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Suicide, Risk and Protective Factors: Individual Level
Risk and protective factors related to suicide can be grouped in several ways, one of which is to separate them into individual, interpersonal, and environmental factors. Such distinctions are somewhat artificial, as individual characteristics can be fully understood only as they exist and are expressed in a person's social and physical environment. However, categorizing risk and protective factors this way is useful in identifying potential solutions to the complex causes of suicidal behavior.
The body of research examining suicide risk and protective factors is so large that it is impossible to list all that has been learned, let alone describe how the influence of each characteristic varies for different groups by age, sex, race-ethnicity, and geography. Lor example, a debilitating physical illness influences suicidal behavior somewhat differently for males than females and for adolescents compared to elderly individuals. Similarly, some risk and protective factors influence fatal and nonfatal suicidal behavior differently, with small differences in the magnitude of their effects. However, the associations identified here are robust for describing overall suicidal behavior.
Although most of the risk factors below are discussed individually, recent research indicates that the number of cumulative risk factors may be a better predictor of suicide risk than the risk factors themselves. This has been shown most convincingly for environmental exposures experienced in childhood, but likely applies to individual risk factors as well.
Mental and Physical Illnesses
Mental illnesses, particularly when two or more coexist, are the most potent risk factors yet identified for suicidal behavior. Depression is the most frequently diagnosed mental illness in both fatal and nonfatal suicide attempts; diagnoses related to alcohol abuse are also common. Duration, relapse/recurrence after treatment, and severity all contribute to suicide risk. A suicide attempt, particularly one of high intent or lethality, is a risk factor for a later completed suicide, with the risk most pronounced in the 6 months following the attempt.
Other factors related to mental illness that influence suicidal behavior include the availability and accessibility of treatment, and patients' willingness and ability to accept a mental illness diagnosis and adhere to their treatment protocols. From 2001-2003, 59% of persons in the United States with mental illness were not receiving any type of treatment. Of those receiving treatment, 67% were undertreated. Many patients do not take their medications as prescribed or fail to appear for therapy sessions.
Certain types of physical illness are also correlated with suicidal behavior, independent of their influence on mental health. Predominant among these are illnesses and injuries that result in chronic, severe pain or disability. Examples include AIDS, renal disease, coronary artery disease, some types of cancer, back injuries, and traumatic brain injuries.
Values, Temperament, and Other Personal Attributes
Individual values can influence whether or not a person considers suicide. For example, some religions forbid suicide and warn of serious consequences for those who kill themselves. Participation in religious activities has been shown to be protective with respect to suicide, perhaps in part because these activities provide individuals with a community and a support system. Also, cultural (including religious) teachings can influence a person's perspective on the value of human life. Other values that have been shown to be protective factors in suicide are self-esteem (self-value), feeling as though life has a purpose, and feeling useful and valued at home, at work, and in the community.
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