Suicide: can we predict it?

Emerging Themes and Research Frontiers in Suicide Prediction: A Scientometric Analysis

Suicide remains a critical global health issue despite advancements in mental health treatment. The purpose of this analysis is to emphasize the development, patterns, and noteworthy outcomes of suicide prediction research. It also helps to uncover gaps and areas of under-researched topics within suicide prediction. A scientometric analysis was conducted using Biblioshiny and VOSviewer. To thoroughly assess the academic literature on suicide prediction, various scientometric methodologies such as trend analysis and citation analysis were employed. We utilized the temporal features of the Web of Science to analyze publication trends over time. Author affiliation data were used to investigate the geographic distribution of research. Cluster analysis was performed by grouping related keywords into clusters to identify overarching themes within the literature. A total of 1,703 articles from 828 different sources, spanning from 1942 to 2023, were collected for the analysis. Machine learning techniques might have a big influence on suicide-related event prediction, which would enhance attempts at suicide prevention and intervention. The conceptual understanding of suicide prediction is enhanced by scientometric analysis, which further uncovers the research gap and literature in this area. Suicide prediction research underscores that suicidal behavior is not caused by a single factor but is the result of a complex interplay of multiple factors. These factors may include biological, psychological, social, and environmental factors. Understanding and integrating these factors into predictive models is a theoretical advancement in the field. Unlike previous bibliometric studies in the field of suicide prediction that have typically focused on specific subtopics or data sources, our analysis offers a comprehensive mapping of the entire landscape. We encompass a wide range of suicide prediction literature, including research from medical, psychological, and social science domains, thus providing a holistic overview.

Mental health workers’ views about their suicide prevention role

Aim

Mental Health workers bear responsibility for preventing suicide in their client group. Survey studies have indicated that staff can be seriously adversely affected when a client suicides. The aim of the current study is to describe and evaluate the effects on mental health (MH) workers of their ongoing role in managing suicidal behaviours and to identify the thoughts and feelings associated with this role.

Method

A survey was administered to 135 MH workers via an on-line self-report vehicle. The survey comprised standardised measures of anxiety and burnout as well as a questionnaire developed for this study concerning perceptions and attitudes to suicide and suicide prevention.

Results

Factor analysis of 12 retained items of the questionnaire identified three factors: 1) preventability beliefs (beliefs about suicide being always and/or permanently preventable); 2) associated distress (stress/anxiety about managing suicidal behaviour); and 3) the prevention role (covering views about personal roles and responsibilities in preventing suicidal behaviours). Analysis of these factors found that many MH workers experience an elevation of stress/anxiety in relation to their role in managing suicidal behaviours. This distress was associated with the emotional exhaustion component of burnout. Measures showed adverse responses were higher for outpatient than inpatient workers; for those who had received generic training in suicide prevention: and for those who had experienced a workplace related client suicide.

Conclusion

There is a need for the development of appropriate self-care strategies to alleviate stress in MH workers exposed to suicide.

Suicide in a spinal cord injured population: its relation to functional status

OBJECTIVE

To determine the relation between functional status and risk of suicide among individuals with spinal cord injury (SCI).

DESIGN

A follow-up study of all individuals who survived a traumatic SCI during the period from 1953 through 1990.

SETTING

An SCI center in eastern Denmark.

SUBJECTS

A total of 888 individuals with SCI, including 236 who died, 23 of whom committed suicide.

MAIN OUTCOME MEASURES

Standardized Mortality Ratios (SMRs) of suicides among individuals with SCI.

RESULTS

A 100% follow-up was established January 1, 1993. The total suicide rate among individuals with SCI was nearly five times higher than expected in the general population and lower for men than for women. The suicide rate doubled from an early inclusion period (1953-1971) to a later period (1972-1990). An unexpected finding was that the suicide rate in the group of marginally disabled persons was nearly twice as high as the group of functionally complete tetraplegic individuals.

CONCLUSION

Given the high frequency of suicide, there is a need for increased awareness by rehabilitation staff and general practitioners regarding depression and psychological adjustment difficulties. Such conditions should be given special attention during rehabilitation and follow-up, especially among women with SCI and the marginally disabled.

Suicide and mental disorders

In Japan, there has not yet been a complete psychological autopsy study. The author conducted a retrospective study of failed suicides (quasi-completed suicides) admitted to an emergency critical care center. According to the lethality of suicide methods, 133 out of 265 subjects over 6 years (1986-1991) were classified as the absolutely dangerous (AD; the failed suicides) group. As a principal diagnosis, psychoses, endogenous depression, substance abuse were present in 75% of the AD group. The diagnostic distribution largely differed with depressive disorders being mainly in the older group (50+ years), and psychoses predominating in the younger group (< 30 years). This study suggested that the majority of suicide victims in Japan also had mental disorders, and suicide prevention should be confronted with this clinical fact.

