Serious Suicide Attempts: Systematic Review of Psychological Risk Factors

Abstract

BackgroundOne of the main obstacles in studying suicide risk factors is the difference between cases in which the individual died by suicide and those in which the individual engaged in suicidal behavior. A promising strategy that overcomes this obstacle is the study of survivors of serious suicide attempt (SSA), i.e., an attempt that would have been lethal had it not been for the provision of rapid and effective emergency treatment. Serious suicide attempters are epidemiologically very much like those who died by suicide, and thus may serve as valid proxies for studying suicides. This paper aims to define the specific risk factors for SSAs by conducting a qualitative data synthesis of existing studies.MethodsFollowing Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic search of the literature in PubMed, ProQuest, and Psychlit electronic research-literature databases. Search terms were “serious” “OR” “near lethal,” combined with the Boolean “AND” operator with “suicide*.” In addition, we performed a manual search on Google Scholar for further studies not yet identified.ResultsThe preliminary search identified 683 citations. A total of 39 research reports that met the predefined criteria were analyzed. Mental pain, communication difficulties, decision-making impulsivity, and aggression, as well as several demographic variables, were found to be major risk factors for SSAs.LimitationsWe found a variability of definitions for SSA that hamper the ability to draw a model for the risk factors and processes that facilitate it. Moreover, the role of suicide intent and planning in SSA is still unclear. Further studies should aim to clarify and refine the concepts and measures of SSA, thereby enabling more specific and concrete modeling of the psychological element in its formation.ConclusionSSA is a distinguishable phenomenon that needs to be addressed specifically within the scope of suicidal behavior. Interpersonal problems, as well as impulsivity and aggression, seem to facilitate SSA when mental pain serves as a secondary factor. Healthcare professionals should be aware of SSA, and familiar with its specific risk factors. Moreover, psychological and suicidal risk assessment should include a designated evaluation of these risk factors as part of intervention and prevention models for SSA.

Predictive factors for suicidal attempts: A case‐control study

“…These additional predictors include socio-demographics, clinical and psychosocial variables such as depression, substance abuse, mental anguish, communication difficulties, interpersonal problems, and impulsivity. 5,6 However, personality traits have been shown repeatedly to be the strongest variables related to suicidality, 7 and an extensive review showed that PDs, based on DSM classifications, place individuals at significantly greater risk for suicide. 8 Cluster B PD, especially borderline PD, was identified as the strongest risk factor for suicide attempts.…”

Risk Factors for Serious Suicide Attempts with High Medical Severity

“…Depression, alcohol abuse, hopelessness, and prior suicide attempts are associated with medical severity (Bostwick, Pabbati, Geske, & McKean, ; Swahn & Potter, ; Trakhtenbrot et al, ; Wilcox, Conner, & Caine, ). However, results from previous studies vary because of different definitions of medical severity, and only a few studies compare high lethal attempters to low lethal attempters with sufficient sample sizes (Gvion & Levi‐Belz, ). Considering the scarcity of research on this subject, it is still unclear which factors are most associated with high medical severity in suicide attempts.…”

Identification of gene ontology and pathways implicated in suicide behavior: Systematic review and enrichment analysis of GWAS studies

“…It is known that SB is a complex disorder, which involves many environmental, behavioral, neurobiological, and genetic factors (Gvion & Levi‐Belz, ; Speed, Drapeau, & Nadorff, ). Researchers of suicide behavior are looking for predisposing (distal) and precipitating (proximal) factors (Conejero, Olie, Courtet, & Calati, ; Gerada, ; Gvion & Levi‐Belz, ; Speed et al, ). Besides, there are several biological, genetic, and environmental abnormalities have been reported in SB, but it is not clear which ones are risk factors (Fiori et al, ; Schneider et al, ).…”