Suicide Risk Assessment: Research, Themes, and Best Practices

Overview

As Castaneda (2018) points out, suicide has become something of an epidemic in the United States, where in 2016 alone 45,000 people died by suicide. Furthermore, from 1999 to 2016, suicide rates rose in almost every U.S. state (Castaneda, 2018). Even highly successful people like Kate Spade and Anthony Bourdain have been susceptible to suicide, which is why it is so important to be able to identify indicators of when someone is at risk. Suicide is clearly a major public health concern, and risk assessments are a key part of suicide prevention.

Risk assessments help identify individuals who may be at risk for suicide and provide information about the signs and symptoms associated with it. They also help determine the level of risk and the best course of treatment. While risk assessments are not perfect, they are an important tool in suicide prevention. By identifying those at risk, interventions can be put in place to help reduce the likelihood of suicide. This paper provides a literature review of sources related to this topic, summarizes the findings and methods of those sources, examines common themes, and discusses best practices that organizations might consider regarding suicide risk assessment going forward.

Literature Review

The article by Zalsman et al. (2016) provides a ten-year systematic review of suicide prevention strategies. By examining articles in the PubMed and Cochrane libraries published between 2005 and 2014, the authors sought to identify and assess seven suicide prevention strategies and what the research had to say about each. The seven strategies included: public and physician education, media strategies, screening, restricting access to suicide means, treatments, and internet or hotline support. After reviewing the literature, the authors found that no single strategy worked better than others, but that combinations of evidence-based strategies can help at both the individual and population levels. They did conclude, however, that more research is needed to understand how these strategies can best be applied.

The article by Nock et al. (2008) focused on examining government data on suicide and suicidal behavior and conducting a systematic review of studies on the causes of suicide published from 1997 to 2007. The researchers wanted to learn more about how widespread suicide was, what kinds of risk and protective factors other researchers had identified, and what trends in the statistics revealed. They found that completed suicides tend to involve men, while suicide attempts are more common among women and among people who are young, unmarried, or have psychiatric problems. They also found that, despite new interventions, rates have not changed substantially. They concluded that more research is needed on clinical assessments to help bring suicide rates down more effectively.

The article by Chan et al. (2016) focused on a systematic review of the literature examining the relationship between suicide and self-harm. The goal was to determine whether predictors could be found to indicate when people who engage in self-harm might also be at risk of suicide. The researchers found that no existing scales are sufficient for assessing suicide risk and that risk factors are broadly common across populations. They concluded that using risk scales such as the Beck Hopelessness Scale or the Suicide Intent Scale can do more harm than good because these tools are not proficient at indicating actual risk. Instead, the authors recommend that professionals use more comprehensive psychosocial assessments that consider each individual specifically, making it easier to identify that person's particular needs and risks. In this way, professionals can be of greater service to individuals who have engaged in self-harm and who may need suicide prevention support.

Harris et al. (2019) sought to determine whether risk scales could effectively predict future episodes of suicide or self-harm in adolescents and young adults who had presented at a clinic for self-harm or suicidal ideation. Searching online databases such as Medline and CINAHL, they found no evidence that any one scale works better than another in predicting future behavior. Like Chan et al. (2016), they concluded that individuals must be examined on a case-by-case basis following thorough psychosocial assessment.

The article by Castaneda (2018) explains that suicide is a widespread problem in America that can affect anyone, including those who appear to be highly successful and happy. The reality is that everyone has an interior life, and people can struggle with depression and despair without ever revealing that struggle to others. It is important, therefore, to recognize whether warning signs exist and, if so, what can be done to help. The article focuses in particular on Kate Spade and Anthony Bourdain, both of whom died by suicide seemingly without warning. The author concludes that warning signs can be identified in retrospect, but that people need to approach this subject with greater care and awareness going forward.

Common Themes

The common themes across these articles center on a clear need for greater understanding of how best to apply suicide prevention strategies and how to assess suicide risk at both individual and population levels. Most research shows that men tend to complete suicide at higher rates than others, and that suicide rates have not changed significantly over recent years despite interventions, prevention strategies, and the use of risk assessments. This suggests that suicidal ideation tends to build internally and may not send off strong external signals. The research also consistently suggests that comprehensive psychosocial assessments are necessary to better understand individual needs and risks.

Conclusion

The suicide epidemic is a growing problem in the United States. Each year, suicide kills more people than homicide, and suicide is now the 10th leading cause of death in the U.S. The numbers continue to rise, and there are no clear signs that the trend is slowing. A number of factors contribute to this epidemic. Mental illness, for example, is a major contributor, as are social factors such as isolation, economic hardship, and relationship difficulties — all of which can lead to suicidal thoughts and behaviors. The suicide epidemic is a complex problem with no easy solutions, but researchers continue to explore strategies and assessment tools to better understand their effectiveness and improve outcomes for those at risk.