Understanding and managing suicide risk

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Suicidal behaviours and non-suicidal self-harm (NSSH) are global public health concerns that affect millions of lives.

Sources of data

This review is a narrative synthesis of systematic reviews, meta-analyses of randomized control trials (RCTs) and landmark studies published in scientific journals.

Areas of agreement

Restricting access to lethal means reduces the likelihood of future suicide deaths.

Areas of controversy

Our ability to predict future suicidal behaviour is no better than chance. No individual risk prediction instrument offers sufficient sensitivity and specificity to inform clinically useful decision-making.

Growing points

Different types of psychosocial interventions may be effective in preventing future suicide attempts; such interventions include clinical assessment, tailored crisis response and safety plans and follow-up contact.

Areas timely for developing research

Whilst some psychosocial interventions can be effective in reducing suicide risk, little is known about the mechanisms of recovery from suicidal thoughts and behaviours.

Related collections

Most cited references 42

Record: found
Abstract: found
Article: found

Is Open Access

Hospital Presenting Self-Harm and Risk of Fatal and Non-Fatal Repetition: Systematic Review and Meta-Analysis

Robert Carroll, Chris Metcalfe, David Gunnell (2014)

Background Non-fatal self-harm is one of the most frequent reasons for emergency hospital admission and the strongest risk factor for subsequent suicide. Repeat self-harm and suicide are key clinical outcomes of the hospital management of self-harm. We have undertaken a comprehensive review of the international literature on the incidence of fatal and non-fatal repeat self-harm and investigated factors influencing variation in these estimates as well as changes in the incidence of repeat self-harm and suicide over the last 30 years. Methods and Findings Medline, EMBASE, PsycINFO, Google Scholar, article reference lists and personal paper collections of the authors were searched for studies describing rates of fatal and non-fatal self-harm amongst people who presented to health care services for deliberate self-harm. Heterogeneity in pooled estimates of repeat self-harm incidence was investigated using stratified meta-analysis and meta-regression. The search identified 177 relevant papers. The risk of suicide in the 12 months after an index attempt was 1.6% (CI 1.2–2.4) and 3.9% (CI 3.2–4.8) after 5 years. The estimated 1 year rate of non-fatal repeat self-harm was 16.3% (CI 15.1–17.7). This proportion was considerably lower in Asian countries (10.0%, CI 7.3–13.6%) and varies between studies identifying repeat episodes using hospital admission data (13.7%, CI 12.3–15.3) and studies using patient report (21.9%, CI 14.3–32.2). There was no evidence that the incidence of repeat self-harm was lower in more recent (post 2000) studies compared to those from the 1980s and 1990s. Conclusions One in 25 patients presenting to hospital for self-harm will kill themselves in the next 5 years. The incidence of repeat self-harm and suicide in this population has not changed in over 10 years. Different methods of identifying repeat episodes of self-harm produce varying estimates of incidence and this heterogeneity should be considered when evaluating interventions aimed at reducing non-fatal repeat self-harm.

0 comments Cited 174 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Examination of Real-Time Fluctuations in Suicidal Ideation and Its Risk Factors: Results From Two Ecological Momentary Assessment Studies.

Evan Kleiman, Brianna J Turner, Szymon Fedor … (2017)

Two studies examined 2 important but previously unanswered questions about the experience of suicidal ideation: (a) How does suicidal ideation vary over short periods of time?, and (b) To what degree do risk factors for suicidal ideation vary over short periods and are such changes associated with changes in suicidal ideation? Participants in Study 1 were 54 adults who had attempted suicide in the previous year and completed 28 days of ecological momentary assessment (EMA; average of 2.51 assessments per day; 2,891 unique assessments). Participants in Study 2 were 36 adult psychiatric inpatients admitted for suicide risk who completed EMA throughout their time in the hospital (average stay of 10.32 days; average 2.48 assessments per day; 649 unique assessments). These studies revealed 2 key findings: (a) For nearly all participants, suicidal ideation varied dramatically over the course of most days: more than 1-quarter (Study 1 = 29%; Study 2 = 28%) of all ratings of suicidal ideation were a standard deviation above or below the previous response from a few hours earlier and nearly all (Study 1 = 94.1%; Study 2 = 100%) participants had at least 1 instance of intensity of suicidal ideation changing by a standard deviation or more from 1 response to the next. (b) Across both studies, well-known risk factors for suicidal ideation such as hopelessness, burdensomeness, and loneliness also varied considerably over just a few hours and correlated with suicidal ideation, but were limited in predicting short-term change in suicidal ideation. These studies represent the most fine-grained examination of suicidal ideation ever conducted. The results advance the understanding of how suicidal ideation changes over short periods and provide a novel method of improving the short-term prediction of suicidal ideation. (PsycINFO Database Record

0 comments Cited 170 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: not found
Article: not found

Ideation-to-Action Theories of Suicide: A Conceptual and Empirical Update

E Klonsky, Craig Bryan, Boaz Y. Saffer (2018)

0 comments Cited 135 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Tiago C Zortea: (View ORCID Profile)

Seonaid Cleare: (View ORCID Profile)

Ambrose J Melson: (View ORCID Profile)

Karen Wetherall: (View ORCID Profile)

Rory C O’Connor: (View ORCID Profile)

Journal

Title: British Medical Bulletin

Publisher: Oxford University Press (OUP)

ISSN (Print): 0007-1420

ISSN (Electronic): 1471-8391

Publication date Created: June 2020

Publication date Created: July 09 2020

Publication date Created: May 21 2020

Publication date Other: June 2020

Publication date (Print): July 09 2020

Publication date (Electronic): May 21 2020

Volume: 134

Issue: 1

Pages: 73-84

Affiliations

[1 ]Suicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow

Article

DOI: 10.1093/bmb/ldaa013

SO-VID: 670b8103-917a-4ef8-b940-52d58f1197ee

License:

https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model

Understanding and managing suicide risk

Read this article at

Abstract

Background

Sources of data

Areas of agreement

Areas of controversy

Growing points

Areas timely for developing research

Related collections

UCL Grand Challenges: Cultural Understanding

Most cited references 42

Hospital Presenting Self-Harm and Risk of Fatal and Non-Fatal Repetition: Systematic Review and Meta-Analysis

Examination of Real-Time Fluctuations in Suicidal Ideation and Its Risk Factors: Results From Two Ecological Momentary Assessment Studies.

Ideation-to-Action Theories of Suicide: A Conceptual and Empirical Update

Author and article information

Contributors

Journal

Affiliations

Article

History

Comments

Comment on this article

Similar content 620

Cited by 4

Most referenced authors 689