Suicide and suicide risk

Abstract

Although recent years have seen large decreases in the overall global rate of suicide fatalities, this trend is not reflected everywhere. Suicide and suicidal behaviour continue to present key challenges for public policy and health services, with increasing suicide deaths in some countries such as the USA. The development of suicide risk is complex, involving contributions from biological (including genetics), psychological (such as certain personality traits), clinical (such as comorbid psychiatric illness), social and environmental factors. The involvement of multiple risk factors in conveying risk of suicide means that determining an individual’s risk of suicide is challenging. Improving risk assessment, for example, by using computer testing and genetic screening, is an area of ongoing research. Prevention is key to reduce the number of suicide deaths and prevention efforts include universal, selective and indicated interventions, although these interventions are often delivered in combination. These interventions, combined with psychological (such as cognitive behavioural therapy, caring contacts and safety planning) and pharmacological treatments (for example, clozapine and ketamine) along with coordinated social and public health initiatives, should continue to improve the management of individuals who are suicidal and decrease suicide-associated morbidity.

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Fig. 1: Global variations in suicide rates.
Fig. 2: Suicide rates by sex from 2000 to 2015.
Fig. 3: Suicide rates in selected countries from 2000 to 2015.
Fig. 4: The biopsychosocial model of suicide risk.
Fig. 5: Neurobiological changes in suicidal behaviour.
Fig. 6: Approaches for preventing suicide.

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Acknowledgements

G.T. holds a Canada Research Chair (Tier 1) and is supported by grants from the Canadian Institute of Health Research (CIHR) (FDN148374, EGM141899, ENP161427), and by the Fonds de Recherche du Québec – Santé (FRQS) through the Quebec Network on Suicide, Mood Disorders and Related Disorders. D.A.B. receives research support from US National Institute of Mental Health (NIMH), American Foundation for Suicide Prevention (AFSP), the Once Upon a Time Foundation and the Beckwith Foundation, and salary support from the University of Pittsburgh, University of Pittsburgh Physicians (UPP), NIMH and AFSP. The authors are indebted to Sylvanne Daniels, McGill University, for essential help in the preparation of this Primer.

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Aside from G.T., authors are listed in alphabetical order. Introduction (G.T.); Epidemiology (D.G.); Mechanisms/pathophysiology (G.T. and D.G.); Diagnosis, screening and prevention (D.A.B. and J.P.); Management (B.H.S., R.C.O’C. and M.A.O.); Quality of life (G.T.); Outlook (G.T.); Overview of Primer (G.T.).

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Correspondence to Gustavo Turecki.

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Competing interests

D.A.B. receives royalties from Guilford Press, from the electronic self-rated version of the Columbia Suicide Severity Rating Scale (C-SSRS) from eRT Inc., and from performing duties as an UptoDate Psychiatry Section Editor. He receives consulting fees from Healthwise, and receives honoraria from the Klingenstein Third Generation Foundation for scientific board membership and grant review. D.G. is a member of the Department of Health for England’s National Suicide Prevention Advisory Committee, Samaritans Policy and Research Committee and Movember’s Global Advisory Committee. M.A.O. receives royalties for commercial use of the C-SSRS and her family owns stock in Bristol Myers Squibb. B.H.S. receives royalties from the Research Foundation for Mental Hygiene, Inc., for the commercial use of the C-SSRS. The remaining authors declare no competing interests.

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Nature Reviews Disease Primers thanks E. Boudreaux, Y. Conwell, C. King and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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The Joint Commission: https://www.jointcommission.org/assets/1/6/NPSG_Chapter_HAP_Jan2019.pdf

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Turecki, G., Brent, D.A., Gunnell, D. et al. Suicide and suicide risk. Nat Rev Dis Primers 5, 74 (2019). https://doi.org/10.1038/s41572-019-0121-0

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