Accurate assessment and management of risk is crucial to the prevention of suicidal behavior. In the present article, the interpersonal theory of suicide (T. E. Joiner, 2005, Why people die by suicide, Cambridge, MA: Harvard University Press; K. A. Van Orden, et al., 2010, The interpersonal theory of suicide, Psychological Review, 117, 575–600) is used as the main backdrop for conceptualizing targets for suicide risk assessment and attendant management strategies. In addition to providing an overview of the theory and its corroborating empirical evidence, we discuss its tenets in relation to three other leading theories of suicidal behavior. The shared features and unique strengths of the empirical approaches are noted. Following this, leading risk factors for imminent suicidal behavior are discussed and possible links to existing empirical perspectives are highlighted. In particular, evidence is reviewed for marked social withdrawal and key indicators of overarousal (namely, agitation, nightmares, and insomnia). We offer recommendations for appropriate empirically based assessment and intervention strategies and close with a discussion of future directions for research.