Understanding Suicide

Risk Factors for Suicide and Suicidal Behaviors I.

Chronic Risk Factors (If present, these increase risk over one’s lifetime.)

Perpetuating Risk Factors – permanent and non-modifiable

  • Demographics: White, American Indian, Male, Older Age (review current rates ), Separation or Divorce, Early Widowhood
  • History of Suicide Attempts – especially if repeated
  • Prior Suicide Ideation
  • History of Self-Harm Behavior
  • History of Suicide or Suicidal Behavior in Family
  • Parental History of:
    -Substance Abuse (Drugs or Alcohol)
    -Hospitalization for Major Psychiatric Disorder
  • History of Trauma or Abuse (Physical or Sexual)
  • History of Psychiatric Hospitalization
  • History of Frequent Mobility
  • History of Violent Behaviors
  • History of Impulsive/Reckless Behaviors

Predisposing and Potentially Modifiable Risk Factors

  • Major Axis I Psychiatric Disorder, especially:
    -Mood disorder
    -Anxiety Disorder
    -Substance Use Disorder (Alcohol Abuse or Drug Abuse/Dependence)
    -Eating Disorders
    -Body Dysmorphic Disorder
    -Conduct Disorder…
  • Axis II Personality Disorder, especially Cluster B
  • Axis III Medical Disorder, especially if involves functional impairment and/or chronic pain)
  • Traumatic Brain Injury
  • Co-morbidity of Axis I Disorders (especially depression and alcohol misuse), of Axis I and Axis II (especially if Axis II Disorder is Antisocial PD or Borderline PD), of Axis I and Axis III Disorders
  • Low Self-esteem/High Self-hate
  • Tolerant/Accepting Attitude Toward Suicide
  • Exposure to Another’s Death by Suicide
  • Lack of Self or Familial Acceptance of Sexual Orientation
  • Smoking
  • Perfectionism (especially in context of depression)

Risk Factors for Suicide and Suicidal Behaviors II.

Contributory Risk Factors

  • Firearm Ownership or Easy Accessibility
  • Acute or Enduring Unemployment
  • Stress (job, marriage, school, relationship…)

Acute Risk Factors (If present, these increase risk in the near-term)

  • Demographics: Recently Divorced or Separated with Feelings of Victimization or Rage
  • Suicide Ideation (Threatened, Communicated, planned, or Prepared for);
  • Current Self-Harm Behavior
  • Recent Suicide Attempt
  • Excessive or Increased Use of Substances (alcohol or drugs)
  • Psychological Pain (acute distress in response to loss, defeat, rejection, etc.)
  • Recent Discharge from psychiatric hospitalization
  • Anger, Rage, Seeking Revenge
  • Aggressive Behavior
  • Withdrawal from Usual Activities, Supports, Interests, School or Work; Isolation (e.g. lives alone)
  • Anhedonia
  • Anxiety, Panic
  • Agitation
  • Insomnia
  • Persistent Nightmares
  • Suspiciousness, Paranoia (ideas of persecution or reference)
  • Severe feelings of confusion or disorganization
  • Command Hallucinations Urging Suicide
  • Intense affect states (e.g. desperation, intolerable aloneness, self-hate…)
  • Dramatic Mood Changes
  • Hopelessness, Poor Problem-solving, Cognitive Constriction (thinking in black and white terms, not able to see gray areas, alternatives…), Rumination, Few Reasons for Living, Inability to Imagine Possibly Positive Future Events
  • Perceived Burdensomeness
  • Recent diagnosis of terminal condition
  • Feeling Trapped, Like There is No Way Out (other than death); Poor Problem-Solving
  • Sense of Purposelessness or Loss of Meaning; No Reasons for living
  • Negative or mixed attitude toward help-receiving
  • Negative or mixed attitude by potential caregiver to individual
  • Recklessness or Excessive Risk-Taking Behavior, Especially if Out of Character or Seemingly Without Thinking of Consequences, Tendency toward Impulsivity

Precipitating or Triggering Stimuli (Heighten Period of Risk if Vulnerable to Suicide)

  • Any Real or Anticipated Event Causing or Threatening:
    -Shame, Guilt, Despair, Humiliation, Unacceptable Loss of Face or Status
    -Legal Problems (loss of freedom), Financial Problems , Feelings of Rejection/Abandonment
    -Recent Exposure to Another’s Suicide (of friend or acquaintance, of celebrity through media…)

Read about The Warning Signs.