Treatment of suicidal patients: a risk-benefit analysis

A therapist may be held liable when a patient commits suicide if previous suicidal tendencies were observed but reasonable precautions were not taken. In order to reduce liability and enhance treatment effectiveness, therapeutic decisions can be critiqued by estimating the risks and benefits associated with different courses of action. An evaluation of risks and benefits can be used to guide decisions regarding assessment, hospitalization, medications, and discharge from the hospital. A risk-benefit analysis can help therapists utilize a broad range of treatment options while allowing patients the maximum degree of autonomy. Additionally, all aspects of treatment should be well documented, including information about the specific course of action chosen, other treatment options considered, and the therapeutic rationale for deciding which treatment plan was best suited to the patient's needs.

Imitative suicide in a cohesive organization: observations from a case study

Three suicides occurred within 3 years in a military unit of 35 individuals. This represented an annual rate 220 times the North American average. A clinical intervention was requested by medical authorities, the goal being to minimize the risk of further deaths. Group and individual therapy was conducted over 3 days and ongoing referrals were made as necessary. In addition, measures of anxiety, depression, and hostility were obtained from this unit and from a unit equivalent in size and job description to examine whether these constructs could be used diagnostically. Analysis of the data indicated that differences in mean scores between the units yielded potentially misleading information, although on an individual basis scores were useful in identifying clients at risk of suicide. When those who personally knew one or more of the decreased were compared with those who did not, variability of scores in conjunction with interviews was helpful in identifying relatively high-risk subgroups.

Risk of suicide by psychiatric diagnosis in Stockholm County. A longitudinal study of 80,970 psychiatric inpatients

The risk of suicide associated with different psychiatric diagnoses was estimated in 80,970 inpatients in Stockholm County (population 1.6 million). All patients discharged with at least one psychiatric diagnosis between 1973 and 1986 were followed by linkage with the cause-of-death registry through 1987. There were 1,115 definite suicides and 467 undetermined suicides among these during the 15-year follow-up. When 12 diagnostic categories were entered in a proportional hazards model, the highest relative risk (RR) of definite suicide, controlling for sex and age, was noted for affective disorders (RR 2.82), followed by unspecified psychoses (RR 2.69), paranoid psychoses (RR 2.60), addiction to prescription drugs (RR 2.38), neuroses and reactive psychoses (RR 1.96), and schizophrenia (RR 1.64). Alcoholism, personality disorders, organic psychoses, and street drug addiction did not have significantly increased risks of suicide. Male sex increased the risk for definite suicide by 1.56, while the risk was somewhat higher among the young. Having more than one diagnosis increased the relative risk by 1.42. When undetermined suicides were included in the analysis, to alcoholism and street drug abuse were attributed significantly increased risks of suicide, probably owing to the greater difficulty of verifying such cases. We conclude that several psychiatric disorders were conductive to suicide, but that the risk did not vary much with the type of diagnosis. Further studies of confounders are needed, such as the reasons for being admitted to inpatient care, and the impact of somatic and psychiatric comorbidity.

Psychiatric diagnoses as predictors of suicide. A comparison of diagnoses at conscription and in psychiatric care in a cohort of 50,465 young men

In a cohort of 50,465 Swedish men conscripted for military service in 1969-70, the relative risk for suicide was 3.1 (95% Cl 2.3-4.0) among those who had a psychiatric diagnosis at conscription, and 16.7 (95% Cl 13.8-20.1) among those who had a psychiatric diagnosis in in-patient care during a 13-year follow-up. Of the diagnoses at conscription, only neurotic disorder, personality disorder and drug dependence were associated with a significantly increased risk for future suicide. Among those who were admitted to hospital, almost all in-patient diagnoses were associated with a significantly increased suicide risk. Although a psychiatric diagnosis in in-patient care was a strong predictor of suicide, only 44% of all 247 men who committed suicide had ever been treated in in-patient psychiatric care.

Personality and suicidal behavior in depressed patients

The relationship between personality and suicidal behavior was evaluated in 53 patients with primary major depressive disorder. Mean borderline personality scale scores on the Millon Clinical Multiaxial Inventory (MCMI) differed between suicide attempters and non-attempters. The frequency of personality disorder diagnoses, especially borderline personality disorder, was not higher in the suicide attempters. Clinical and theoretical implications of these findings are discussed.