Suicidality is often inappropriately associated with symptoms of major depression. And while many of those who attempt suicide may suffer from a mental health challenge, the vast majority of those that suffer from depression do not attempt nor die by suicide.
A large percentage of severely depressed patients never think about suicide and more than half of suicides occur independently of a known mental health condition. Moreover, many of those who attempt or die by suicide do so without warning, particularly those under 20 years of age.
Dr. Craig Bryan, PsyD and clinical researcher who developed Vita Health’s suicide clinical intervention argues that most suicide prevention efforts fail because those prevention efforts focus too much on mental health-focused solutions such as access to treatment and crisis services. Instead we should approach suicide as a highly complex problem with many risk factors.
Thus, as one of America’s leading causes of death, it is imperative we understand the risk factors that lead to suicide and address it distinctly from concurrent mental health diagnosis.
Understanding Suicide Risk
Suicide risk is not linear or static and involves understanding both baseline risk for suicide and acute risk factors. Further, suicidality results from a series of risk factors that can differ across individuals. A complex interplay of biological, clinical, neurological, and situational components, risk factors can include:
- Baseline risk factors
- prior suicide attempts and non suicidal self injury
- historical and developmental vulnerabilities
- history of depression, psychosis, or anxiety
- exposure to past or current trauma
- Activating events
- significant losses, such as the death of a partner or loss of employment,personal crises, breakups or divorce
- loss of social support or feelings of isolation
- exposure to the suicidal behaviors of others, whether through friends, family, or media
- financial uncertainty
- Perceptions and beliefs about suicide
- Hopelessness
- Belief that the world would be better off without me
- Perceive self as a burden
- Impulse Control or Dysregulation
- Availability of lethal means
- Illness or medication-induced mood changes
Chiefly, psychological pain, the burden of negative emotions including shame, guilt, fear, anxiety, loneliness and angst, indicate suicidality as a behavior, as opposed to a symptom of depression. While the presence of hopelessness (lack of positive expectations), including a difficulty in believing that there are non-suicidal alternatives to life problems, provides a more reliable predictor of risk than depression.
Variations in DNA also play a part. A recent study involving more than 29,000 individuals with a history of suicide attempts identified a genetic predisposition to suicide. Sharing an underlying biology with known, non-psychiatric risk factors such as sleep disorders, substance abuse and pain, it suggests a common architecture between suicide attempt and these risk factors, not mediated by psychiatric illness.
Furthermore, research has revealed structural and chemical changes in the brains of people who die by suicide, such as alterations in the prefrontal cortex, which controls decision-making, and lower levels of serotonin, a key mood regulator. These changes have been observed regardless of whether the individual had depression, schizophrenia, or no diagnosed disorder.
Importantly, these findings indicate that suicidality can occur independently of other mental health conditions, underscoring the need to approach suicidality with a distinct program of care.
A Sudden Decision
Society often assumes that someone who attempts or dies by suicide must have been struggling for a long time, dropping clear warning signs along the way. But evidence demonstrates that approximately half of those who make an attempt do so within 20 minutes of deciding to take their own life.
The physiological functioning of certain parts of the brain change in the acute moment of suicidal thinking. Cognitive constriction prevents the brain’s usual ability to problem solve. By frustrating clear thought, individuals are unable to see beyond their circumstance and don’t believe their pain will end. While not permanent, this mental distortion is why safety planning and understanding reasons for living form a part of the treatment protocol.
This unpredictability can make it difficult for even the closest family members or friends to understand the risk of suicide. There are often no clear, long-term signs. Some people mask their pain exceptionally well, hiding behind routine activities until the very last moment. Even those who are struggling may not have solidified any plans until a moment of intense vulnerability.
Difficulties with emotional regulation and impulse control are factors that increase risk for someone struggling with suicidal thinking. A fleeting moment of despair, a comment made in passing about life being too difficult, or a sudden withdrawal from social interactions can all be red flags. While not every person who experiences these feelings will act on them, the unpredictability of suicide means that it’s always worth understanding both a person’s baseline risk for suicide as well as their acute risk.
The goal is to provide effective assistance in a timely manner. Suicide prevention and care requires a more nuanced, comprehensive understanding of risk factors, protective factors, and approaches to address and heal underlying beliefs and behaviors that put one at risk of suicide.
Vita Health’s Change in Approach
Vita Health’s clinicians and prescribers are all experts in the delivery of our suicide care model. Based on clinically validated pathways that address suicidality independent of other mental health diagnosis, Vita Health’s suicide intervention demonstrates remarkable success, reducing suicide attempts by 60% and deaths by 80%.
Comprising of Brief Cognitive Behavioral Therapeutic approach and supported by a proprietary app, Vita Health’s online, outpatient intervention significantly reduces suicide risk, ideation, attempts, and death. Drawing alongside patients to deliver compassionate support, which includes the identification of escalating feelings and safety planning, Vita equips patients with the tools to build hope and skills to regulate emotions that mitigate suicidal crisis.
Vita Health’s care is available across the continental US, and accessible from the comfort of home, at significantly less cost than treatment as usual, mitigating barriers to help. This proactive, accessible care model provides patients with critical support, whenever and wherever they need it, all while lowering the financial and, most significantly, the emotional costs associated suicide for both the sufferer and their loved ones.
