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Suicidality: what are the risk factors?
Over 800,000 people die by suicide each year.1 Early identification, assessment, management, and follow-up ensure that people who are at risk of suicide, or who have attempted suicide, receive the support and care that they need.2 To help healthcare practitioners recognise individuals who may be at high risk, studies have identified factors that are associated with suicidality, as well as protective strategies that may benefit those at risk.
Mental health disorders are a major risk factor
Previous suicide attempts are strongly associated with future suicidal behaviour3
Having a mental health diagnosis is a major risk factor for suicide, being estimated to make up 47–74% of the total suicide risk.4,5
The risk of suicide among patients with depression has been estimated at 4–7% in long-term studies.5,6 Patients with substance/alcohol-related disorders, bipolar disorder, and schizophrenia are also at increased risk, especially when multiple disorders are present at the same time.3,5,6
Which other groups are at risk?~90% of people who die by suicide have a mental health disorder6
Suicide affects people of all ages; however, globally, the highest suicide rates are in older age groups.7 In younger people, although rates are lower, suicide makes up a greater proportion of overall deaths; being the second highest cause of death for 15–29-year-olds globally, and the leading cause of death in young women aged 15–19 years in Europe.1,4 Tragically, adolescents are vulnerable due to the stress and insecurity that can result from transitions in their lives and increased pressure from peers and family.4
Suicide disproportionately affects the lesbian, gay, bisexual and transgender community, attributed to factors such as family rejection, victimisation, and shame through internalised transphobia.8
Immigrants and ethnic minorities may also be more likely to experience suicidal behaviour than the general population, with language barriers and family separation acting as additional risk factors.9
Negative life experiencesRisk factors for suicide exist on systemic, societal, and individual levels1
Stress is a factor in suicidal behaviour, influencing sleep, impulsivity, and executive function.10 Suicidal behaviour in a relative is linked to future suicide attempts and childhood trauma can lead to suicidality decades later.10,11
Stress, sleep, and suicidality are highly interlinked10
Financial strain, in the form of lower income, debt, unemployment or past homelessness, is also significantly associated with suicide.12 Individuals experiencing all four of these factors have a 20-times greater risk of attempting suicide than someone facing no financial strain.12
Protecting against suicideMaintaining healthy relationships can help to protect against suicidality, and having a close-knit social circle can be vital to provide support in times of crisis.1
Habits to promote well-being, such as developing a sense of identity and problem-solving skills, can help to protect against the impact of stress and trauma, and promote help-seeking behaviour for mental health problems.1 Additionally, healthy lifestyle choices regarding diet, exercise, sleep, and social contact can promote physical and mental well-being, potentially protecting against suicidal behaviour.1
Understanding the risk factors for suicide may help to identify individuals at risk and provide opportunities to implement protective strategies and access to the support they need.
If you are at risk, please see a list of helplines and crisis centres here.
Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.
References
1. World Health Organization. Preventing suicide: a global imperative. Geneva: World Health Organization, 2014.
2. World Health Organization. Live life: an implementation guide for suicide prevention in countries. Geneva: World Health Organization, 2021. Licence: CC BY-NC-SA 3.0 IGO.
3. Yoshimasu K, et al. Environ Health Prev Med 2008; 13 (5): 243–256.
4. Bilsen J. Front Psychiatry 2018; 9: 540.
5. Nordentoft M, et al. Arch Gen Psychiatry 2011; 68 (10): 1058–1064.
6. Holmstrand C, et al. Acta Psychiatr Scand 2015; 132 (6): 459–469.
7. Värnik P. Int J Environ Res Public Health 2012; 9: 760–771.
8. Narang P, et al. Prim Care Companion CNS Disord 2018; 20 (3): 18nr02273.
9. Forte A, et al. Int J Environ Res Public Health 2018; 15 (7): 1438.
10. O’Connor, DB et al. Int Rev Neurobiol 2020; 152: 101–130.
11. Pitman A, et al. Lancet Psychiatry 2014; 1 (1): 86–94.
12. Elbogen EB, et al. Am J Epidemiol 2020; 189 (11): 1266–1274.