BOSTON, Mass.—A multitude of factors contribute to a person being at risk of suicide, and clinicians need to understand those contributors in order to help prevent suicide, an expert told attendees at Elevate at Psych Congress.
“It is a health condition that we can do something about,” said Jill M. Harkavy-Friedman, PhD, vice president of research for the American Foundation for Suicide Prevention (AFSP), which has partnered with Psych Congress.
The best predictor of future suicidal behavior is past suicidal behavior, she explained in her presentation, “Suicide Prevention: Understanding and Approaching Suicide Risk.” About 40% of people who die by suicide have attempted it previously.
Mental health also plays a key role, Dr. Harkavy-Friedman said, explaining that 90% of people who die by suicide have some type of underlying mental health condition, although they may not be aware that they do. About 60% have major depression or bipolar disorder, 15% have psychosis, 10% have borderline personality disorder, and 6% have anxiety disorders or post-traumatic stress disorder. Nearly 30% are intoxicated at the time of the death. (However, most people with a mental health disorder do not attempt suicide or die by suicide.)
Other contributing factors include: brain functions regarding decision-making and behavioral control, cognitive inflexibility, genetics, health factors, family history, social and environmental factors such as feeling disconnected, adverse life events, contagion, availability of means, and gender identify/sexual orientation.
Dr. Harkavy-Friedman encouraged the attendees to assess patients’ suicidal behavior at intake, regularly, and at times of stress.
It is important to remember, she said, that while many people think about suicide (3.9% of the population per year) and some people attempt suicide (0.5% per year), very few people die by suicide (0.014% per year).
Although clinicians must respond when a patient talks about suicide, they should not panic, the speaker said.
“Inside they feel it’s never going to get better. When you hear that, take a breath, say ‘What’s going on? What makes you feel that way?’ ” she said. “You don’t say ‘Wait, let me call the police. We’re going to get the ambulance here.’ Stop. Listen to them.”
Talking should be encouraged, she said, as the people who are thinking about suicide but not talking about it are often at the highest risk.
“Suicide prevention: understanding and approaching suicide risk.” Presented at Elevate by Psych Congress: Boston, Massachusetts; March 10, 2019.