What We Know (And What We Don鈥檛) About Predicting Suicide Risk
National Council Blog; Dr. Jane Pearson, National Institute of Mental Health; Dr. Lisa Colpe, National Institute of Mental Health; and Colleen Carr, National Action Alliance for Suicide Prevention; 4/3/2015
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Screening for suicide risk is common to most suicide prevention efforts and clinical practices that aim to identify at-risk individuals. To reduce suicide鈥檚 burden, there are a number of research-supported screening and risk detection tools to employ, but there is no doubt that further research is necessary to better understand the various factors that put people at risk of suicide.
The Continuum of Suicide Risk
Ideas about screening reflect our assumptions about a continuum of suicide risk鈥攊t is assumed there is a progression of suicide ideation, plans and eventual behavior (i.e., suicide attempts, suicide death). For example, multinational surveys have found that about a third of individuals who think about suicide make a plan and about a third go on to attempt suicide. Meanwhile, another subgroup reports having made an attempt with little or no ideation or planning.
Active versus Passive Ideation
Current approaches to assessing risk are heavily weighted toward identifying active ideation with a plan versus passive ideation (e.g., desire for death). However, some studies have found that passive ideation is just as strongly associated with morbidity as active ideation.
Screening Approaches
Many stakeholders consider screening for suicide risk an essential step in reducing suicides鈥攁nd there are many opportunities to screen. Holding an annual depression screening day in the workplace or a school screening event following a suicide are two community examples. Screenings can be standalone, web-based for use in public settings or clinical tools (e.g.,听) integrated into primary care or other intake procedures to detect and monitor depression with suicide ideation. In fact, research looking at a large set of electronic health record data found a six-fold increased risk for suicide attempt (includes 709 attempts and 46 deaths) if someone responded 鈥榚very day鈥 to the question, 鈥淥ver the past two weeks, how often have you been bothered by thoughts that you would be better off dead, or hurting yourself in some way?鈥 on PHQ-9.
Screening within Health Systems
Screening practices are ahead of research.听听recommends screening in all medical care settings to prevent suicide attempts and deaths. However, health care settings vary with regard to the proportion of patients at risk and the steps necessary to get identified patients to adequate care. In any setting, risk detection alone will not reduce suicide. Assessment, adequate intervention and ongoing monitoring must support screening and detection efforts to have the desired impact of reduced suicidal behavior.
Promising Research
Research links neurocognitive science with risk detection and screening. For example, the听has shown to improve prediction of who will attempt suicide in the future. It examines reaction times to 鈥榣ife鈥 and 鈥榙eath鈥 words and can be administered on the computer in 5-10 minutes. It is currently being studied in emergency department environments with both youth and adults.
Recent research has also identified specific genetic markers for suicidal behavior, but the studies require replication before having a role in clinical practice.
How Can Risk Detection Contribute to Achieving a 20% Reduction in Suicide?
There are a number of ways to model how our nation could achieve a 20% reduction in suicides. One strategy is to stratify risk and identify those in the high-risk group due to risk factors and those in the low-risk group due to risk and protective factors. If we can identify those in the high-risk group and intervene so we move more individuals into the lower part of the triangle (see graphic), we can begin to reduce suicide鈥檚 burden on our nation.
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On January 29, the National Council launched a six-part webinar series highlighting the National Action Alliance for Suicide Prevention鈥檚听.听This series is a collaborative effort between the National Council for Behavioral Health,听听and the听. Subsequent webinars will describe how this current understanding influences detecting those at risk, clinical care and services, as well as highlighting a number of the pressing research needs to reduce the burden of suicide. For more information about this webinar series, see Linda Rosenberg鈥檚听听announcing this collaboration.
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Read听from NIMH Director, Dr. Tom Insel, about the Germanwings tragedy and the difficulties of understanding and predicting suicidal behavior.
Register for upcoming webinars in this series:
Thur., April 2:听
Wed., April 29:听
Wed., May 27:听
Wed., June 24:听
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For more information about detecting and predicting suicide risk,听听of our second webinar in a series of six,听鈥淗ow can we better detect and predict suicide risk?鈥, and download听
The National Action Alliance for Suicide Prevention is the public-private partnership advancing the. This is achieved by catalyzing implementation of high priority NSSP objectives. One such example is the Prioritized Research Agenda for Suicide Prevention: An Action Plan to Save Lives. This groundbreaking document advances NSSP objective 12.1- Develop a national suicide prevention research agenda with comprehensive input from multiple stakeholders.
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