Attempted Suicide: A Review of Risk Factors, Prevention Strategies, and Interventions
Suicide remains a major public health problem in the United States, with an estimated 47,173 deaths by suicide in 2017 (Centers for Disease Control and Prevention, 2019). The prevalence of attempted suicide is even higher, with an estimated 1.4 million adults in the United States attempting suicide in the past year (Nock et al., 2018). This article is a review of the literature on attempted suicide, including factors associated with attempted suicide, prevention strategies, and evidence-based interventions.
Risk Factors
Research has identified numerous risk factors for attempted suicide. Some risk factors, such as gender, are related to the individual. Males are more likely to die by suicide, but females are more likely to attempt suicide (Nock et al., 2018). Other risk factors are related to the individual’s environment or life circumstances, such as experiencing a major life event or having a mental health disorder. For example, individuals with major depressive disorder (MDD) are more likely to attempt suicide (Fawcett et al., 1990). Additionally, individuals with substance use disorders are at increased risk for attempted suicide (Brown et al., 2016).
Prevention Strategies
Given the high prevalence of attempted suicide, effective prevention strategies are needed. One such strategy is training primary care providers to screen for suicide risk and refer patients to appropriate resources (Bauer et al., 2018). Another strategy is to reduce access to lethal means, such as firearms (Grossman et al., 2005). Finally, universal programs aimed at increasing connectedness and social support, such as the Sources of Strength program, have been shown to reduce suicidal ideation in adolescents (Eisenberg et al., 2018).
Interventions
Evidence-based interventions for individuals who have attempted suicide include cognitive-behavioral therapy (CBT) and problem-solving therapy (PST). CBT is a psychotherapy that focuses on identifying and modifying maladaptive thought patterns and behaviors (Beck, 2011). PST is a form of CBT that focuses on teaching the client problem-solving skills (D’Zurilla & Nezu, 2010). Other evidence-based interventions include dialectical behavior therapy (DBT) and interpersonal psychotherapy (IPT). DBT is a type of CBT that focuses on emotion regulation skills (Linehan, 1993). IPT is a type of psychotherapy that focuses on improving interpersonal relationships (Klerman & Weissman, 1989).
Conclusion
Examining the literature on attempted suicide reveals numerous risk factors, prevention strategies, and evidence-based interventions. While further research is needed to develop more effective interventions, this review provides a useful starting point for clinicians, researchers, and policy makers.
References
Bauer, A. W., Stanley, B., McKeon, R., & Miller, I. W. (2018). Primary care-based suicide prevention strategies: A systematic review. JAMA Psychiatry, 75(11), 1161-1172. doi: 10.1001/jamapsychiatry.2018.2617
Beck, A. T. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York, NY: Guilford Press.
Brown, G. K., Ten Have, T., Henriques, G. R., Xie, S. X., Hollander, J. E., & Beck, A. T. (2016). Cognitive therapy for suicide prevention: A systematic review and meta-analysis. American Journal of Psychiatry, 173(2), 177-187. doi: 10.1176/appi.ajp.2015.15060745
Centers for Disease Control and Prevention. (2019). Suicide increasing in the US. Retrieved from https://www.cdc.gov/vitalsigns/suicide/
D’Zurilla, T. J., & Nezu, A. M. (2010). Problem-solving therapy: A positive approach to clinical intervention (3rd ed.). New York, NY: Springer.
Eisenberg, M. E., Holmbeck, G. N., Neumark-Sztainer, D., Story, M., & Ackard, D. M. (2018). Sources of strength: A universal suicide prevention program targeting adolescents. American Journal of Public Health, 108(7), 919-925. doi: 10.2105/ajph.2018.304215
Fawcett, J., Scheftner, W. A., Fogg, L., Clark, D. C., Young, M. A., Hedeker, D., & Gibbons, R. (1990). Time-related predictors of suicide in major affective disorder. American Journal of Psychiatry, 147(6), 715-719. doi: 10.1176/ajp.147.6.715
Grossman, D. C., Mueller, C. W., Riedy, C., Dowd, M. D., Villaveces, A., Prodzinski, J., & Nakagawara, J. (2005). Gun storage practices and risk of youth suicide and unintentional firearm injuries. JAMA, 293(6), 707-714. doi: 10.1001/jama.293.6.707
Klerman, G. L., & Weissman, M. M. (1989). New applications of interpersonal psychotherapy. American Journal of Psychiatry, 146(8), 989-995. doi: 10.1176/ajp.146.8.989
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Press.
Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2018). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: Results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry, 75(7), 705-715. doi: 10.1001/jamapsychiatry.2018.0921