PRIMEVIEW

SUICIDE AND SUICIDE RISK

For the Primer, visit doi:10.1038/s41572-019-0121-0

The WHO estimates ~785,000 suicides PREVENTION
(that is, the act of intentionally ending
one’s own life) occur annually. Suicide and
suicidal behaviours are important public Indicated
health issues that still require further interventions
TGUGCTEJCPFRWDNKE|CYCTGPGUU target people
who already exhibit
suicidal thoughts or
MECHANISMS behaviours. Examples
include psychological or
pharmacological therapies
Risk factors for suicide can be classified as distal and telephone crisis
(or predisposing), developmental (or mediating) services (also known
and proximal (or precipitating) factors, depending as ‘hotlines’).
on their temporal association with suicide.
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genetic predisposition to suicide and early life
adversity (that is, physical or sexual abuse, or RESPONSIBLE MEDIA
neglect, during childhood). The link between these REPORTING CAMPAIGNS
factors and suicide is at least partially mediated
by other developmental factors, which can
include specific personality traits (such as anxiety
and impulsive−aggressive traits) and cognitive MENTAL
en de
n
tio
PHARMACOLOGICAL EPIDEMIOLOGY
THERAPY Selective
interventions
TELEPHONE target people at The incidence of suicide varies substantially
PSYCHOLOGICAL CRISIS increased risk of suicidal
THERAPY SERVICES between countries; rates are relatively
thoughts or behaviours but who high in Russia, South Korea and eastern
do not currently experience these Europe, and low in the Middle East
behaviours (such as individuals with and some regions of south and central
psychiatric disorders). Examples of
America. Globally, for every death by
this type of intervention include
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pharmacological therapies and
make suicide attempts, although the
supportive environments
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DOCTOR in schools that target
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of children.
SUPPORTIVE
Universal SCHOOL
ENVIRONMENTS
interventions
target the entire Although rates of suicide attempts
population and include are higher in females, the rates
restricting access to means, of suicide deaths are 2–3 times higher

promoting the use of guidelines

ev ci

HEALTH
deficits (such as reduced problem-solving ability, KP|OCNGU
pr sui

AWARENESS
impaired memory and reduced positive future for media organizations to
thinking). Factors that associate closely with promote the responsible
suicide and are seen as precipitating or facilitating reporting of suicide
it (proximal factors) include psychiatric disorders and resources for MANAGEMENT
RESOURCES
(of which major depressive disorder, bipolar FOR SOCIAL
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disorder, substance use disorder and schizophrenia MEDIA Long-term psychosocial interventions, such as
predominate) and other factors (such as cognitive therapy or cognitive behavioural therapy,
psychological pain, recent bereavement, financial that target suicidal thoughts and behaviours have
losses and social isolation, among others). been shown to reduce the incidence of self harm
For a list of global crisis centres visit https://www.iasp.info/resources/Crisis_Centres/
in one systematic review and meta-analysis. Brief
Distal factors interventions, such as caring contacts and crisis
response planning, can reduce the incidence of
SCREENING
suicide in those released from inpatient treatment
facilities or after discharge from the emergency
Developmental factors
Screening for suicide risk in single risk factor can predict computerized adaptive tests, room. Pharmacological therapies for suicide
the emergency department whether an individual will which are semi-personalized include lithium and clozapine, which is approved
or in primary care settings transition from suicidal ideation based on an individual’s response for the prevention of suicide in people with
Proximal factors
is important, given that the to suicidal behaviour and to questions, and machine schizophrenia. Some studies evaluating the use of
last clinical contact of many suicide, several factors should learning of electronic health ketamine, selective serotonin-reuptake inhibitors
individuals who die by suicide be assessed simultaneously. records to identify precursors and buprenorphine have demonstrated positive
SUICIDE RISK
is in these settings. As no Available screening tools include QH|UWKEKFCNDGJCXKQWT results, although further studies are required.

doi:10.1038/s41572-019-0130-z; Article citation ID: (2019) 5:73 Written by Louise Adams; designed by Laura Marshall
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