SUicidal risk factors and completed suicide: Meta-analyses based on psychological autopsy studies

Department of Hygiene, School of Medicine, Wakayama Medical University, 8-1-1 Kimiidera, Wakayama, 641-0012, Japan.
Environmental Health and Preventive Medicine 10/2008; 13(5):243-56. DOI: 10.1007/s12199-008-0037-x
Source: PubMed


The purpose of the present review is to evaluate the effects of common risk factors for suicide by meta-analyses using data extracted from studies based on the psychological autopsy method. We focused on five common risk factors of suicide: substance-related disorders, mood disorders, adverse marital status, adverse employment status, and self-harm behaviors. A total of 24 articles were identified from MEDLINE in which the crude odds ratio (OR) could be calculated for the above five risk factors through 30 April 2007, using such search keywords as "suicide," "psychological autopsy," and "case-control study." Overall, both substance-related disorders [OR = 5.24; 95% confidence interval (CI) = 3.30-8.31] and mood disorders [OR = 13.42; 95% CI = 8.05-22.37] were strongly associated with suicidal risk. Suicidal attempt and deliberate self-harm, which can directly lead to completed suicide, have been shown to be very strongly associated with suicidal risk [OR = 16.33; 95% CI = 7.51-35.52]. Effects of social factors such as adverse marital and employment status were relatively small. As substance-related disorders and mood disorders were strongly associated with an increased risk of completed suicide, the comorbidity of these two disorders should be paid a maximum attention. The effective prevention of suicide depends on whether we can successfully incorporate these personal factors as well as social factors into an adequate multi-factorial model.

Full-text preview

Available from:
  • Source
    • "This has also been found in adolescents (Bukstein et al., 1993; Shafii et al., 1985). A meta-analysis of psychological autopsies indicated that previous suicide attempts and self-harm were associated with an increased risk of 16.3 for completed suicide compared to control groups (Yoshimasu et al., 2008). However, other studies have indicated otherwise, reporting suicide completers had fewer previous suicide attempts (Gladstone et al., 2001) and less suicidal ideation (Gladstone et al., 2001; Smith et al., 2013) compared to matched controls. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In an individual who seeks help or is referred to a mental health professional it is common sense and clinical practice to assume that suicidal thoughts and previous attempts constitute risk factors for imminent suicide. However, this assumption has not been supported by large, population-based longitudinal studies. The current study investigated whether reports of current suicidal ideation and a history of suicide attempts indeed increase risk for later completed suicide in a historical prospective study design. Sequential records on 89,049 young males assessed by mental health professionals were screened for suicidal ideation and a history of suicide attempts. The data were linked with death records from the Israeli Central Bureau of Statistics. Over a follow-up period ranging from 2 months to 9.8 years, 54 individuals died by suicide, constituting an average suicide rate of 6.48 per 100,000 person-years. Overall, neither reporting current suicidal ideation (without a history of suicide attempts; HR=1.29, 95% CI=0.57-2.90) nor reporting a history of suicide attempts (with or without current suicidal ideation; HR=1.67, 95% CI=0.71-3.97) were significantly associated with increased risk for later completed suicide. However, young males with a previously diagnosed psychiatric disorder who reported current suicidal ideation (HR=4.52, 95% CI=1.08-18.91) or a history of suicide attempts (HR=6.43, 95% CI=1.54-26.90) were at increased risk of death by suicide. These findings indicate that in this particular population reports of current suicidal ideation or of a history of suicide attempts are helpful in predicting future suicide only among those with a previous diagnosis of a psychiatric disorder.
    Full-text · Article · Dec 2015 · European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology
  • Source
    • "Understanding the risk factors leading to suicide is crucial for effectively preventing suicide and managing individuals at risk of suicide. Depression has been strongly associated with suicide in retrospective psychological autopsy studies (Hawton & van Heeringen, 2009; Yoshimasu, Kiyohara & Miyashita, 2008), although an over-underestimation of the association, and biases such as interviewer bias, surrogate interview bias, and recall bias may not be ruled out (Hjelmeland et al., 2012). Prospective studies have been conducted mainly among patients with psychiatric disorders, who may not represent the people with psychiatric disorders in the community (Agerbo, 2007). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background. Few studies have prospectively examined whether depressive symptoms and other risk factors are associated with a higher risk of suicide death in individuals other than high-risk populations such as psychiatric patients and individuals with self-harm histories. The purpose of the study is to prospectively examine whether depressive symptoms assessed by the Beck Depression Inventory (BDI) are associated with greater risk of suicide death and whether depressive symptoms and other risk factors are independent predictors of suicide in general-risk populations. Another aim is to evaluate the sensitivity of the BDI for predicting suicide death. Methods. 10,238 Korean Vietnam War veterans (mean age: 56.3 years) who participated in two surveys in 2001 were followed up for suicide mortality over 7.5 years. Results. 41 men died by suicide. Severely depressed participants had a higher adjusted hazard ratio (aHR = 3.4; 95% CI [1.5–7.7]) of suicide than non-to-moderately depressed ones. Higher suicide risk was associated with more severe depressive symptoms (p for trend = 0.009). After adjustment for depressive symptoms and other factors, very poor health, low education, and past drinking were associated with higher suicide risk, while good health, body mass index, and marital status were not associated with suicide. The sensitivity at the cut-off score of 31 for detecting suicide was higher during the earlier 3.5 years of the follow-up (75%; 95% CI [50–90]) than during the latter 4 years (60%; 95% CI [41–76]). Conclusions. Depressive symptoms are a strong independent predictor and very poor health, low education, and drinking status may be independent predictors of future suicide. The BDI may have acceptable diagnostic properties as a risk assessment tool for identifying people with depression and suicidal potential among middle-aged men.
    Full-text · Article · Jul 2015 · PeerJ
  • Source
    • "I Sverige har man funnet at alkoholmisbruk eller alkoholavhengighet forekom i 31 % av undersøkte selvmord (Schneider, 2009), mens norske studier har funnet noe lavere andeler i spesielle utvalg av selvmord (Bjornaas et al., 2010; Thoresen & Mehlum, 2004). Forekomsten av alkoholmisbruk er betydelig høyere (i gjennomsnitt fem ganger høyere) blant dem som tar sitt eget liv enn i befolkningen ellers, for eksempel blant pasienter i primaerhelsetjenesten (Yoshimasu et al., 2008). "

    Full-text · Article · Jun 2015
Show more