How do distal and proximal risk factors combine to predict suicidal ideation and behaviors? A prospective study of the narrative crisis model of suicide

Bloch-Elkouby, Sarah; Gorman, Bernard S.; Lloveras, Lauren; Wilkerson, Timothy; Schuck, Allison; Barzilay, Shira; Calati, Raffaella; Schnur, David B.; Galynker, Igor

doi:10.1016/j.jad.2020.08.088

Cited by 51 publications

(34 citation statements)

References 72 publications

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“…However, a developmental approach to suicide etiology and prevention that also incorporates distal factors could expand opportunities to prevent suicide once the mechanisms underlying distal factors are understood. In theory, the presence of proximal factors, such as having depression, in the context of vulnerability established years earlier—such as exposure to pregnancy complications as shown here—might be more strongly associated with suicide than depression in the absence of this prior vulnerability, and if so, that knowledge could be used to develop a more precise risk assessment among individuals with psychiatric conditions [ 72 ]. Future research is needed to examine the mechanisms underlying the association between early risk factors and suicide mortality later in life that incorporates information about factors more proximal to time of death that might inform us on causal pathways [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Prenatal origins of suicide mortality: A prospective cohort study in the United States

et al. 2022

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Most suicide research focuses on acute precipitants and is conducted in high-risk populations. Yet, vulnerability to suicide is likely established years prior to its occurrence. In this study, we aimed to investigate the risk of suicide mortality conferred by prenatal sociodemographic and pregnancy-related factors. Offspring of participants (N = 49,853) of the Collaborative Perinatal Project, a U.S. population-based cohort of pregnancies enrolled between 1959 and 1966, were linked to the U.S. National Death Index to determine their vital status by the end 2016. We examined associations between sociodemographic factors during pregnancy, pregnancy complications, labor and delivery complications, and neonatal complications with suicide death coded according to ICD-9/10 criteria. By the end of 2016, 3,555 participants had died. Of these, 288 (214 males, 74 females) died by suicide (incidence rate = 15.6 per 100,000 person-years, 95% Confidence Interval [CI] = 13.9–17.5). In adjusted models, male sex (Hazard Ratio [HR] = 2.98, CI: 2.26–3.93), White race (HR = 2.14, CI = 1.63–2.83), low parental education (HR = 2.23, CI = 1.38–3.62), manual parental occupation (HR = 1.38, CI = 1.05–1.82), being a younger sibling (HR = 1.52, CI = 1.10–2.11), higher rates of pregnancy complications (HR = 2.36, CI = 1.08–5.16), and smoking during pregnancy (HR = 1,28, CI = 0.99–1.66) were independently associated with suicide risk, whereas birth and neonatal complications were not. Consistent with the developmental origins of psychiatric disorders, vulnerability to suicide mortality is established early in development. Both sociodemographic and pregnancy factors play a role in this risk, which underscores the importance of considering life course approaches to suicide prevention, possibly including provision of high-quality prenatal care, and alleviating the socioeconomic burdens of mothers and families.

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Section: Discussionmentioning

confidence: 99%

Prenatal origins of suicide mortality: A prospective cohort study in the United States

et al. 2022

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“…Since we disentangled effects of time and those of newly added variables, we can state that this difference only resulted from the fact that the second model contained indicators of the adolescents' characteristics closer in time to the outcome. Although this result may seem sobering from a practical perspective, it reconfirmed a golden rule of assessment, namely that proximal predictors are better than distal ones (e.g., Bloch-Elkouby et al, 2020). Moreover, measures of prevention should be tailored to specific phases of development.…”

Section: The How and The When Of Suicide Screeningmentioning

confidence: 81%

Predicting Lifetime Suicide Attempts in a Community Sample of Adolescents Using Machine Learning Algorithms

Jankowsky¹,

Steger²,

Schroeders³

2022

Preprint

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Suicide is a major global health concern and a prominent cause of death in adolescents. Previous research on the prediction of suicide attempts has mainly focused on clinical or adult samples. To prevent suicides at an early stage, however, it is necessary to better understand the risk factors in a community sample of adolescents. In this study, we used elastic net regressions to predict suicide attempts of 17-year-olds in the Millennium Cohort Study, combining a large set of self- and other-reported variables from different categories (e.g., demographics, health, personality, emotions, sexuality, or victimization). Balanced predictive accuracy (= mean of sensitivity and specificity) was .84 when using data of the 17-year-olds’ assessment, but significantly lower (.76) when trying to predict suicide attempts three years in advance. We identified a set of essential variables that should be considered when screening for suicidal behavior and compare it to existing measures currently used.

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“…Conceptually, suicidal behaviors do not always follow a linear progression from ideation to behavior. Instead, suicidal behavior is the cumulative effect of long-term and short-term risk factors which can produce ideations and behaviors all at once or within a short interval ( Bloch-Elkouby et al, 2020 ).…”

Section: Linking Evolutionary and Psychological Concepts: A Search For Proximate Explanationsmentioning

confidence: 99%

Choosing Death Over Survival: A Need to Identify Evolutionary Mechanisms Underlying Human Suicide

Chatterjee

Rai

2021

Front. Psychol.

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The act of killing self contradicts the central purpose of human evolution, that is, survival and propagation of one’s genetic material. Yet, it continues to be one of the leading causes of human death. A handful of theories in the realm of evolutionary psychology have attempted to explain human suicide. The current article analyses the major components of certain prominent viewpoints, namely, Inclusive fitness, Bargaining model, Pain-Brain model, Psychological aposematism, and few other perspectives. The article argues that relatively more weightage has been given to understanding ultimate (the “why”) rather than proximate (the “how”) functionality of suicidal acts. Evolutionary theorists have consistently pointed out that to comprehensively understand a trait or behavior, one needs to delineate not only how it supports survival but also the evolution of the mechanisms underlying the trait or behavior. Existing theories on suicide have primarily focused on its fitness benefits on surviving kin instead of providing evolutionary explanations of the more complex mechanisms leading up to such self-destructive motivations. Thus, the current paper attempts to highlight this gap in theorizing while suggesting probable proximate explanations of suicide which stresses the need to diffuse attention paid to fitness consequences of the act alone. We speculate that such explorations are needed in order to build a robust and comprehensive evolutionary theory of human suicide.

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How do distal and proximal risk factors combine to predict suicidal ideation and behaviors? A prospective study of the narrative crisis model of suicide

Cited by 51 publications

References 72 publications

Prenatal origins of suicide mortality: A prospective cohort study in the United States

Prenatal origins of suicide mortality: A prospective cohort study in the United States

Predicting Lifetime Suicide Attempts in a Community Sample of Adolescents Using Machine Learning Algorithms

Choosing Death Over Survival: A Need to Identify Evolutionary Mechanisms Underlying Human Suicide

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