New Strategies for Suicide Risk Assessment: Suicide: 9 Main Data Points and 11 Main Risk Factors


New Strategies for Suicide Risk Assessment: Suicide: 9 Main Data Points and 11 Main Risk Factors

“She was just there joking with all of us. She was getting ready for Valentine’s Day, explaining how much shopping she had to do, to have enough gifts for everyone. The last thing I thought about was that she would be ending her life.” Lola’s mother, Eileen, inconsolable, said these words to Claire, Lola’s clinician, after Lola was found in the park, hanging and then pronounced dead at the hospital.  Claire could not hold back her tears, and being alone in her office, behind her phone, allowed her all the privacy she would need to tear up, with Lola’s mother on the other line.

 

For every hundred persons who die in the world, one will be due to suicide.  Suicide is generally defined as intentionally causing one’s death.  And a mental health condition is present 27% to 90% of the time.  In fact, it has been shown that those with a history of psychiatric hospitalization have a lifetime risk of suicide, almost 10%, and about 40% of those who die by suicide had received mental health services within the year preceding their death.

 

While suicide happens every day, it is hard to “get used to it,” especially when its ramifications can be rather unpredictable.  And given the strong link between suicide and health—mental health—there is a need for new strategies for suicide risk assessment.  But before delving into these new strategies, let us consider an overview on suicide, looking at, (1) What the latest data can teach us and (2) The 11 risk factors for suicide.


What can the data teach us?

New Strategies for Suicide Risk Assessment: Suicide: 9 Main Data Points and 11 Main Risk Factors
New Strategies for Suicide Risk Assessment: Suicide: 9 Main Data Points and 11 Main Risk Factors
  • The most commonly used method is based on availability of effective means.

  • Some of the most common methods are firearms, hanging, and poisoning.

  • Suicide is the 10th leading cause of death.

  • Suicide has been increasing and not decreasing.

  • Men are more likely than women to die by suicide (This difference is between 1.5 to 3.5 times more likely. However, suicide attempts are more common in women).

  • Suicide is more common in those over 70 years old and those between 15 and 30 years old. Attempts, however, are overall more common in young people.

  • Suicide notes are typically left in 15% to 40% of the cases.

  • Major Depressive Disorder may have been present in 50% of those who died by suicide, while a personality disorder, especially Borderline Personality Disorder, may also have been present in that same number of cases. This data is related to psychological autopsy.

  • The higher the rate of alcohol use in a specific country, the higher the rate of suicide.


Risk factors:

Who is more likely to die by suicide?

 

After looking at the nine (9) main data points, let us look at the eleven (11) main risk factors for suicide:

 

  1. Depression leads to a 20-fold increase risk for suicide

  2. Bipolar Disorder, like depression, increases the risk for suicide by 20-fold

  3. A diagnosis of Schizophrenia increases the risk for suicide by 14%. In this condition 5% of those affected will die by suicide

  4. Personality disorders lead to a 10% increase in risk

  5. Substance Use Disorder is considered the second most common risk factor, after a mood disorder. This risk is related to both the chronic nature of the substance use disorder and to acute intoxication. Further, alcohol and benzodiazepines have been shown to be the main two substances most commonly associated with suicide, with alcohol present in 15% to 61% of all cases. With ongoing issues regarding best practices around the use of benzodiazepines, it is worth emphasizing the role these medications play in increased rate of both suicide attempt and completion. This phenomenon is often related to side effects, including paradoxical effects, and other types of potential withdrawal symptoms that are not uncommon in those taking this group of medications, especially those with a severe trauma history, with severe personality disorder, or substance use disorder.

  6. Impulsive reaction in response to stressors or trauma and/or TBI

  7. Previous suicide attempts

  8. Access to lethal methods

  9. Subject to media reporting of suicide

  10. Cultural beliefs

  11. Genetic vulnerability carries an influential factor of 38% to 55%

 

 

“She was just there joking with all of us. She was getting ready for Valentine’s Day, explaining how much shopping she had to do, to have enough gifts for everyone. The last thing I thought about was that she would be ending her life.” Lola’s mother, Eileen, inconsolable, said these words to Claire, Lola’s clinician, after Lola was found in the park, hanging and then pronounced dead at the hospital. Claire could not hold back her tears, and being alone in her office, behind her phone, allowed her all the privacy she would need to tear up, with Lola’s mother on the other line.

In summary, suicide is real.  Previously considered a crime in most countries, today, only some countries consider it criminal activity.  We know that it is the 10th leading cause of death in both the United States and in the rest of the world.  We have data telling us of its significance , and I have just outlined eleven (11) risk factors, over 90% of which are related to mental health.  As mental health clinicians and related agency leaders, what should be our role in fostering new strategies for suicide risk assessment?

New Strategies for Suicide Risk Assessment: Suicide: 9 Main Data Points and 11 Main Risk Factors
New Strategies for Suicide Risk Assessment: Suicide: 9 Main Data Points and 11 Main Risk Factors
New Strategies for Suicide Risk Assessment: Suicide: 9 Main Data Points and 11 Main Risk Factors
New Strategies for Suicide Risk Assessment: Suicide: 9 Main Data Points and 11 Main Risk Factors

 

For more in this series of articles, check below!

 

SWEET Institute- Mardoche Sidor, MD

Dr. Sidor is quadruple board certified in psychiatry, with board certification in General adult, Child and adolescent, Addiction, and Forensic, psychiatry. He also has additional training in public psychiatry, in several treatment modalities, in addition to his teaching, supervision, mentorship, coaching, and management, experience. Some of his passions are public speaking, leadership, entrepreneurship, and research, in addition to program development and project management. His overall goal is to empower all health care professionals throughout the United States and globally, towards ensuring the continuity of excellent patient care, while balancing the need to take care of themselves. Dr. Sidor is the main instructor for the SWEET Institute, and he is currently an Assistant Professor of Psychiatry at Columbia University. He is also the past-Medical Director for CASES (Center for Alternative Sentencing and employment Services), and he speaks and writes fluently in four (4) languages—French, English, Spanish, Creole, and has intermediate proficiency in Portuguese and Italian.


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