We know that suicide has a low base rate and that most individuals with suicidal ideation will never make an attempt, much less, complete a suicide. Given this very low rate of individuals who are at great risk for suicide, how can we best identify and prevent the act of suicide?
Dear Neil
The following risk factors are associated with suicide attempt during stay: female gender, borderline personality disorder (F60.3), more previous psychiatric hospitalizations, shorter duration of disorder, earlier age of onset, suicidality according to clinical impression at admission or suicide attempt before admission.
Lieb et al. (2014) DOI: 10.1055/s-0033-1343267
Best regards and a happy Easter
Egon
Neil, here are some thoughts. While it not certain that all acutely suicidal individuals start with some episode of suicidal ideation, it seems likely many of those who manifest serious suicidality (intent, plans, attempts) do. It would, therefore, seem helpful to motivate such at-risk individuals to disclose ideation when it persists or becomes hard to dismiss. In effect, we could follow what has happened with cancer that has increasingly been identified in early stages because of self-screenings. Of course, cancer is no longer stigmatized (as it was once in the US, at least) and suicide remains very much so. While suicide is very preventable, this is not widely recognized and some still see it as inevitable as well as something to be regarded with shame even in oneself. If we could get ideation accepted as a likely outcome of routine adverse life events in some individuals we might reduce the number of ideators who move up the suicidal behavior continuum.
The best way to prevent suicide is to deliver adequate mental health treatment to the population. The problem with focusing on suicide is that there is a contagion effect with too much attention placed on it. And as you stated, there is a low base rate, and we have no biological markers. Instead of focusing on suicide, we should focus on mental health treatment to those in the population who need it, as the majority of people who have completed suicide have psychopathology. So this is really a public health issue for governments to address, the mortality (and morbidity) associated with lack of mental health treatment.
I believe the best way to prevent completed suicide is to treat all suicidality instead of only treating other psychiatric disorders. If every person experiencing any level of suicidality (even those only experiencing passive suicidal ideation) had access to proper anti-suicidality treatments (not just anti-depressants) then the likelihood that a patient's suicidality would progress to the stage of a completed suicide would be reduced. Unfortunately, this will take researchers shifting their perspective from suicidality being the result of depression or some other psychiatric disorder to suicidality being a disorder or even a set of disorders. Once researchers make this shift they may find that treatments have specific anti-suicidality effects. At which point, those treatments could be given to patients that experience suicidality in order to reduce their suicidality and lessen the likelihood they will actually take their own life.
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