Suicide Categories by Patterns of Known Risk Factors

Abstract

Most suicide decedents could be classified by patterns of risk factors. Furthermore, most classes revealed a need for more connected services across medical, mental health/substance abuse, and court/social service systems. Reducing fragmentation across these agencies and recruiting family, friend, and community support for individuals experiencing mental health problems and/or other stress might significantly reduce suicides.

Characterizing Suicide in Toronto: An Observational Study and Cluster Analysis

“…We found that suicide deaths predominantly occurred among males, age 18 to 65, who suffered from depression or another major mental illness. These demographic patterns are in keeping with the literature on suicide, 17,29,32 and their strong effect helps to explain why the identified clusters all overlap to some degree. Nevertheless, our study did identify 5 clinically Cluster 1 had the highest proportion of females and involves suicidal acts that may have been less well planned and more impulsive.…”

“…A similar study 16 analyzed 148 suicide deaths in Hong Kong and found 2 groups: one associated with psychotic disorders, psychiatric treatment, and acute stress, and one associated with financial problems, chronic stress, and no psychiatric illness. Most recently, Logan et al 17 examined US National Violent Death Reporting System data on 28 703 suicide deaths and identified 9 different suicide clusters that differed based on rates of mental illness, substance abuse, past suicide attempts, stressors, and acute alcohol intoxication. While this is the largest and most comprehensive study examining suicide clusters to date, it is unclear to what extent the results can be generalizable outside the United States, most strikingly because 50% of them occurred by firearms.…”

“…It has previously been argued that the court system could be an important ally in suicide prevention strategies. 17 Perhaps such efforts would be best focused on middle-aged men with substance histories.…”

“…An analysis of the content of suicide notes may be an important next step in understanding the motivation for suicide in this group, and, indeed, in each of the other groups, although some evidence suggests that studies of those who leave notes may not be generalizable to everyone who dies from suicide. 40 Directly comparing these clusters to the 9 clusters identified in the United States by Logan et al 17 is challenging, given that their study separated known mental health diagnoses from depressed mood at the time of death without a prior diagnosis and separated a history of substance abuse from the presence of alcohol at the time of death. The nature of the data in our study meant that we were unable to make these distinctions.…”

“…Cluster 2 in our study includes elements of class 2 (mental health conditions with recent crises), class 4 (current depressed mood with financial problems), and class 6 (medical health problems with depressed mood) from the US study. 17 Cluster 3 in our study includes elements of class 1 (mental health conditions with alcohol problems), class 5 (alcohol problems with other stressful life events, and class 7 (recent stressors with criminal legal problems) from the US study. The US study also distinguished clusters with known histories of mental illness (classes 1-3) from those without known mental illness that had combinations of stressors and substance abuse with or without depressed mood (classes 4-9).…”