Risk Factors for Suicide
Clinicians must actively identify patients with mental health disorders—particularly depression, which more than doubles suicide risk—along with specific demographic and psychosocial risk factors, as approximately 87% of suicide deaths occur in individuals with one or more psychiatric diagnoses 1.
Psychiatric Risk Factors (Strongest Associations)
Mental health disorders represent the most powerful risk factors for suicide:
- Depression: The single strongest predictor, conferring a >15-fold increased risk, with risk peaking to 32-fold within the first 3 months of diagnosis 2. Present in 50-79% of youth suicide attempts and doubles the odds of attempts in adults 1.
- Schizophrenia: 4-13 fold increased risk 1
- Bipolar disorder and mixed states: Particularly with rapid cycling or hypomanic traits 3
- Posttraumatic stress disorder: Especially in military veterans 1
- Substance use disorders: Major independent risk factor 1, 4
- Borderline personality disorder: Associated with recurrent suicidal behavior and impulsivity 3
The evidence here is robust from guideline-level sources, though clinicians should note that depression may go unrecognized in adolescents despite its high prevalence in suicide attempts 1.
Demographic Risk Factors
Age, sex, and race/ethnicity create distinct risk profiles 1:
Highest absolute risk groups:
- American Indian/Alaska Native males aged 19-24 years
- Non-Hispanic white males >75 years
- Men aged 50-59 years (suicide rates increased 47-49% from 1999-2010)
- Women aged 60-64 years (60% increase in rates)
- Hispanic adolescent females (highest attempt rates among adolescents)
Sex differences: Male sex independently increases risk, with men showing higher completion rates across age groups 2.
Psychosocial and Historical Risk Factors
High-priority factors 1:
- Previous suicide attempt: Confers 6-16 fold increased risk—the strongest behavioral predictor 5
- Suicidal ideation: 6-16 fold increased risk 5
- Family history of suicide: Particularly parental death by suicide 5
- Adverse childhood events: Including physical/sexual abuse 1
- Recent psychiatric hospitalization discharge: Represents a critical high-risk period requiring intensive follow-up 1
Social determinants 1:
- Never married status (2.58-fold risk) 4
- Social isolation (particularly in older adults)
- Unemployment or low income (especially in males)
- Recent spousal bereavement (older adults)
- LGBTQ+ identity with associated discrimination
- History of bullying
Medical Comorbidities
Several physical illnesses independently increase suicide risk 1, 2:
- Chronic obstructive pulmonary disease: 2.79-fold risk 4
- Liver disease: 4.63-fold risk 4
- Cancer: 2.18-fold risk 4
- Epilepsy and chronic pain: Established associations 1
- Kidney disease: 2.26-fold risk 4
- Stroke, asthma, spine disorders: 1.4-2.1-fold risks 2
Behavioral and Environmental Risk Factors
- Current smoking: 2.26-fold increased risk 4
- Current alcohol use: 1.93-fold risk 4; alcohol represents a major modifiable societal risk factor 6
- Access to lethal means: Particularly firearms 1
- Sleep disturbances: Emerging risk factor 1
- Workplace factors: Job strain, bullying, burnout, work-family conflict 7
Military-Specific Risk Factors
Veterans face unique risks 1:
- Traumatic brain injury
- Separation from service within past 12 months
- PTSD and other mental health conditions
Critical Clinical Caveats
Individual risk factors have limited predictive ability for suicide at a specific time point—many Americans have one or more risk factors, yet only a small proportion attempt suicide and even fewer complete it 1. This underscores that risk assessment must be dynamic and repeated, not a one-time checklist.
The evidence quality is limited by excess significance bias and high heterogeneity across studies, with poor replicability for nearly two-thirds of identified risk factors 5. Despite this, the guideline evidence consistently identifies the factors above as warranting clinical attention.
Highest priority actions: Screen for depression systematically (USPSTF recommendation), assess for previous attempts and current ideation, evaluate access to lethal means, and intensify monitoring during high-risk periods (first 3 months after depression diagnosis, immediately post-psychiatric hospitalization) 1, 2.