Risk Factors www.ZeroAttempts.org ZERO ATTEMPTS One Million & Counting when IN CRISIS cALL 800-273-8255 or text "sos" to 741741 Risk Factors Top Two Risk Factors Teen students are more likely to take their life when Risk factors are not warning signs Why are Risk and Protective Factors Important? Using Risk and Protective Factors in the Strategic Planning Process Key Points about Risk and Protective Factors for Suicide Prevention Risk, Protective and Precipitating Factors, Warning Signs, Interventions, What Not to Do, What Not to Say Risk Factors A combination of individual, relationship, community, and societal factors contribute to the risk of suicide. Risk factors are those characteristics associated with suicide—they might not be direct causes. Watch Moving Forward to learn more about how increasing what protects people from violence and reducing what puts people at risk for it benefits everyone. Top Two A review of the three organization's which rank the leading risk factors for a first suicide attempt show the following: Leading Risk Factor:* Family history of suicide - NAMI History of mental disorders, particularly clinical depression - NIHM Misuse and abuse of alcohol of other drugs - SPRC Second Leading Risk Factor: Substance abuse disorder - NAMI, NIHM History of mental disorders, particularly clinical depression - SPRC My two picks are: 1. Being born MAAB - Male Assigned At Birth (Males represent almost 80% of all first suicidal attempts.) 2. Access to lethal methods (A lethal means is used in 65 to 80% of all first suicidal attempts.) * NIMH and SPRC listed "Previous suicide attempt(s)" which doesn't qualify to answer the question since we're talking about the first attempt.   Risk Factors AFSP CDC NAMI NIMH SPRC Access to firearms x Access to firearms: a key suicide prevention measure is to reduce access to firearms, which can significantly increase suicide risk. (6) Access to lethal means including firearms and drugs x Access to lethal methods x 4 7 4 Adverse childhood experiences such as child abuse and neglect x An arrest (2) Barriers to accessing mental health treatment x 8 Barriers to health care x Being a pregnant teenager Being between the ages of 15 and 24 or over 60. 11 Being exposed to others' suicidal behavior, such as that of family members, peers, or celebrities x Being born MAAB (Male Assigned At Birth) Being in prison or jail 8 Being exposed to others' suicidal behaviors, family member, peer or media figure or graphic or sensationalized accounts of suicide x 9 Bullying x Certain medical conditions x Childhood abuse, neglect or trauma x Childhood abuse, neglect, maltreatment or trauma Chronic disease and disability 7 Chronic pain x Criminal problems x Cultural and religious beliefs (e.g., belief that suicide is noble resolution of a personal dilemma) x Cultural and religious beliefs such as a belief that suicide is noble resolution of a personal problem x Depression, other mental disorders, or substance abuse disorder x Easy access to lethal means among people at risk (e.g. firearms, medications) x End of a relationships or marriage (2) Ethnicity/race: the highest rates across ages are among American Indian/Alaska Native and white populations. (7) Exposure to another person’s suicide, or to graphic or sensationalized accounts of suicide x Family history of child maltreatment Family history of suicide x x x x Family history of suicide or child maltreatment (2) Family history of a mental health or substance abuse disorder x 4 Family history of suicide x x 1 5 5 Family violence including physical and/or sexual abuse 6 Feelings of hopelessness x Financial problems x Gender. Although more women than men attempt suicide, men are nearly 4x more likely to die by suicide. 6 Having guns or other firearms in the home x Having recently been released from prison or jail x History of mental disorders, particularly clinical depression x x 2 3 History of trauma or abuse 7 Impulsive or aggressive tendencies x Impulsivity:One study found that more than 50% of suicide attempts were impulsive, which may explain in part why “up to 50% of people who attempt suicide make the decision to do so within minutes to an hour before they act.” (5) Internal stuff: Depression, addiction, Bipolar disorder, Schizophrenia, anxiety, chronic pain or other serious health conditions, traumatic brain injury x Isolation, a feeling of being cut off from other people Intoxication. More than 1 in 3 people who die from suicide are under the influence of alcohol at the time of death. x Job problems or loss x Legal problems x Local epidemics of suicide x (2) Loss of someone or something they care about (2) Loss (relational, social, work, or financial) x Major health issues (2) Mental illness: It is estimated that nearly 90% of people worldwide who die by suicide have a mental illness. However, only about half of people who die by suicide in the U.S. are actually diagnosed. (3) Medical illness - serious or chronic 5 10 Mental illness, such as depression x Mental health conditions: anxiety disorders, bipolar disorder, conduct disorder, depression, spersonality traits of aggression, mood changes and poor relationships, substance use problems, schizophrenia. x Misuse and abuse of alcohol or other drugs. Intoxication-More than 1 in 3 people who die from suicide are under the influence of alcohol at the time of death. 