What are the scientifically proven indicators of increased suicidal risk?

Scientifically Proven Indicators of Increased Suicide Risk

Several specific risk factors have been scientifically proven to indicate increased suicide risk, with the strongest evidence supporting previous suicide attempts, self-directed violence-related thoughts or behaviors, and current psychiatric conditions as the most significant indicators.

Key Risk Domains with Strong Scientific Evidence

According to the 2024 VA/DOD Clinical Practice Guidelines, a comprehensive suicide risk assessment should include factors from the following domains 1:

1. Self-directed violence-related thoughts and behaviors:

   • Previous suicide attempts (increases risk by 4.84 times in depressed individuals) 2
   • Current suicidal ideation
   • History of self-harm

2. Current psychiatric conditions:

   • Depression (present in 50-79% of youth suicide attempts) 1
   • Schizophrenia or schizoaffective disorder
   • Substance use disorders (increases risk by 2.17 times) 2
   • Anxiety disorders (increases risk by 1.59 times) 2

3. Psychiatric symptoms:

   • Hopelessness (increases risk by 2.20 times) 2
   • More severe depression (increases risk by 2.20 times) 2
   • Agitation or irritability 3

4. Social determinants and adverse life events:

   • Access to lethal means, especially firearms 1, 4
   • Social isolation 1
   • Recent financial loss or threat of loss 5
   • Feeling like a burden to others 5

5. Demographic characteristics:

   • Male gender (increases risk by 1.76 times in depressed individuals) 2
   • Older age groups (particularly men aged 50-59 and women aged 60-64) 1
   • American Indian/Alaska Native ethnicity 1, 4

Method of Attempt as a Critical Risk Indicator

The method used in previous suicide attempts is particularly significant:

• Violent methods (especially firearms) are associated with dramatically higher risk of completed suicide (hazard ratio=15.86 compared to poisoning) 6
• The risk is especially high during the first 30 days after an attempt using violent methods (hazard ratio=17.5) 6

Validated Assessment Tools

The 2024 VA/DOD guidelines recommend using validated assessment tools 1:

• For general population:

  • Columbia Suicide Severity Rating Scale Screener
  • Suicide Cognition Scale-Revised
  • Patient Health Questionnaire-9

• For high-risk populations:

  • Beck Suicide Intent Scale/Beck Scale for Suicidal Ideation
  • Columbia Suicide Severity Rating Scale Screener

High-Risk Combinations

Research has identified that having four or more of these specific characteristics indicates high near-term suicide risk with 79% sensitivity and 81% specificity 5:

• Prior psychiatric hospitalization
• Contemplation of violent methods (hanging or jumping)
• Presence of suicidal impulses
• Being divorced
• Threat of financial loss
• Feeling a burden to others
• Unable to cry or severe crying
• Severe/moderate ideas of persecution
• Negative reaction to the patient by the interviewer

Important Caveats

1. No single predictor is sufficient: Individual risk factors have limited ability to predict suicide in a specific person at a particular time 1.

2. Risk stratification limitations: Despite being a routine component of care, there is insufficient evidence to recommend any specific tool or method to determine the level of suicide risk 1.

3. False positives: Current screening tools tend to have high false-positive rates and may miss some true cases 1.

4. Temporal considerations: Risk is particularly elevated in the immediate aftermath of a suicide attempt, especially when violent methods were used 6.

5. Screening limitations: There remains "insufficient evidence to recommend for or against suicide risk screening programs to reduce the risk of suicide or suicide attempts" 1, though screening is standard in many mental health settings.