Analysis highlights five preventable suicide risk profiles

Researchers from Weill Cornell Medicine, Columbia University, UC Berkeley School of Public Health, the University of Hong Kong and University of Kentucky have identified five preventable suicide risk profiles, according to a recent study published in JAMA Psychiatry.

Suicide is a leading cause of death in the United States, as the suicide death rate increased 37 percent between 2000 and 2018 per Centers for Disease Control and Prevention (CDC) data. This rate decreased five percent between 2018 and 2020, but rebounded to pre-2018 levels in 2021.

Preventing suicide has become a major public health priority, but proactively reaching and supporting individuals in need presents a significant challenge. The research team emphasized that most individuals who die by suicide do so on the first attempt, making understanding risk factors for suicide critical for effective prevention efforts.

“Identifying distinct subgroups of individuals at risk of suicide may help us develop tailored prevention strategies that may be more effective than one-size-fits-all approaches,” explained lead author Yunyu Xiao, PhD, assistant professor of population health sciences at Weill Cornell Medicine, in a news release.

To gain insights into suicide risk, the research team analyzed data on 306,800 suicide deaths in the US between 2003 and 2020 from the National Violent Death Reporting System Restricted Access Database. This information included factors precipitating death, means of death, toxicology results and other data.

Using these data, the researchers performed latent class analyses to identify distinct suicide profiles, associated signs of suicidal intent and patterns of modifiable risk.

The study revealed five classes of suicide risk: “comorbid mental health and substance use disorders; mental disorders alone; crisis, alcohol-related, and intimate partner problems; physical health problems; and polysubstance use.”

Unexpectedly, the analyses showed that nearly one-third of the deaths in the dataset occurred in individuals with no documented mental health concerns or antidepressant use.

“We used to think of suicide as being only related to mental health and mental illnesses, but we found that the largest subgroup that die by suicide involves people presenting complaints of physical illnesses,” Xiao noted.

These findings led the research team to suggest that psychiatric disorders in this group may have gone undetected – as these individuals exhibited minimal suicidal intent – underscoring the need for effective risk screening in primary care settings.

Individuals in this risk class were more likely to be 55 years of age or older, have less than a high school education, reside in a rural area, have veteran status or be widowed.

The presence of five distinct suicide profiles may indicate that a tailored approach to prevention is needed, the research team stated.

“Suicide prevention strategies may be more effective when tailored to different suicide profiles because integrated care enhances the detection and treatment of comorbid mental health conditions, substance and alcohol use disorders, and physical health problems,” the authors wrote.

“Improving the detection and treatment of coexisting mental health conditions, substance and alcohol use disorders, and physical illnesses is paramount. The implementation of means restriction strategies plays a vital role in reducing suicide risks across most of the profiles, reinforcing the need for a multifaceted approach to suicide prevention,” they continued.

The prevalence of suicide has led some healthcare organizations to deploy risk stratification-driven prevention efforts.

In a February interview, experts from the Parkland Health & Hospital System (PHHS) and Parkland Center for Clinical Innovation (PCCI) Universal Suicide Screening Program detailed the key role that health systems play in preventing suicide and how stakeholders can build the data analytics infrastructure necessary to guide these efforts.