3 2 Personality traits of aggression, mood changes and poor relationships Physical illness Previous suicide attempt(s) x x 1 1 Previous attempt: The leading suicide risk factor is a prior suicide attempt. (1) Prior suicide attempt x Prolonged stress x Prolonged stress such as harassment, bullying, relationship problems or unemployment x Recent tragedy or loss 8 Relationship problems such as a break-up, violence, or loss x Serious financial problems (2) Serious illness x Serious or chronic medical illness x Serious physical health conditions including pain x x Sexual orientation/gender identity: LGB youth are almost five times as likely to have attempted suicide compared to heterosexual youth. Transgender adults are at even higher risk with 40% reporting a suicide attempt in their lifetime (8) Sexual violence x Social Isolation, a feeling of being cut off from other people x Stigma associated with mental illness or help-seeking x Stressful life events, like rejection, divorce, financial crisis, other life transitions or loss x Substance abuse disorder x x 2 3 Substance abuse: People who are dependent on alcohol or use drugs have a 10–14 times greater suicide risk than the general population. This risk is even more significant when a there is a co-occurrence of substance use disordersand mental illness. (4) Substance use. Drugs can create mental highs and lows that worsen suicidal thoughts x Suicide cluster in the community x Traumatic brain injury x Triggers: These can include a wide range of significant events, especially relationship problems and unemployment. Additionally, a history of child abuse, including bullying or sexual abuse, traumatic brain injury, chronic pain and chronic health conditions may heighten suicide risk (2) Unsafe media portrayals of suicide x Unwillingness to seek help because of the stigma attached to mental health and substance abuse disorders or to suicidal thoughts x Work pressure or constant stress (2) Teen students are more likely to take their life when: (6) Alcohol or drugs are involved (6) If their parents are divorced (6) If they have access to a fire arm (6) Are failing education (6) Are involved in teen pregnancy (6) Hear of other teen suicides (6) Have low self-esteem (6) Are highly sexually active (6) Legend: Red - Leading risk factor, Blue - 2nd leading risk factor ASFP: https://bit.ly/2QKNlFz CDC: https://bit.ly/3u9XJnT NAMI https://bit.ly/3ywBQmd NIMH https://bit.ly/3fejSgN SPRC: https://bit.ly/2QKThOZ (1) NAASP  National Action Alliance for Suicide Prevention https://conta.cc/3viIaf5 (2) "R  U OK?" A conversation could change a life. www.ruok.org.au/ (6) Brain Blogger https://bit.ly/3wshE2V Risk factors can vary by age group, culture, sex, and other characteristics. For example: Stress resulting from prejudice and discrimination (family rejection, bullying, violence) is a known risk factor for suicide attempts among lesbian, gay, bisexual, and transgender (LGBT) youth and The historical trauma suffered by American Indians and Alaska Natives (resettlement, destruction of cultures and economies) contributes to the high suicide rate in this population. For men in the middle years, stressors that challenge traditional male roles, such as unemployment and divorce, have been identified as important risk factors. Precipitating Factors AFSP CDC NAMI NIMH SPRC Precipitating factors are stressful events that can trigger a suicidal crisis in a vulnerable person. Alcohol/Drugs 5% An arrest x Any real or anticipated eent causing or threatening: Shame, guilt, despair, humiliation, unacceptible loss of face or status Legal problems (loss of freedom), financial problems, feellings of rejection/abandonment (3) Death of a loved one x End of a relationship or marriage x Family Problems 40% Financial 6% Handling the arrest of a loved one x Physical health 17% Recent exposure to another's suicide (of friend or acquaintance, of celebrity through media (3) Searching for a missing loved one x Serious financial problems x Serious health issues Unknown 32% NAMI: SPRC: (3) AAS: American Association of Suicidology: https://bit.ly/2SjtrSG   Risk factors are not warning signs Risk and protective factors play a critical role in suicide prevention. For clinicians, identifying risk and protective factors provides critical information to assess and manage suicide risk in individuals. For communities and prevention programs, identifying risk and protective factors provides direction about what to change or promote. This provides a brief overview of the importance of risk and protective factors as they relate to suicide and offers guidance about how communities can best use them to decrease suicide risk. Risk factors are often confused with warning signs of suicide, and frequently suicide prevention materials mix the two into lists of “what to watch out for.” But the two are very different. Warning signs indicate an immediate risk of suicide, whereas risk factors indicate someone is at heightened risk for suicide, but indicate little or nothing about immediate risk (Rudd et al., 2006). Warning signs are only applicable to individuals, whereas risk and protective factors are found in individuals and communities. Being able to tell the difference is important in communications about suicide risk. Talking about warning signs helps people know what actions they can take right now to help someone at immediate risk for suicide. Talking about risk factors helps people understand what might need to change within an individual or a community in order to decrease suicide risk over time. Risk and protective factors for heart disease and warning signs of a heart attack provide a familiar example. (See table below) Risk factors for heart disease—such as tobacco use, obesity, and high cholesterol—do not indicate that someone is having a heart attack, merely that he or she is at heightened risk for suffering a heart attack at some point in time. On the other hand, warning signs of a heart attack—chest pain, shortness of breath, and nausea—indicate that someone may be having a heart attack right now. Similarly, risk factors for suicide—prior attempts, mood disorders, and substance abuse—indicate that someone is at heightened risk for suicide. But warning signs—threatening suicide, seeking means for suicide, and dramatic mood changes—indicate that someone may be at immediate risk for suicide For a list of expert recommended warning signs, see here Examples of Risk and Protective Factors and Warning Signs for Heart Attack and Suicide Heart Attack Suicide Examples of Risk Factors (Individual level) Indicate that