Risk Factors
A risk factor is an aspect of personal behavior or lifestyle, an environmental exposure, or an inborn or inherited characteristic that has been shown to be associated with an increased occurrence of death by suicide. People possessing the risk factor are considered to be at greater potential for suicidal behavior. Risk factors are not predictors or causes of suicide. Risk factors can be divided into five general categories:
Permanent and non-modifiable risk factors
Permanent and non-modifiable risk factors cannot be changed and may alert others to the heightened risk of suicide during periods of the recurrence of a mental or substance abuse disorder or following stressful life events.
- Demographics: White, American Indian, male, older age, separation or divorce, early widowhood
- Personal history of suicide ideation or attempts
- Personal or family history of:
- Self-harm behavior
- Suicidal behavior
- Violence
- Substance abuse (drugs or alcohol)
- Divorce
- Trauma or abuse (physical or sexual)
- Psychiatric hospitalization
- Frequent mobility
- Impulsive or reckless behaviors
Predisposing and potentially modifiable risk factors
Predisposing and potentially modifiable risk factors can be reduced by certain interventions, such as prescribing mood stabilizing medication for bipolar disorder or strengthening social support in a community.
- Mental illness
- Mood disorder
- Anxiety disorder
- Schizophrenia
- Substance use disorder (alcohol abuse, drug abuse or dependence)
- Eating disorders
- Body dysmorphic disorder
- Conduct disorder (in adolescents)
- Low self-esteem or high self-hate
- Tolerant or accepting attitude toward suicide
- Exposure to another’s death by suicide
- Lack of self- or familial-acceptance of sexual orientation
- Smoking
- Perfectionism (especially in context of depression)
Acute risk factors
Acute risk factors indicate an increase risk in the near-term and most can be modified with immediate crisis intervention.
- Recently divorced or separated
- Feelings of victimization
- Suicide ideation (threatened, communicated, planned, or prepared for)
- Current self-harm behavior
- Excessive or increased use of substances (alcohol or drugs)
- Psychological pain (severe distress in response to loss, defeat, rejection, etc.)
- Anger, rage, seeking revenge
- Aggressive behavior
- Withdrawal from usual activities, supports, interests, school or work
- Isolation (e.g. lives alone)
- Anxiety, panic
- Agitation
- Insomnia
- Persistent nightmares
- Suspiciousness, paranoia (ideas of persecution or reference)
- Severe feelings of confusion or disorganization
- Hallucinations urging suicide
- Intense affect states (e.g. desperation, intolerable loneliness, self-hate, etc.)
- Dramatic mood changes (in either direction)
- Hopelessness
- Poor problem-solving (thinking in black and white terms, not able to see gray areas, alternatives, etc.)
- Few reasons for living and inability to imagine possibly positive future events
- The perception of being burdensome
- Recent diagnosis of terminal condition
- Feeling trapped, like there is no way out (other than death)
- Sense of purposelessness or loss of meaning
- Negative or mixed attitude toward receiving help
- Recklessness or excessive risk-taking behavior, especially if out of character or impulsive (without thinking of consequences)
Precipitating or triggering stimuli
Precipitating or triggering stimuli are events that put a person in a heightened period of risk, particularly if the person is vulnerable to suicide based on the presence of previously mentioned risk factors.
- Any real or anticipated event causing or threatening:
- Feelings of shame, guilt, despair, humiliation, rejection, abandonment or unacceptable loss of face or status
- Loss of freedom (legal problems), financial problems
- Recent exposure to another person’s suicide, especially when it is a friend or family member but can also occur through exposure by the media
Contributory risk factors
Contributory risk factors add to the possibility that someone may attempt suicide or complete suicide.
- Firearm ownership or easy accessibility
- Acute or enduring unemployment
- Stress (job, marriage, school, relationships, etc.)
- Grief and loss