis of diagnostic 263Results