someone is at higher risk for heart attack or suicide Tobacco use Obesity High LDL cholesterol Stress management Prior suicide attempt Mood disorders Substance abuse Access to lethal means Examples of Protective Factors (Individual level) Indicate that someone is at lower risk for heart attack or suicide Exercise Sound diet High HDL cholesterol Stress management Connectedness Availability of physical and mental health care Coping ability Examples of Warning Signs Indicate that someone is having a heart attack or is seriously considering suicide Chest pain Shortness of breath Cold sweat Nausea Lightheadedness Threatening to hurt or kill oneself Seeking a means to kill oneself Hopelessness Increasing alcohol or drug use Dramatic mood changes Source: https://bit.ly/3f67G1D Why are Risk and Protective Factors Important? Risk and protective factors provide areas of emphasis for interventions that help prevent suicide. Simply stated, decreasing risk factors and/or increasing protective factors should decrease suicide risk. For example, depression is a significant risk factor for suicide; therefore, lessening the number of individuals with depression should result in decreasing suicide. A study from the island of Gotland, Sweden, found that when primary care physicians were trained to identify and treat depression in their patients, the suicide rate of islanders went down (Rihmer, Rutz, & Pihlgren, 1995). Similarly, the restriction of lethal means—creating barriers to jumping from bridges as well as reducing access to poisons, drugs, and firearms—has demonstrated reductions in suicide risk (Daigle, 2005; Mann, Apter, Bertolote, & Beautrais, 2005). Risk factors can also be used to identify and target prevention efforts for members of groups that are at higher risk for suicide, for example, those who have attempted suicide in the past (Harris & Barraclough, 1997), those with mood disorders (Arsenault-Lapierre, Kim, & Turecki, 2004; Cavanagh, Carson, Sharpe, & Lawrie, 2003), gay and lesbian individuals who have been rejected by their families (Ryan, Russell, Huebner, Diaz, & Sanchez, 2010), individuals in substance abuse treatment (Britton & Conner, 2010), and older males (Conwell, Van Orden, & Caine, 2011). By identifying groups at higher risk, prevention practitioners can create and target interventions to the needs of members of those groups. Using Risk and Protective Factors in the Strategic Planning Process Effective prevention efforts are developed strategically. Using SPRC’s six-step strategic planning process will increase the likelihood that suicide prevention efforts will lead to the desired outcomes. Identifying risk and protective factors plays a critical role in several strategic planning steps. Strategic Planning Steps 1. Describe the problem and its context 2. Choose long-term goals 3. Identify key risk and protective factors 4. Select or develop interventions 5. Plan the evaluation 6. Implement, evaluate, and improve If a community were concerned with reports of teen suicide attempts, the resulting strategic planning steps might look something like this: 1. Describe the problem and its context. The community hospital has reported a significant increase in teens who have been admitted to the emergency room (ER) due to suicide attempts, most by overdose of prescription medications. 2. Choose long-term goals. The goal is to reduce these ER admissions by 50 percent. 3. Identify key risk and protective factors. A review of the literature and consultation with a prevention expert indicate that a combination of restricting access to prescription medications (risk factor) and increasing teen problem-solving skills (protective factor) may prove effective in reducing suicide attempts. 4. Select or develop interventions. An awareness campaign to educate parents about means restriction and a classroom program to bolster teen problem-solving skills are selected as interventions. 5. Plan the evaluation. An evaluation plan is developed to measure restriction of means, student problem-solving skills, and relevant admissions to the ER. 6. Implement, evaluate, and improve. A risk factor (access to prescription drugs) and a protective factor (problem-solving skills) that contribute to teen suicide attempts are identified, interventions to impact these are selected, and an evaluation plan to measure these are created. Evaluation results then allow the community to improve on the intervention as needed. This example used interventions to decrease risk factors and increase protective factors. Other strategic efforts may include risk or protective factors alone or in some combination. Generally, prevention efforts are more likely to be effective if multiple factors are addressed. Existing suicide prevention programs that address specific risk and protective factors or the needs of specific groups can be found in the Resources and Programs section of the SPRC website at www.sprc.org/resources-programs Key Points about Risk and Protective Factors for Suicide Prevention Risk and protective factors play a critical role in the prevention of suicide for both individuals and communities. Risk factors are not warning signs. Major risk factors include prior suicide attempt(s), mood disorders, substance abuse, and access to lethal means. Major protective factors include effective mental health care, connectedness, problem-solving skills, and contacts with caregivers. Risk and protective factors provide targets for intervention in both individuals and communities: Decreasing risk factors generally decreases risk, and increasing protective factors generally decreases risk. Risk and protective factors vary between individuals and across settings. Suicide prevention efforts should begin with a strategic planning process that, among other goals, identifies and targets specific risk and protective factors for intervention. Source: https://bit.ly/342FaaA ©2017-2023, www.ZeroAttempts.org/riskfactors.html or https://bit.ly/32SXJNK 051921